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2.

Determinantes sociales de la salud en pacientes con tuberculosis - Manizales ­ Colombia 2012 -2014/ Social determinants of health in patients whit tuberculosis Manizales - Colombia 2012 -2014

López Palacio, Juan Diego
| Idioma(s): Español
Objetivo: describir los determinantes sociales de la salud en pacientes con tuberculosis 2012 ­ 2014. Materiales y métodos: estudio descriptivo, basado en el referente conceptual de la Organización Mundial de la Salud sobre los Determinantes Sociales de la Salud. Se analizaron circunstancias sociales y de salud de 273 pacientes Manizaleños durante el año previo al diagnóstico. La información provino de fichas epidemiológicas,registros programáticos, encuesta de identificación social de beneficiarios y certificados de defunción; se utilizó el Statistical Package for the Social Sciences.Resultados: el 60% fueron hombres; edad promedio 46,2 años +/- 19,1 años; 91,2 % con residencia urbana; 8,4% con vulnerabilidad social extrema; 92% tenían educación secundaria o menos; 55,2% de estrato social bajo. Se encontró un promedio de 4,38 personas/vivienda; el 4% fueron habitantes de calle. El 93% afiliados al sistema de salud; el 80,2% con tuberculosis pulmonar; el 12,8% con asociación de VIH-Sida; el 95,6% pacientes nuevos al ingreso; egresaron del programa, 33,7% curados; 39,9% terminado; 8,4% fracaso o abandono y 13,9% fallecidos. La incidencia en comunas osciló entre 0,9 y 4.4 por 10 000 personas/año. Conclusiones: la presencia y persistenciade la tuberculosis está relacionada con las condiciones materiales de vida delas clases sociales. Diversos autores han encontrado gradientes sociales relacionados con tuberculosis. Las personas con tuberculosis tienen en común determinantes que los categorizan socialmente, que influyen en la mortalidad, letalidad e incidencia; es necesaria la articulación multisectorial y fortalecer investigaciones en los determinantes sociales de la salud...(AU) Objective: to describe the behavior of the social determinants of health in patients with tuberculosis. Materials and methods: a descriptive study, based on the conceptual reference of the World Health Organization on the social determinants of health. Health and social residents of 273 patients were analyzed in Manizales circumstances during the year prior to diagnosis. The information came from the epidemiological profile, program records, national survey of social identification of beneficiaries and death certificate; the Statistical Package for the Social Sciences was used. Results: 60% were men; average age 46,2 years +/- 19,1 years; 91,2% with urban residence; 8,4% with extreme social vulnerability; 92% had secondary education or less; 55,2% of low social status. An average of 4,38 people / housing was found; 4% were street dwellers. 93% affiliated to the health system; 80,2% with pulmonary tuberculosis; 12,8% with HIVAIDS Association; 95,6% new income patients; they exited the program 33,7% cured; 39,9% completed; Failure or neglect 8,4% and 13,9% died. The incidence in the districts ranged between 0,9 and 4,4 per 10 000 people/year. Conclusions: the presence andpersistence of tuberculosis is related to the material conditions of life of social classes.Several authors have found social gradients related to tuberculosis. People with TB of Manizales have in common various social determinants and are socially categorized influencing mortality, incidence and lethality; It is necessary that coordination coming from various sectors strengthen research on the social determinants of health...(AU)
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3.

Impacto de salud oral sobre calidad de vida en adultos jóvenes de clínicas odontológicas universitarias/ Oral health impact on life quality in young adults at dental university clinics

