[Effective coverage to manage domestic violence against women in Mexican municipalities: limits of metrics]. / Cobertura efectiva del manejo de la violencia contra mujeres en municipios Mexicanos: límites de la métrica.

The study estimated the effective coverage of health services in primary care for the management of domestic violence against women in three municipalities in Mexico. We estimated the prevalence and severity of violence using a validated scale, and the effective coverage proposed by Shengelia and partners with any modifications. Quality care was considered when there was a suggestion to report it to authorities. The use and quality of care was low in the three municipalities analyzed, used most frequently when there was sexual or physical violence. Effective coverage was 29.41%, 16.67% and zero in Guachochi, Jojutla and Tizimín, respectively. The effective coverage indicator had difficulties in measuring events and responses that were not based on biomedical models. Findings suggest that the indicator can be improved by incorporating other dimensions of quality.

COVID-19 distribution in Bogotá, Colombia: effect of poverty during the first 2 months of pandemic.

BACKGROUND: The current SARS-CoV-2 pandemic has especially affected individuals living in conglomerate settings having poverty as common characteristic. However, evidence of the association between COVID-19 severity and social determinants is still scarce, particularly, for Latin American countries. The objective was to assess the effect of socioeconomic deprivation in the clinical severity of COVID-19 infection among different localities of Bogotá, Colombia. METHODS: Secondary analyses using data of SARS-CoV-2 infected cases in Bogotá from 6 March 2020 to 19 April 2020 were carried out. Direct and indirect indicators of deprivation at area level and individual demographic characteristics (age, sex and type of case) were included in the analyses. FINDINGS: 1684 COVID-19 cases were included in the study. There were 217 (12.9%; 95% CI 11.3 to 14.5) serious cases, of which 32.6% (95% CI 26.4 to 38.8) cases were deceased. In the multilevel logistic regression, age, sex (female), type of case (different of imported case), number of serious cases recorded the previous day and multidimensional poverty were associated with serious cases (median OR: 1.72, 95% CI 1.56 to 1.87). INTERPRETATION: This paper explored the association between COVID-19 severity and social determinants. Expressions of poverty were associated with more severe cases during first 2 months of pandemic. It is a clear syndemic for the joint presentation of COVID-19 and other comorbidities among more serious cases.

Organochlorine pesticide exposure among agricultural workers in Colombian regions with illegal crops: an exploration in a hidden and dangerous world.

A previous study suggested that banned organochlorine pesticides were being used to protect illegal crops from pests. The study herein explored the exposure of individuals living in a region with such crops. Samples from 99 individuals were collected during 2005 and 2006 and organochlorine pesticides were quantified using chromatography in serum samples. We detected heptachlor (72.73%), 4,4-DDE (19.19%), aldrin (15.15%), γ-chlordane (12.12%), dieldrin (11.11%), α-chlordane (10,10%), α-endosulfan (8.08%), endosulfan (6.06%), ß-endosulfan (5.05%), oxychlordane (3.03%), 4,4-DDT (3.03%), and 2,4-DDT (2.02%). Heptachlor had a skewed and negative distribution (median: 8.69 ng/l and maximum: 43.8 ng/l). A two-dimensional biplot suggested that mixtures present were endosulfan/4,4-DDT, aldrin/γ-chlordane, and oxychlordane/ß-endosulfan/dieldrin. We did not identify variables associated with exposure levels. These data suggest that banned organochlorine pesticides are used. This is an example of research in a war context, where the problems related with pesticides are complex, and their implications go beyond a toxicological or epidemiological viewpoint.

Data Quality of Chinese Surveillance of COVID-19: Objective Analysis Based on WHO's Situation Reports.

Was there quality in the Chinese epidemiological surveillance system during the COVID-19 pandemic? Using data of World Health Organization's situation reports (until situation report 55), an objective analysis was realized to answer this important question. Fulfillment of Benford's law (first digit law) is a rapid tool to suggest good data quality. Results suggest that China had an acceptable quality in its epidemiological surveillance system. Furthermore, more detailed and complete analyses could complement the evaluation of the Chinese surveillance system.

