Social representations of cancer in patients from Medellín, Colombia: a qualitative study.

Background: Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia. Methods: This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages. Results: SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic. Conclusion: In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.

Influence of Positive Thinking Ideology on Physician Representations of Cancer.

To understand the influence of positive thinking ideology on cancer representations among physicians in the city of Medellín. METHODS: This qualitative study was conducted on the basis of the theoretical and methodological elements of Corbin and Strauss's grounded theory. Fourteen physicians were included and selected according to the criteria of maximum variation for education, years of study, and personal and family history of cancer. The information was collected through semi-structured interviews and analyzed with open, axial, and selective coding. RESULTS: the ideology of positive thinking has managed to permeate the medical discourse and the representations that they form about the etiology and treatment of cancer. Physicians place the mind, emotions, attitude, and positive thinking as determinants of the origin of the disease and the response to therapy. To argue this link, they use two strategies: (i) a sophisticated and specialized discourse that involves relationships among thoughts, genetics, the neurological, immune and endocrine system and (ii) a mystical and less rational discourse that emphasizes the omnipotence of the mind and thoughts. In no case was the idea of positive thinking rejected or in disagreement with this style of thinking expressed. CONCLUSION: The fact of linking the disease with mental factors refers to the mind-body dualism and generates a responsibility of the patients on the etiology and therapeutics of the disease, as well as an erasure of the social and political determinants of cancer. The technical discourse and the symbolic capital of physicians offer scientific legitimacy to these ideas and can become performative for patients.

Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia.

BACKGROUND: Understanding the causal attributions for cancer, the elements affecting therapeutic adherence, and behaviors that may compromise people's health or even put them at risk of dying from this disease has garnered a considerable degree of attention. METHODS: This study was designed in the city of Medellín with the aim to develop and validate a model for the study of (i) the categories that can be attributable to cancer etiology, (ii) the categories that can be attributed to the efficacy of treatment, and (iii) the relationship between the categories that can be attributed to the etiology and to the efficacy of the treatment. Structural equations were performed on 611 participants. RESULTS: The analysis revealed that attributing the disease to psychogenic factors distances people from biomedical treatments (ß coefficient, -0.12), and brings them closer to psychogenic (ß coefficient, 0.22) and alternative treatments (ß coefficient, 0.24). Attributing cancer to behavioral factors brings people closer to psychogenic treatments (ß coefficient, 0.40) over biomedical treatments (ß coefficient, 0.24). CONCLUSIONS: Symbolic, cultural, and social factors were evidenced, thereby leading to the underestimation of biomedical treatments and imparting a greater degree of importance to psychogenic or alternative therapies. These therapies will subsequently affect the achievement of therapeutic objectives such as increased survival.

Desempeño psicométrico e intervalos de referencia del WHOQOL-BREF en población sana, Medellín-Colombia / Psychometric performance and WHOQOL-BREF reference intervals in a healthy population, Medellín-Colombia

Resumen Introducción: El instrumento de calidad de vida de la Organización Mundial de la Salud es ampliamente utilizado en personas sanas y enfermas; sin embargo, son pocos los estudios colombianos que han analizado sus dimensiones en población sana. Objetivo: Evaluar las propiedades psicométricas del WHOQOL-BREF en población sana de Medellín, y estimar los intervalos de referencia para sus cuatro dimensiones. Métodos: Estudio transversal y de evaluación psicométrica en 1938 personas. Se evaluó fiabilidad con el α de Cronbach, consistencia interna y poder discriminante con Rho de Spearman, validez de contenido con coeficientes λ y varianza explicada mediante un análisis factorial exploratorio con extracción por componentes principales. Se eliminaron valores aberrantes mediante el estadístico de Grubbs, se estimaron los intervalos de referencia globales para cada dimensión del WHOQOL-BREF y los específicos, según variables demográficas y socioeconómicas, mediante intervalos de confianza del 95% para la media, y comparaciones mediante T- Student y Anova. Los análisis se realizaron en SPPS 25.0®. Resultados: Se halló una excelente fiabilidad, consistencia interna, poder discriminante y validez de contenido en las cuatro dimensiones del instrumento en población sana. Los valores de referencia fueron 64,3-65,6 en salud física, 70,8-72,0 en salud psicológica, 64,3-65,9 en salud social y 60,5-61,6 en salud ambiental, con diferencias estadísticamente significativas según las características demográficas y socioeconómicas Conclusión: El excelente desempeño psicométrico de la escala en población sana, permitió la estimación de los intervalos de referencia para las cuatro dimensiones, así como los valores para subgrupos conformados por variables demográficas y socioeconómicas, lo que resulta determinante para incluir los desenlaces centrados en las personas en los programas de medicina y salud pública, así como comparadores adecuados para población enferma.

Abstract Introduction: The Quality of Life Instrument of the World Health Organization is widely used in healthy and sick people; however, few Colombian studies have analyzed its dimensions in a healthy population. Objective: To evaluate the psychometric properties of the WHOQOL-BREF in a healthy population of Medellín and to estimate the reference intervals for it's four dimensions. Methods: Cross-sectional study and psychometric evaluation in 1938 people. Reliability was evaluated with Cronbach's α, internal consistency and discriminant power with Spearman's Rho, content validity with λ coefficients and variance explained by means of an exploratory factor analysis with extraction by principal components. Aberrant values were eliminated using the Grubbs statistic, the global reference intervals were estimated for each dimension of the WHOQOL-BREF and the specific ones, according to demographic and socioeconomic variables, using 95% confidence intervals for the mean, and comparisons using Student's t and Anova. The analyzes were carried out in SPPS 27.0®. Results: Excellent reliability, internal consistency, discriminating power, and content validity were found in the four dimensions of the instrument in a healthy population. The reference values were 64.3-65.6 in physical health, 70.8-72.0 in psychological health, 64.3-65.9 in social health and 60.5-61.6 in environmental health, with statistically significant differences according to demographic and socioeconomic characteristics Conclusion: The excellent psychometric performance of the scale in the healthy population allowed the estimation of the reference intervals for the four dimensions, as well as the values for subgroups made up of demographic and socioeconomic variables, which is decisive for including the outcomes centered on people in medicine and public health programs, as well as suitable comparators for the sick population.

