Hemorrhagic Cystitis after Haploidentical Transplantation with Post-Transplantation Cyclophosphamide: Protective Effect of MESNA Continuous Infusion.

Hemorrhagic cystitis (HC) is an important complication after haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with post-transplantation cyclophosphamide (PT-CY). Sodium 2-mercaptoethanesulfonate (MESNA) can prevent bladder injury when given with PT-CY. However, the best way to deliver MESNA is not known. This study assessed the incidence of HC after haplo-HSCT with PT-CY with 2 different methods of MESNA administration. The cumulative incidence of HC was lower in patients who received MESNA as a continuous infusion compared with those who received it as an intermittent bolus (5.6% versus 27.8%; P = .01). MESNA administration as an infusion was associated with a lower risk of developing HC (hazard ratio [HR], .19; 95% confidence interval [CI], .04 to .86; P = .02) on univariate analysis. This effect remained significant after adjustment in multivariate analysis (HR, .21; 95% CI, .04 to .88; P = .03). MESNA delivered as a continuous infusion is a simple and potentially useful way to prevent HC after PT-CY.

[Evolution of the concept of positive mental health: a systematic review]. / Construcción del concepto de salud mental positiva: revisión sistemática.

Objective Characterize the theoretical models that have underpinned empirical research on the concept of positive mental health from the time it first emerged in the field of health up to the present. Methods A systematic search of the literature was conducted in PubMed, EBSCO (including Academic Search Complete, ERIC, Academic Source, MasterFILE Premier, MedicLatina, MEDLINE, and the Psychology and Behavioral Sciences Collection), Science Direct, Psicodoc, Springer Link, Taylor & Francis, Wiley Online Library, Directory of Open Access Journals (DOAJ), Redalyc, SciELO, Ovid, Embase, and ProQuest (including Health and Medical Complete, the Nursing and Allied Health Source, Psychology Journals, and Social Science Journals). The search criterion was the descriptor "positive mental health." Results Of 51 studies consulted, 84% used a quantitative approach; 84% were published in English; and the same percentage were conducted between 2000 and 2014. The concept of positive mental health has been applied in essentially five different ways: as the absence of disease; as the subject of the Jahoda model; as a combination of factors on the Lluch scale; as a synonym of well-being; and as part of more complex scales of measurement. Conclusions Positive mental health should not be viewed as the opposite of a mental disorder, the absence of disease, or the sum of a given set of personal conditions. It is important to move forward in the development of conceptual models that will serve as a basis for approaching mental health from the perspective of health promotion.

The public health impact of economic fluctuations in a Latin American country: mortality and the business cycle in Colombia in the period 1980-2010.

INTRODUCTION: Studies in high-income countries suggest that mortality is related to economic cycles, but few studies have examined how fluctuations in the economy influence mortality in low- and middle-income countries. We exploit regional variations in gross domestic product per capita (GDPpc) over the period 1980-2010 in Colombia to examine how changes in economic output relate to adult mortality. METHODS: Data on the number of annual deaths at ages 20 years and older (n = 3,506,600) from mortality registries, disaggregated by age groups, sex and region, were linked to population counts for the period 1980-2010. We used region fixed effect models to examine whether changes in regional GDPpc were associated with changes in mortality. We carried out separate analyses for the periods 1980-1995 and 2000-2010 as well as by sex, distinguishing three age groups: 20-44 (predominantly young working adults), 45-64 (middle aged working adults), and 65+ (senior, predominantly retired individuals). RESULTS: The association between regional economic conditions and mortality varied by period and age groups. From 1980 to 1995, increases in GDPpc were unrelated to mortality at ages 20 to 64, but they were associated with reductions in mortality for senior men. In contrast, from 2000 to 2010, changes in GDPpc were not associated with old age mortality, while an increase in GDPpc was associated with a decline in mortality at ages 20-44 years. Analyses restricted to regions with high registration coverage yielded similar albeit less precise estimates for most sub-groups. CONCLUSIONS: The relationship between business cycles and mortality varied by period and age in Colombia. Most notably, mortality shifted from being acyclical to being countercyclical for males aged 20-44, while it shifted from being countercyclical to being acyclical for males aged 65+.

