Scarcity in abundance? Spatial inequalities in Rheumatoid Arthritis in a health system with financial equity.

BACKGROUND: This paper estimates spatial inequalities of Rheumatoid Arthritis (RA) in Colombia and explores correlates of those disparities from a health system perspective. METHODS: We apply descriptive epidemiology to healthcare administrative records for estimation of crude and age-standardized prevalences, and health systems thinking for identification of barriers to effective access in RA diagnosis. RESULTS: The crude and age-standardized RA prevalence for Colombia in 2018 is estimated at 0.43% and 0.36%, respectively. In the contributory regime, the binding constraint is effective access to rheumatologists in rural and sparsely populated areas; this constraint in workforce affects service delivery, and ultimately comes from the lack of a differentiated model for effective provision of healthcare in those areas (governance). CONCLUSIONS: There are opportunities for implementation of public health policies and health system interventions that would lead to a better identification of RA patients and the subsequent more precise estimation of RA prevalence, and most importantly, to reduce exposition to risk factors and accurate diagnosis and treatment of RA patients.

Sick Leave in Colombia in the 2016-2018 period: A Retrospective Cross-Sectional Observational Study / Licencia por enfermedad en Colombia en el período 2016-2018: Estudio observacional transversal retrospectivo

Introduction: To understand the sick leave situation and the causes and effects of a temporary loss of capacity to work allows for the strengthening of policies and management in the provision of health services. Objective: To analyze sick leave in Colombia in the 2016-2018 period. Materials and methods: A retrospective cross-sectional observational study and the relative risk was calculated. Sick leave reports were provided by the Ministry of Health and Social Protection. 12,410,837 reports from formal workers between the ages of 18-70 years and had at least one temporary disability were processed. Results: The average age of people with sick leave was 37.11 years, 53% corresponding to females. On average, sick leave was 90.6% and 5.6% for dependent and independent workers, respectively. The principal causes of disability were musculoskeletal diseases and were more likely in men and adults according to RR. Men in comparison to females and adults in comparison to youths are less likely to have sick leave due to respiratory disease. Conclusions: In Colombia, females presented more temporary sick leave, even if males had more days of disability, even though the median was three days in both genders. Youth and adults had more sick leave days.

Introducción: Comprender la situación de incapacidad por enfermedad, causas y efectos de una pérdida temporal de la capacidad de trabajo fortalece las políticas y la gestión en la prestación de servicios de salud. Objetivo: Analizar las incapacidades por enfermedad en Colombia en el período 2016-2018. Materiales y métodos: Estudio observacional transversal retrospectivo, con cálculo del riesgo relativo. Se procesaron 12.410.837 registros de trabajadores formales entre 18 y 70 años de edad y con al menos una incapacidad temporal, según los informes del Ministerio de Salud y Protección Social. Resultados: La edad promedio de las personas fue de 37,11 años, 53% fueron mujeres. En promedio, el 90,6% de las incapacidades fue para trabajadores dependientes y el 5,6% trabajadores independientes. Las principales causas de incapacidad fueron las enfermedades del sistema musculoesquelético más frecuentes en hombres adultos según RR. Los hombres en comparación con las mujeres y los adultos en comparación con los jóvenes tienen menos probabilidades de tener licencia por enfermedad respiratoria. Conclusiones: Las mujeres presentaron más incapacidades temporales por enfermedad, aunque los hombres tuvieron más días de incapacidad, la mediana fue de tres días en ambos géneros. Los jóvenes y los adultos tenían más días de baja por enfermedad.

How much for a broken heart? Costs of cardiovascular disease in Colombia using a person-based approach.

The shift of the Noncommunicable Diseases (NCDs) epidemic, including cardiovascular disease, from developed to Low and Middle Income Countries (LMIC), creates new challenges in contexts where there is poor information on healthcare costs. Clearly this information is essential for planning, and its relevance is even more valuable as a driver for prevention and control of NCDs. This paper begins to address that handicap by estimating the healthcare cost of Cardiovascular Disease (Coronary Heart Disease and Stroke) in Colombia, using a person-based approach. Results show that the annual healthcare cost of a person with Coronary Heart Disease is between INT$ 4,277 and INT$ 4,846, while the cost for a person with Stroke varies between INT$5,816 and INT$6,616. The expansion of the NCDs epidemic combined with such high costs threatens the financial sustainability of health systems; primary prevention and policies targeting structural and intermediate determinants of health are a promising way to make health systems financially sustainable.