Díaz-Cárdenas, Shyrley; Meisser-Vidal, Madera Anaya; Tirado-Amador, Lesbia Rosa; Fortich-Mesa, Natalia; Tapias-Torrado, Liliana; González-Martínez, Farith Damián
| Idioma(s): Español
El objetivo de este estudio es asociar estado de salud oral y calidad de vida en adultos de clínicas odontológicas universitarias de Cartagena, Colombia. Material y Métodos: Estudio analítico, en 400 adultos jóvenes y maduros (20 a 59 años), que asistieron a las clínicas odontológicas de la Universidad de Cartagena y Corporación Universitaria Rafael Núñez, distribuidos equitativamente; se aplicó un instrumento validado para indagar variables sociodemográficas, el General Oral Health Assesment Index (GOHAI) para evaluar impacto calidad de vida relacionada con la salud oral (CVRSB) y examen oral para evaluar número de dientes, presencia de caries dental, placa bacteriana, restos radiculares, cálculo dental y obturaciones. Se analizaron datos a través de frecuencia y proporciones, significancia de relaciones entre variables (c2), estimación del riesgo (OR) y modelo de regresión logística con un intervalo de confianza 95 %. Resultados. 66,7 % de los participantes eran mujeres y se hallaban en adultez madura (54,7 %) edad promedio 44,6 años (DE=13,7). El 33,2 % presentó un impacto negativo de CVRSB (IC 95 %). Se hallaron asociaciones entre bajo nivel de escolaridad (OR=2,4; IC 95 %= 1,6-3,8; p=0,000), ausencia de servicios de salud (OR=1,9; IC 95 %= 1,2-2,8; p=0,002), presencia de menos de 19 dientes (OR=3,6; IC 95 %= 2,3-5,8; p=0,000), restos radiculares (OR=6,5; IC 95 %= 4,1-10; p=0,000) y cálculos (OR=5,3; IC 95 %= 3,3-8,4; p=0,000;) con el impacto negativo de CVRSB. En el modelo multivariado las variables que mejor explican el impacto negativo fueron: ausencia de servicios de salud, contar con menos de 19 dientes, presencia de restos radiculares y cálculos (p<0,05). Conclusión. Adultos jóvenes y maduros presentan un impacto negativo de CVRSB al contar con menos de 19 dientes, presencia de restos radiculares y cálculos dentales y ausencia de servicios de salud. The aim of this study is to associate oral health status and quality of life in adults treated at university dental clinics in Cartagena, Colombia second semester 2013. Cross-sectional analytical study, in 400 young and mature adults (20-59 years) attending dental clinics University and the University Corporation Cartagena Rafael Nunez and distributed equally between the two institutions; a validated instrument was applied to investigate for sociodemographic variables and the General Oral Health Assessment Index (GOHAI) evaluating the impact of oral health on quality of life (CVRSB); oral exam was performed to evaluate the number of teeth, presence of dental caries and plaque, root fragments, dental calculus and seals. Data were analyzed by frequency and proportion, taking confidence intervals of 95 %, significance of relationships between variables by means of chi-square, risk estimation through OR, and logistic regression model with a confidence level of 95 %. 66.7 % of participants were women and were at the stage of mature adulthood with 54.7 %, with an average age of 44.6 years (SD= 13.7). 60.2 % (95 % CI 55-65) had a low impact of oral health on quality of life, followed by a high impact with 33.2 %. We found associations between low levels of schooling (p=0.000; OR=2.4; IC 95 %= 1.6-3.8), social security (p=0.0.02; OR=1.9; IC 95 %= 1.2-2.8), presence of less than 19 teeth (p=0.000; OR=3.6; IC 95%= 2.3-5.8), root fragments (p=0.000; OR=6.5; IC 95 %= 4.1-10), dental calculus (p=0.000; OR=5.3; IC 95 %= 3.3-8.4) with the negative impact of the CVRSB. In the multivariate model variables that best explain the negative impact of CVSB they were: lack of social security, have fewer than 19 teeth, presence of root fragments and stones (p <0.05). Young and mature adults have a negative impact on CVRSB especially when they have less than 19 teeth, presence of root fragments and dental calculus or when they have no social security arises.
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4.

Impacto económico y sanitario del control prenatal en embarazadas afiliadas al régimen subsidiado en Colombia durante 2014/ Economic and health impact of prenatal care in pregnant women with public health insurance in Colombia during 2014