Factors associated with recurrence and survival in liver transplant patients with HCC--a single center retrospective study.

INTRODUCTION: Hepatocellular carcinoma is the most common primary tumor of the liver and is diagnosed in more than a half million people worldwide each year. This study aims to assess factors associated with the recurrence and survival of patients with hepatocellular carcinoma and liver transplantation in a cohort of patients from Medellín, Colombia. MATERIAL AND METHODS: This was a descriptive retrospective study of a consecutive series of liver transplant patients from the Pablo Tobon Uribe Hospital of Medellín from January 2004 to May 2013. Demographic, clinical, imaging, and pathology variables were analyzed. RESULTS: Three hundred thirty liver transplants were performed during the study period, 54 cases (16.4%) had one or more hepatocellular carcinomas in the explant, and 79.6% of these patients were men. Cirrhotic patients had different etiologies, but most of them were due to alcohol abuse (22.2%), followed by hepatitis B virus infection (20.4 %), and hepatitis C virus infection (18.5%). In the pathology specimen, 51.9% had only one focus of hepatocellular carcinoma, 22.2% had two foci and 12.9% had three tumors. Recurrence of hepatocellular carcinoma occurred in 7.4% patients with an average time of 81 months. During follow-up, 25.9% of the patients died in an average time of 67.9 months (CI95 59.1-80.1 months). CONCLUSION: Recurrence and survival of patients with liver transplantation for hepatocellular carcinoma in this study had a similar behavior as that reported in the world literature. The factors associated with these outcomes were vascular invasion, poor tumor differentiation and satellitosis.

Socioeconomic inequalities in premature mortality in Colombia, 1998-2007: the double burden of non-communicable diseases and injuries.

OBJECTIVES: Non-communicable diseases have become the leading cause of death in middle-income countries, but mortality from injuries and infections remains high. We examined the contribution of specific causes to disparities in adult premature mortality (ages 25-64) by educational level from 1998 to 2007 in Colombia. METHODS: Data from mortality registries were linked to population censuses to obtain mortality rates by educational attainment. We used Poisson regression to model trends in mortality by educational attainment and estimated the contribution of specific causes to the Slope Index of Inequality. RESULTS: Men and women with only primary education had higher premature mortality than men and women with post-secondary education (RRmen=2.60, 95% confidence interval [CI]: 2.56, 2.64; RRwomen=2.36, CI: 2.31, 2.42). Mortality declined in all educational groups, but declines were significantly larger for higher-educated men and women. Homicide explained 55.1% of male inequalities while non-communicable diseases explained 62.5% of female inequalities and 27.1% of male inequalities. Infections explained a small proportion of inequalities in mortality. CONCLUSION: Injuries and non-communicable diseases contribute considerably to disparities in premature mortality in Colombia. Multi-sector policies to reduce both interpersonal violence and non-communicable disease risk factors are required to curb mortality disparities.

The impact of increasing health insurance coverage on disparities in mortality: health care reform in Colombia, 1998-2007.

OBJECTIVES: We examined the impact of expanding health insurance coverage on socioeconomic disparities in total and cardiovascular disease mortality from 1998 to 2007 in Colombia. METHODS: We used Poisson regression to analyze data from mortality registries (633 905 deaths) linked to population census data. We used the relative index of inequality to compare disparities in mortality by education between periods of moderate increase (1998-2002) and accelerated increase (2003-2007) in health insurance coverage. RESULTS: Disparities in mortality by education widened over time. Among men, the relative index of inequality increased from 2.59 (95% confidence interval [CI] = 2.52, 2.67) in 1998-2002 to 3.07 (95% CI = 2.99, 3.15) in 2003-2007, and among women, from 2.86 (95% CI = 2.77, 2.95) to 3.12 (95% CI = 3.03, 3.21), respectively. Disparities increased yearly by 11% in men and 4% in women in 1998-2002, whereas they increased by 1% in men per year and remained stable among women in 2003-2007. CONCLUSIONS: Mortality disparities widened significantly less during the period of increased health insurance coverage than the period of no coverage change. Although expanding coverage did not eliminate disparities, it may contribute to curbing future widening of disparities.