The Relation of Ideology of Positive Thinking with the Perception of Cancer Risk and Ways of Treating It in Medellin, Colombia.

Purpose: This study has the following objectives: i) to construct an instrument to measure positive thinking ideology (PTI) regarding cancer, and to evaluate its psychometric properties, ii) to describe the effects of PTI on cancer risk and its treatment, and iii) to identify the associated factors with PTI in the study group. Methods: A cross-sectional study was conducted with 611 people from the Medellin, Colombia. Participants were selected through stratified sampling with proportional assignment. A survey with three constructs was applied: the role of negative emotions in cancer etiology, cancer as a redeeming event, and the effects of PTI in cancer treatment. Results: In negative emotions construct 47% considered that holding anger, resentment, and hatred represent a moderate or high risk of generating cancer. In redeeming power construct 46.5% found that cancer is a battle that the best warriors win. Concerning the treatment, 77.3% considered that facing the disease with a fighting spirit had a moderate to high positive effect in response to the treatment. The associated factors with PTI were reading self-help books and education level. Conclusion: The results show that PTI affects perceptions about the cancer, its etiology and treatment. This effect is greater in undereducated people and in self-help book readers. The instrument showed excellent reliability, internal consistency, discriminating power, content, and construct validity properties.

Revisión sistemática de la exactitud diagnóstica de la gota gruesa en comparación con la reacción en cadena de la polimerasa para malaria asociada al embarazo, 2010-2022 / Systematic review of the diagnostic accuracy of thick smear compared to polymerase chain reaction for pregnancy-associated malaria, 2010-2022

RESUMEN Objetivos. Evaluar la exactitud de gota gruesa (GG) frente a la reacción en cadena de la polimerasa (PCR) cuantitativa para la malaria asociada al embarazo (MAE). Materiales y métodos. Se realizó una revisión sistemática de pruebas diagnósticas en nueve bases de datos. Se evaluó la calidad metodológica con QUADAS. Se estimó sensibilidad, especificidad, cociente de probabilidad positivo (CPP) y negativo (CPN), razón de odds diagnóstica (ORD) y área bajo la curva ROC. Se determinó la heterogeneidad con el estadístico Q de Der Simonian-Laird y la incertidumbre con el porcentaje de peso de cada estudio sobre el resultado global. Resultados. Se incluyeron diez estudios con 5691 gestantes, 1415 placentas y 84 neonatos. En los estudios con nPCR (PCR anidada) y qPCR (PCR cuantitativa) como estándar, los resultados de exactitud diagnóstica fueron estadísticamente similares, con sensibilidad muy baja (50 y 54%, respectivamente), alta especificidad (99% en ambos casos), alto CPP y deficiente CPN. Usando nPCR la OR diagnóstica fue 162 (IC95%=66-401) y el área bajo la curva ROC fue 95%, mientras que con qPCR fueron 231 (IC95%=27-1951) y 78%, respectivamente. Conclusiones. Mediante un protocolo exhaustivo se demostró el bajo desarrollo de investigaciones sobre la exactitud diagnóstica de la GG en MAE. Se demostró que la microscopía tiene un desempeño deficiente para el diagnóstico de infecciones asintomáticas o de baja parasitemia, lo que afianza la importancia de implementar otro tipo de técnicas en el seguimiento y control de las infecciones por malaria en las gestantes, con el fin de lograr el control y posible eliminación de la MAE.

ABSTRACT Objective. To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). Materials and methods. We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. Results. We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. Conclusions. We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.

Healthcare Inequities Experienced by Patients with Cancer: A Qualitative Study in Medellín, Colombia.

Purpose: This study aimed to understand the lived experiences of patients with cancer that facing inequities in oncological care in the city of Medellín. Patients and Methods: A qualitative study was conducted based on the theoretical and methodological elements of the grounded theory, specifically the description and conceptual ordering of Corbin and Strauss. Sixteen patients with cancer, who belonged to low (n=5), middle (n=4) and high (n=7) social classes, were included by theoretical sampling with category saturation. Data were collected using semi-structured interviews and analyzed in a category system based on the three social classes. Results: The patients were aged between 23 and 71 years old, and they were diagnosed with different types of cancer such as breast, cervical, prostate, stomach, leukemia and lymphoma. Patients' experiences showed that diagnosis, specialized care, treatment and hospital discharge were different based on their social class. Conclusion: Patients' lived experiences associated with cancer reflect complex social situations, in which social determinants affect the level of citizens' empowerment and self-management against the risks of get disease and die. Being part of low and middle social classes meant being subjected to a dehumanized, cold, impersonal and discontinuous treatment, in which healthcare was focused on the disease instead of individuals' preferences and values. In contrast, patients belonging to the high class had the resources necessary to face risks, which ensured access to more humanized and individualized healthcare.

Prevalencia de infección por Treponema pallidum en individuos atendidos en un centro especializado de Medellín, Colombia / Prevalence of Treponema pallidum infection in individuals treated in a specialized center in Medellín, Colombia / Prevalência de infecção por Treponema pallidum em indivíduos atendidos em um centro especializado em Medellín, Colômbia

