Experiencias departamentales en la construcción, divulgación y uso del análisis de situación de salud, Colombia 2016

Objetivo El Análisis de Situación de Salud (ASIS) es una metodología que se encuentra en implementación recientemente en Colombia. Este estudio buscó comprender la experiencia de construcción, divulgación y uso del ASIS para la toma de decisiones en  algunas entidades territoriales (ET).Métodos Entrevistas semiestructuradas a funcionarios de las entidades departamentales  de salud; la información fue analizada de acuerdo a un conjunto de categorías establecidas previamente.Resultados Las ET implementan el ASIS incorporando el enfoque de los Determinantes Sociales de la Salud; sin embargo, las capacidades técnicas, económicas y humanas son desiguales para la elaboración de este tipo de análisis; la participación intersectorial y social aún es débil y los resultados generados todavía no orientan latoma de decisiones a nivel territorial.Conclusiones La metodología ASIS aspira a posicionarse como uno de los mecanismos oficiales para generar evidencia que oriente las políticas y la toma de decisiones en salud a nivel nacional, regional y local; existen desafíos a nivel económico, institucional y político para su consolidación como estrategia de útil en la planificación en salud. El ASIS es una metodología de gran relevancia para las ET y debe seguir fortaleciéndose su implementación.Objetive The Health Situation Analysis (ASIS in Spanish) is a methodology that has been implemented recently in Colombia. This study aims at understanding the experience of building, disseminating and using ASIS for decision-making in some territorial entities.Methods Semistructured interviews were applied to officials of the departmental health entities. The information was analyzed according to a set of categories previously established.Results The territorial entities implement ASIS by incorporating the Social Determinants of Health approach; however, the technical, economic and human capacities for the elaboration of this type of analysis are not equitable. Intersectoral and social participation isstill weak and the results do not guide the decision making at territorial level yet.Conclusions The ASIS methodology seeks to position itself as one of the official mechanisms to generate evidence that guides health policy and decision making at national, regional and local levels. There are economic, institutional and political challenges forits consolidation as a useful strategy in health planning. ASIS is a methodology of great relevance for the territorial entities and its implementation should be further strengthened

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Costos económicos del virus chikungunya en Colombia.

Objective: The aim of the present study was to estimate the economic impact of chikungunya virus (CHIKV) infection in Colombia from a societal perspective. Methods: We conducted a retrospective, bottom-up cost-of-illness study in clinically confirmed cases during the first chikungunya (CHIK) outbreak in Colombia in 2014. Direct and indirect costs were estimated per patient. Economic costs were calculated by the addition of direct costs (direct medical costs and out-of-pocket heath expenditures) and indirect cost as a result of loss of productivity. Results: A total of 126 patients (67 children and 59 adults) with CHIK were included. The median of the direct medical cost in children was US$257.9 (interquartile range [IQR] 121.7–563.8), and US$66.6 (IQR 26.5–317.3) for adults. The productivity loss median expenditures reached US$81.3 (IQR 72.2–203.2) per adult patient. The median economic cost in adults as a result of CHIK was US$152.9 (IQR 101.0–539.6), of which 53.2% was a result of indirect costs. Out-of-pocket expenditures comprised 3.3% of all economic costs. Conclusions: Our study can help health decision makers to properly assess the burden of disease caused by CHIK in Colombia, an endemic tropical country. We recommend to strength the health information systems and to continue investing in public health measures to prevent CHIK.Objetivo: el objetivo del presente estudio fue estimar el impacto económico de la infección por el virus chikungunya (CHIKV) en Colombia desde una perspectiva social. Métodos: en 2014, realizamos un estudio retrospectivo y de abajo hacia arriba sobre el costo de la enfermedad en casos clínicamente confirmados durante el primer brote de chikungunya (CHIK) en Colombia. Los costos directos e indirectos se estimaron por paciente. Los costos económicos se calcularon mediante la suma de los costos directos (costos médicos directos y gastos de salud de bolsillo) y los costos indirectos como resultado de la pérdida de productividad. Resultados: se incluyeron 126 pacientes (67 niños y 59 adultos) con CHIK. La mediana del costo médico directo en niños fue de US $257.9 (rango intercuartil [IQR] 121.7–563.8) y de US$ 66.6 (IQR 26.5–317.3) para adultos. Los gastos medianos de la pérdida de productividad alcanzaron los US $81.3 (RIC 72.2–203.2) por paciente adulto. La mediana del costo económico en adultos como resultado de CHIK fue de US$ 152.9 (IQR 101.0–539.6), de los cuales el 53.2% fue resultado de costos indirectos. Los gastos de bolsillo representaron el 3.3% de todos los costos económicos. Conclusiones: Nuestro estudio puede ayudar a los encargados de tomar decisiones en materia de salud a evaluar adecuadamente la carga de la enfermedad causada por CHIK en Colombia, un país tropical endémico. Recomendamos fortalecer los sistemas de información de salud y continuar invirtiendo en medidas de salud pública para prevenir el CHIK

Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015.

BackgroundThe burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.ObjectivesThe GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.MethodsCVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.ResultsIn 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.ConclusionsCVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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