The subjective perception of the happiness of older adult residents in Colombia.

Introduction: Happiness is understood as the perception of subjective well-being, it can be a quality, a result, or a state characterized by well-being or satisfaction that every person wants to achieve. In older adults, this satisfaction is a sum of lifelong achievements and triumphs; However, some factors influence this ideal. Objective: Analyze demographic, family, social, personal, and health factors associated with the subjective perception of happiness in older adults, using data from a study conducted in five cities in Colombia, in order to make a theoretical contribution in the search for improvement of their physical, mental and social health. Materials and methods: A quantitative, cross-sectional, analytical study was carried out, using primary source information, obtained with 2,506 surveys from voluntary participants aged 60 and over, who had no cognitive impairment, and who reside in urban areas but not in long-term centers. The variable happiness (classified as high or moderate/low) was used for: (1) A univariate explorative characterization of older adult, (2) a bivariate estimation of the relationships with the factors studied, and (3) a multivariate construction of profiles through multiple correspondences. Results: 67.2% reported high happiness levels, with differences by city: Bucaramanga (81.6%), Pereira (74.7%), Santa Marta (67.4), Medellín (64%), and Pereira (48.7%). Happiness was explained by the absence of risk of depression and little hopelessness, strengthened psychological well-being, a perception of high quality of life, and living in a functional family. Conclusion: This study provided an overview of possible factors that can be enhanced and strengthened with public policies (structural determinant), community empowerment, family strengthening (intermediate determinant), and educational programs (proximal determinant). These aspects are included in the essential functions of public health, in favor of mental and social health in older adults.

Educational inequalities in suicide in a middle-income country: A socioeconomic approach of mental health.

OBJECTIVE: This research aims to describe trends in inequalities in suicide mortality by educational level in Colombia between 1998 and 2015. METHOD: Standardized suicide mortality rates (SMR) were calculated by educational level, sex, and age in adult men and women over 25 years of age. Poisson regression models were used to calculate the RR (rate ratio) with those highly educated as a reference, and the RII (relative index of inequality). RESULTS: The number of reported deaths by suicide between 1998 and 2015 was 24,654, of which 84.7% were men. By age-group, 48.5% of suicides were among young adult men and women (25-44). Men had higher suicide rates than women (SMR men = 10.44/100,000; SMR women = 1.72/100,000). The age-standardized mortality rates (SMR) were higher in the groups with the lowest educational level in both sexes and all age-groups, except for senior adult women (65+). Broadly, while SMR reduced throughout most of the period, inequalities grew. CONCLUSIONS: We found that the educational inequities associated with suicide in Colombia grew slightly. This suggests the need to work on suicide prevention strategies that go beyond the individual risk factors. Socioeconomic issues need to be considered as a key tool to prevent suicide by improving peoples' quality of life and their mental health.

Sociodemographic, labor conditions, habits, lifestyles and diabetes mellitus in workers with subsistence jobs, Medellín-Colombia.