Resumen Objetivo: Describir la prevalencia de infección por Treponema pallidum en individuos atendidos en un centro especializado de Medellín, Colombia, 2019. Metodología: Estudio de corte, con 776 sujetos de población general (aparentemente sanos-asintomáticos y sin factores de riesgo para sífilis), 126 hombres que tienen sexo con hombres (hsh) y 190 jóvenes vulnerables (estrato socioeconómico bajo, desempleados y sin finalizar educación básica), captados intramural y extramuralmente en espacios de concentración de hsh y organizaciones no gubernamentales. Se empleó fuente de información primaria basada en un encuesta y prueba de detección de anticuerpos IgG, IgM e IgA específicos para T. pallidum, Resultados: La prevalencia de infección por T. pallidum fue 0,53 % en jóvenes vulnerables, 2,19 % en población general y 16,67 % en hsh. La razón de odds de infección en los sujetos con edad entre 51-60 años fue 13,8 (ic 95 % = 3,5-51,5) respecto a la hallada en los jóvenes entre 21-30 años; 12,0 (ic 95 % = 1,8-79,2) en quienes no tienen escolaridad frente a los universitarios; 3,3 (ic 95 % = 1,1-9,9) en las personas sin afiliación en salud, comparadas con las del régimen contributivo, y 8,1 (ic 95 % = 2,8-23,0) en quienes tiene relaciones sexuales con grupos clave versus quienes no refieren estas prácticas. Conclusión: Se halló una menor prevalencia de infección por T. pallidum en los jóvenes, seguida de los sujetos de población general y fue mayor en hsh. Se identificaron los grupos de mayor riesgo (entre los tres subgrupos estudiados), que incluyen sujetos excluidos de los programas de prevención, con confluencia de factores de riesgo sexual y privación socioeconómica

Abstract Objective: To describe the prevalence of Treponema pallidum infection in individuals treated in a specialized medical center in Medellín, Colombia in 2019. Methodology: A cross-sectional study was conducted, including 776 subjects of the general population (apparently healthy-asymptomatic and without risk factors for syphilis), 126 men who have sex with men (msm) and 190 vulnerable young people (low socioeconomic strata, unemployed and low educational level) which were identified within and beyond spaces of concentration of msm and non-governmental organizations. A survey and a detection test for IgG, IgM and IgA for T. pallidum specific antibodies were used as the primary information source. Results: Prevalence of T. pallidum infection was 0.53 % in vulnerable young participants, 2.19% in the general population and 16.67 % in msm. The odds ratio of infection in subjects aged between 51 and 60 years was 13.8 (95% ci = 3.5-51.5) compared to that found in young people aged between 21 and 30 years; 12.0 (95% ci = 1.8-79.2) comparing those with low educational level to university students; 3.3 (95% ci = 1.1-9.9) for people without health insurance compared to those belonging to the contributory health insurance regime; and 8.1 (ci 95 % = 2.8- 23.0) in those who have sex with key groups versus those who do not report these practices. Conclusion: A low prevalence of T. pallidum infection was found in young participants, followed by subjects belonging to the general population and was higher in msm. Groups with the highest risk were identified (among the three subgroups studied), including subjects excluded from prevention programs, with a confluence of sexual risk factors and socioeconomic deprivation.

Resumo Objetivo: Descrever a prevalência de infecção por Treponema pallidum em indivíduos atendidos num centro especializado de Medellín, Colômbia, 2019. Metodologia: Estudo de coorte, com 776 pessoas da população em geral (aparentemente saudáveis-assintomáticos e sem fatores de risco para sífilis), 126 homens que fazem sexo com outros homens (HSH) e 190 jovens vulneráveis (classe socioeconômica baixa, desempregados e sem finalizar o ensino fundamental I e II), captados intramural e extramuralmente em espaços de concentração de HSH e organizações não governamentais. Foi usada uma fonte de informação primária baseada numa pesquisa e teste de detecção de anticorpos IgG, IgM e IgA específicos para T. pallidum. Resultados: A prevalência de infecção por T. pallidum foi de 0,53% em jovens vulneráveis, 2,19% na população geral e 16,67% em HSH. A razão de odds ratio de infecção nos indivíduos na faixa etária de 51-60 anos foi 13,8 (IC95% = 3,5-51,5) em relação a que foi encontrada nos jovens entre 21-30 anos; 12,0 (IC95% = 1,8-79,2) em quem não tem escolaridade comparada com os universitários; 3,3 (IC95% = 1,1-9,9) nas pessoas sem acesso aos serviços de saúde comparadas com as do regime contributivo, e 8,1 (IC95% = 2,8-23,0) em quem tem relações sexuais com grupos-chave vs. quem não tem estas preferências. Conclusão: Foi encontrada uma menor prevalência de infecção por T. pallidum nos jovens seguida dos indivíduos da população geral e foi maior em HSH. Foram identificados os grupos de maior risco (entre os três subgrupos estudados), que incluem sujeitos excluídos dos programas de prevenção, com confluência de fatores de risco sexual e privação socioeconômica.

Revision sistemática de las aplicaciones de la escala CS-DS Chronic Self Destructiveness Scale, 1985-2019 / Systematic review of the applications of CS-DS Chronic Self Destructiveness Scale, 1985-2019

Resumen Introducción: La escala CS-DS (Chronic Self-Destructiveness Scale) fue disenada y validada en 1985 y a la fecha no se conocen sus aplicaciones en estúdios investigativos. Objetivo: Analizar los usos de la escala CS-DS mediante una revision sistemática de la literatura y comparar los puntajes de autodestructividad indirecta en diferentes grupos poblacionales en el periodo 1985-2019. Materiales y métodos: Revision sistemática en cinco bases datos multidisciplinarias con tres estrategias de búsqueda siguiendo las recomendaciones de Cochrane, las fases de la guía PRISMA y los criterios de la guía MOOSE. La selección de los estudios y la extracción de las variables se realizo por dos investigadores garantizando exhaustividad y reproducibilidad. Se evaluó la calidad metodológica y se realizó metanálisis de medidas indirectas por tipo de población estudiada, metanálisis de efectos aleatorios para diferencia de medias según el sexo y metarregresión por dimensiones de la escala. Resultados: Se incluyeron 23 estudios con 6382 individuos. La menor autodestructividad se halló en población sana y con psoriasis, la mayor en drogadicción, seguido de intento suicida, delincuencia, ansiedad o depresión y esquizofrenia. En población sana e intento suicida no se hallaron diferencias según el sexo. Conclusión: La escala CS-DS ha sido aplicada básicamente en Estados Unidosy Polonia, en diferentes poblaciones de personas sanasy enfermas. CSDS demuestra capacidad discriminante para perfilar la autodestructividad en diferentes poblaciones, principalmente con afectaciones mentales.

