Out-of-pocket health expenditures in Colombia: a systematic review

Objectives To review the evidence of out-of-pocket (OOPE) and catastrophic expenditures (CHE) in health in Colombia. Methods Systematic review of the literature (SLR). Searches were performed in PubMed, Scopus, Scielo and Google Scholar. We used the MESH terms: out-of-pocket, catastrophic health expenditure, health and Colombia. We included cost description or cost analysis studies. Cost-effectiveness analysis of health technologies and qualitative studies were excluded. Data about period of analysis, type of study, costing perspective, OOPE, and CHE were extracted. Studies were classified as macroeconomic, microeconomic, and diseases analysis. All costs were indexed to 2018 and reported in Colombian pesos (COP)

Economic burden of air pollution in Colombia

To estimate indirect costs related to the loss of productivity due to premature mortality associated with air quality risk factors in Colombia, 2016. We estimated potential productivity years of life lost (PPYLL) related to indoor (biomass fuels) and outdoor pollution (PM2.5 and ozone). We analyzed deaths records of the Departamento Administrativo Nacional de Estadística, 2016, with the following basic causes of death related to air quality risk factors: isquemic hearth disease (IHD), cardiovascular disease (CD), lower respiratory tract infections (LRTI), lung cancer (LC) and chronic obstructive pulmonary disease(COPD), according to ICD-10. PPYLL were valued considering the productive age in Colombia, which ranges from 18-57 years for women and up to 62 for men. Three scenarios were built: lower loss (minimum legal wage), average loss [one per capita gross domestic product (GDPpc)] and higher loss (three GDPpc). PPYLL for the mentioned causes were multiplied by the fraction attributable to each air risk factor. The latest were estimated from IDEAM (outdoor) and the survey of Quality of Life 2016 and systematic reviews (indoor pollution). Costs were reported in American dollars, using the December 31 (2016) exchange rate: 1USD=3,000.7 Colombian Pesos. The economic burden due to premature deaths caused by the analyzed diseases was US$845,967,999 ($444,320,058-$2,537,903,997). From this burden, 17.8$150,585,143 ($79,090,461-451,755,428). Regarding to the studied diseases, IHD deaths caused by air quality risk factors accounted US$83.007.582. The second with the highest economic burden attributable to air quality risk factors was CD (US$32,750,315), followed by LRTI (US$22,077,091), LC (US$6,909,659) and COPD (US$5,840,495). The exposure to PM2.5 particulate matter represented the largest share of the economic burden attributable to air quality risk factors. Our estimations suggest that premature deaths caused by exposure to air qualityrisk factors represented 0.052% of GDP for 2016

Validation of hypermethylated DNA regions found in colorectal cancers as potential aging-independent biomarkers of precancerous colorectal lesions

BACKGROUND We previously identified 16,772 colorectal cancer-associated hypermethylated DNA regions that were also detectable in precancerous colorectal lesions (preCRCs) and unrelated to normal mucosal aging. We have now conducted a study to validate 990 of these differentially methylated DNA regions (DMRs) in a new series of preCRCs. METHODS We used targeted bisulfite sequencing to validate these 990 potential biomarkers in 59 preCRC tissue samples (41 conventional adenomas, 18 sessile serrated lesions), each with a patient-matched normal mucosal sample. Based on differential DNA methylation tests, a panel of candidate DMRs was chosen on a subset of our cohort and then validated on the remaining part of our cohort and two publicly available datasets with respect to their stratifying potential between preCRCs and normal mucosa. RESULTS Strong statistical significance for the difference in methylation levels was observed across the full set of 990 investigated DMRs. From these, a selected candidate panel of 30 DMRs correctly identified 58/59 tumors (area under the receiver operating curve: 0.998). CONCLUSIONS These validated DNA hypermethylation markers can be exploited to develop more accurate noninvasive colorectal tumor screening assays

PIH11 out-of-pocket health expenditures related to prenatal care: evidence from Colombia, 2018