INTRODUCTION: According to American Diabetes Association, diabetes is a metabolic change characterized by the presence de hyperglycemia caused by a deficiency and/or malfunctioning of insulin secretion. OBJECTIVES: To determine sociodemographic and labor conditions, habits and lifestyles that explain diabetes in a group of informal street workers in downtown Medellín, Colombia. METHODS: This is a cross-sectional study with analytical intent based on primary sources information and on a survey with a sample of 686 workers in 2016, after obtaining informed consent. Study variables included sociodemographic and labor conditions, habits, lifestyles, and diagnosis of diabetes. Univariate, bivariate and multivariate analyses were performed. RESULTS: Workers with 50 years, 57.6% men, with a partner (56.8%), and more than 20 years in their profession. Higher prevalence of diabetes in those aged 18 to 44 and 45 to 59 years of age, lower schooling, consumed mid-morning, mid-afternoon, and evening snacks, and of households with food insecurity. Higher prevalence of diabetes was explained by: lower age, higher education, consumption of sugars, sweets, and desserts; and lower prevalence by consumption of mid-morning snacks, and household food insecurity. CONCLUSIONS: This disease of public health concern is explained by modifiable factors that can be controlled and avoided to improve the living and health conditions of this workers' population.

Index of vulnerability of elderly people in Medellín, Barranquilla, and Pasto

Introduction: Vulnerability can be defined as a lack of material and immaterial resources, which prevents the use of opportunities that may advance one's self-interest. The presence of these welfare resources prevents reductions in the quality of life. Objective: The objective of this study was to build an index of vulnerability using characteristics of the physical, human, social and functional capital of adults in three cities of Colombia in the year 2016 and to determine the factors that contribute most to vulnerability. Materials and methods: We conducted a transversal study with primary information sources applying 1,514 surveys among people aged 60 years and over in Medellín, Barranquilla, and Pasto. For the construction of the vulnerability index, we used factor analysis with varimax rotation and the principal component method. Results: The conditions that lead to a person's vulnerability were related mainly to human capital (quality of life, mental health and habits). The other types of capital that contributed to vulnerability were physical capital (occupation), social capital (accompaniment), and functional capital (functional independence). The highest vulnerability was registered among the residents of Pasto. The factors associated with vulnerability were the city of residence, the sex, the educational level and the role of the person in the home. Conclusion: In 58.55% of elderly people vulnerability was explained by the use of time, the functional independence and the subjective well-being. These findings contribute to the improvement of the quality of life, mainly those related to maintaining functional independence as long as possible, being occupied, improving mental health, and avoiding the risks of depression, anxiety, cognitive deterioration and deleterious habits.

[Trends in adult mortality in the city of Medellín, Colombia, 1994-2003]. / Tendencias de mortalidad en población adulta, Medellín, 1994-2003.

INTRODUCTION: The death of an adult affects the family as well as the adults role in its labor and social environment. In developing countries, the load of diseases and associated trauma continues to increase and place increasing demands for the intervention by public health authorities. OBJECTIVE: Trends of mortality were determined for adults of 20 to 64 years in Medellín, Colombia, between 1994 and 2003 according to sex. MATERIALS AND METHODS: A retrospective, longitudinal study was undertaken that analyzed trends in mortality rates. A secondary data source consisted of death certificates recorded at the Departamento Administrativo Nacional de Estadísticas (National Department of Statistics) during the decade 1994-2003. RESULTS: The rate average of mortality for the decade was 497 deaths per 1000 habitants. Men displayed a risk of dying of 3.5 (95%CI: 2.0-6.0) times that of women. Approximately 59% of the deaths had external causes (i.e., not related to illness or old age). Twenty-nine percent of the female deaths were due to tumors; this trend was positive throughout the decade. The 5 most important causes of mortality were as follows: aggressive behaviors, heart disease, traffic accidents, malignant tumors and pulmonary disease. The trend in deaths due to by external causes was negative, but positive for the deaths due to acute myocardial infarctions (mainly in the 45 to 64 year population) and HIV in young adults. An increasing trend in malignant breast cancer was observed in young adult women, but remained constant in the 45 to 64 year-old female population. CONCLUSION: Mortality in the adult population differs by sex and age. The younger male population is more at risk than women as a consequence of environmental factors in early life. In later life, women are more strongly affected by increasing incidence of cardiovascular disease and malignant tumors. The increased levels of mortality at all age levels represent a problem that generates a high human and economic cost.

