La Atención Primaria en Salud, un camino inconcluso en Colombia: Lecciones aprendidas de la Primera Ola de la Pandemia por COVID-19 / Primary Health Care, an unfinished road in Colombia: Lessons learned from the First Wave of the COVID-19 Pandemic

RESUMEN Introducción: En 2020, Colombia adoptó diferentes medidas para mitigar el impacto de la pandemia por Covid-19, principalmente medidas de aislamiento social y fortalecimiento en la prestación de servicios hospitalarios. Sin embargo, el país no contempló acciones para abordar los otros problemas en salud, como tampoco consideró la relevancia de la Atención Primaria en Salud (APS) para responder a la pandemia. Por lo cual se realizó una investigación para indagar por la oferta y posicionamiento de la APS entre los tomadores de decisiones para atender la emergencia de Covid-19 durante la primera ola de la pandemia y los aprendizajes para las siguientes. Metodología: De abril a junio de 2020 se realizó un estudio descriptivo exploratorio mixto en 2 fases: (1) Encuesta a tomadores de decisiones, prestadores y académicos, y (2) Grupo focal a informantes clave. Resultados: La encuesta fue respondida por 227 participantes, 41 % académicos, 34.8 % prestadores y 17.6 % funcionarios de direcciones locales de salud; el 28.2 % consideró que la APS estuvo adaptada en los territorios para diferentes programas de salud por ciclo vital y entre el 80 al 98 % que la APS debía instaurarse en el territorio para vigilancia de casos, atención ambulatoria, manejo de pacientes crónicos, atención de otros programas y educación sanitaria. En el grupo focal participaron 12 informantes claves, quienes concluyeron que desde la autoridad sanitaria se debía promover la integración de la APS de forma urgente en los territorios, y garantizar una gobernanza eficaz para lograrlo; igualmente, recomendaron intensificar la alfabetización en salud y el empoderamiento de la población para la adopción de medidas individuales y colectivas. Conclusiones: Se concluye que la APS era una oportunidad para responder a la primera ola de la pandemia, como también para subsanar los problemas actuales y anticiparse a problemas futuros. Por lo cual, la APS debe convertirse en una política de Estado.

ABSTRACT Introduction: In 2020, Colombia adopted different measures to mitigate the impact of the Covid-19 pandemic, social isolation measures and strengthening the provision of hospital services. However, the country did not contemplate actions to address other health problems, nor did it consider the relevance of Primary Health Care (PHC) to respond to the pandemic. Therefore, an investigation was done to investigate the offer and positioning of PHC among decision-makers to address the Covid-19 emergency during the first wave of the pandemic and the learning for the following ones. Methodology: From April to June 2020, a mixed exploratory descriptive study was conducted in two phases: (1) a survey of decision-makers, providers, and academics, and (2) a focus group of key informants. Results: The survey was answered by 227 participants, 41 % academics, 34.8 % providers, and 17.6 % officials from local health directorates; 28.2 % considered that PHC was adapted in the territories for different life cycle health programs, and between 80 and 98 % that PHC should be established in the territory for case surveillance, outpatient care, management of chronic patients, care of other programs and health education. Twelve key informants participated in the focus group, who concluded that the health authority should urgently promote the integration of PHC in the territories, and guarantee effective governance to achieve it; Likewise, they recommended intensifying health literacy and the empowerment of the population for the adoption of individual and collective measures. Conclusions: It is concluded that PHC was an opportunity to respond to the first wave of the pandemic, as well as to correct current problems and anticipate future problems. Therefore, PHC must become a state policy.

Glycemic status and health-related quality of life (HRQOL) in populations at risk of diabetes in two Latin American cities.

PURPOSE: To estimate the health-related quality of life (HRQOL) according to glycemic status, and its relationship with sociodemographic and clinical factors in a population at risk of developing type 2 diabetes (T2D). METHODS: Cross-sectional study, using cluster sampling. Data were collected from 1135 participants over 30 years of age, at risk of developing T2D from the PREDICOL project. Participants' glycemic status was defined using an oral glucose tolerance test (OGTT). Participants were divided into normoglycemic subjects (NGT), prediabetes and diabetics do not know they have diabetes (UT2D). HRQOL was assessed using the EQ-5D-3L questionnaire of the EuroQol group. Logistic regression and Tobit models were used to examine factors associated with EQ-5D scores for each glycemic group. RESULTS: The mean age of participants was 55.6 ± 12.1 years, 76.4% were female, and one in four participants had prediabetes or unknown diabetes. Participants reported problems most frequently on the dimensions of Pain/Discomfort and Anxiety/Depression in the different glycemic groups. The mean EQ-5D score in NGT was 0.80 (95% CI 0.79-0.81), in prediabetes, 0.81 (95% CI 0.79-0.83), and in participants with UT2D of 0.79 (95% CI 0.76-0.82), respectively. Female sex, older age, city of residence, lower education, receiving treatment for hypertension, and marital status were significantly associated with lower levels of HRQOL in the Tobit regression analysis. CONCLUSIONS: HRQOL of NGT, prediabetes, and UT2D participants was statistically similar. However, factors such as gender, age. and place of residence were found to be significant predictors of HRQOL for each glycemic group.