Gómez-De la Rosa, Fernando; Marrugo-Arnedo, Carlos Alberto; Florez-Tanus, Álvaro; López-Pájaro, Keity; Mazenett-Granados, Enrique; Orozco-Africano, Julio; Alvis-Guzmán, Nelson
| Idioma(s): Español
Resumen: Objetivo: Analizar el impacto sanitario y económico del control prenatal (CPN) en mujeres de hogares pobres. Material y métodos: Se tomó una muestra aleatoria de 9 244 mujeres embarazadas (población= 25 000). Se estimó la incidencia de mortalidad materna, los costos directos de atención y la diferencia de medias y proporciones. Los costos fueron estimados en dólares americanos (USD) de 2014, con perspectiva del tercer pagador. Resultados: El 75% de las mujeres viven en zonas urbanas. La media de edad fue de 23 años (IC95%: 23.5-23.8). El 87.5% asistió al menos a una cita de CPN. El costo medio de partos con CPN fue de USD$ 609.1 (IC95%: 581-632.7). Sin CPN fue de USD $857.8 (IC95%: 774.7-923.8). Los costos se incrementan 32% (IC95% 27.1-41) sin CPN. Conclusión: El CPN es una intervención eficiente y efectiva para la gestión del riesgo de la salud materna. Abstract: Objective: To estimate health care costs of live births and the impact of prenatal care visit (PCV) in women from poor households. Materials and methods: A randomized sample of 9 244 pregnant women (out of total= 25 000). Mean differences and proportions were calculated to compare results in both groups of women. The costs were estimated in American Dollars (USD) 2014, from the payer’s perspective. Results: 75% of women live in urban areas. The mean age was 23 years old (CI95% 23.5-23.8). The average cost with PCV was USD 609.1 (CI95%: 581-632.7) and without PCV was USD 857.8 (CI95%: 774.7-923.8) and 87% of women attended at least one PCV. The health care costs increased in 32% (CI95% 27.1-41) in women who did not attended PCV. Conclusion: The PCV is an efficient and effective intervention for managing the risk of maternal health.
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5.

Barreras para la atención en salud durante el diagnóstico y tratamiento del cáncer gástrico/ Obstacles to health care during the diagnosis and treatment of gastric cancer

Amado Niño, Angélica María; Mantilla Villabona, Leydi Yurani; Ospina Galeano, Diana Carolina; Maturana Martínez, Dely María Auxiliadora; Uribe Pérez, Claudia Janeth
;
| Idioma(s): Español
Introducción: El cáncer gástrico es una neoplasia maligna de alta morbimortalidad. Ocupa el quinto lugar en prevalencia mundial. Objetivo: Describir las barreras para la atención en salud durante el diagnóstico y tratamiento del cáncer gástrico. Metodología: Para la revisión de la literatura se emplearon bases de datos (PubMed, Lilacs, Ebsco, Science-direct, Ovid y google académico), que incluyó la consulta de ensayos clínicos, revisiones de tema y guías de manejo relacionadas con cáncer gástrico y sus barreras durante el diagnóstico y tratamiento, entre 2009-2016. Resultados: 56 artículos cumplieron con los criterios de inclusión y exclusión. Las barreras halladas son administrativas, institucionales, económicas, culturales y de conocimientos del paciente y el médico, que limitan el acceso a la atención médica. Conclusión: En Colombia, la fragmentación y segmentación del sistema de salud impone barreras en la atención de los adultos con cáncer gástrico ocasionando las disparidades en salud que impactan en su sobrevida...(AU) Gastric cancer is a malignant neoplasm of high morbi-mortality. It ranks fifth in world prevalence. Objective: To describe the obstacles to health care during the diagnosis and treatment of gastric cancer. Methodology: PubMed, Lilacs, Ebsco, Science-direct, Ovid and google scholar were used to the review of literature that included the consultation of clinical trials, topic reviews and management guides related to gastric cancer and its barriers during diagnosis and treatment between 2009 and 2016. Results: 56 articles achieved the inclusion and exclusion criteria. The obstacles found are administrative, institutional, economic, cultural and knowledge of the patient and the physician about gastric cancer which could limit the access to medical care. Conclusion: In Colombia, the fragmentation and segmentation of the health system impose obstacles on the care of adults with gastric cancer, which cause disparities in health that impact on their survival...(AU) O câncer gástrico é uma neoplasia maligna de alta morbidade e mortalidade. Ele ocupa o quinto lugar na prevalência mundial. Objetivo: Descrever as barreiras encontradas no sistema de saúde para o diagnóstico e o tratamento do câncer gástrico. Metodologia: Para rever a literatura existente foi utilizada a base de dados da (PubMed, Lilacs, EBSCO, Science-diretas, Ovídio e Google acadêmico), incluindo a consulta dos ensaios clínicos, a revisão do tema e as guias relacionadas com câncer gástrico e suas barreiras durante o diagnóstico e tratamento, entre 2009-2016. Resultados: 56 artigos preencheram os critérios de inclusão e de exclusão. As barreiras encontradas são de carater administrativo, institucionais, económicas, culturais e do conhecimento do paciente e do médico, limitando assim o acesso aos cuidados médicos. Conclusão: Na Colômbia, a fragmentação e segmentação do sistema de saúde impõe barreiras no atendimento dos adultos com câncer gástrico causando as disparidades de saúde que afetam a sua sobrevivência...(AU)
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6.