[Personal satisfaction as a component of adult's quality of life in Medellin]. / Satisfacción Personal como Componente de la Calidad de Vida de los Adultos de Medellín.

OBJECTIVE: Determining personal satisfaction as the main component of the quality of life of men and women aged 20 to 64 in Medellin during 2005. METHODS: This was a cross/sectional descriptive population study. Its primary source of information consisted of two samples (659 men and 683 women) representing 523,705 and 651,704 people respectively, according to population expansion factors, selected via probabilistic complex sampling, stratified by socioeconomic level, clustering, city blocks, houses and people. RESULTS: The quality of life for adults in Medellin is mainly represented by personal and economic aspects, their housing's physical environment and social security. The aspects analysed in this study were evaluated above 75%; personal abilities and capability produced the greatest satisfaction, whilst the economic situation and social security produced least satisfaction. There were no significant differences according to gender regarding personal satisfaction concerning various aspects of life. CONCLUSIONS: This study's contribution to knowledge lies in making evident the need to integrate each person's subjectivity, opinions and individual perception of his/her own life, since these are the main components in evaluating an individual's quality of life.

[Quality of life and health conditions of the elderly population of Medellin]. / Calidad de vida y condiciones de salud de la población adulta mayor de Medellín.

INTRODUCTION: The process of aging presents functional limitations, loss of autonomy, independence, adaptability and motor disfunction. These changes raise challenges and concerns of vital importance both for those individuals who face them and for government organizations, thus motivating inquiry about the life and health conditions of the elderly. OBJECTIVE: To describe some components of the quality of life of the elderly population (aged 65 years or older) living in Medellin, including socio-demographic, family, social security and health conditions. MATERIALS AND METHODS: A descriptive study was conducted using the following sources of information: a survey of quality of life that was carried out in 1997 and 2001; death certificates from 1990 to 1999; hospital discharge records from 1990 to 1997; and a telephone survey carried out in the year 2002 in 637 randomly selected elderly individuals. RESULTS: A 168% increase occurred in this population group from 1964 to 2001, substantiating the stage of demographic transition throughout the city. The 65% loss of purchasing power observed between 1997 to 2001 and the situation of isolation in which the elderly population lives, characterize its loss of independence and self-esteem. CONCLUSION: 97% of the quality of life in the elderly population of Medellin was explained by the following components: independence, social and economic security, and networks of social support.

[Trends in pertussis mortality and morbidity in Colombia, 2002-2012].

INTRODUCTION: Whooping cough is a public health problem that mainly affects children under one year of age with highly lethal outcomes. It is a re-emerging disease, which is preventable by immunization. Objective: To analyze mortality and morbidity trends of whooping cough in Colombia between 2002 and 2012. Materials and methods: We conducted a quantitative descriptive study of deaths by pertussis between 2002 and 2012 using data from death certificates registered by the Departamento Administrativo Nacional de Estadística, and cases reported to the Sistema Nacional de Vigilancia en Salud Pública, 2005-2012. Frequency measurements, morbidity and mortality ratios and female increased mortality were calculated. Results: Fifty one point two percent of the deaths occurred in women; the year with more deaths was 2012; 67.3% occurred in urban areas, and 43.5% of the subjects were affiliated to the subsidized health regime. The risk of illness was 1.88 per 1,000 live births with increased risk in Vaupés and Vichada. The risk of death was 0.02 per 1,000 live births; there was a decrease in the lethality trend. Conclusions: Pertussis has reemerged with increasing mortality and morbidity. Since this is a preventable disease through vaccination, it is advisable to increase control and enhance vaccination coverage in both children and adults, who are an important reservoir of the disease. The effective control of pertussis demands continued work aimed at early identification. It is also necessary to carry out actions to improve data quality in order to facilitate its analysis and the generation of more valid information.

[Level of and change in road traffic mortality in Argentina, Chile, Colombia and Mexico, 2000-2011]. / Nivel y cambio de la mortalidad vial en Argentina, Chile, Colombia y México, 2000-2011.