[The other epidemiologic transition: landmarks in the development of risk factor epidemiology in Colombia]. / La otra transición epidemiológica: hitos en el desarrollo de la epidemiología de los factores de riesgo en Colombia.

The history of risk factor epidemiology is detailed as it emerged in Colombia as well as more recent developments. The origins of risk factor epidemiology are described in the context of the national health situation of the mid-20th century, when changes were occurring in the profiles of infectious and nutritional diseases in comparison to chronic diseases and traumatisms. The main achievements in the history of national risk factor epidemiology are described, including: the studies on endemic goiter, gastric and uterine cervical cancers, adverse effects of child undernourishment, and the institution of local health surveys. The important influence of the Rockefeller Foundation and the Pan American Health Organization on the epidemiology education in Colombia is highlighted. Finally, the main, currently active research lines in epidemiology are described. Investigative guidelines are suggested for future historians of Colombian public health and epidemiology.

[Adverse reproductive outcomes among women working in Colombian floriculture: a summary of the evidence through metaanalysis]. / Resultados adversos en la procreación en mujeres trabajadoras en la floricultura colombiana: un resumen de la evidencia mediante metanálisis.

INTRODUCTION: Workers in floriculture are exposed to pesticides and other risk factors. Work in these occupational environments is suspected to be associated with adverse reproductive outcomes. However, epidemiological studies in Colombia, a country that has a long tradition with this occupation, have not been consistent or conclusive. OBJECTIVE: To quantify the effect of womens work in Colombian floriculture in the occurrence of spontaneous abortion, prematurity, and birth defects, using the results of two previous studies. MATERIAL AND METHODS: The results of two previous studies among Colombian floriculture worker populations were summarized with metaanalysis techniques. A critical evaluation of each of the studies identified potential biases and methodological limitations. RESULTS: The pooled estimator of spontaneous abortion was 2.24 (95CI: 1.87-2.68); that of premature infant birth was 1.49 (95%CI: 0.91-2.43), and of birth defects 1.31 (95%CI: 1.95-1.64). CONCLUSIONS: The analyses suggested that work in floriculture is associated with a higher occurrence of spontaneous abortion and birth defects. However, these effects are not necessarily associated with pesticide exposure. Other risk factors requiring further study are levels of physical activity and high temperature in greenhouses. Data from countries which have initiated occupations in floriculture more recently will add valuable evidence for this controversial association.

Association of tuberculosis with multimorbidity and social networks.

The combination of tuberculosis with other diseases can affect tuberculosis treatment within populations. In the present study, social network analysis of data retrieved from the Mexican National Epidemiological Surveillance System was used in order to explore associations between the number of contacts and multimorbidity. The node degree was calculated for each individual with tuberculosis and included information from 242 contacts without tuberculosis. Multimorbidity was identified in 49.89% of individuals. The node degrees were highest for individuals with tuberculosis + HIV infection (p < 0.04) and lowest for those with tuberculosis + pulmonary edema (p < 0.07). Social network analysis should be used as a standard method for monitoring tuberculosis and tuberculosis-related syndemics. RESUMO A combinação de tuberculose e outras doenças pode afetar o tratamento da tuberculose nas populações. No presente estudo, a análise de redes sociais de dados extraídos do Sistema Nacional de Vigilância Epidemiológica do México foi usada para explorar as relações entre o número de contatos e a multimorbidade. O grau do nó foi calculado para cada indivíduo com tuberculose e incluiu informações a respeito de 242 contatos sem tuberculose. A multimorbidade foi identificada em 49,89% dos indivíduos. Os maiores graus dos nós foram os referentes a indivíduos com tuberculose + infecção pelo HIV (p < 0,04), e os menores foram os referentes a indivíduos com tuberculose + edema pulmonar (p < 0,07). A análise de redes sociais deve ser usada como método-padrão para monitorar a tuberculose e a sindemia relacionada com a tuberculose.

[Social capital, violent deaths, and cancer mortality in Colombia: a population approach]. / Capital social, muertes violentas y mortalidad por cáncer en Colombia: una aproximación poblacional.