[Permanent professional development in health through the Virtual Campus for Public Health in Colombia (2012-2019)Desenvolvimento profissional permanente em saúde por meio do Campus Virtual de Saúde Pública na Colômbia (2012-2019)]. / Desarrollo profesional permanente en salud por intermedio del Campus Virtual de Salud Pública en Colombia (2012-2019).

Objective: Reconstruct the experience of the Virtual Campus for Public Health (VCPH) from 2012 to 2019 in Colombia. Methods: The experience of public health training through the VCPH in Colombia in the period 2012-2019 was systematized. The information is presented in cross-section time series to show the evolution of the VCPH in Colombia over time. Results: A total of 2 627 health professionals took tutored courses and 34 012 followed self-learning courses on relevant, up-to-date, priority public health issues. An important aspect was the opportunity to access remote regions through VCPH training processes that were cost-free for end users. The experience highlights the relevance of the VCPH in reducing the gap in updated human talent in the health field through virtual education with diversity in its modalities and content. Conclusions: Reconstruction of the experience in Colombia showed how the VCPH evolved and strengthened to offer quality training processes that respond to the country's problems and needs. Collaborative work between universities and the Pan American Health Organization resulted in consolidation of the VCPH.

Objetivo: Reconstruir a experiência do Campus Virtual de Saúde Pública (CVSP) de 2012 a 2019 na Colômbia. Métodos: Realizou-se a sistematização da experiência do processo de formação em saúde pública na Colômbia por meio do Campus, referente ao período de 2012 a 2019. As informações são apresentadas em séries transversais de períodos de tempo para mostrar a evolução histórica do CVSP na Colômbia. Resultados: Foram capacitados 2.627 profissionais de saúde em cursos com instrutor e 34.012 em cursos de autoaprendizagem sobre temas relevantes, atuais e prioritários de saúde pública. Destacam-se a oportunidade e o acesso a regiões remotas que o Campus obteve, por meio de processos de formação sem custo para o usuário final. A experiência destaca a relevância do Campus na redução da lacuna de atualização do talento humano da área da saúde, mediante processos de educação virtual com diversidade nas modalidades e ofertas de formação. Conclusões: A reconstrução da experiência da Colômbia mostrou a evolução e o fortalecimento do CVSP para oferecer processos de formação com qualidade, a fim de responder aos problemas e necessidades do país. A consolidação do Campus deve-se ao trabalho colaborativo entre as universidades e a Organização Pan-Americana da Saúde.

Desarrollo profesional permanente en salud por intermedio del Campus Virtual de Salud Pública en Colombia (2012-2019)

[RESUMEN]. Objetivo. Reconstruir la experiencia del Campus Virtual de Salud Pública (CVSP) desde el año 2012 al 2019 en Colombia. Métodos. Se realizó la sistematización de la experiencia del proceso de formación en salud pública para Colombia, por intermedio del Campus para el periodo de 2012 a 2019. La información se presenta en series transversales de periodos de tiempo para visibilizar la evolución histórica del CVSP en Colombia. Resultados. Se han capacitado 2 627 profesionales de la salud en cursos con tutoría y 34 012 en cursos de autoaprendizaje en temáticas relevantes, actualizadas y prioritarias en salud pública. Se destaca la oportunidad y acceso a regiones remotas que ha tenido el Campus mediante procesos de formación sin costo para el usuario final. La experiencia destaca la relevancia del Campus en la reducción de la brecha de actualización del talento humano en salud, mediante procesos de educación virtual, con diversidad en la modalidad y en la oferta formativa. Conclusiones. La reconstrucción de la experiencia en Colombia mostró la evolución y fortalecimiento del CVSP para ofertar procesos de formación con calidad para responder a los problemas y necesidades del país; la consolidación del Campus se debió al trabajo colaborativo entre las universidades y la Organización Panamericana de la Salud.