The aim of this study was to estimate the effect of run-over fatalities and traffic collisions in life expectancy in Argentina, Chile, Colombia and Mexico, between 2000 and 2011. Years of life expectancy lost (YLEL) were calculated for the periods 2000-2002 and 2009-2011. The results show that road traffic deaths made up between 1% and 4% of all deaths in each country. In the first period, the highest level of mortality occurred in Colombia (YLEL=0.96) and the lowest in Argentina (YLEL=0.59). In all the countries studied except Argentina, the impact of these deaths on life expectancy was reduced in the second period. The main change took place in Colombia, reaching 0.72 YLEL in the second period. It is concluded that traffic-related deaths have a negative impact on health systems, victims, the productive sector, and society in general. From this point of view, the issue of road transit must be considered a matter of public health, requiring multi-sector intervention in the design of national and regional policies.

[Contextual effects associated with depression risk variability in the elderly, Antioquia, Colombia, 2012]. / Efectos contextuales asociados a la variabilidad del riesgo de depresión en adultos mayores, Antioquia, Colombia, 2012.

INTRODUCTION: Depression is an affective disorder where interest in living is lost and functional areas like work, feelings, personal life, and relationships are negatively altered. However, little has been said about the association between place of residence and this mood disorder. OBJECTIVE: To determine the effects of the municipality and block of residence on the depression risk variability in the elderly in the Department of Antioquia, Colombia, in 2012. MATERIALS AND METHODS: This was a multilevel descriptive study of secondary source records of 4,060 elderly people from the Department of Antioquia. Demographic, social and functional characteristics were assessed to calculate raw and adjusted odds ratios and find an association between the risk of depression, as measured by Yesavage´s Geriatric Depression Scale, and context variables (municipality and block of residence) in the design of the model. We used Markov chain Monte Carlo estimation methods and the deviance information criterion to assess goodness of fit. RESULTS: The prevalence of the risk of depression was 29.5% and we found an association with ages over 75 years, being female, residing in rural areas, and widowhood. Additionally, they had a higher risk of anxiety, moderate functional capacity and malnutrition. The municipality and block of residence were associated with this risk in the elderly. CONCLUSIONS: The municipality and block of residence had a 10% contribution toward the total variability in the risk of depression for the elderly. This information is important to encourage participation and adherence of the elderly to community groups.

Vulneración a la integridad física de personas mayores: prevalencia del maltrato y factores asociados / Violation of the Physical Integrity of the Elderly: Prevalence of Abuse and Related Factors

Resumen El envejecimiento poblacional que experimenta actualmente América Latina trae consigo retos para la sociedad, como la prevención de la vulneración a los derechos humanos y libertades de las personas mayores y la eliminación de todas las formas de maltrato. La prevalencia de maltrato físico a personas mayores fue de 4,1%. Se presentó principalmente en mujeres, personas sin pareja y con ingreso económico. Además, fue más prevalente en personas mayores con riesgo de depresión, ante cedentes de pensamientos suicidas, insatisfacción con la salud y que convivían con familias disfuncionales. Los hallazgos de esta investigación muestran como las re laciones familiares pueden ser un factor clave a la hora de abordar la problemática del maltrato; además, las graves repercusiones que generan estos hechos sobre la víctima, como afectaciones no solo a la salud física sino también mental.

Abstract The ageing population currently experienced by Latin America brings with it cha llenges for society, such as the prevention of human rights violation and freedoms of the elderly, and the elimination of all forms of abuse. The prevalence of physical abuse for the elderly was 4.1%. It was mainly presented in women, people without a partner, and with financial income. In addition, it was more prevalent in older people at risk of depression, a history of suicidal thoughts, dissatisfaction with health, and living with dysfunctional families. The findings of this research show how family re lationships can be a key factor in addressing the problem of abuse. In addition, the serious impact of these facts on the victim, such as affectations not only to physical health, but also to mental health.