OBJECTIVE: In Colombia there are evidences that social capital (SC) is associated with greater rates of violent crime ("perverse" SC). This study explores the relation between SC, violent deaths (1973-1996), and the accumulated occurrence of cancer deaths (1990-1996). MATERIAL AND METHODS: An ecologic study with the 33 Colombian departments was carried out. Correlations between violent deaths (inverse proxy of SC), the internal displacement ratio, and the mortality rates by each type of cancer. With robust regressions the effect of violent deaths ("perverse" SC) on the occurrence of mortality cancer were explored, adjusting by economic convergence or polarization (1960-1995), and the internal displacement ratio until 1996. RESULTS: Positive correlations (p < 0.05) between violent deaths ("perverse "CS) and all types of cancer, except breast and lung among men, were observed. In all the cases statistically significant associations were observed, after adjust by departments' economic convergence/polarization and internal displacement. DISCUSSION: This study shows a direct relation between violent deaths on the occurrence of cancer. The findings obtained here suggest an inverted U shape relation between SC and disease occurrence.

Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center.

OBJECTIVE: To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. METHODS: Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. RESULTS: A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5km) than by ground (median: 11.3km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. CONCLUSIONS: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance.

[Monitoring the Paraguayan epidemiological dengue surveillance system (2009-2011) using Benford's law].

INTRODUCTION: Dengue is the most widespread arbovirus worldwide. In Paraguay, it reappeared in 1988-1989, with one of the largest epidemic outbreaks occurring in 2011. OBJECTIVE: To evaluate the performance of the dengue epidemiological surveillance system in Paraguay between 2009 and 2011. MATERIALS AND METHODS: We conducted an ecological study with secondary epidemiological surveillance data. We analyzed notified cases of the disease based on the distribution expected by Benford's law. To this end, we used the first and second digits from the global records stratified by region, season, population density, indicators of housing conditions and heads of cattle. RESULTS: The epidemiological surveillance system performed better during non-epidemic periods and in the states with better housing conditions and fewer heads of cattle. CONCLUSION: Given that a difference in the performance existed, we recommended that the system remains operating at the same high alert level even during periods when fewer cases are expected. The technology used by the method proposed to monitor the notification of cases is easy to transfer to operational staff.

[Possible health effects associated with Pre-Columbian metallurgy]. / Posibles efectos en la salud asociados con la metalurgia precolombina.

In the Old World, several researchers have indicated that adverse health effects were associated with exposure to arsenic, and that this influenced a change in the use of copper-arsenic alloys to others less toxic. This hypothesis was evaluated for three Pre-Columbian metallurgy traditions: Central Andes, Intermediate Area, and West Mexico. The metal artifacts from the Central Andes showed arsenic concentrations similar to those in the Old World (0.5%-1.0%). In the Intermediate Area the values were smallest; however, in West Mexico the arsenic content was very high (7%-25%). In Central Andes arsenical bronze was used initially, but copper-tin alloys when introduced were preferred and distributed throughout the Inca Empire. Osteological and artistic evidences of foot amputations among Moche individuals from Central Andes support the presence of "black foot disease" (a condition associated with arsenic poisoning) among Pre-Columbian populations. In conclusion, the adverse effects of arsenic have been observed in the New World, and that these effects promoted a change toward the use of less toxic alloys.

[Evaluation of time-to-pregnancy as a measure in environmental epidemiology]. / Tiempo para quedar en embarazo: consideraciones generales y metodológicas.

Since the late 80's, time to pregnancy has been used in environmental epidemiology to explore adverse effects of different exposures. The advantages of this measure and additional elements to be considered in the performance of this type of studies are reviewed. Study design includes the following steps: population selection, sample size, outcome measurement, statistical analyses and sources of bias. Guidelines were suggested for the properly development of this type of study.

[Toward a pluralistic public health: the case of pesticides and human health]. / Hacia una salud pública pluralista: el caso de los plaguicidas y la salud humana.

