The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities.

AIMS: To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia. METHODS: This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI. CONCLUSION: Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.

Social Cognitive Theory-Based Interventions to Address Interpersonal Violence Among Hispanic Youth-A Systematic Review.

Introduction: The prevalence of interpersonal violence among Hispanic youth is high and effective interventions are sparse yet needed to prevent and address interpersonal violence. Theory-based interventions are crucial for creating robust interventions for public health concerns, such as interpersonal violence. Methods: In our systematic literature review, we sought to examine social cognitive theory (SCT)-based Interventions addressing interpersonal violence among Hispanic youth. Searching in both English and Spanish, we used the search engines, PubMed, Google Scholar, CINAHL, Web of Science, and Lilacs, and restricted the years to 2010-2022. Results: Self-efficacy and normative beliefs were the two most commonly addressed SCT constructs in the interventions. SCT-based interventions were found to increase confidence in not engaging in negative behaviors and improve coping skills. Moreover, within the context of implementing SCT-based interventions, school-based interventions and Participatory Action Research, were foundational to the SCT-based interventions. Conclusion: Overall, SCT-based interventions were found to be effective in interpersonal violence mitigation and reduction among Hispanic youths. There was a synergistic effect between the number of SCT constructs incorporated in an intervention and the positive results of the intervention. Thus, future studies are both needed and should robustly incorporate SCT constructs to yield the best possible outcomes.

Glycemic status and health-related quality of life (HRQOL) in populations at risk of diabetes in two Latin American cities.

PURPOSE: To estimate the health-related quality of life (HRQOL) according to glycemic status, and its relationship with sociodemographic and clinical factors in a population at risk of developing type 2 diabetes (T2D). METHODS: Cross-sectional study, using cluster sampling. Data were collected from 1135 participants over 30 years of age, at risk of developing T2D from the PREDICOL project. Participants' glycemic status was defined using an oral glucose tolerance test (OGTT). Participants were divided into normoglycemic subjects (NGT), prediabetes and diabetics do not know they have diabetes (UT2D). HRQOL was assessed using the EQ-5D-3L questionnaire of the EuroQol group. Logistic regression and Tobit models were used to examine factors associated with EQ-5D scores for each glycemic group. RESULTS: The mean age of participants was 55.6 ± 12.1 years, 76.4% were female, and one in four participants had prediabetes or unknown diabetes. Participants reported problems most frequently on the dimensions of Pain/Discomfort and Anxiety/Depression in the different glycemic groups. The mean EQ-5D score in NGT was 0.80 (95% CI 0.79-0.81), in prediabetes, 0.81 (95% CI 0.79-0.83), and in participants with UT2D of 0.79 (95% CI 0.76-0.82), respectively. Female sex, older age, city of residence, lower education, receiving treatment for hypertension, and marital status were significantly associated with lower levels of HRQOL in the Tobit regression analysis. CONCLUSIONS: HRQOL of NGT, prediabetes, and UT2D participants was statistically similar. However, factors such as gender, age. and place of residence were found to be significant predictors of HRQOL for each glycemic group.

Viruses responsible for acute respiratory infections before (2016-2019) and during (2021) circulation of the SARS-CoV-2 virus in pediatric patients in a reference center at Barranquilla Colombia: A pattern analysis.

OBJECTIVE: To evaluate the behavior of the viruses responsible for acute respiratory infections before (2016-2019) and after (2020-2021) the start of the circulation of the SARS-CoV-2 virus in pediatric patients treated at a reference center from Barranquilla, Colombia. MATERIALS AND METHODS: A descriptive observational study was carried out, and data were obtained by reviewing the influenza-like illness and severe acute respiratory infection database in the pediatric population of the sentinel surveillance reference center in the district of Barranquilla during the years 2016-2021, applying inclusion and exclusion criteria. RESULTS: During 2016-2019, the average age of individuals was 1.3 (±1.7) years, during 2021, it was 2.3 (±3.5) years. The distribution by sex was similar, predominantly male. August and February were the months with the highest record of symptoms for 2016-2019 and 2021, respectively, the most frequent being cough, fever, shortness of breath, and diarrhea. By 2021 there was a higher use of antibiotics and antivirals reported than in 2016-2019. Most patients tested negative for viral detection. When comparing the percentage of viruses detected by age group and years of detection, positivity was lower in 2021 by every age group, and respiratory syncytial virus (RSV) was the most frequently detected. CONCLUSIONS: There was less virus positivity in viral detection tests in the pediatric population in 2021. RSV persists as the main etiology affecting this population, especially infants. The use of antibiotic therapy in viral infections continues to be a problematic practice in their management. Sentinel surveillance can be strengthened throughout the country.

Risk of violence from a current or former partner: Associated factors and classification in a nationwide study in Colombia.

