Opioid use disorders national registries and opioids sales registries: A 10-year prevalence study from a middle-income country.

OBJECTIVES: (1) To estimate the prevalence, geographic distribution, and demographic characteristics of patients diagnosed with mental and behavioral disorders due to the use of opioids in Colombia, between 2009 and 2018. (2) To describe the opioid sales trends in Colombia over the last few years. METHODS: We conducted an observational study analyzing information from Individual National Registry of Health Services and the Colombian official database for pharmaceuticals prices and quantities sold. The included ICD-10 codes were mental and behavioral disorders due to the use of opioids (F11) codes subdivisions. RESULTS: 12,557 cases of mental and behavioral disorders due to opioid use were reported, with a rate of 3.0 per 100,000 inhabitants for the studied period. Men represented 74.2 percent, with a male:female ratio of 2.9:1. The highest prevalence was found between 20 and 24 years, in the northwest Colombian area. A progressive increase in the total number of opioid units sold during the study period was found, and the most frequently sold opioids were tramadol (55 percent) and codeine (20 percent). CONCLUSIONS: Recognition of opioid use disorders has increased in the last 10 years; it affects more males than females, mostly young adults, and is higher in certain affluent regions of Colombia. We found a progressive annual increase in the sales of opioids in the country, which could be related to the increase in the rate of registries. Studies that have analyzed opioid abuse in Latin America are limited, and further studies are needed to evaluate this situation in middle-income countries from the region.

Burden of Disease Attributable to Obesity and Overweight in Colombia.

OBJECTIVES: To estimate the burden of disease attributable to obesity and overweight conditions using disability-adjusted life-years (DALYs) in Colombia. METHODS: The burden of disease was estimated following an adapted methodology published by the World Health Organization. A selection of diseases was performed in which overweight and obesity are risk factors. DALYs were calculated by obtaining the proportion of cases and deaths of every disease that can be attributable to obesity and overweight conditions. The economic impact of obesity was calculated by multiplying the cost of care per patient for each comorbidity by the number of cases attributable exclusively to obesity. RESULTS: A total of 997 371 DALYs were estimated, 45% of which corresponded to men; 81% of DALYs corresponded to years lived with disability. Conditions with greater attributable DALYs are, in order, hypertension (31.6% of the total DALYs), type 2 diabetes mellitus (28.0%), cardiac ischemic disease (14.6%), and lower back pain (11.2%). An estimation of 20.5 DALYs per 1000 inhabitants was made. The economic impact of care for comorbidities associated with obesity could amount to $2158 million. CONCLUSIONS: Obesity and overweight conditions are related to higher mortality and disability than previously estimated; effective interventions aimed at prevention and treatment will have a high impact on quality of life.

How Much Does it Cost to Train a Physician in Colombia? / ¿Cuánto cuesta formar a un médico en Colombia? / Quanto custa formar a um médico na Colômbia?

Abstract Introduction: The aim of this project is to estimate the costs to society of training a doctor at either a public or a private university in Colombia. Materials and methods: Direct and indirect costs were estimated in 2016 Colombian pesos (average exchange rate 3051 COP per US dollar), as was the return on investment, expressed as net present value, return on investment, and internal rate of return. The time required to recover the investment in studying medicine was also determined, and this was contrasted with the counterfactual of studying in another academic program. A discount rate of 12 % was used. A sensitivity analysis was performed with several alternative scenarios. Results: In the baseline scenario, the total cost of training a physician in Colombia is US $80, 971.80 at a private university and US $54, 971.79 at a public university (of which $14, 436.57 is contributed by the State in the latter case). The time to return of investment is 3 years 6 months for study at a public university and 7 years 3 months for study at a public university. Applying discount rates of 5 %, 7.5 %, and 12 %, studying medicine presents a higher return than that obtained by studying in another academic program. Conclusions: The cost of training a medical doctor in Colombia is 70 % higher than the cost of training other professionals, but returns are greater due to subsequent higher income. Net returns are higher for graduates of public universities because their initial investment is smaller and their incomes are similar.