Abstract Background: The CS-DS (Chronic Self-Destructiveness Scale) was designed and validated in 1985 and, to date, its applications in research studies are unknown. Objective: To analyze the uses of the CS-DS scale through a systematic review, and to compare scores of indirect self-destructive behaviors in different population groups, in the period of 1985-2019. Methods: Systematic review in five multidisciplinary databases, with three search strategies following Cochrane recommendations, the phases of the PRISMA guide, and the MOOSE guide criteria. The selection of the studies and the extraction of the variableswere carried out by two researchers, guaranteeing reproducibility. The methodological quality was evaluated, and meta-analysis of indirect measures was performed by type of population, random effects meta-analysis for difference of means according to sex, and meta-regression by scale dimensions. Results: 23 studies, with 6,382 individuals, were included. The lowest self-destructiveness was found in a healthy population and psoriasis, the highest in drug addiction, followed by suicide attempts, delinquency, anxiety or depression, and schizophrenia. In healthy population and suicide attempt, no differences were found according to sex. Conclusion: The CS-DS scale has been applied basically in the United States and Poland, in different populations of healthy and sick people. CS-DS demonstrates discriminating ability to profile self-destructiveness in different populations, mainly with mental disorders.

Preferences in a Group of Patients with Cancer: A Grounded Theory.

PURPOSE: This study was conducted to understand the preferences of patients with cancer in Medellin, Colombia. METHODS: A qualitative approach based on the theoretical and methodological resources of the grounded theory was conducted. Between June 2020 and March 2021, patients over 18 years old with a confirmed diagnosis of cancer within the past 2 years treated in Medellin, Colombia, were selected. Theoretical saturation sampling was performed. Each participant was interviewed between 2 and 3 times in accordance with the open, axial, and selective coding of the grounded theory. RESULTS: A common preference set emerged in all patients related to the attributes of healthcare professionals and is a category that unites their scientific and humanistic aspects. On the other hand, very heterogeneous preferences were presented that were associated with the doctor-patient relationship and the therapeutic objectives. In the doctor-patient relationship, there are those who adhere to a paternalistic model and those who opt for an informative model. In therapeutic objectives, two subcategories emerged: those who are inclined to preserve life and those who accord more value to the quality of life. CONCLUSION: The categories that emerged illustrate the complexity and challenges of the preferences of patients with cancer in theoretical and experiential terms for social studies of medicine, philosophy, and bioethics. From medical social studies, it's emphasized that the experiences of dehumanization are constant, which generates shared preferences in the patients related to the ideal of the medical professional. From the philosophical perspective, the care received by patients coincides with what was called medicine for slaves in ancient Greece, insofar as patients are not assumed to be free subjects. With respect to bioethics, some ideas are raised contrary to the support of individual autonomy; relational autonomy and the respect for the person above the autonomy itself are advocated.

Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis

Abstract Objective: To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument. Sources of data: A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out. Summary of the findings: 17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3−5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the phys- ical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points. Conclusion: The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the ''school'' dimension being the most affected and the ''emotional'' one the least. In this sense, we suggest monitoring the healthrelated quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease.

Reflexión epistemológica para la investigación de los procesos de determinación social de la salud / Epistemological reflection for the investigation of the processes of social health determination / Reflexão epistemológica para a investigação dos processos de determinação da saúde social

Resumen Un debate central en la salud pública contemporánea gira en torno de los determinantes sociales de la salud, en las posturas de la Organización Mundial de la Salud y de la medicina social latinoamericana. Dado que, en la literatura sanitaria, se presentan múltiples críticas al modelo de dicha organización, así como a su énfasis positivista, a su reduccionismo de la ontología de lo social y a la linealidad de sus métodos, al tiempo que existen pocos textos en salud sobre el "realismo crítico" como fundamento epistemológico de la corriente latinoamericana, el presente trabajo tiene como objetivo describir algunos hitos históricos de la determinación social de la salud y las características del realismo crítico como principal postura epistemológica para esta corriente. Desde esta postura se evidencia una suerte de "ingenuidad" epistemológica en el modelo de la Organización Mundial de la Salud; también demuestra que la diferencia de ambos enfoques no es reductible a una semántica o estilo de abordaje de lo social en salud, y pone de manifiesto retos operativos para la corriente latinoamericana.

Abstract A central debate in contemporary public health revolves around the social determinants of health in the model of the World Health Organization (who) and Latin American social medicine. Considering that in the health literature there are multiple criticisms of the who approach such as its positivist emphasis, reductionism of the ontology of the social and linearity of its methods; at the same time that there is a low amount of health texts about "critical realism" as the epistemological foundation of the Latin American current; The present work exposes some historical concepts of the Latin American proposal and tries to deepen the development of its epistemological positioning from the "critical realism". Critical realism demonstrates a sort of epistemological "naivety" in the who model, demonstrates that the difference of both approaches is not reducible to a semantics or social approach of the health, and highlights operational challenges for the model Latin American

Resumo Um debate central em saúde pública contemporânea gira em torno dos determinantes sociais da saúde nas posições da Organização Mundial da Saúde (oms) e da medicina social latino-americana. Considerando que na literatura em saúde existem múltiplas críticas à corrente da oms, como ênfase positivista, reducionismo da ontologia do social e linearidade de seus métodos; embora exista uma baixa quantidade de textos sobre saúde sobre "realismo crítico" como fundamento epistemológico da corrente latino-americana; O presente trabalho expõe alguns conceitos históricos da proposta latino-americana e tenta aprofundar o desenvolvimento de seu posicionamento epistemológico a partir do "realismo crítico". O "realismo crítico" evidencia uma espécie de "ingenuidade" epistemológica no modelo da oms, demonstra que a diferença entre as duas abordagens não é redutível a uma semântica ou abordagem à saúde social e destaca os desafios operacionais para a modelo América Latina

Seropositivity of HIV and associated factors in donors of a blood bank in the city of Medellin - Colombia, 2005 - 2018 / Seropositividad de vih y factores asociados en donantes de un banco de sangre de la ciudad de medellín - colombia, 2005 - 2018