Intimate partner violence (IPV) includes assaults that risk a woman's bodily integrity. Intimate partners commit IPV, people with whom the victim shares (or shared) a close personal or sexual relationship. This phenomenon has a great global and national impact. Thus, it is necessary to establish trends of the risk of physical violence to women by their current or former partner in each department of Colombia and its relationship with sociodemographic and health characteristics. This study uses an ecological approach at the departmental level, with victims of intimate partner violence treated at the National Institute of Legal Medicine and Forensic Sciences (INMLyCF). Potential factors were identified through Bayesian factor analysis and were included in the model to estimate risk. The findings show that the Casanare department had the highest risk of producing victims (SMR: 2.545). In departments where the educational level of women is at or below primary school, there is a high-risk ß = 0.343 (0.285, 0.397) of them being assaulted. For the departments in which the employment of women is in sales and services or office workers, the associated factor presents a higher risk ß = 0.361 (0.201, 0.485), as in the risk related to affiliation with the social security system ß = 0.338 (0.246, 0.498), as well as sexual and reproductive life ß = 0.143 (0.003, 0.322). The following categories were associated with physical gender violence: no education and low participation in making purchases at home ß = 0.106 (0.049, 0.199), low participation in decisions about their health, and visits to family and friends ß = 0.240 (0.170, 0.299). Therefore, public health programs should strengthen women's empowerment in household decisions and increase their educational level to reduce this incidence.

Predictors of diabetes risk in urban and rural areas in Colombia.

BACKGROUND: Nutritional habits low in fruits and vegetables and sedentary lifestyle are associated with a higher risk of developing Type 2 Diabetes (T2D). However, it is important to assess differences between urban and rural areas. This study aimed to analyze the associations between the risk of developing T2D and setting in the Colombian north coast in 2017. METHODS: This cross-sectional study included 1,005 subjects. Data was collected by interviewing self-identified members of an urban community and a rural-indigenous population. The interaction terms were evaluated as well as the confounders. Then, adjusted binary logistic regressions were used to estimate the odds ratio (OR) and 95% Confidence Intervals (CI). RESULTS: subjects with a high risk of T2D are more likely to belong to the urban setting (OR = 1.908; 95%CI = 1.201-2.01) compared with those with lower T2D after adjusting for age, Body Mass Index (BMI), physical activity, history of high levels of glycemia, and diabetes in relatives. CONCLUSIONS: Urban communities are more likely to have T2D compared with rural-indigenous populations. These populations have differences from the cultural context, including personal, and lifestyle factors.

Factors associated with the double burden of malnutrition at the household level: A scoping review.

The double burden of malnutrition (DBM) at the household level has been defined as the coexistence of underweight children and overweight mothers within the same household. The objective of the scoping review was to identify and understand factors associated with DBM. We conducted the scoping review of published, peer-reviewed journal articles in two major databases used in public health research (PubMed and Web of Science). A total of 70 articles met the eligibility criteria. The following factors were identified: mother's age, height, educational level, occupation, food intake, breastfeeding, family income, family size, and urbanization type. Overall, results were heterogeneous. Two scenarios have been identified. The first scenario is those obese women with a job, having a sufficient income, a high educational level, the ability to purchase food, and live either in rural or urban areas. The second scenario is obese women without a job, having an insufficient income, a low educational level, without the ability to purchase food, and live either in rural or urban areas. The DBM at the household level is a complex public health problem. There is a need for target-specific interventions to address child undernutrition and maternal overweight/obesity simultaneously.

COVID-19 en la Región Caribe Colombiana: un análisis documental / Covid19 in the Colombian Caribbean Region: A Documentary analysis

Resumen Introducción: El impacto social y sanitario que ha generado la pandemia COVID-19 a nivel global permite repensar aspectos de vigilancia epidemiológica y comunicación en tiempos de crisis. Objetivo: Describir el comportamiento de la pandemia COVID-19 en los departamentos y distritos especiales de la región caribe colombiana. Materiales y Métodos: Análisis documental e interpretativo a partir de fuentes secundarias de vigilancia nacional "SIVIGILA" y datos de entes territoriales. Resultados: Cartagena de Indias es la primera unidad territorial del Caribe en presentar casos por COVID-19, seguido de Santa Marta y Barranquilla. El mayor número de casos se registró en Barranquilla, Atlántico, Cartagena y Córdoba. Así mismo, la mayor tasa de muertes por 100 000 habitantes se registró en Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre y Cartagena. En el Caribe se implementaron estrategias de distanciamiento social como prohibición de eventos masivos y cierre de fronteras. Discusión: Para describir el comportamiento de la pandemia es importante que las autoridades sanitarias continúen asumiendo el reto para la detección, sistematización y manejo oportuno de los casos. El comportamiento de la pandemia ha sido similar en los departamentos del Caribe Colombiano, hay una homogeneidad al momento de acatar las normas del gobierno, y cada región adaptó diferentes estrategias dentro de un marco general para reducir la incidencia de la enfermedad. Se recomienda fortalecer la similitud entre los datos reportados por el Ministerio de Salud, SIVIGILA y los entes territoriales. El talento humano en salud cualificado puede soportar este ejercicio a fin de superar la actuación mediática y avanzar hacia la gobernanza.

