Medical geography in the study of hepatitis A, in the Coffee-triangle region, Colombia, 2007-2011

Objectives: There are few studies of geographical characterization of viral hepatitis. For this reason, we after estimating the incidence rates for Hepatitis A (HAV), we developed epidemiological GIS-based maps for this viral disease, within a well-defined geographic region (the coffee triangle) in Colombia. Study design: A retrospective cross-sectional analysis of surveillance data and GIS-based developing of epidemiological maps. Methods: Surveillance cases data (2007-2011) were used to estimate annual incidence rates using reference population data, on hepatitis, to develop the first maps of HAV in the 53 municipalities of the coffee-triangle region of Colombia (departments Caldas, Quindio, Risaralda). GIS used was Kosmo® 3.1. To summarize and compare the data among municipalities and departments (as units of analysis) we generate indicators such as accumulated incidence rates (AIR) and incidence rates ratios. Results: 1518 HAV cases were reported, 47% from Quindío, 30% Caldas and 22% Risaralda. Quindio presented with the highest AIR (131.54) among all the administrative units under study (Caldas, AIR: 46.39; Risaralda, AIR: 37.62). Interestingly, the highest rates in Quindio, during the period, could be related to the increased number of cases reported in two municipalities from 2008 (Quimbaya, AIR ratio: 4.0 and Montenegro: 3.61). The causes that underlie this augmentation will be subject to further research. Conclusions: Incidence rates for HAV is still high in the region. Showing epidemiological data, particularly in maps would allow planning actions oriented to interventions at the different forms of transmission that this disease has, which is highly important for decisions in public health policies

Medical geography in the study of hepatitis A, in the Coffee-triangle region, Colombia, 2007-2011

Objectives: There are few studies of geographical characterization of viral hepatitis. For this reason, we after estimating the incidence rates for Hepatitis A (HAV), we developed epidemiological GIS-based maps for this viral disease, within a well-defined geographic region (the coffee triangle) in Colombia. Study design: A retrospective cross-sectional analysis of surveillance data and GIS-based developing of epidemiological maps. Methods: Surveillance cases data (2007-2011) were used to estimate annual incidence rates using reference population data, on hepatitis, to develop the first maps of HAV in the 53 municipalities of the coffee-triangle region of Colombia (departments Caldas, Quindio, Risaralda). GIS used was Kosmo® 3.1. To summarize and compare the data among municipalities and departments (as units of analysis) we generate indicators such as accumulated incidence rates (AIR) and incidence rates ratios. Results: 1518 HAV cases were reported, 47% from Quindío, 30% Caldas and 22% Risaralda. Quindio presented with the highest AIR (131.54) among all the administrative units under study (Caldas, AIR: 46.39; Risaralda, AIR: 37.62). Interestingly, the highest rates in Quindio, during the period, could be related to the increased number of cases reported in two municipalities from 2008 (Quimbaya, AIR ratio: 4.0 and Montenegro: 3.61). The causes that underlie this augmentation will be subject to further research. Conclusions: Incidence rates for HAV is still high in the region. Showing epidemiological data, particularly in maps would allow planning actions oriented to interventions at the different forms of transmission that this disease has, which is highly important for decisions in public health policies

Factores de riesgo cardiovascular en estudiantes de medicina que ingresan a una Universidad Colombiana*

Introducción: Las enfermedades cardiovasculares son la primera causa de muerte en muchos países. Empero, en poblaciones seleccionadas, existen escasos estudios, tal como son los estudiantes de medicina. Objetivo: Evaluar variables físicas, fisiológicas, comportamentales y bioquímicas en estudiantes medicina de la Universidad Tecnológica de Pereira (UTP), Risaralda, Colombia, 2012-2013. Material y Métodos: Se realizó un estudio descriptivo con una población de 91 estudiantes pertenecientes al primer semestre, con la presentación de los análisis basales (transversales), donde se miden: índice de masa corporal (IMC), circunferencia abdominal (CA), Presión arterial (PAS/PAD), VO2 Indirecto (test de Leger); actividad física (IPAQ corto), glicemia y perfil lipídico (ATPIII). Resultados: Se analizaron basalmente 91 estudiantes. Edad promedio 18,86 años (±3,13); 52,7% masculino. Actividad vigorosa: 30,8% (58,2% <1 día/semana; 58,2% <10 minutos/vez). Tiempo sentado: mediana 600 minutos (10 horas)/día, (RIQ 480-900). IMC promedio 22,65±3,6 Kg/m2 (20,9% sobrepeso/obesidad). CA promedio 77,22±9,42 cm (81,3±9,3 hombres, 17,10% >90 cm; 73,1±7,6 mujeres, 15%>80 cm). LDL promedio 109,4±28,1 mg/dl (60,9% con valores no óptimos >/=100). Colesterol-total promedio 174,1±33,5 mg/dl (25,8% con >/=200). VO2 promedio 41,31±6,3 (37,8% de mujeres en sedentarismo/borderline/intolerancia; 12,8% en hombres). PAS promedio 115,4±10,9 mmHg (59,3% en rango Pre-HTA/HTA; ≥120); PAD promedio 75,7±9,8mmHg (40,7% en rango de Pre-HTA/HTA;≥80) y 13,6% en rango de HTA E1. Conclusiones: Se observa preocupantes frecuencias basales de factores de riesgo cardiovascular al ingreso de la carrera sobre las cuales debe intervenirse y valorarse en el tiempo, durante los planteados 6 años de seguimiento. * Trabajo previamente presentado en parte en el XXVIII Congreso Científico Internacional de la Federación Latinoamericana de Sociedades Científicas de Estudiantes de Medicina (XXVIII CCI FELSOCEM), Tegucigalpa, Honduras 2013