RESUMEN El objetivo de esta investigación fue estimar la seropositividad de VIH y factores asociados en donantes de un banco de sangre de la ciudad de Medellín - Colombia, 2005 - 2018. Se realizó un estudio transversal en 166 603 donantes del banco de Sangre de la Escuela de Microbiología de la Universidad de Antioquia. Las estimaciones se basaron en proporciones y razones de odds con sus intervalos de confianza del 95 %. La mayoría de donantes fueron del Valle de Aburrá, 50,2 % hombres, 65,4 % altruistas, 59,3 % de primera vez y 81,2 % captados fuera de las instalaciones del Banco. La seropositividad general de VIH fue 0,275 % (IC 95 %=0,25-0,30), en las frecuencias específicas fue del 0,324 % en hombres y 0,224 % en mujeres; 0,299 % en donantes con edad entre 18 - 40 años, 0,212% en los de 41 - 65 años, 0,333 % en los de primera vez; 0,213 % en los no repetitivos y 0,149 % en los donantes repetitivos. Se concluye que la seropositividad de la infección fue similar en comparación con investigaciones previas, con un descenso importante desde el 2013. El riesgo de infección fue estadísticamente mayor en los hombres, los menores de 40 años y donantes de primera vez. Esto es importante para conocer la línea base y evaluar acciones de prevención en la población de estudio, orientar estudios etiológicos y mejorar políticas de hemovigilancia.

ABSTRACT The objective of this study was to estimate the seropositivity of HIV and associated factors in donors of a blood bank in the city of Medellín- Colombia, 2005 - 2018. A cross-sectional study in 166 603 donors of the Blood Bank of the School of Microbiology. Estimates were based proportions and odds ratios with 95 % confidence intervals. The majority of donors were from the Aburrá Valley, 50.2 % men, 65.4 % altruistic, 59.3 % first time and 81.2 % received outside the blood bank. The general seropositivity of HIV was 0.275 % (95 % CI = 0.25-0.30), the specific proportions were 0.324 % in men and 0.224 % in women; 0.299 % in donors with 18-40 years old and 0.212 % in the group of41-6540 years old, and 0.333 % in donors of first-time, 0.213 % in non-repetitive and 0.149 % in repetitive donors. The conclusion was that the seropositivity of the infection was similar in comparison with previous investigations, with a significant decrease since 2013. The risk of infection was statistically higher in men, under 40 years and first-time donors. All this takes is important to know the baseline and evaluate prevention actions in the study population, guide etiological studies, and improve hemovigilance policies.

Analysis of internal medicine training in Colombia. An essay containing health economics elements / Análisis de la formación en medicina interna en Colombia. Un ensayo con elementos de economía de la salud

Abstract In Colombia, there is a significant gap between the educational supply of medical specialties and their demand in health care institutions of varying complexity. This is a serious problem in the case of internal medicine, given its importance in the clinical management of complex patients and diseases, its interdependence with a large number of specialties and its impact on morbidity, mortality, quality of life and patient and family satisfaction with care. Thus, this study, using some elements of health economics, develops four topics:i)the introduction, which highlights the importance of internal medicine within the framework of Colombia's healthcare laws and provides a definition which gives specificity and identity to this specialty;ii)an analysis of this specialty's supply and demand;iii)health impacts or outcomes which may be attributed to the presence of internists; andiv)in conclusion, a discussion of elements which vindicate the need to improve the educational supply in this field.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1309).

Resumen En Colombia existe una brecha importante entre la oferta educativa de especializaciones médicas y su demanda en los servicios de salud de diferente complejidad. Esto constituye un grave problema en el caso de la medicina interna, dada su importancia en el manejo clínico de pacientes y enfermedades complejas, su interdependencia con un gran número de especializaciones y sus impactos sobre la morbilidad, mortalidad, discapacidad, calidad de vida y satisfacción con la atención de los pacientes y sus familiares. En tal sentido, este estudio, retomando algunos elementos de la economía de la salud, desarrolla cuatro tópicos:i)la introducción que destaca la importancia de la medicina interna en el marco de las leyes en salud de Colombia y precisa una definición que le brinda especificidad e identidad a esta especialización,ii)análisis de la oferta y la demanda de esta especialización,iii)impactos o desenlaces en salud atribuibles a la presencia de médicos internistas yiv)a manera de conclusión, se discuten elementos que vindican la necesidad de mejorar la oferta educativa en este campo.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1309).

Seroprevalence of Hepatitis C Virus in a blood bank of Medellín-Colombia, 2005-2018 / Seroprevalencia del virus de la hepatitis c en un banco de sangre de medellín-colombia, 2005-2018

RESUMEN El objetivo de este estudio fue estimar la seroprevalencia del virus de la hepatitis C (VHC) en donantes de un banco de sangre de Medellín- Colombia en el periodo 2005-2018 e identificar sus factores asociados. Se realizó un estudio ecológico mixto con 166603 sujetos. La descripción se realizó con frecuencias, series de tiempo con las seroprevalencias y sus intervalos de confianza del 95 %. Se estimaron razones de odds crudas y ajustadas mediante regresión logística binaria en SPSS 25.0®. La seroprevalencia fue 0,567 % (IC 95 % = 0,53-0,60) con una endemia baja y estable desde el 2010. Los únicos factores que presentaron diferencias estadísticas en la seroprevalencia fueron el grupo etario y la frecuencia de donación, con una infección 23 % mayor en los donantes con edad mayor de 40 años (frente a las personas con edad entre 18-40), y 94 % mayor en los donantes de primera vez, en comparación con quienes donan a repetición . Se concluye que en Medellín los niveles endémicos del VHC han sido estables y bajos en la última década, evidenciando la importancia de la vigilancia epidemiológica que realizan los bancos de sangre. La menor prevalencia en la última década hace suponer una exposición diferencial al virus en función de la generación a la que se pertenece, de manera que el efecto de cohorte de nacimiento debe ser investigada en estudios posteriores.