Abstract Background: The social and health impact generated by the COVID-19 pandemic allows us to re-think aspects of epidemiological surveillance and communication in struggle-times. Objective: To describe the behavior of the COVID-19 pandemic in the departments and special districts of the Colombian Caribbean region. Methodology: This is a documentary and interpretive analysis from secondary sources of National Surveillance "SIVIGILA" and data from local governments. Results: Cartagena de Indias is the first territorial area in the Caribbean to present cases COVID-19, followed by Santa Marta and Barranquilla. The highest number of cases was registered in Barranquilla, Atlántico, Cartagena and Córdoba. Likewise, the highest death rate per 100,000 inhabitants was observed in Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre and Cartagena. In the Caribbean, social distancing was implemented, as well as the limitation of mass gatherings and border closure. Discussion: To describe the pandemic behavior, it is important that health authorities continue to assume the challenges of detection, systematization, and timely handling of cases. The COVID-19 performance has been similar in the Colombian Caribbean. There is a homogeneity regarding the government regulations compliance and each region adapted different strategies to reduce the incidence of the dicease. It is recommended to strengthen the concordance between the data reported by the Ministry of Health, SIVIGILA, and the territorial entities. Qualified human talent can support this exercise in order to overcome the media performance through the strengthening of governance.

Utilización de anticonceptivos en población migrante: el caso de las gestantes migrantes venezolanas en dos ciudades receptoras de la costa norte de Colombia / Contraceptive use in the migrant population: the case of pregnant Venezuelan migrants in two receiving cities on the north coast of Colombia / Uso de anticoncepcionais em população migrante: O caso das gestantes migrantes venezuelanas em duas cidades receptoras do litoral norte da Colômbia

Resumen Objetivo: Describir la utilización de métodos anticonceptivos de gestantes migrantes venezolanas, en dos ciudades de la costa norte de Colombia (Barranquilla y Riohacha), entre 2018 y 2019. Metodología: Se diseñó un estudio descriptivo de corte transversal. Las participantes se seleccionaron mediante muestreo sistemático en hospitales y muestreo en bola de nieve en la comunidad. Un cuestionario estandarizado permitió la recolección de variables sociodemográficas, de migración, de uso de anticonceptivos, entre otras. Resultados: Fueron encuestadas 552 mujeres gestantes provenientes de Venezuela, principalmente jóvenes, casadas o en unión libre; la minoría de los embarazos fueron planificados (37,7 %), aun cuando las mujeres conocían sobre métodos de anticoncepción. El preservativo (condón) y la píldora fueron los métodos más conocidos (94,7 y 96,1 %, respectivamente). Conclusión: Casi todas las mujeres conocen métodos anticonceptivos y los lugares dónde obtenerlos; no obstante, solo la mitad logró conseguirlos la última vez que los buscó; así, la mayoría de los embarazos fueron no planificados. La garantía de los derechos sexuales y reproductivos, incluyendo la satisfacción de necesidades de planificación familiar, debe ser una prioridad en las acciones de atención a la población migrante, en el marco del fenómeno migratorio colombo-venezolano.

Abstract Objective: To describe the use of contraceptive methods by pregnant Venezuelan migrants in two cities on the north coast of Colombia (Barranquilla and Riohacha), between 2018 and 2019. Methodology: A descriptive cross-sectional study was designed. Participants were selected through systematic sampling in hospitals and snowball sampling in the community. A standardized questionnaire allowed the sociodemographic, migration, contraceptive use and other variables to be collected. Results: 552 pregnant, mainly young, women from Venezuela who are married or living with their partner were surveyed. The minority of pregnancies were planned (37.7%), even though the women knew about contraception methods. The condom and the pill were the most well-known methods (94.7 and 96.1%, respectively). Conclusion: Nearly all of the women knew about birth control and where it can be accessed. However, only half managed to get them the last time they looked for them, meaning that most of the pregnancies were unplanned. Guaranteed sexual and reproductive rights, including satisfactory family planning requirements, must be a priority in actions aimed at the migrant population, within the framework of the Colombian-Venezuelan migratory phenomenon.

