Medical resource use in patients with psoriatic arthritis in a comprehensive rheumatological center in Colombia

Psoriatic arthritis (PsA), a chronic systemic inflammatory disorder, impairs the quality of life of patients. The aim of this study was to describe the medical resource use in patients with PsA in a comprehensive rheumatological center in Colombia. We retrospectively analyzed patients diagnosed with PsA who were attended in a center of excellence for rheumatic diseases located in Bogotá, D.C. Colombia, from January to December 2019. A database of medical records was analyzed to identify the use of medical resources classified by specialized physician visits, medications and ambulatory services (e.g., diagnostic, laboratory or image procedures, physical therapy). We reported absolute and relative frequencies among diagnostic groups. This study had no risk for patients. Ninety-six patients with PsA were studied, 57% were women. The mean age was 58.08 (±12.3 years), 90.63% of diagnostic was arthropathic psoriasis, other diagnostics were rheumatoid arthritis without rheumatoid factor, unspecified site (2.08%) and psoriasis, unspecified (2.08%) (ICD-10 code L405, M060, L409, respectively). In terms of treatments, most of the patients used a conventional disease-modifying antirheumatic drugs (DMARDs), methotrexate was the most frequent (represented the 14% of prescription and 78% of patients). On the other hand, 56.25% of patients receive treatment with biological DMARDs (10% of prescription). Among these biologicals, adalimumab (17.71%) and secukinumab (16.67%) were the most used. Regarding other health services, the visit to the specialist and the RX were the most common (83.33% of patients). Chest RX and column RX (17.71% each) had the highest frequency. This is one of the first approaches to the estimation of use of medical resources of PsA in Colombia. Frequency of DMARS use was associated to the severity and medical control of patients

Prevalence and associated factors to suicide attempts in low-income adolescents from the Caribbean region of Colombia

Objectives to establish the prevalence and associated factors to suicide attempts (SA) in low-income adolescents from the Caribbean region of Colombia Methods A cross sectional study was conducted. Adolescents between 10-24 years of age residents in 21 municipalities in the Caribbean region of Colombia were randomly selected from the population affiliated to a subsidized-regime insurance company between 2014-2018. A previously constructed questionnaire was used to obtain information regarding sociodemographic variables and potential risk factors. A self-reported antecedent of suicide attempt was defined as a case. Bivariate and multivariate logistic regression models were used to establish associated factors. Absolute and relative frequencies were reported. Relative frequencies were compared with the Chi2 test and continuous variables were compared with the t-test. A p value <0.050 was considered significan

Sexual behavior, use of contraceptive methods and pregnancy in young people from a population affiliated in a health insurer company in Colombia 2018

Describe the average age of sexual life onset from young people and adolescents, the prevalence of contraceptive methods and explore determinants of pregnancy. A retrospective cohort (2014-2018) was followed by a health insurer of the subsidized regime in Colombia. The study sample consisted of 35,214 young people aged 10-24 years living in 21 municipalities of the Colombian Caribbean region. For the social determinants of pregnancy, a multivariate probit model was estimated using as explanatory variables, housing area, education, family functionality and sexual behavior. 10.3% of women and 14.1% of men had their first sexual encounter before age 14 and 43.5% of women and 37.4% of men began their sex life after age 17. From the young people who claimed to have started their sexual life, 70.9% of the men made use of the condom as a contraceptive method, while the women divided on average 27.2% for the pills and / or injections followed by 16 , 1% in the use of the subdermal implant. As determinants of pregnancy in young people under 20, it was found that variables such as suspending school years [Yes (β = 0.6, p = 0.006)], being planned with hormonal method [Yes (β = 0.5, p = 0.000)] or start sexual life [Between 10 to 14 years (β = 0.14, p = 0.000)], increase the likelihood of young women becoming pregnant at some time in their life. These results also showed that the schooling of the young [University (β = -0.4, p = 0.038)] and always use condoms in sexual intercourse [Yes (β = -0.5, p = 0.042)] help prevent the pregnancy event from occurring. The age of sexual onset establishes a basis on which decision makers should intervene for promote a safe sex life, from use of anticonceptives in young people and thus avoiding unplanned pregnancy

Perception, prevalence and factors associated to school bullying in young people from a population affiliated in a colombian health subsidized insurance company in 2018.

Describe the perception from young people about bullying, the prevalence of this event and explore the factors associated with being a victim. A retrospective cohort (2014-2018) was followed by a health insurer company of the subsidized regime in Colombia. The study sample consisted of 35,214 young people aged 10-24 years living in 21 municipalities of the Colombian Caribbean region. Means and standard deviation were expressed for continuous variables and frequencies for categorical variables. For the associated factors, a logistic model was estimated using as explanatory variables, sex, housing area, age range, family functionality, disability of the young person, disability of a family member and variables of psychological perception. 63.6% of young people answered that they have knowledge about what school bullying is, noting that as the schooling of the young person increases, the higher the proportion of positive response. The physical or verbal school bullying rate was 94 young people per 1,000. It was found that factors such as the youth feeling useless and guilty (OR = 3.14, p = 0.000), attending psychological counseling (OR = 1.78, p = 0.000), repeating years (OR = 1.49, p = 0.000), that the young person has a disability (OR = 1.33, p = 0.004), or a family member has a disability (OR = 1.27, p = 0.000), is associated with being a victim of bullying. Likewise, it was found that belonging to a highly functional family environment (OR = 0.57, p = 0.000) is a protective factor. School bullying is an event that needs attention and requires supervision of all those around young people, in order to avoid changes in behavior or suicide. Therefore, health systems must offer comprehensive care to prevent mental health risks related to bullying given their relationship with the presence of disability of the young person or a relativ