Resumen Introducción: este estudio busca estimar los costos de formar un médico en Colombia, tanto en una universidad pública como privada, desde la perspectiva de la sociedad. Materiales y métodos: se calcularon los costos directos e indirectos en pesos colombianos de 2016 (tasa de cambio promedio 3051 COP por USD), así como el retorno a la inversión, expresado en valor actual neto, retorno sobre la inversión, y tasa interna de retorno y, el periodo de recuperación de la inversión de estudiar medicina frente al contrafactual de estudiar otra carrera. Se empleó una tasa de descuento de 12 %. Se realizó un análisis de sensibilidad con varios escenarios. Resultados: en el escenario base, el costo total de la formación de un médico en Colombia es de $80971.80 USD en una universidad privada y de $54971.79 USD en una pública (de los cuales $14436.57 USD son aportados por el Estado). El tiempo de retorno de la inversión es de 3 años y 6 meses en una universidad pública y 7 años y 3 meses en una privada. Aplicando tasas de descuento de 5 %, 7,5 % y 12 %, estudiar medicina presenta mayor retorno que el obtenido con otra carrera. Conclusiones: el costo de formación de un médico en Colombia es un 70 % mayor al requerido para la formación de otro profesional; sin embargo, los retornos son mayores debido los mayores ingresos percibidos. Los retornos son mayores en los egresados de universidades públicas, debido a que la inversión es menor y los ingresos percibidos son similares.

Resumo Introdução: o objetivo deste trabalho é estimar os custos de formar um médico na Colômbia, tanto em uma universidade pública quanto privada, desde a perspectiva da sociedade. Materiais e métodos: calcularam-se os custos diretos e indiretos em pesos colombianos de 2016 (taxa de câmbio médio 3051 COP por USD) assim como o retorno ao investimento, expressado em valor atual neto, retorno sobre o investimento, e taxa interna de retorno e, o período de recuperação do investimento de estudar medicina frente ao contrafactual de estudar outra carreira. Empregou-se uma taxa de desconto de 12 %. Se realizou uma análise de sensibilidade com vários cenários. Resultados: no cenário base, o custo total da formação de um médico na Colômbia é de $80971.80 USD em uma universidade privada e $54971.79 USD em uma pública (dos quais $14436.57 USD são aportados pelo Estado). O tempo de retorno do investimento é de 3 anos e 6 meses em uma universidade pública e 7 anos e 3 meses em uma privada. Aplicando taxas de desconto de 5 %, 7.5 % e 12 %, estudar medicina apresenta maior retorno que o obtido com outro curso. Conclusões: o custo de formação de um médico na Colômbia é um 70 % maior ao requerido para a formação de outro profissional, no entanto, os retornos são maiores devido aos maiores ingressos percebidos. Os retornos são maiores nos formados de universidades públicas, devido a que o investimento é menor e os ingressos percebidos são similares.

Suplementos nutricionales en el deterioro cognitivo y la enfermedad de Alzheimer: revisión de la literatura / Dietary supplements in cognitive impairment and Alzheimer's disease: a literature review

RESUMEN OBJETIVOS: Evaluar los efectos del consumo de ácidos grasos omega 3 en forma de suplementos, complementos o alimentos sobre la función cognitiva de los adultos. MÉTODOS: Se realizó una revisión de la literatura en las bases de datos Medline y Embase, buscando ensayos clínicos, estudios observacionales, revisiones sistemáticas y estudios experimentales que relacionaran los ácidos grasos omega 3 con función cognitiva y Alzheimer. RESULTADOS: La mayoría de los estudios relacionó la suplementación de cápsulas con omega 3, el consumo de pescado u otros alimentos con contenido de omega 3, con resultados en pruebas de función cognitiva, desenlace de enfermedad o imágenes diagnósticas, encontrando en general efectos benéficos, que parecen ser mayores en personas sanas y con mejor función cognitiva de base. Hubo diferencias en los resultados encontrados en los ensayos clínicos y revisiones sistemáticas, que podrían atribuirse a la variabilidad en las dosis de la suplementación, el tiempo de seguimiento y la manera en que se midió la función y el deterioro cognitivo. CONCLUSIÓN: El consumo de ácidos grasos omega 3 en forma de suplementos, complementos o alimentos ricos en estos como el pescado parece tener efectos benéficos en la función cognitiva de las personas adultas.