La participación juvenil en la Política Pública de Juventud, 1997 – 2011 (Caldas, Colombia)/ The participation of young people in the Youth Public Policy, 1997-2011 (Caldas, Colombia)/ A participação dos jovens na Política Pública de Juventude, 1997-2011 (Caldas, Colômbia)

Peralta-Duque, Beatriz del Carmen
| Idioma(s): Español
Analizo aquí la participación política de los sujetos jóvenes en las políticas públicas de juventud en Caldas (Colombia), según sus garantías constitucionales y sus condiciones sociopolíticas, económicas y culturales, a partir de la Ley 375 de 1997 hasta 2011, a la culminación de los períodos de las alcaldías. En cuanto a la metodología, se trata de un estudio de caso efectuado en los municipios de Manizales, Palestina, Chinchiná, Neira y Villamaría, Región Centro Sur de Caldas. Cómo técnicas utilicé la observación directa y el análisis de artículos periodísticos, así como grupos focales, entrevistas en profundidad y encuesta. Según los resultados de la investigación, los sujetos jóvenes de los Grupos y Clubes juveniles y de las Casas de la Cultura, hacen de las artes y la ecología espacios de participación, más que los Consejos Municipales de Juventud. El Gobierno Escolar incentiva la participación. La Iglesia Católica y el movimiento MIRA promueven la participación juvenil. This article analyses the political participation of young people in youth public policies in the department of Caldas (Colombia) based on their constitutional rights and socio-political, economic and cultural conditions between the creation of Law 375 of 1997 until 2011. The methodology involved case studies in the municipalities of Manizales, Palestina, Chinchiná, Neira and Villamaría, forming the southern central region of Caldas. The techniques used included direct observation and analysis of new articles, focus groups, in-depth interviews and surveys. The results showed that young people participating in Youth Groups and Clubs and Culture Houses turn their practice of arts and interest in ecology into participation spaces more than the Municipal Youth Councils. The study also found that school governments encourage student participation while the Catholic Church and the MIRA political movement promote youth participation. Neste trabalho é analisada a participação dos jovens nas políticas públicas de juventude em Caldas (Colômbia) de acordo com suas garantias constitucionais e suas condições sociopolíticas, econômicas e culturais, a partir da Lei 375 de 1997 até 2011, segundo as datas da prefeitura. Método: estudo de caso nos municípios de Manizales, Palestina, Chinchiná, Neira e Villamaría, Região Centro-Sul de Caldas. Metodologia: observação direta e análise de artigos jornalísticos, grupos focais, entrevistas em profundidade e pesquisa. Resultados: os jovens dos grupos e clubes juvenis e das Casas de Cultura fazem das artes e da ecologia espaços de participação em maior proporção que os Conselhos Municipais de Juventude. O Governo Escolar incentiva a participação. A Igreja Católica e o movimento MIRA promovem a participação dos jovens.
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7.