Impact in hospitalization costs of a cardiovascular risk management program in Colombia: a propensity score matching model

Cardiovascular diseases (CVD) are the leading cause of death and burden of disease in Colombia and globally. In 2017, CVD represented the 12% of total DALYs. CVD is a costly disease from patient, family and societal perspectives. Effective prevention and risk management programs reduces the incidence of CVD by as much as 80%. We aimed to estimate the impact of direct medical hospitalization costs related to adherence in a risk management program in Colombia, 2018. We retrospectively collected data from 6,243 patients with data of enrollment in a cardiovascular risk management program (DTC, in Spanish) of a subsidized insurer, who presented arterial hypertension (AH) or AH+ type 2 diabetes mellitus (DM2). 1,065 were identified adherent to the program (treated) and 5.178 non adherent (controls). We designed a propensity score matching model adjusted with confounding variables to estimate the effect of treatment (program adherence) over hospitalization cost. Costs were calculated based on hospitalization invoices and expressed in Colombian pesos (COP) 2018. DTC has an average negative effect on cost of treated population. Being treated avoids hospitalization costs; these results were statistically significant at the 5% and 10% level (with 95%CI that goes through zero). Hence, being in the DTC program reduces hospital costs that ranges from COP-$11,346,372 to -$ 799,259 (95%CI) compared to the average cost. The overall impact on program costs is a significant saving of COP583,670 per event-year. If all members of the DTC program fulfilled its activities by more than 80%, the savings generated by the program would be close to COP$ 6.85 billion. DTC risk management program reduces direct hospitalization costs of events associated to CVD. Our results are important to design policies focused on the cost and risk management of patients with CVD in poor population

Adherence to long-acting reversible contraceptive methods in low- income young women from the caribbean region of Colombia

Adolescent pregnancies are more likely to occur in poor communities, commonly driven by lack of education and employment opportunities. We aimed to estimate the subdermal implant discontinuation rate and to establish the factors associated with the discontinuation of long-acting reversible contraceptive (LARC) methods in a cohort of poor women in the Caribbean region of Colombia. A retrospective cohort study of LARC method use through review of administrative record data was conducted. A population of 2,192 adolescents and young women between 10-24 years old enrolled in the “SER JOVEN” program and who received subdermal implants between 2015-2018 was considered for eligibility. This program is for young people affiliated to a health care company in the Caribbean region of Colombia. We realized a follow-up time-person of the retrospective cohort, and we estimated the incidence of discontinuation of the subdermal implant at six months, one year, two years, and three years. Kaplan-Meier estimator for survival curves, and Cox proportional hazard model were used to ascertain factors associated with method discontinuation risk. A p-value <0.050 was considered significant. A total of 2,192 women were selected with a mean (standard deviation -SD) age of 19.4 (2.8) years and a mean duration of use of subdermal implant of 2.6 (0.8) years. We estimated the subdermal implant discontinuation rate at six months in 0.7% [CI95% 0.3-1.1], a year later in 1.5% [CI95% 1-2], two years later in 2.1% [CI95% 1.5-2.7] and finally at three years in 2.2% [CI95% 1.6-2.8]. Women who stated they have children at baseline were about 70% less risk to discontinue subdermal implants (HR: 0.3 [CI95% 0.1 – 0.8]). Adolescent pregnancy is a public health problem, and it is an important cause of poverty and illness. Then, the use of subdermal implants is an effective alternative to prevent unintended pregnancies

Effectiveness of a cardiovascular risk management program in the reduction of premature mortality associated to cardiovascular events in the Caribbean region of Colombia

Objectives: To establish the effectiveness of a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] in the reduction of premature mortality associated to cardiovascular events (CVE) (male , 55 years, female , 60 years). Methods: The population eligible for the study were patients over 18 years of age affiliated to Mutual SER insurance company between June 2015 and June 2018 and residents of the Caribbean region of Colombia, enrolled or not to DTC program in which a cardiovascular event (CVE) occurred. The main outcomes considered were age of occurrence of cardiovascular events (AOCVE), age at death due to CVE (ADCVE) and years life lost (YLL). For the evaluation of the effectiveness, differences in AOCVO, ADCVO and the YPLL between the patients enrolled and nonenrolled in the DTC program were estimated using a Simple Linear Regression model. Results: A total of 3.902 CVE occurred in the study period among both groups. The enrolled patients had an average of AOCVE of 4.96 years (95% CI 3.85-6.06) higher than in non-enrolled patients. The ADCVE average was 4.64 years (95% CI 1.47 - 7.81) higher in the enrolled patients compared with the non-enrolled patients. Patients enrolled in the DTC program had on average -3.54 (95% CI -5.62 - -1.46) YLL compared to the non-enrolled patients. Conclusions: The DTC program in Mutual SER-EPS was effective to delay the AOCVE, ADCVE and YPLL. DTC program is an effective strategy to reduce the incidence and premature mortality due to CVE in the Caribbean region of Colombia