ABSTRACT The objective of this study was to estimate the seroprevalence of hepatitis C virus (HCV) in donors of a Medellín-Colombia blood bank in the 2005-2018 period and to identify its associated factors. A mixed ecological study was conducted with 166603 donors. The description was made with frequencies, time series with seroprevalences and their 95 % confidence intervals. Odds ratios were estimated raw and adjusted by binary logistic regression in SPSS 25.0®. The seroprevalence was 0.567 % (95 % CI = 0.53-0.60) with a low and stable endemicity since 2010. The only factors that presented statistical differences in seroprevalence were the age group and the frequency of donation, with an infection 23 % higher in donors aged over 40 years (compared to people aged 18-40), and 94 % higher in first-time donors, compared to repeat ones. It is concluded that in Medellín the endemic levels of HCV have been stable and low in the last decade, evidencing the importance of the epidemiological surveillance carried out by blood banks. The lower prevalence in the last decade suggests a differential exposure to the virus depending on the generation to which it belongs, so that the birth cohort effect that should be studied in later research.

Construcción de una escala sobre acepciones, percepciones y sensaciones durante la ECOE en estudiantes de Medicina / Development of a scale for medical students' meanings, perceptions and sensations during OSCE

Introducción: La evaluación clínica objetiva y estructurada ha tenido una amplia difusión en programas de la salud. A pesar de la validez, confiabilidad y versatilidad de la prueba, se ha descrito que el desempeño de los estudiantes se puede afectar por las acepciones, percepciones y sensaciones que tengan de ella. Objetivo: Construir una escala sobre acepciones, percepciones y sensaciones de la evaluación clínica objetiva y estructurada, para evaluar su reproducibilidad y validez en estudiantes de una facultad de medicina de Medellín. Métodos: La construcción de la escala se realizó en tres etapas: revisión de literatura, reducción de ítems y evaluación de las propiedades psicométricas. Se calculó el Alpha de Cronbach, las correlaciones de Pearson y t Student. El análisis factorial exploratorio se complementó con el estadístico de Kaiser-Meyer-Olkin, la esfericidad de Bartlett y la matriz de rotación varimax. Los ítems se describieron con medidas de resumen. Además se respetaron los principios de la Declaración de Helsinki y se garantizó la privacidad en el manejo de la información. Resultados: El Alpha de Cronbach fue > 0,70 para los tres dominios. El éxito en la consistencia interna y el poder discriminante resultó de 100 por ciento; y en la validez de contenido, de 100 por ciento para los dominios de acepciones y sensaciones. La validez predictiva evidenció que los ítems explicaban el 61 por ciento de la variabilidad. El análisis factorial exploratorio fue satisfactorio con un Kaiser-Meyer-Olkin de 0,812 y esfericidad de Bartlett < 0,001. La matriz rotada evidenció los tres dominios. Conclusiones: La escala presentó excelente reproducibilidad, según los criterios de fiabilidad, consistencia interna y poder discriminante, y excelente validez de apariencia, contenido y predictiva. Esto constituye un insumo importante para la aplicación del recurso didáctico(AU)

Introduction: Objective structured clinical examination has had widespread dissemination in healthcare programs. Despite its validity, reliability and versatility, it has been pointed out that students' performance may be affected by their meanings, perceptions and sensations concerning the test. Objective: Develop a scale for meanings, perceptions and sensations triggered by the objective structured clinical examination, to evaluate its reproducibility and validity among students from a medical school in Medellín. Methods: Development of the scale consisted of three stages: literature review, item reduction and evaluation of psychometric properties. Estimation was made of Cronbach's alpha, Pearson's correlation coefficient and Student's t-distribution. Exploratory factor analysis was complemented with Kaiser-Meyer-Olkin's statistical analysis, Bartlett's sphericity and varimax rotation matrix. Items were described with summary measurements. Declaration of Helsinki principles were abided by, and privacy in the management of information was ensured. Results: Cronbach's alpha was > 0,70 for the three domains. Discriminating power and internal consistency success was 100 percent, while in terms of content validity it was 100 percent for the domains meanings and sensations. Predictive validity found that items explained 61 percent of the variability. Exploratory factor analysis was satisfactory, with a Kaiser-Meyer-Olkin value of 0.812 and Bartlett's sphericity < 0.001. The matrix rotated revealed the three domains. Conclusions: The scale displayed excellent reproducibility in terms of reliability, internal consistency and discriminating power criteria, and excellent appearance, content and predictive validity. This constitutes important input for the application of the didactic resource(AU)

Incidencia de tuberculosis, VIH e Índice de Desarrollo Humano en Colombia: un análisis por departamentos 2005-2014 / Incidence of tuberculosis, HIV and Human Development Index in Colombia: an analysis by departments 2005-2014

Objetivo: Correlacionar la incidencia de tuberculosis pulmonar, tuberculosis extrapulmonar y VIH con el índice de desarrollo humano por departamentos en Colombia entre los años 2005 y 2014. Métodos: Estudio ecológico en 29 departamentos de Colombia, con datos de las secretarias de salud, SIVIGILA y del Programa de las Naciones Unidas para el Desarrollo. Los análisis se realizaron con medidas de resumen, intervalos de confianza, Kruskal Wallis y correlación de Spearman en SPSS. Resultados: Se encuentra incremento en la incidencia de tuberculosis pulmonar y VIH en el lapso estudiado. Por otra parte, no se halló correlación entre el IDH con la tasa de tuberculosis pulmonar; sin embargo, con la tuberculosis extrapulmonar y el VIH se identificaron correlaciones positivas y significativas con Rho Spearman de 0,320 y 0,324 respectivamente. Conclusión: Este estudio puso de manifiesto una correlación positiva y significativa entre la infección por VIH, tuberculosis extrapulmonar e índice de desarrollo humano que indica que las regiones del país con mayor nivel de desarrollo presentan las mayores tasas de infección. Esta información es importante para que las autoridades sanitarias realicen acciones que ayuden a comprender las causas que explican este fenómeno.