Suggesting that epidemiology should be employed as the standard means of studying public health problems. Some authors have called for the use of qualitative research methods during the last few decades due to the complexity of sanitary problems. The complementary use of quantitative and qualitative methods is conservative and limited, which is why it is suggested that public health should use diverse epistemological approaches and not just conjugate quantitative and qualitative methods. The case of pesticides and their effect on human health is used as an example to show different theoretical models' contribution towards and limitations on public health (i.e. sanitary, biomedical, classical epidemiological, hygienist-preventative, ecological, social-epidemiological, economic, material-historical and neoconservative) as well as expressing the need to use different epistemological approaches. An integrated approach will lead to more pluralist and democratic public health.

[Income inequality, corruption, and life expectancy at birth in Mexico]. / Desigualdad en el ingreso, corrupción y esperanza de vida al nacer en México.

OBJECTIVE: To ascertain if the effect of income inequality on life expectancy at birth in Mexico is mediated by corruption, used as a proxy of social capital. MATERIAL AND METHODS: An ecological study was carried out with the 32 Mexican federative entities. Global and by sex correlations between life expectancy at birth were estimated by federative entity with the Gini coefficient, the Corruption and Good Government Index, the percentage of Catholics, and the percentage of the population speaking indigenous language. Robust linear regressions, with and without instrumental variables, were used to explore if corruption acts as intermediate variable in the studied relationship. RESULTS: Negative correlations with Spearman's rho near to -0.60 (p < 0.05) and greater than -0.66 (p < 0.05) between life expectancy at birth, the Gini coefficient and the population speaking indigenous language, respectively, were observed. Moreover, the Corruption and Good Government Index correlated with men's life expectancy at birth with Spearman's rho -0.3592 (p < 0.05). Regressions with instruments were more consistent than conventional ones and they show a strong negative effect (p < 0.05) of income inequality on life expectancy at birth. This effect was greater among men. CONCLUSION: The findings suggest a negative effect of income inequality on life expectancy at birth in Mexico, mediated by corruption levels and other related cultural factors.

[Physical workload and maximum acceptable work time among supermarket workers in Cali, Colombia]. / Carga física y tiempo máiximo de trabajo aceptable en trabajadores de un supermercado en Cali, Colombia.

OBJECTIVES: In order to guarantee safety and health conditions in labor the maximum physical workload that can be supported by a worker during a labor day, without causing fatigue, must be determined. The objective of this study was to determine the relationship between the physical load, expressed as relative heart rate (RHR), and the maximum acceptable work time (MAWT) in a Colombian working population (n = 30) from a tropical environment. METHODS: An observational study was carried out during a typical labor day in the warehouses of a supermarket. Physiological, demographic, health and labor conditions data were collected. The resting heart rate level and the average heart rate during work were measured, and the RHR was estimated according to with the model described by Wu & Wang. RESULTS: Significant correlations between MAWT and RHR and other physiological variables were observed. 43% of workers didn't fulfill the MAWT. The only single variable that was associated with fulfillment was a body mass index under 18.5 Kg/m2; the other associated variables were some specific conditions of the occupational environment. Results showed a negative correlation between physiological variables and MAWT. The RHR showed its potential usefulness in the enterprise's occupational health practice. CONCLUSIONS: It is important for companies to diminish extended schedules and implement physical conditioning programs.

[Historical, social and epidemiological roots of tuberculosis in Bogotá, Colombia]. / Raíces históricas, sociales y epidemiológicas de la tuberculosis en Bogotá, Colombia.

Understanding the current epidemiologic dynamic of tuberculosis (TB) in any society requires a holistic approach. In the current paper, the history and behavior of the TB is summarized for Bogotá, Colombia. In prehispanic periods the occurrence of TB was low. During the Conquest and the Colony periods, a moderate increase of pulmonary and abdominal TB was observed. In the 1870s, a great increase in cases of pulmonary TB was associated with the accelerated urbanization process. Since the 1920s, the occurrence of pulmonary TB shifted to the status of an endemic disease. After 1920, its occurrence was relatively steady until the 1970s, when its occurence greatly decreased. More recently, however, an increase in case numbers has been observed. The occurrence of TB in each period is associated with clearly defined social and environmental phenomena.