[Experiences of Life and Work of a Group of Epidemiologists in Training in Order to Address Mental Health Problems and Issues at Local and Departmental Level. Medellin, 2013]. / Experiencias de vida y de trabajo de un grupo de epidemiólogos en formación acerca del abordaje local y departamental de problemas y situaciones de salud mental. Medellín, 2013.

OBJECTIVE: To examine, from the point of view of a group of epidemiologists in training, their life experiences and work related to addressing mental health problems and mental health issues. METHODS: An exploratory qualitative-descriptive study was conducted using ethnographic tools, non-participant observation, note-taking, and group interviews (FG). RESULTS: The participants mentioned that mental health and mental health issues are managed and poorly differentiated either by them and the community in general. They also said they were not ready to handle mental problems, or have the support of services for patient care, as mental health issues have not yet been clearly dimensioned by society. Epidemiology has its limitations, it focuses on knowledge of the physical-biological aspects and the use of quantitative approach with poor integration of the qualitative approach, thus hindering the understanding of a phenomenon that exceeds the limits of a research approach. CONCLUSIONS: This approach to issues of health and mental illness widens the view of knowledge from only a single focus. It includes an understanding of the qualitative approach as an option to advance the knowledge and recognition of a public health problem overshadowed by stigma and apathy of society.

[Inequities in health among Latin American and Caribbean countries (2005-2010)]. / Inequidades en salud entre países de Latinoamérica y el Caribe (2005-2010).

OBJECTIVE: To identify health inequalities among Latin American and Caribbean countries in recent years (2005-2010), based on the view that measurement of inequalities is the first step in identifying health inequities. METHOD: We performed an ecological study, whose units of analysis were 20 Latin American and Caribbean countries. These units were used to build the Inequalities in Health Index. This index summarizes, in a value ranging from 0 to 1, a set of socio-economic and health indicators, developed by international organizations. These indicators are considered as proximal and contextual determinants of health. RESULTS: According to the index calculated, the five countries with the worst health status were Haiti, Guatemala, Bolivia, Venezuela and Honduras. In contrast, the five countries with the most favorable health status were Cuba, Argentina, Uruguay, Chile and Mexico. CONCLUSION: Even today, there are wide health inequalities in Latin America and the Caribbean. The country with the most favorable health indicators was Cuba and that with the least favorable was Haiti. We recommend systematic evaluation of health inequalities in Latin America and the Caribbean through the Inequalities in Health Index and other indices, in order to analyze actions, policies and programs to reduce inequities in this region.

[Homicide and suicide in 15 to 24 year-old people in Colombia, 1998-2008]. / Homicidios y suicidios en jóvenes de 15 a 24 años, Colombia, 1998-2008.

INTRODUCTION: Psychosocial behaviors are the object of indifference, which has lead to a generalized increase in attitudes favoring violence. Among these, we can find young people as victims or killers. OBJECTIVE: To describe the behavior of mortality due to homicide and suicide in young population between 15 and 24 years old in the departments of Colombia from 1998 to 2008. MATERIALS AND METHODS: This was a descriptive study form a secondary source. We used 150,433 death certificates with homicide or suicide as cause of death in 15 to 24 years old population in Colombia during the period 1998-2008. We calculated an index for favorable conditions for violence according to economical, social and educational variables. RESULTS: Mortality rate was 95.6 deaths/100,000 people in this age range for homicide, and 10.1 for suicide. Men showed greater risk than women, with it being 12.3 higher for homicide and 1.2 for suicide. This evidences the way in which violence takes productive and reproductive lives, thus affecting the structure by sex and age and decreasing the opportunity window, but having a higher risk in some departments more than in others. CONCLUSION: According to the index for conditions for violence, the departments of Vaupés, Guaviare, Arauca and Guainía are the ones with more favorable conditions for an increased risk of dying by homicide and suicide in people from 15 to 24 years old, regardless of other departments having higher deaths rates.