Objective: To correlate the incidence of pulmonary tuberculosis, extrapulmonary tuberculosis and HIV with the human development index by departments in Colombia between 2005 and 2014. Methods: Ecological study in 29 departments of Colombia. The incidence data of pulmonary, extrapulmonary and HIV tuberculosis were obtained through the request to departmental health secretaries and data registered in SIVIGILA. The information on the human development index (HDI) was obtained from the United Nations Development Program. The description of the variables was made with measures of central tendency, position, dispersion and 95% confidence intervals. The variation of the disease rates over time was done with the H Kruskal Wallis test. The covariation between the rates of diseases and the HDI was evaluated with scatter plots and Spearman correlation coefficients. In all the analyzes p values lower than 0.05 were considered significant. Results: There is an increase in the incidence of pulmonary tuberculosis and HIV in the period studied. On the other hand, no correlation was found between the HDI with the rate of pulmonary tuberculosis; however, positive and significant correlations with Rho Spearman of 0.320 and 0.324 were found with extrapulmonary tuberculosis and HIV, respectively. Conclusion: this study showed a positive and significant correlation between HIV infection, extrapulmonary tuberculosis and human development index, which indicates that the regions of the country with the highest level of development have the highest infection rates. This information is important for the health authorities to carry out actions that help to understand the causes that explain this phenomenon.

Metaanálisis de la prevalencia de Chlamydia trachomatis entre hombres y mujeres militares / Meta-analysis of Chlamydia trachomatis prevalence among military men and women

Introducción: La Chlamydia trachomatis constituye la primera causa de infecciones de transmisión sexual en el mundo. Los grupos de riesgo son adultos jóvenes y se postula que es mayor en militares y en mujeres. Sin embargo, la evidencia es heterogénea. Objetivo: Realizar un metaanálisis de la prevalencia de infección por Chlamydia trachomatis en hombres y mujeres militares. Metodología: Revisión sistemática con metaanálisis. Se aplicó un protocolo con criterios de inclusión, exclusión, evaluación de la calidad metodológica y reproducible. Se calculó la prueba Z para diferencia de proporciones, prevalencias con sus intervalos de confianza del 95 por ciento, razones de prevalencia y análisis de sensibilidad. Resultados: Se incluyeron 11 artículos con 108.856 militares de ocho países diferentes. La prevalencia osciló entre 15,4 por ciento (IC 95 por ciento 11,6- 19,3) y 3,0 por ciento (IC 95 por ciento 0,4 - 0,5). La prevalencia global fue 5,5 por ciento (IC 95 por ciento 5,3 - 5,6) con diferencias significativas entre hombres 2,5 por ciento (IC 95 por ciento 2,4 - 2,7) y mujeres 9,5 por ciento (IC 95 por ciento 9,2 - 9,7). En el metaanálisis de medidas indirectas se halló una razón de prevalencia 3,7 (IC 95 por ciento 3,5 - 3,9) y una diferencia de proporciones de 6,9 (IC 95 por ciento 6,6 - 7,2). Conclusión: La prevalencia de infección en militares es superior a lo hallado en otros grupos poblacionales con mayor proporción en las mujeres. Se evidencia la necesidad de implementar programas de tamización al momento del ingreso a las fuerzas armadas, realizar vigilancia periódica e implementar investigaciones posteriores que estudien la doble vulnerabilidad de la mujer milita(AU)

Introduction: Chlamydia trachomatis is the first cause of sexually transmitted infections in the world. The risk groups are young adults and it is postulated that it is greater in the military and in women. However, the evidence is heterogeneous. Objective: To perform a meta-analysis of the prevalence of Chlamydia trachomatis infection in military men and women. Methods: Systematic review with meta-analysis. Was applied a protocol with criteria for inclusion, exclusion, evaluation of methodological quality and reproducibility. Was calculated the Z-test for difference in proportions, prevalence with their 95 percent confidence intervals, prevalence ratios and sensitivity analysis. Results: Were included eleven articles with 108 856 soldiers from eight different countries. The prevalence ranged between 15.4 percent (95 percent CI 11.6- 19.3) and 3.0 percent (95 percent CI 0.4- 0.5). The overall prevalence was 5.5 percent (95 percent CI 5.3- 5.6) with significant differences between men 2.5 percent (95 percent CI = 2.4-2.7) and women 9.5 percent (95 percent CI = 9.2 - 9.7). In the meta-analysis of indirect measures, we found a prevalence ratio of 3.7 (95 percent CI = 3.5-3.9) and a difference in proportions of 6.9 (95 percent CI = 6.6-7.2). Conclusion: The prevalence of infection in the military is higher than that found in other population groups with a greater proportion in women. There is evidence of the need to implement screening programs at the time of entry into the armed forces, to carry out periodic surveillance and to implement subsequent investigations that study the double vulnerability of the military woman(AU)

Metanálisis de pruebas inmunológicas para el diagnóstico de la infección por Paracoccidioides, 1972-2017 / Meta-analysis of immunological tests for the diagnosis of Paracoccidioides infection, 1972-2017

Objetivo: Evaluar la validez diagnóstica de las pruebas inmunológicas en la infección por Paracoccidioides, a partir de un metaanálisis de la literatura publicada entre 1972-2017. Métodos: Se realizó un metanálisis según las fases de identificación, tamización, elección e inclusión descritas en la guía PRISMA. Se evaluó la calidad metodológica con la guía QUADAS y se garantizó la reproducibilidad en la selección de estudios y extracción de la información. Se estimó la sensibilidad, especificidad, razones de verosimilitud, OR diagnóstica y área bajo la curva ROC usando Meta-DiSc. Resultados: Se identificaron 21 estudios que evaluaron 32 pruebas diagnósticas con una población de 1.404 individuos sanos, 2.415 con otras infecciones y 2.337 con Paracoccidioides. La mayoría de pacientes son de Brasil y Colombia. Las pruebas analizadas incluyen inmunodifusión, western blot, ELISA, aglutinación en látex. Las pruebas presentaron una sensibilidad y especificidad superior al 90%, razón de verosimilitud positiva y negativa de 24,7 y 0,08 respectivamente. La OR diagnóstica fue 495,9 y el área bajo la curva de 0,99. En la meta-regresión por tipo de antígeno se encontró que las mezclas de antígenos y el gp43 presentaron resultados satisfactorios en todos los parámetros; por su parte, los que utilizaron el antígeno p27 no presentaron resultados aceptables en ninguno de los parámetros. Conclusión: La elevada validez diagnóstica hallada en las pruebas serológicas que utilizan mezclas de antígenos o gp43 purificada evidencia la pertinencia de su uso en clínica y en programas de tamización.