Resumo Objetivo: Descrever o uso de métodos anticoncepcionais de gestantes migrantes venezuelanas, em duas cidades do litoral norte da Colômbia (Barranquilla e Riohacha), entre 2018 e 2019. Metodologia: Foi desenhado um estudo de corte transversal descritivo. As participantes foram selecionadas através de uma amostragem sistemática em hospitais e amostragem em bola de neve feita na comunidade. Um questionário padrão permitiu a coleta de variáveis sócio demográficas, de informação relacionada à migração, ao uso de anticoncepcionais, entre outras. Resultados: O questionário foi aplicado a 552 mulheres gestantes vindas da Venezuela, principalmente jovens, casadas ou em união estável; a minoria das gestações foi planejada (37,7%), mesmo conhecendo os métodos anticoncepcionais. O preservativo (camisinha) e a pílula foram os métodos mais identificados (94,7 e 96,1% respectivamente). Conclusão: Quase todas as mulheres conhecem métodos anticoncepcionais e os lugares onde podem obtê-los; porém somente a metade delas conseguiu adquiri-los quando procuraram pela última vez; assim que a maioria das gestações não foi planejada. A garantia dos direitos sexuais e reprodutivos, incluindo a satisfação das necessidades de planejamento familiar, deve ser uma prioridade nos programas de atenção à população migrante, dentro do marco do fenômeno migratório colombo-venezuelano.

Metered-dose inhalers versus nebulization for the delivery of albuterol for acute exacerbations of wheezing or asthma in children: A systematic review with meta-analysis.

OBJECTIVES: The benefits of metered-dose inhalers with a spacer (MDI+S) have increasingly been recognized as an alternative method of albuterol administration for treating pediatric asthma exacerbations. The aim of this systematic review was to compare the response to albuterol delivered through nebulization (NEB) with albuterol delivered through MDI+S in pediatric patients with asthma exacerbations. METHODS: We conducted an electronic search in MEDLINE/PubMed, EMBASE, Ovid, and ClinicalTrials. To be included in the review, a study had to a randomized clinical trial comparing albuterol delivered via NEB versus MDI+S; and had to report the rate of hospital admission (primary outcome), or any of the following secondary outcomes: oxygen arterial saturation, heart rate (HR), respiratory rate (RR), the pulmonary index score (PIS), adverse effects, and need for additional treatment. RESULTS: Fifteen studies (n = 2057) met inclusion criteria. No significant differences were found between the two albuterol delivery methods in terms of hospital admission (relative risk, 0.89; 95% confidence interval [CI], 0.55-1.46; I2 = 32%; p = .65). There was a significant reduction in the PIS score (mean difference [MD], -0.63; 95% CI, -0.91 to -0.35; I2 = 0%; p < .00001), and a significantly smaller increase in HR (better; MD -6.47; 95% CI, -11.69 to -1.25; I2 = 0%; p = .02) when albuterol was delivered through MDI+S than when it was delivered through NEB. CONCLUSIONS: This review, an update of a previously-published meta-analysis, showed a significant reduction in the PIS and a significantly smaller increase in HR when albuterol was delivered through MDI+S than when it was delivered through NEB.

Depresión y trastornos del sueño relacionados con hipertensión arterial: un estudio transversal en Medellín, Colombia / Depression and sleep disorders related to hypertension: A cross-sectional study in Medellín, Colombia

RESUMEN Introducción: Los factores psicosociales se han mostrado como potenciadores y desencadenantes de enfermedades cardiovasculares como la hipertensión arterial. El propósito del estudio es explorar la relación de los factores psicosociales con la presencia de hipertensión arterial en una muestra aleatoria poblacional en la ciudad de Medellín. Métodos: Estudio de tipo observacional de corte transversal con enfoque analítico. La variable respuesta (hipertensión arterial) se contrastó con las psicosociales y sociodemográficas mediante análisis bivariable, y posteriormente se realizó un análisis de regresión logística multivariable. Resultados: Tras ajustar por edad, sexo y eventos de vida estresantes, los factores psicosociales asociados con hipertensión arterial son la depresión (OR = 1,65; IC95%, 1,13-2,41) y los trastornos del sueño (OR = 1,41; IC95%, 1,00-1,98). Conclusiones: La depresión y los trastornos del sueño se relacionan con la hipertensión arterial. En Colombia hay estudios que relacionan factores psicosociales como la depresión con la hipertensión, pero se desconoce el impacto de los trastornos de sueño en la población.

ABSTRACT Introduction: Psychosocial factors have been shown to be potentiators and triggers of cardiovascular diseases such as hypertension. The purpose of the study is to explore the relationship between psychosocial factors and the presence of hypertension in a random population sample in the city of Medellin. Methods: Observational cross-sectional study with an analytical approach. The endpoint (hypertension) was contrasted with the psychosocial and sociodemographic endpoints by means of a bivariate analysis, and later a multivariate logistic regression analysis was carried out. Results: After adjusting for age, gender and stressful life events, depression (OR= 1.65; 95% CI: 1.13-2.41) and sleep disorders (OR= 1.41; 95% CI: 1.00-1.98) were found to be psychosocial factors associated with hypertension. Conclusions: Depression and sleep disorders are related to hypertension. In Colombia there are studies that correlate psychosocial factors such as depression with hypertension; however, the impact of sleep disorders on the population is unknown.