Efectos inmunotoxicológicos e histopatológicos de la exposición a concentraciones subletales de cloruro de mercurio (HgCl2) en cachama blanca (Piaractus brachypomus) / Immunotoxicological and histopathological effects of exposure to sublethal concentrations of mercuric chloride (HgCl2) in red-bellied pacu (Piaractus brachypomus) / Avaliação imunotoxicológica e histopatológica da exposição a concentrações subletais de cloreto de mercúrio (HgCl2) em Pirapitinga branca (Piaractus brachypomus)

Resumen El mercurio es un contaminante xenobiótico encontrado frecuentemente en ecosistemas naturales, representando un aspecto relevante en salud pública y ambiental debido a los niveles encontrados en fuentes de agua en correlación con la bioacumulación en organismos vivos. El objetivo fue evaluar los efectos inmunotoxicológicos e histopatológicos de la exposición a concentraciones subletales de Cloruro de Mercurio (HgCl2) en cachama blanca (Piaractus brachypomus). Se utilizaron alevinos de cachama blanca, con un peso de 10 ± 2,1 g, distribuidos en acuarios con aireación constante, sin filtro. El periodo experimental fue de 18 días, utilizando 4 concentraciones basadas en la décima parte de la CL50 descrita para cachama, así como un grupo control. Se realizaron seis muestreos (días 1, 2, 4, 7, 12 y 18) en los cuales se tomaron muestras de sangre para la evaluación de la explosión respiratoria y la capacidad bactericida del plasma. Se calculó el índice hepatosomático y se tomaron muestras para procesamiento histopatológico. Se evidenció una elevación del nivel de explosión respiratoria (estrés oxidativo) en animales expuestos a HgCl2 de una manera dependiente de la concentración, siendo más marcado este efecto al día 12 de exposición. No se encontraron diferencias significativas en los valores de índice hepatosomático (IHS). En la actividad bactericida del plasma se halló una actividad menor en animales expuestos a HgCl2. En el análisis histopatológico se encontraron cambios como hiperplasia, aneurismas y sinequias en branquias; inclusiones hialinas en hígado y centros melanomacrófagos en riñón. Los alevinos de cachama blanca expuestos a dosis subletales de HgCl2, muestran un incremento significativo en la explosión respiratoria (estrés oxidativo), así como cambios en la actividad bactericida del plasma, además de cambios anatomopatológicos a nivel branquial, hepático y renal.

Mercury is a xenobiotic contaminant often found in natural ecosystems. It is relevant for public and environmental health because of the existing correlation between its content in water sources and mercury bioaccumulation in living organisms. This work assessed the immune and histopathological effects of exposure to sublethal concentrations of mercury chloride (HgCl2) in Pacu (Piaractus brachypomus). Pacu fingerlings weighing 10 ± 2.1 g were distributed in constantly aerated tanks with no filter. The experimental period was 18 days. A negative control group and four Hg levels were used based on the tenth of LC50 for Pacu. Six blood samples were taken on days 1, 2, 4, 7, 12 and 18 to measure respiratory burst and bactericidal activity of the plasma. The hepatosomatic index was calculated and samples were taken for histopathological examination. Increased respiratory burst (oxidative stress) was observed in animals exposed to HgCl2 in a concentration-dependent manner. This effect was more pronounced at day 12 of exposure. Hepatosomatic index (HSI) values showed no significant differences. Animals exposed to HgCl2 showed low bactericidal activity of plasma. Histopathological changes such as hyperplasia, aneurysms and synechiae were found in gills, while hyaline inclusions were observed in liver and melanomacrophage centers in kidney. Pacu fingerlings exposed to sublethal doses of HgCl2 had a significant increase in oxidative stress and changes in plasma bactericidal activity in addition to pathological changes in the gills, hepatic and renal tissues.

O mercúrio é um contaminante xenobiótico encontrado frequentemente nos ecossistemas naturais, o qual representa um aspecto muito importante na saúde pública e ambiental devido aos níveis encontrados nas fontes de agua, as quais além, tem correlação com a bioacumulação em organismos vivos. O objetivo desta pesquisa foi avaliar os efeitos imunotoxicológicos e histopatológicos da exposição a concentrações subletais de Cloreto de Mercúrio (HgCl2) em Pirapitinga branca (Piaractus brachypomus). Utilizaram-se alevinos de Pirapitinga branca com um peso médio de 10 ± 2,1 g, distribuídos em aquários com tanques de aireação constante sem filtro. O período experimental foi de 18 dias, utilizando quatro concentrações baseadas na decima parte da CL50 descrita para Pirapitinga branca assim como no grupo controle. Realizaram-se seis amostragens (dias 1, 2, 4, 7, 12 e 18) nos quais tomaram-se amostras de sangue para a avaliação da explosão respiratória e a capacidade bactericida do plasma. Calculou-se o índice hepatosomático e pegaram-se amostras para processamento histopatológico. Evidenciou-se uma elevação do nível de explosão respiratória (estresse oxidativo) em animais expostos ao HgCl2 de uma maneira dependente da concentração, sendo mais marcado este efeito ao dia 12 da exposição. Não se encontraram diferenças significativas nos valores do índice hepatosomático (IHS). Na atividade bactericida do plasma achou-se uma atividade menor em animais expostos ao HgCl2. Na análise histopatológica encontraram-se mudanças como hiperplasia, aneurisma e sinéquias em brânquias, inclusões hialinas no fígado e centros melanomacrófagos nos rins. Os alevinos de Pirapitinga branca expostos a doses sub-letais de HgCl2, amostraram um incremento significativo na explosão respiratória (estresse oxidativo) assim como mudanças na atividade bactericida do plasma, além de mudanças anatomopatológicas no nível branquial, hepático e renal.