Resultados de la implementación del sistema de vigilancia de la mortalidad materna basada en la Web, Colombia, 2015

Organización Panamericana de la Salud
| Idioma(s): Español
[Introducción]: En respuesta al quinto objetivo de desarrollo del milenio: “Mejorar la salud materna” y a las prioridades nacionales e internacionales relacionadas con la reducción de la mortalidad materna, se desarrolló en Colombia desde el año 2008 el proyecto Sistema de Vigilancia Epidemiológica de la Mortalidad Materna Basado en la Web (SVEMMBW). Este sistema busca que la información sobre muertes maternas sea activa, prospectiva y casi en tiempo real, en el entendido de que disponer de información confiable y oportuna es un paso necesario para mejorar la salud y la calidad de vida de la mujer gestante. Esta iniciativa ha sido liderada por el Ministerio de Salud y Protección Social (MPS) y el Instituto Nacional de Salud (INS), en asocio con la Organización Panamericana de la Salud (OPS), la Organización Mundial de la Salud (OMS), el Centro Latinoamericano de Perinatología y Salud de la Mujer Reproductiva (CLAP/SMR), la División de Salud Reproductiva de los Centros para el Control y la Prevención de las Enfermedades (CDC), el Centro de Salud Sexual y Reproductiva NACER de la Universidad de Antioquia y el auspicio de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID).
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8.

Atención a la salud y morbimortalidad materna: un estudio de casos y controles de base hospitalaria en dos regiones de Colombia (Bogotá y Antioquia), 2009-2011./ [Healthcare and maternal morbidity and mortality: a hospital-based case-control study in two regions of Colombia (Bogotá and Antioquia), 2009-2011].

Yepes, Francisco J; Gómez, Joaquin G; Zuleta, John Jairo; Londoño, Juan Luis; Acosta-Reyes, Jorge Luis; Sánchez-Gómez, Luz Helena; Ramírez, Marta L
| Idioma(s): Español
The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.
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9.

Pobreza y trastornos mentales en la población colombiana, estudio nacional de salud mental 2015./ [Poverty and Mental Disorders in the Colombian Population: National Mental Health Survey 2015].

Quitian, Hoover; Ruiz-Gaviria, Rafael E; Gómez-Restrepo, Carlos; Rondón, Martin
| Idioma(s): Español
INTRODUCTION: Poverty has been associated in some studies with poorer outcomes in mental problems and disorders. A circular relationship has been considered in which poverty fosters the appearance of mental illness and this facilitates greater poverty. There are no studies in Colombia on this subject. OBJECTIVE: To describe the association between mental problems and disorders and poverty according to the Multidimensional Poverty Index (MPI) in Colombia. MATERIAL AND METHODS: Using the 2015 National Mental Health Survey, adjusted with the expansion factors for the population. The prevalences of mental problems and disorders obtained through semi-structured interviews employing the instruments SRQ-20, AUDIT C and A, modified PCL, familiar APGAR and CIDI CAPI. The poverty status was determined by the MPI. RESULTS: A total of 13,200 households were interviewed, of which 13.5% were classified as in a poverty condition, 6.3% of the adolescents of poor households reported a life-time prevalence of any mental disorder, and 4.6% in the last 12 months. On the other hand, the prevalences for the same age group not in a poverty condition were 7.2% and 3.3%, respectively. For adults in poverty, the prevalence of life-time mental disorders were 9.2%, with 4.3% in the last year, while those not considered poor showed prevalences of 9.1% and 3.9% for the same time periods. CONCLUSIONS: For the population of Colombia, there is a relationship between not being able to access the basic basket of goods and the presence of mental diseases, although there does not seems to be an association between an increase in poverty and the deterioration of mental health.
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10.

Impacto económico del tabaquismo en los sistemas de salud de América Latina: un estudio en siete países y su extrapolación a nivel regional./ [Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level].

Pichon-Riviere, Andrés; Bardach, Ariel; Augustovski, Federico; Alcaraz, Andrea; Reynales-Shigematsu, Luz Myriam; Pinto, Márcia Teixeira; Castillo-Riquelme, Marianela; Torres, Esperanza Peña; Osorio, Diana Isabel; Huayanay, Leandro; Munarriz, César Loza; de Miera-Juárez, Belén Sáenz; Gallegos-Rivero, Verónica; Puente, Catherine De La; Navia-Bueno, María Del Pilar; Caporale, Joaquín
| Idioma(s): Español
Objective: Estimate smoking-attributable direct medical costs in Latin American health systems. Methods: A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America's population; the results were then extrapolated to the regional level. Results: Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region's gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina). Conclusions: Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region's countries should seriously consider stronger measures, such as an increase in tobacco taxes.
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