Depression and sleep disorders related to hypertension: A cross-sectional study in Medellín, Colombia. / Depresión y trastornos del sueño relacionados con hipertensión arterial: un estudio transversal en Medellín, Colombia.

INTRODUCTION: Psychosocial factors have been shown to be potentiators and triggers of cardiovascular diseases such as hypertension. The purpose of the study is to explore the relationship between psychosocial factors and the presence of hypertension in a random population sample in the city of Medellin. METHODS: Observational cross-sectional study with an analytical approach. The endpoint (hypertension) was contrasted with the psychosocial and sociodemographic endpoints by means of a bivariate analysis, and later a multivariate logistic regression analysis was carried out. RESULTS: After adjusting for age, gender and stressful life events, depression (OR=1.65; 95% CI: 1.13-2.41) and sleep disorders (OR=1.41; 95% CI: 1.00-1.98) were found to be psychosocial factors associated with hypertension. CONCLUSIONS: Depression and sleep disorders are related to hypertension. In Colombia there are studies that correlate psychosocial factors such as depression with hypertension; however, the impact of sleep disorders on the population is unknown.

Health policies for international migrants: A comparison between Mexico and Colombia.

Objective: The aim of this study was to compare the health policies for international migrants in Mexico and Colombia. Methods: A descriptive comparative study of the documents issued by the national-level government of the most recent past administrations in each country (2012-2018 for Mexico, 2013-2018 for Colombia) was conducted. We identified the documents' objectives, strategies, and evaluation of results, and the representation of international migrants and migrant health in the policy. Results: Both countries situate health care policies for international migrants in a human rights framework. In both, migrants are entitled to health care, but access is limited by migration status. The main contrasts are the focus on different migrant populations (Mexican migrants in the Mexico-US migration circuit in Mexico; Venezuelan immigrants and Colombians returning from Venezuela in Colombia), and the discursive framing of policies as a response to the crisis in Colombia. As a result, while concrete actions are detailed in the Colombian policies, most documents in Mexico are limited to general strategies. These differences can be explained by the context in which each set of policies was issued: a relatively stable Mexico-US migration flow in Mexico, and the reception of hundreds of thousands of migrants from Venezuela in a very short time in Colombia. Conclusions: Tradition in matters of migration, and the current migration context, influence health policies for migrant populations.

Factors Associated With Low Physical Activity in Two Latin American Populations at Risk of Developing Type 2 Diabetes: An Exploratory Analysis.

Low level of physical activity is a risk factor for chronic non-communicable diseases. Specifically, people at risk of Type 2 Diabetes (T2D) have shown to benefit from being physically active. The objective of this study was to explore what factors were associated with low physical activity in people at high risk of T2D living in Bogota and Barranquilla, Colombia. Methodology: Cross-sectional study using baseline data from a quasi-experimental clinical trial (PREDICOL Project). The study included 1,135 participants of Bogota and Barranquilla that presented a high risk of developing T2D according to the Finnish Diabetes Risk Score (>12 points) and who underwent an oral glucose tolerance test. The main outcome variable was the level of physical activity assessed by the International Physical Activity Questionnaire. Unadjusted and adjusted logistic regression analysis were used to calculate odds ratios (OR) and the corresponding 95% confidence intervals (CI). Results: In total, 72.5% of the study participants had low level of physical activity. Participants in the age group between 45 and 54 years showed 74% greater odds of having low physical activity compared with the youngest age group (OR 1.74, 95% CI 1.1 -2.8). People living in Barranquilla were eight times more likely to have low physical activity compared with those in Bogotá D.C. (OR 8.1, 95% CI 5.7 to 11.4). Conclusion: A large proportion of the population at risk of developing D2T in two large cities of Colombia have a sedentary lifestyle. Interventions should be designed and implemented in order to increase physical activity in these populations.

