Acercamiento multifactorial a la fisiopatología de la obesidad. Modelo de abordaje COD2 / A multi-factor approach to the physiopathology of obesity: COD2 model

La obesidad en este momento representa una de las peores amenazas del sector salud. El acelerado aumento de la prevalencia y mortalidad a causa de enfermedades cardiovasculares establece un precedente histórico como problema de salud pública mundial. La elevada incidencia de obesidad y enfermedades crónicas ha llevado a múltiples áreas de la salud a entender y buscar un detonante claro que explique esta patología. Existen numerosas causas que explican su comportamiento agresivo, progresivo y crónico. Sin embargo, ninguna de ellas satisface como el solo factor desencadenante que ofrezca un tratamiento único que genere una reducción de su rápida expansión. En este artículo se buscan explicar las principales causas relacionadas con esta entidad así como los mecanismos que lo demuestran, para lograr entender el abordaje adecuado de los pacientes que acuden buscando el manejo de la obesidad (modelo COD2).

Obesity is currently considered as one of the major life-threatening conditions affecting the healthcare system. The accelerated increase in prevalence and mortality due to cardiovascular diseases establishes an historical precedent as a global public health issue. The increased incidence of obesity and chronic diseases, has led multiple health researchers to try to identify a clear triggering factor contributing to obesity. There are numerous causes which explain its aggressive, progressive and chronic behavior. However, they do not satisfactorily elucidate a unique triggering factor which would determine a unique treatment to help decelerate its rapid expansion. This article seeks to explain the major causal factors and mechanisms leading to obesity, in order to find the most appropriate approach for obese patients seeking treatment options (COD2 model).

Prevalence of suicide risk factors and suicide-related outcomes in the National Mental Health Study, Colombia.

A community survey in 4,426 adults was undertaken as part of the World Mental Health Survey Initiative reporting the prevalence and risk factors for suicide-related outcomes in Colombia. Lifetime prevalence estimates of suicide ideation, plans, attempts, and risk factors for suicide-related outcomes were assessed. Retrospective reports of disorders age-of-onset were used to study associations between primary mental disorders and first onset of suicide-related outcomes. Risks of plans and attempts were highest with ideation early age-of-onset and within the first year. The highest risk for ideation and attempt among ideators occurred in the 18-29 age group. After first employment (defined as the first paid job accepted by the respondent) and presence of mental disorders constituted risk factors. Impulse-control disorders were strongest diagnostic predictors.

[Health care workers' perception of the Internet and mobile technologies in Colombia]. / Percepciones de los trabajadores del sector salud frente a Internet y las tecnologías móviles en Colombia.

In July 2007 in Medellín, Colombia, 1,200 health care professionals were asked to complete a questionnaire: of the 493 who participated, the mean age was 31.2 years; 58.8% were physicians; and 97.6% had Internet access, 60.5% on a daily basis and 27.7%, weekly. The preferred place to access the Internet was from home (58%) or from the work place (12.5%); 98% reported having a cell phone, and of those, 80% were interested in using health education tools via cell phone. These are the first data published regarding Internet and cellular phone penetration among health care workers in Colombia. Acceptance of the Internet and mobile systems as health information tools is gaining, and as such, creating a new opportunity for training and harnessing of these new technologies.

Percepciones de los trabajadores del sector salud frente a Internet y las tecnologías móviles en Colombia / Health care workers' perception of the Internet and mobile technologies in Colombia

In July 2007 in Medellín, Colombia, 1 200 health care professionals were asked to complete a questionnaire: of the 493 who participated, the mean age was 31.2 years; 58.8 percent were physicians; and 97.6 percent had Internet access, 60.5 percent on a daily basis and 27.7 percent, weekly. The preferred place to access the Internet was from home (58 percent) or from the work place (12.5 percent); 98 percent reported having a cell phone, and of those, 80 percent were interested in using health education tools via cell phone. These are the first data published regarding Internet and cellular phone penetration among health care workers in Colombia. Acceptance of the Internet and mobile systems as health information tools is gaining, and as such, creating a new opportunity for training and harnessing of these new technologies.

Web-based asynchronous teleconsulting for consumers in Colombia: a case study.

BACKGROUND: Fourteen years after the reform to Colombia's health system, the promises of universality, improved equity, efficiency, and better quality of care have not materialized. Remote areas remain underserved and access to care very limited. Recognizing teleconsultation as an effective way to improve access to health care and health information, a noncommercial open-access Web-based application for teleconsultation called Doctor Chat was developed. OBJECTIVE: The objective was to report the experience of the Center for Virtual Education and Simulation eHealth (Centro de Educación Virtual y Simulación e-Salud) with open-access Web-based asynchronous teleconsultation for consumers in Colombia. METHODS: A teleconsultation service in Spanish was developed and implemented in 2006. Teleconsultation requests were classified on three axes: (1) the purpose of the query, (2) the specialty, and (3) the geographic area of the query. Content analysis was performed on the free-text queries submitted to Doctor Chat, and descriptive statistics were gathered for each of the data categories (name, email, city, country, age, and gender). RESULTS: From September 2006 to March 2007, there were 270 asynchronous teleconsultations documented from 102 (37.8%) men and 168 (62.2%) women. On average, 1.4 requests were received per day. By age group, the largest number of requests (n = 80; 30%) were from users 24-29 years, followed by users (n = 66; 24%) 18-23 years. Requests were mainly from Colombia (n = 204; 75.6%) but also from Spain (n = 17; 6.3%), Mexico (n = 11; 4.1%), and other countries. In Colombia, 137 requests (67.2%) originated in Bogotá, the nation's capital, 25 (12.4%) from other main cities of the country, 40 (19.7%) from intermediate cities, and 2 (0.7%) from remote areas. The purpose of the majority of requests was for information about symptoms, health-related problems, or diseases (n = 149; 55.2%) and medications/treatments (n = 70; 25.9%). By specialty, information was most requested for gynecology and obstetrics (n = 71; 26%), dermatology (n = 28; 10%), urology (n = 22; 8%), and gastroenterology (n = 18; 7%), with anesthesiology, critical care, physical medicine and rehabilitation, and pathology being the least requested (n = 0; 0%). Overall, sexual and reproductive health (n = 93; 34%) issues constituted the main query subject. The average time to deliver a response was 120 hours in 2006 and 59 hours in 2007. Only 19 out of 270 users (7%) completed a survey with comments and perceptions about the system, of which 18 out of 19 (95%) corresponded to positive perceptions and 1 out of 19 (5%) expressed dissatisfaction with the service. CONCLUSION: The implementation of a Web-based teleconsulting service in Colombia appeared to be an innovative way to improve access to health care and information in the community and encouraged open and explicit discussion. Extending the service to underserved areas could improve access to health services and health information and could potentially improve economic indicators such as waiting times for consultations and the rate of pregnancy among teenagers; however, cultural, infrastructural, and Internet connectivity barriers are to be solved before successful implementation can derive population-wide positive impacts.

Vida y muerte en la UCI / Life and death in ICU

La aplicación de métodos sistematizados de pronóstico en las UCI de USA ha mejorado ostensiblemente la atención de los pacientes que requieren monitorización permanente de sus constantes vitales, gracias a la creación del APACHE como instrumento eficaz para tal fín según la literatura anglosajona. Ante esto y la parte de rutinización de este registro en Colombia, se estudian 51 pacientes admitidos en la UCI de la Clínica el Bosque, aplicado el test APACHE II, encontrando valores pronósticos altamente específicos dentro de las primeras 24 horas de su ingreso, determinando la necesidad de posteriores trabajos interhospitalarios