To estimate the out-of-pocket expenditures (OOPE) and indirect costs related to prenatal check-ups and pregnancy complications in women seen in a maternity hospital in Cartagena-Colombia, 2018. Cost description study. A survey was constructed to estimate OOPE and indirect costs owing to prenatal check-ups. Women were asked about sociodemographic variables. The survey investigated how much pregnant women spend in the care of prenatal check-ups. Also, it explored OOPE linked to pregnancy complications. Productivity losses were quantified from the reduction of work time produced by the prenatal check-up. Absolute and relative frequencies, averages and interquartile ranges (IQR) were used to describe the population and estimate the OOPE and indirect costs in pregnant women. The latter were calculated from the percentile method. We performed a bootstrapping to generate an empirical estimate of the complete sample distribution. Costs were reported in Colombian pesos (COP), 2018. Fifty-six pregnant women were surveyed, with an average age of 25.9 years (±6.2). 96.4% of the respondents had completed at least primary school studies, 7.3% were married. All women surveyed had OOPE in at least one cost-item. Transportation was the item with the highest frequency of expenses. The mean of OOPE for women who attend their prenatal check-up were COP$71,736 (IQR COP$53,400-$92,715). Twenty-five women reported some complication related to their pregnancy status. The mean OOPE associated with a pregnancy complication was COP$57,539 (IQR COP$28,686-$100,124). Women reported a time average of 4.2 hours (range 1-12) for attending the prenatal check-up, and their companions spent 4.5 (range 1-13). On average a woman had productivity losses of COP$13,541 (IQR COP$8,138- $16,276) and her companion COP$14,475 (range $8,130-$19,531). Expenses produced by prenatal care could totalize 9.2% (6.8-11.9) of the monthly income of a poor household, which unfortunately makes prenatal care an important source of economic burden, impacting poor population in Cartagena

Machine learning in the loop for tuberculosis diagnosis support

The use of machine learning (ML) for diagnosis support has advanced in the field of health. In the present paper, the results of studying ML techniques in a tuberculosis diagnosis loop in a scenario of limited resources are presented. Data are analyzed using a tuberculosis (TB) therapy program at a health institution in a main city of a developing country using five ML models. Logistic regression, classification trees, random forest, support vector machines, and artificial neural networks are trained under physician supervision following physicians' typical daily work. The models are trained on seven main variables collected when patients arrive at the facility. Additionally, the variables applied to train the models are analyzed, and the models' advantages and limitations are discussed in the context of the automated ML techniques. The results show that artificial neural networks obtain the best results in terms of accuracy, sensitivity, and area under the receiver operating curve. These results represent an improvement over smear microscopy, which is commonly used techniques to detect TB for special cases. Findings demonstrate that ML in the TB diagnosis loop can be reinforced with available data to serve as an alternative diagnosis tool based on data processing in places where the health infrastructure is limited

Detección de la leptospirosis renal porcina (LRP) mediante la técnica de inmuno peroxidasa (IP).

Con el propósito de estandarizar el valor diagnóstico de la técnica de inmunoperoxidasa indirecta (IP) y establecer niveles de anticuerpos anti-pomona y anti-bratislava, se recolectaron 200 muestras de riñones y sangre de 200 cerdos sacrificados en el frigorífico Guadalupe de Bogotá. En 64 (32 por ciento) riñones se observaron lesiones macroscópicas (riñón moteado blanco) y lesiones microscópicas compatibles con nefritis intersticial no supurativa en 100 tejidos renales. A todas las muestras se les aplicó la IP, para lo cual se utilizó suero policlonal de conejo contra el serovar L. pomona, resultando 62 (31 por ciento) muestras positivas. Analizados los sueros por microaglutinación (MA), se detectaron títulos entre 1:50 y 1:3200 para L. pomona en el 82.5 por ciento de los casos y para L. bratislava en el 90.5 por ciento de los mismos. Se establecieron asociaciones estadísticas mediante chi cuadrado (X2) y su fuerza se midió utilizando tasas de productos cruzados (OR), cuyos resultados fueron significativos (p igual 0.003 y OR igual 2.32) tanto para la relación entre análisis microscópico y diagnóstico por IP, como para la relación entre análisis macroscópico y diagnóstico por IP (p igual 0.001), la OR fue de 2.58. En cambio, para la relación entre los diagnósticos de IP y el serológico estas pruebas no resultaron significativa