Enfermedades crónicas no transmisibles prioritarias en la Región Caribe Colombiana en el periodo 2008-2015: un análisis de la mortalidad / Chronic noncommunicable diseases priority in the Colombian Caribbean Region in the period 2008-2015: An analysis of mortality

RESUMEN Objetivo: Estimar el riesgo de muerte por enfermedades crónicas no transmisibles prioritarias en la región Caribe colombiana en el periodo 2008-2015. Materiales y métodos: Mediante un estudio ecológico se analizaron los datos de mortalidad disponibles en el Departamento Administrativo Nacional de Estadística (DANE). Con el ajuste de las tasas de mortalidad mediante razones estandarizadas de mortalidad (REM) por edad y sexo y mediante un modelo bayesiano, se estimó el riesgo suavizado de morir por causa de las enfermedades priorizadas. Se valoró su evolución temporal con tasas ajustadas anuales de mortalidad. Resultados: De 2008 a 2015 ocurrieron 148.331 muertes, de las cuales 76 201 (51,4 %) ocurrieron en hombres. El 58.1 % (86 185 muertes) corresponden a trastornos en el sistema circulatorio, seguido de los tumores malignos con un 24.4 % (36 188 muertes). Las enfermedades isquémicas del corazón ocupan el primer lugar en las causas de muerte, con un aumento significativo (p<0,001) del riesgo a partir de 2011, al igual que la tendencia en neoplasias de próstata (p<0,001) y mama en mujeres (p=0,022). Conclusión: La mortalidad debida a las enfermedades crónicas no transmisibles estudiadas aumentó en la región en el período 2008-2015. Con una mayor tendencia en el riesgo en los hombres para la mayoría de las enfermedades, lo que genera información relevante para que los tomadores de decisiones en salud ajusten los programas y servicios de prevención de la enfermedad, promoción, atención y rehabilitación en salud acorde a la realidad del ente territorial.

ABSTRACT Objective: To estimate the risk of mortality due to Chroic noncommunicable diseases priority in the Colombian Caribbean region using Bayesian methods for the 2008-2015 period. Instruments and methods: Through an ecological study, the mortality data available in the National Administrative Department of Statistics (DANE) database was analyzed. Adjusting the mortality rates using standardized mortality ratios (REM) by age and gender and using a Bayesian model, the smoothed risk of dying due to prioritized diseases was estimated. Its temporal evolution was assessed with annual adjusted mortality rates. Results: For the 2008 - 2015 period, 148,331 people died, 76 201 (51.4 %) of which were men. 58.1 % (86 185 deaths) correspond to disorders in the circulatory system, followed by malignant tumors with 24.4 % (36 188 deaths). Ischemic heart diseases occupy the first place in the causes of death with a significant increase (p<0,001) of risk as of 2011, likewise for prostate neoplasms (p<0,001) and breast neoplasms in women (p=0,022). Conclusion: Mortality due to the observed chronic noncommunicable diseases increased in the region during the 2008-2015 period. There is a greater tendency of risk for men for the majority of the diseases which generates relevant information so that the decisión makers in healthcare adjust the programs and services of disease prevention, promotion, attention and rehabilitation according to the reality of the territorial entity.

Situación de salud de gestantes migrantes venezolanas en el Caribe colombiano: primer reporte para una respuesta rápida en Salud Pública / Health situation of Venezuelan pregnant migrants in the Colombian Caribbean: first report for a rapid response in Public Health

Resumen Introducción: En el fenómeno migratorio desde Venezuela hacia Colombia, las mujeres representan una proporción significativa entre los migrantes irregulares; de ellas, las gestantes han sido priorizadas por sus condiciones particulares de vulnerabilidad. Sin embargo, se desconocen sus condiciones de salud. Objetivos: Caracterizar multidimensionalmente la situación de salud de las gestantes venezolanas migrantes irregulares, residentes en las principales ciudades receptoras del Caribe colombiano: Barranquilla y Riohacha. Metodología: Estudio descriptivo de corte transversal en 520 gestantes venezolanas migrantes irregulares, captadas por muestreo sistemático en hospitales públicos, y comunitariamente a través de búsqueda activa en bola de nieve entre agosto de 2018 y mayo de 2019. Con un cuestionario estandarizado se evaluaron los principales problemas de salud, estado nutricional, seguridad alimentaria, presencia de síntomas depresivos, accesibilidad y satisfacción con los servicios de salud. Resultados: La mitad percibía su salud durante el embarazo como buena o muy buena (53,4%). El 51,3% presentó anemia ferropénica y la mayoría algún grado de inseguridad alimentaria (87,5%). La prevalencia de síntomas depresivos clínicamente significativos fue del 32,1%. Una alta proporción reportó algún tipo de violencia por parte de su pareja (90,2%). El 25,9% requirió atención sanitaria por urgencias independiente de la atención prenatal. El 62,7% calificó la atención por urgencias como muy buena o buena, mientras que el 73,1% piensa que le brindaron la atención necesaria para su problema de salud. Conclusiones: Los principales problemas de salud en gestantes que participaron en el estudio corresponden a la inseguridad alimentaria, anemia, síntomas depresivos, violencia de pareja y ausencia de controles prenatales. Su situación de salud debe considerarse en el marco del proceso migratorio y desde los determinantes sociales de la salida, tránsito, llegada y retorno. Las medidas de atención primaria para esta población deben seguir siendo fortalecidas por el sistema de salud a nivel territorial y basadas en evidencia.