Objective: To evaluate the diagnostic validity of the immunological tests in Paracoccidioides infection, from a meta-analysis of the literature published between 1970-2017. Methods: Meta-analysis according to the identification, screening, eligibility and inclusion phases of PRISMA. The methodological quality was evaluated with the QUADAS guide and the reproducibility in the selection of studies and extraction of the information was guaranteed. Sensitivity, specificity, likelihood ratios, diagnostic OR and area under the ROC curve were estimated using Meta-DiSc. Results: We identified 21 studies that evaluated 32 diagnostic tests with a population of 1404 healthy individuals, 2415 with other infections and 2337 with Paracoccidioides. The majority of patients are from Brazil and Colombia. The tests analyzed include immunodiffusion, western blot, ELISA, latex agglutination. The tests presented a sensitivity and specificity higher than 90%, positive and negative likelihood ratio of 24,7 and 0,08 respectively. The diagnostic OR was 495,9 and the area under the curve was 0,99. In the meta-regression by type of antigen it was found that mixtures of antigens and gp43 showed satisfactory results in all parameters; those who used the p27 antigen did not present acceptable results in any of the parameters. Conclusion: The diagnostic validity of the serological tests using mixtures of antigens or purifed gp43 is clinically similar, for the other antigens the validity was scarce.

Costos médicos directos de las infecciones del tracto urinario por bacilos Gram negativos resistentes a betalactámicos en un hospital de alta complejidad de Medellín, Colombia / Direct medical costs of urinary tract infections by Gram-negative bacilli resistant to beta-lactams in a tertiary care hospital in Medellín, Colombia

Resumen Introducción. Las infecciones del tracto urinario son muy frecuentes en el ámbito hospitalario. Debido a la aparición de la resistencia antimicrobiana, la complejidad de los procesos de atención ha aumentado y, con ello, la demanda de recursos. Objetivo. Describir y comparar el exceso de los costos médicos directos de las infecciones del tracto urinario por Klebsiella pneumoniae, Enterobacter cloacae y Pseudomonas aeruginosa resistentes a betalactámicos. Materiales y métodos. Se llevó a cabo un estudio de cohorte en una institución de tercer nivel de Medellín, Colombia, entre octubre del 2014 y septiembre del 2015. Se incluyeron los pacientes con infección urinaria, unos por bacterias sensibles a los antibióticos betalactámicos, y otros por bacterias resistentes a las cefalosporinas de tercera y cuarta generación y a los antibióticos carbapenémicos. Los costos se analizaron desde la perspectiva del sistema de salud. La información clínico-epidemiológica se obtuvo de las historias clínicas y los costos se calcularon utilizando los manuales tarifarios estándar. El exceso de costos se estimó mediante análisis multivariados. Resultados. Se incluyeron 141 pacientes con infección urinaria: 55 (39 %) por bacterias sensibles a los betalactámicos, 54 (38,3 %) por bacterias resistentes a las cefalosporinas y 32 (22,7 %) por bacterias resistentes a los carbapenémicos. El exceso de costos totales ajustado de los 86 pacientes con infecciones del tracto urinario por bacterias resistentes a las cefalosporinas y a los carbapenémicos, fue de USD$ 193 (IC95% -347 a 734) y USD$ 633 (IC95% -50 a 1.316), respectivamente comparados con el grupo de 55 pacientes por bacterias sensibles a los betalactámicos. Las diferencias se presentaron principalmente en el uso de antibióticos de amplio espectro, como el meropenem, la colistina y la fosfomicina. Conclusión. Los resultados evidenciaron un incremento sustancial de los costos médicos directos de los pacientes con infecciones del tracto urinario por bacterias resistentes a las cefalosporinas o a los carbapenémicos. Esta situación genera especial preocupación en los países endémicos como Colombia, donde la alta frecuencia de infecciones del tracto urinario y de resistencia a los betalactámicos puede causar un mayor impacto económico en el sector de la salud.

Abstract Introduction: Urinary tract infections are very frequent in the hospital environment and given the emergence of antimicrobial resistance, they have made care processes more complex and have placed additional pressure on available healthcare resources. Objective: To describe and compare excess direct medical costs of urinary tract infections due to Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa resistant to beta-lactams. Materials and methods: A cohort study was conducted in a third level hospital in Medellín, Colombia, from October, 2014, to September, 2015. It included patients with urinary tract infections caused by beta-lactam-susceptible bacteria, third and fourth generation cephalosporin-resistant, as well as carbapenem-resistant. Costs were analyzed from the perspective of the health system. Clinical-epidemiological information was obtained from medical records and the costs were calculated using standard tariff manuals. Excess costs were estimated with multivariate analyses. Results: We included 141 patients: 55 (39%) were sensitive to beta-lactams, 54 (38.3%) were resistant to cephalosporins and 32 (22.7%) to carbapenems. The excess total adjusted costs of patients with urinary tract infections due to cephalosporin- and carbapenem-resistant bacteria were US$ 193 (95% confidence interval (CI): US$ -347-734) and US$ 633 (95% CI: US$ -50-1316), respectively, compared to the group of patients with beta-lactam sensitive urinary tract infections. The differences were mainly found in the use of broad-spectrum antibiotics such as meropenem, colistin, and fosfomycin. Conclusion: Our results show a substantial increase in the direct medical costs of patients with urinary tract infections caused by beta-lactam-resistant Gram-negative bacilli (cephalosporins and carbapenems). This situation is of particular concern in endemic countries such as Colombia, where the high frequencies of urinary tract infections and the resistance to beta-lactam antibiotics can generate a greater economic impact on the health sector.