Sobre el currículo oculto: del buen médico, la jerarquía y el maltrato

Objetivo: Describir las interacciones de algunos estudiantes de dos programas de Medicina en Colombia relacionadas con el currículo oculto. Metodología: Estudio hermenéutico, que utilizó la etnografía y la teoría fundamentada, mediante la aplicación de observación participante en cinco escenarios de práctica y once entrevistas en profundidad. El análisis de los datos se hizo con codificación abierta, axial y selectiva, propias de la teoría fundamentada, lo que generó una matriz del paradigma. Resultados: Estudiar Medicina implica hacer parte de una jerarquía desde inspiradora hasta excesiva. La exigencia de la educación médica por formar un médico incansable e intachable, la competencia para ser admitido a cada rango y el miedo a equivocarse exacerban el funcionamiento negativo de la jerarquía médica. Esta jerarquía se basa en el poder del conocimiento que permite el maltrato. Lo anterior desencadena agotamiento, frustración, desinterés y afecta la ética profesional, aspectos que estropean al médico en formación. Conclusión: El currículo oculto determina la formación del médico más que el currículo formal. Reconocer y reflexionar sobre el currículo oculto desde la comunidad académica permite visibilizar, en futuras reformas curriculares, el papel que este desempeñ

Mapping the ecoepidemiology of Zika virus infection in urban and rural areas of Pereira, Risaralda, Colombia, 2015-2016: Implications for public health and travel medicine

Geographical information systems (GIS) have been demonstrated earlier to be of great use to inform public health action against vector-borne infectious diseases. Using surveillance data on the ongoing ZIKV outbreak from Pereira, Colombia (2015-2016), we estimated incidence rates (cases/100,000 population), and developed maps correlating with the ecoepidemiology of the area. Up to October 8, 2016, 439 cases of ZIKV were reported in Pereira (93 cases/100,000 pop.), with highest rates in the South-West area. At the corregiments (sub-municipalities) of Pereira, Caimalito presented the highest rate. An urban area, Cuba, has 169 cases/100,000 pop., with a low economical level and the highest Aedic index (9.1%). Entomological indexes were associated with ZIKV incidence at simple and multiple non-linear regressions (r(2) > 0.25; p < 0.05). Combining entomological, environmental, human population density, travel patterns and case data of vector-borne infections, such as ZIKV, leads to a valuable tool that can be used to pinpoint hotspots also for infections such as dengue, chikungunya and malaria. Such a tool is key to planning mosquito control and the prevention of mosquito-borne diseases in local populations. Such data also enable microepidemiology and the prediction of risk for travelers who visit specific areas in a destination countr

Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia [version 1; referees: 2 approved]

Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists). Significant differences in the frequency were observed according to age groups and gender. Patients aged >40 years old required more medical attention (39.5%) than those ≤40 years-old (12.1%) (RR=4.748, 95%CI 2.550-8.840). Conclusions: According to our results, at least half of the patients with CHIK developed chronic rheumatologic sequelae, and from those with pCHIK-CPA, nearly half presented clinical symptoms consistent with inflammatory forms of the disease. These results support previous estimates obtained from pooled data of studies in La Reunion (France) and India and are consistent with the results published previously from other Colombian cohorts in Venadillo (Tolima) and Since (Sucre)

Post-chikungunya chronic inflammatory rheumatism: Results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia

Objective: There are limited studies in Latin America regarding the chronic consequences of the Chikungunya virus (CHIK), such as post-CHIK chronic inflammatory rheumatism (pCHIK-CIR). We assessed the largest cohort so far of pCHIK-CIR in Latin America, at the municipality of La Virginia, Risaralda, a new endemic area of CHIK in Colombia. Methods: We conducted a cohort retrospective study in Colombia of 283 patients diagnosed with CHIK that persisted with pCHIK-CIR after a minimum of 6 weeks and up to a maximum of 26.1 weeks. pCHIK cases were identified according to validated criteria via telephone. Results: Of the total CHIK-infected subjects, 152 (53.7%) reported persistent rheumatological symptoms (pCHIK-CIR). All of these patients reported joint pains (chronic polyarthralgia, pCHIK-CPA), 49.5% morning stiffness, 40.6% joint edema, and 16.6% joint redness. Of all patients, 19.4% required and attended for care prior to the current study assessment (1.4% consulting rheumatologists)