Abstract Introduction: In the current migration from Venezuela to Colombia, women represent a significant proportion of the irregular migrant population, and those who are pregnant have been a priority given their particularly vulnerable condition. Nevertheless, their health conditions are not known. Objectives: To obtain a multi-dimensional characterization of the health situation of irregular Venezuelan migrants who are pregnant and residing in the main receiving the Caribbean region of Colombia: Barranquilla and Riohacha. Methods: We carried out a descriptive, cross-sectional study with 520 pregnant women surveyed from August 2018 to May 2019 with a systematic sampling in public hospitals and an active community search using snowball sampling. We used a standardized questionnaire to evaluate the main health problems, nutritional status, food security, presence of depressive symptoms and accessibility/ satisfaction with health services. Results: Half of the participants perceived their health during pregnancy as good or very good (53.4%), 51.3% presented iron deficiency anemia, and the majority (87.5%) experienced some lack of food security. The prevalence of clinically significant depressive symptoms was 32.1%. A high proportion reported some type of intimate partner violence (90.2%). 25.9% required urgent medical care, irrespective of the prenatal care they received. With regard to quality of care in the emergency service, 62.7% rated it as very good or good, and 73.1% reported that they received the care that was needed for their health problem. Conclusions: Food insecurity, anemia, depressive symptoms, violence committed by the partner and lack of prenatal care were the main health problems for pregnant women who participated in the study. Their health situation should be viewed in the context of the migration process, based on the social determinants of emigration, transit, arrival, and return. The health care system should continue to strengthen primary care measures for this population at the local level and based on the evidence.

[Implementation of a clinical guideline for detection of gestational diabetes in primary care]. / Diabetes gestacional: implementación de una guía para su detección en la atención primaria de salud.

BACKGROUND: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. AIM: To estimate the adherence of the guide in primary care centers. MATERIAL AND METHODS: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. RESULTS: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. CONCLUSIONS: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.

Diabetes gestacional: implementación de una guía para su detección en la atención primaria de salud / Implementation of a clinical guideline for detection of gestational diabetes in primary care

Background: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. Aim: To estimate the adherence of the guide in primary care centers. Material and Methods: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. Results: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. Conclusions: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.

Modos de vida y estado de salud de migrantes en un asentamiento de Barranquilla, 2018 / Lifestyles and health status of migrants in a settlement of Barranquilla, Colombia, 2018

RESUMEN Objetivo Describir los modos de vida y el estado de salud de salud de migrantes venezolanos y colombianos de retorno asentados en Villa Caracas, Barranquilla, en el año 2018. Método Estudio descriptivo de corte transversal con muestreo sistemático de viviendas. Fueron incluidas 229 personas mayores de 15 años procedentes de 90 viviendas. Resultados Se encontraron diferencias en las rutas para llegar, tiempos de traslado y estancia en el asentamiento entre migrantes venezolanos y colombianos en retorno. Las condiciones de la vivienda y el acceso a los servicios públicos son limitadas, menos de la mitad de las viviendas tienen acceso a acueducto, alcantarillado y baño. En general el estado de salud auto-reportado por los migrantes es muy bueno o bueno, las prevalencias de enfermedades crónicas fueron relativamente bajas, con excepción de hipertensión arterial. De los que consultaron al servicio de urgencias, la mayoría reportó acceso efectivo. Se encontraron síntomas depresivos clínicamente significativos para el 20% de la población encuestada. Conclusiones Los migrantes de Villa Caracas se encuentran en condiciones de alta vulnerabilidad social dadas sus condiciones económicas y ambientales. A pesar de la falta de aseguramiento al sistema de salud colombiano, reportaron acceso a la atención por urgencias.(AU)

ABSTRACT Objective To describe the lifestyles and health status of returning Venezuelan and Colombian migrants in Villa Caracas, Barranquilla, in 2018. Methods Descriptive, cross-sectional study with systematic sampling of dwellings. 229 people over 15 years of age from 90 homes were included. Results Differences were found in the routes to arrive, commuting times and stay in the settlement between Venezuelan and returning Colombian migrants. Housing conditions and access to public services are limited: less than half of the dwellings have access to aqueduct, sewerage and bathrooms. In general, self-reported health status of migrants is very good or good and the prevalence of noncommunicable diseases was relatively low, with the exception of high blood pressure. Most of the people who consulted the emergency department reported effective access. Clinically significant depressive symptoms were found in 20% of the surveyed population. Conclusions The migrants of Villa Caracas are under high social vulnerability conditions given their economic and environmental conditions. Despite their lack of enrollment in the Colombian health system, they reported access to emergency care.(AU)

