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)

The Structure and Star-Formation History of NGC 5461

We compute photoionization models for the giant extragalactic H II region NGC 5461, and compare their predictions to several observational constraints. Since we aim at reproducing not only the global properties of the region, but its local structure also, the models are constrained to reproduce the observed density profile, and our analysis takes into consideration the bias introduced by the shapes and sizes of the slits used by different observers. We find that an asymmetric nebula with a gaussian density distribution, powered by a young burst of 3.1 Myr, satisfactorily reproduces most of the constraints, and that the star-formation efficiency inferred from the model agrees with current estimates. Our results strongly depend on the assumed density law, since constant density models overestimate the hardness of the ionizing field, affecting the deduced properties of the central stellar cluster. We illustrate the features of our best model, and discuss the possible sources of errors and uncertainties affecting the outcome of this type of studies.Comment: 33 pages (LaTeX), 3 .eps figures. to be published in ApJ, May 200

Prevalence of chronic kidney disease in an urban Mexican population

Prevalence of chronic kidney disease in an urban Mexican population.BackgroundThe present study was primarily designed to assess the prevalence of chronic kidney disease in a Mexican urban population residing in Mexico and to evaluate certain biologic and socioeconomic conditions as risk factors for the development of renal disease.MethodsA population-based cross-sectional survey was conducted, which included 3564 patients of either gender aged >18 years, who were randomly selected from lists of patients assigned to primary care facilities in the city of Morelia. A questionnaire about personal current health status, kidney disease, diabetes, hypertension, or heart disease in close relatives, anthropometric and blood pressure measurements, and blood and urine samples to measure glucose, blood urea nitrogen, and creatinine was obtained for each patient. Creatinine clearance (Ccr) was calculated by the Cockcroft-Gault formula. Patients were classified in 1 of the 5 Ccr categories established by the Kidney Disease Outcomes Quality Initiative guidelines.ResultsThe prevalence rate of Ccr < 15mL/min was 1142 per million population, and that of Ccr <60mL/min 80,788 per million population. Alcohol and tobacco consumption, female gender, age >65 years, educational level < primary school, and income <US $4.00/day were significantly associated with reduced Ccr.ConclusionChronic kidney disease prevalence in this population is similar to that seen in industrialized countries. If these figures are similar to those of the entire Mexican population, only l out of 4 patients requiring renal replacement therapy in the country currently has access to it

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)

NGC 604, the Scaled OB Association (SOBA) Prototype. I: Spatial Distribution of the Different Gas Phases and Attenuation by Dust

We have analyzed HST and ground-based data to characterize the different gas phases and their interaction with the MYC in NGC 604, a GHR in M33. The warm ionized gas is made out of two components: a high-excitation, high-surface brightness H II surface located at the faces of the molecular clouds directly exposed to the ionizing radiation of the central SOBA; and a low-excitation, low-surface brightness halo that extends to much larger distances from the ionizing stars. The cavities created by the winds and SN explosions are filled with X-ray-emitting coronal gas. The nebular lines emitted by the warm gas experience a variable attenuation as a consequence of the dust distribution, which is patchy in the plane of the sky and with clouds interspersed among emission-line sources in the same line of sight. The optical depth at H alpha as measured from the ratio of the thermal radio continuum to H alpha shows a very good correlation with the total CO (1-0) column, indicating that most of the dust resides in the cold molecular phase. The optical depth at H alpha as measured from the ratio of H alpha to H beta also correlates with the CO emission but not as strongly as in the previous case. We analyze the difference between those two measurements and we find that <=11% of the H II gas is hidden behind large-optical-depth molecular clouds. We detect two candidate compact H II regions embedded inside the molecular cloud; both are within short distance of WR/Of stars and one of them is located within 16 pc of a RSG. We estimate the age of the main stellar generation in NGC 604 to be approx. 3 Myr from the ionization structure of the H II region. The size of the main cavity is smaller than the one predicted by extrapolating from single-star wind-blown bubbles.Comment: 50 pages, 15 figures. To appear in the September issue of the Astronomical Journal. Some of the figures in this version have a very low resolution due to the absurd limitations (for 2004) imposed on file size by astro-ph. A full-resolution version of the figures is available at http://www.stsci.edu/~jmai

Ocean acidification affects calcareous tube growth in adults and reared offspring of serpulid polychaetes

The energetically costly transition from free-swimming larvae to benthic life stage and maintenance of a calcareous structure can make calcifying marine invertebrates vulnerable to ocean acidification. The first goal of this study was to evaluate the impacts of ocean acidification on calcified tube growth for two Serpulidae polychaete worms. Spirorbis sp. and Spirobranchus triqueter were collected at 11 m depth from the Northwest Mediterranean Sea and maintained for 30 and 90 d, at three mean pHT levels (total scale) of 8.1 (ambient), 7.7, and 7.4. Moderately decreased tube elongation rates were observed in both species at a pHT of 7.7 while severe reductions occurred at pHT 7.4. There was visual evidence of dissolution and tubes were more fragile at lower pH but, fragility was not attributed to changes in fracture toughness. Instead, it appeared to be due to the presence of larger alveoli covered in a thinner calcareous layer. The second objective of the study was to test for effects in offspring development of the species S. triqueter. Spawning was induced, and offspring were reared in the same pH conditions the parents experienced. Trochophore size was reduced at the lowest pH level but settlement success was similar across pH conditions. Post-settlement tube growth was most affected. At 38 d post-settlement, juvenile tubes at pHT of 7.7 and 7.4 were half the size of those at pHT 8.1. Results suggest future carbonate chemistry will negatively affect initiation and persistence of both biofouling and epiphytic polychaete tube worms

Reaction mechanisms in the 6Li+59Co system

The reactions induced by the weakly bound 6Li projectile interacting with the intermediate mass target 59Co were investigated. Light charged particles singles and $\alpha$-$d$ coincidence measurements were performed at the near barrier energies E_lab = 17.4, 21.5, 25.5 and 29.6 MeV. The main contributions of the different competing mechanisms are discussed. A statistical model analysis, Continuum-Discretized Coupled-Channels calculations and two-body kinematics were used as tools to provide information to disentangle the main components of these mechanisms. A significant contribution of the direct breakup was observed through the difference between the experimental sequential breakup cross section and the CDCC prediction for the non-capture breakup cross section.Comment: 30 pages, 8 figure

Bright Stars and Recent Star Formation in the Irregular Magellanic Galaxy NGC2366

The stellar content of the Im galaxy NGC 2366 is discussed on the basis of CCD BVR photometry. The three brightest blue and red stars have been used to estimate its distance, obtaining a balue of 2.9 Mpc. The spatial distribution of the young stellar population is discussed in the light of the integrated color indices and the color-magnitude diagrams of different zones of the galaxy. A generalized star formation burst seems to have taken place about 50 Myr ago. The youngest stars are preferentially formed in the South-West part of the bar, where the giant HII complex NGC 2363 is located, being younger and bluer. The bar seems to play a role favouring star formation in one of its extremes. Self-propagation however, does not seem to be triggering star formation at large scale. A small region, populated by very young stars has also been found at the East of the galaxy.Comment: Astronomical Journal, accepted. This is a uuencoded, compressed, tar file (102 Kbytes) of 1 text, 1 table postscript files. Figures are retrieved as a separate file. One single file with all figures and tables (552Kb) also available from http://www.ast.cam.ac.uk/~etelles/astronomy.htm

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

SummaryBackground The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Funding Bill & Melinda Gates Foundation