SUMMARY OBJECTIVES: To evaluate the effects of omega 3 fatty acids consumption in the form of dietary supplement, complement or food-products presentation on adult cognitive function. METHODS: A literature review in two databases (Medline and Embase) was undertaken, searching for clinical trials, observational studies, systematic reviews and experimental studies concerning omega-3 fatty acids and their relation with cognitive function and Alzheimer's disease. RESULTS: Most studies linked supplementation with omega-3 capsules and consumption of fish and other omega-3 containing foods with results in cognitive function testing, outcomes in diseases or diagnostic imaging and found beneficial effects, which seem to be stronger in healthier persons with better cognitive function at baseline. There were differences in the results found in clinical trials and systematic reviews, which could be attributable to the variability in the supplementation dose, the length of follow-up and the methods used to assess cognitive function and decline. CONCLUSION: The use of omega-3 fatty acids in supplement, complement or food-products presentation seems to have beneficial effects in the cognitive function of healthy adults.

Mordeduras de serpientes en los RIPS / Snake Bites in the RIPS / Mordeduras de erpentes nos RIPS

Hemos leído con atención el artículo sobre accidentes ofídicos en el departamento del Magdalena, publicado en un número reciente de su revista. Para lograr estos estimados, los autores emplearon los datos del Sistema de Vigilancia en Salud Pública, Sivigila, durante el periodo 2009 a 2013. Hoy se dispone de diferentes fuentes de información, como el Registro Individual de Prestación de Servicios (RIPS); nuestro grupo ha hecho algunas investigaciones basadas en este registro oficial. Dado el rigor del trabajo de Cuéllar-Gordo et al., pensamos que este podría servir como un estándar de oro para evaluar la calidad de la información registrada en los RIPS.

We have carefully read the article on ophidian accidents in the department of Magdalena, published in a recent issue of your journal. To achieve these estimates, the authors used data from the Public Health Surveillance System, Sivigila, during the period 2009 to 2013. Today, different sources of information are available, such as the Registro Individual de Prestación de Servicios (RIPS); our group has done some research based on this official registry. Given the rigor of the work of Cuellar-Gordo et al. we think that this could serve as a gold standard to evaluate the quality of the information recorded in the RIPS.

Venta de alcohol y tasa de enfermedad hepática alcohólica por departamentos en Colombia / Alcoholic Beverage Sales and Alcoholic Liver Disease Rates in Colombian Departments

Objetivos: determinar la asociación estadística entre el diagnóstico de enfermedad hepática alcohólica según Registros Individuales de Prestaciones de Servicios de Salud (RIPS) y ventas de alcohol por departamento, 2012. Métodos: se realizó un estudio ecológico transversal, comparando tasas de prevalencia estimadas por RIPS (códigos CIE K700-9) y población mayor de 18 años (DANE), con ventas de licores nacionales, licores importados y cervezas, convertidas a unidades de alcohol, según datos de la Federación Nacional de Departamentos. Resultados: las tasa de enfermedad hepática alcohólica nacional fue 10,7 por 100 000 con las tasas más elevadas en Santander (27,1), Risaralda (19,9) y Boyacá (15,0). Después de retirar los datos de departamentos con resultados poco confiables o incompletos, la correlación de Pearson para tasa de enfermedad y ventas de unidades de alcohol fue de 0,6. Conclusiones: existe una correlación positiva entre la tasa de enfermedad hepática alcohólica y las ventas de alcohol por departamento.

Objective: The purpose of this study was to determine the statistical association between the diagnosis of alcoholic liver disease and alcohol sales by department based on the Individual Records of the Health Care Services (Registros Individuales de Prestaciones de Servicios de Salud - RIPS) for 2012. Methods: This was a cross-sectional ecologic study conducted to compare prevalence rates of alcoholic liver disease estimated by RIPS (ICD K700-9) in the over 18 population (DANE) with sales, according to the National Federation of Departments, of domestic and imported spirits, liquors and beers, converted into alcohol units. Results: The national rate of alcoholic liver disease was 10.7 per 100,000 with higher rates in Santander (27.1), Risaralda (19.9) and Boyacá (15.0). After removing the data from departments with unreliable or incomplete results, the Pearson correlation rate of illness and alcohol unit sales was 0.6. Conclusions: There is a positive correlation between the rate of alcoholic liver disease and alcohol sales in each department.