Necesidades percibidas de salud por los migrantes desde Venezuela en el asentamiento de Villa Caracas - Barranquilla, 2018: reporte de caso en salud pública / Perceived health needs by migrants from Venezuela residing in the Villa Caracas Settlement, Barranquilla, 2018: public health case report

Resumen Introducción: Actualmente existe un fenómeno inédito para Colombia de migración masiva desde Venezuela que representa grandes retos para la sociedad y el sistema de salud colombiano. Barranquilla es uno de los principales municipios receptores en el norte del país. En esta ciudad, los asentamientos de zonas marginadas están siendo habitados por migrantes venezolanos y colombianos de retorno, a menudo en condiciones de alta vulnerabilidad ambiental y social. Objetivo: El presente estudio realiza una exploración rápida de las necesidades sociales y en salud del asentamiento de Villa Caracas, usando una técnica semi-cualitativa de listados libres para explorar los dominios culturales asociados a tales necesidades. Presentación de caso: Villa Caracas, se encuentra en el Suroccidente de Barranquilla y se cree que la ocupan alrededor de unas 100 familias de venezolanos, sumados a los colombianos de retorno y nativos que nunca se re-ubicaron. Sus habitantes se encuentran en condiciones de vulnerabilidad, pero no se conocen cuáles son las problemáticas más relevantes. Métodos: Se aplicaron 96 listados libres en habitantes de Villa Caracas, a cada sujeto se les interrogó el sexo, la edad, la ocupación, la escolaridad y su estado migratorio. Se hicieron tres preguntas para los listados libres sobre: problemas del asentamiento, problemas de salud, y puntos donde reciben atención en salud. Se calcularon los índices de relevancia de Smith (IRS) para cada dominio. Resultados: En total participaron 96 personas, de los cuales 33 fueron hombres. La edad promedio fue de 31,2 años (SD: 9,6; Rango: 18-65). Del total de la muestra, un 82,3% fueron venezolanos, 8,3% colombianos de retorno y un 9,4% manifestó tener doble nacionalidad. Todos los venezolanos participantes se encontraban en condición migratoria irregular. Se encontraron como principales necesidades sociales percibidas las siguientes: alcantarillado (Índice de relevancia de Smith (IRS): 0,38), agua potable (IRS: 0,31) y fluido eléctrico (IRS: 0,30). Por otro lado, con respecto a los problemas de salud, resaltaron: infección respiratoria aguda (IRS: 0,39) y fiebre no especificada (0,20). Todos los habitantes refirieron no ser atendidos por ser venezolanos. Conclusiones: La aproximación permite destacar las condiciones de vulnerabilidad de los migrantes siendo un punto de partida para un diagnóstico más detallado que permita el desarrollo de planes de respuesta del nivel local. En particular, sobre el saneamiento ambiental como el principal problema del asentamiento que genera un riesgo potencial para la transmisión de diversas enfermedades infecciosas.

Abstract Introduction: An unreported phenomenon currently exists in Colombia, namely, massive emigration from Venezuela that is presenting a great challenge for Colombia's society and health system. Barranquilla is one of the principal recipient municipalities in northern Colombia. Venezuelan emigrants and returning Colombians are settling in this city's marginal zones, frequently under highly vulnerable environmental and social conditions. Objective: The present study is a brief exploration of the social and health needs in the Villa Caracas settlement. It is based on a semi-qualitative technique using free lists to explore the cultural domains associated with these needs. Presentation of Case: Villa Caracas is in southwestern Barranquilla, where roughly 100 Venezuelan families are believed to reside, in addition to returning and native Colombians who never relocated. While the inhabitants live in vulnerable conditions, the most important problems are not known. Methods: A total of 96 free lists were administered to inhabitants in Villa Caracas. Each subject was asked their sex, age, occupation, schooling, and migration status. The free lists included three questions: problems with the settlement, health problems, and where they go for medical care. Smith's salience index was calculated for each domain. Results: A total of 96 persons participated, 33 of which were men. The average age was 31.2 years (s.d. 9.6; range 18-65). Of the total sample, 82.3% were Venezuelan, 8.3% were returning Colombians, and 9.4% reported having dual nationality. All of the participating Venezuelans had an irregular migration status. The principal perceived social needs were: sewer systems (Smith´s salience Index (SSI): 0.38), drinking water (SSI: 0.31), and electricity (SSI: 0.30). With regard to health problems, those that stood out were acute respiratory infection (SSI: 0.39) and unspecified fever (SSI: 0.20). All of the inhabitants reported that they were not treated due to being Venezuelan. Conclusions: This approach made it possible to highlight the vulnerable conditions of the immigrants, serving as a starting point for a more in-depth diagnostic which will enable developing a local response plan, especially with regard to environmental sanitation since this was the principal problem in the settlement and it poses a potential risk for the transmission of various infectious diseases.