[ABSTRACT]. Objective. Reconstruct the experience of the Virtual Campus for Public Health (VCPH) from 2012 to 2019 in Colombia. Methods. The experience of public health training through the VCPH in Colombia in the period 2012-2019 was systematized. The information is presented in cross-section time series to show the evolution of the VCPH in Colombia over time. Results. A total of 2 627 health professionals took tutored courses and 34 012 followed self-learning courses on relevant, up-to-date, priority public health issues. An important aspect was the opportunity to access remote regions through VCPH training processes that were cost-free for end users. The experience highlights the relevance of the VCPH in reducing the gap in updated human talent in the health field through virtual education with diversity in its modalities and content. Conclusions. Reconstruction of the experience in Colombia showed how the VCPH evolved and strengthened to offer quality training processes that respond to the country's problems and needs. Collaborative work between universities and the Pan American Health Organization resulted in consolidation of the VCPH.

[RESUMO]. Objetivo. Reconstruir a experiência do Campus Virtual de Saúde Pública (CVSP) de 2012 a 2019 na Colômbia. Métodos. Realizou-se a sistematização da experiência do processo de formação em saúde pública na Colômbia por meio do Campus, referente ao período de 2012 a 2019. As informações são apresentadas em séries transversais de períodos de tempo para mostrar a evolução histórica do CVSP na Colômbia. Resultados. Foram capacitados 2.627 profissionais de saúde em cursos com instrutor e 34.012 em cursos de autoaprendizagem sobre temas relevantes, atuais e prioritários de saúde pública. Destacam-se a oportunidade e o acesso a regiões remotas que o Campus obteve, por meio de processos de formação sem custo para o usuário final. A experiência destaca a relevância do Campus na redução da lacuna de atualização do talento humano da área da saúde, mediante processos de educação virtual com diversidade nas modalidades e ofertas de formação. Conclusões. A reconstrução da experiência da Colômbia mostrou a evolução e o fortalecimento do CVSP para oferecer processos de formação com qualidade, a fim de responder aos problemas e necessidades do país. A consolidação do Campus deve-se ao trabalho colaborativo entre as universidades e a Organização Pan-Americana da Saúde.

Desarrollo profesional permanente en salud por intermedio del Campus Virtual de Salud Pública en Colombia (2012-2019) / Permanent professional development in health through the Virtual Campus for Public Health in Colombia (2012-2019) / Desenvolvimento profissional permanente em saúde por meio do Campus Virtual de Saúde Pública na Colômbia (2012-2019)

RESUMEN Objetivo. Reconstruir la experiencia del Campus Virtual de Salud Pública (CVSP) desde el año 2012 al 2019 en Colombia. Métodos. Se realizó la sistematización de la experiencia del proceso de formación en salud pública para Colombia, por intermedio del Campus para el periodo de 2012 a 2019. La información se presenta en series transversales de periodos de tiempo para visibilizar la evolución histórica del CVSP en Colombia. Resultados. Se han capacitado 2 627 profesionales de la salud en cursos con tutoría y 34 012 en cursos de autoaprendizaje en temáticas relevantes, actualizadas y prioritarias en salud pública. Se destaca la oportunidad y acceso a regiones remotas que ha tenido el Campus mediante procesos de formación sin costo para el usuario final. La experiencia destaca la relevancia del Campus en la reducción de la brecha de actualización del talento humano en salud, mediante procesos de educación virtual, con diversidad en la modalidad y en la oferta formativa. Conclusiones. La reconstrucción de la experiencia en Colombia mostró la evolución y fortalecimiento del CVSP para ofertar procesos de formación con calidad para responder a los problemas y necesidades del país; la consolidación del Campus se debió al trabajo colaborativo entre las universidades y la Organización Panamericana de la Salud.

ABSTRACT Objective. Reconstruct the experience of the Virtual Campus for Public Health (VCPH) from 2012 to 2019 in Colombia. Methods. The experience of public health training through the VCPH in Colombia in the period 2012-2019 was systematized. The information is presented in cross-section time series to show the evolution of the VCPH in Colombia over time. Results. A total of 2 627 health professionals took tutored courses and 34 012 followed self-learning courses on relevant, up-to-date, priority public health issues. An important aspect was the opportunity to access remote regions through VCPH training processes that were cost-free for end users. The experience highlights the relevance of the VCPH in reducing the gap in updated human talent in the health field through virtual education with diversity in its modalities and content. Conclusions. Reconstruction of the experience in Colombia showed how the VCPH evolved and strengthened to offer quality training processes that respond to the country's problems and needs. Collaborative work between universities and the Pan American Health Organization resulted in consolidation of the VCPH.

RESUMO Objetivo. Reconstruir a experiência do Campus Virtual de Saúde Pública (CVSP) de 2012 a 2019 na Colômbia. Métodos. Realizou-se a sistematização da experiência do processo de formação em saúde pública na Colômbia por meio do Campus, referente ao período de 2012 a 2019. As informações são apresentadas em séries transversais de períodos de tempo para mostrar a evolução histórica do CVSP na Colômbia. Resultados. Foram capacitados 2.627 profissionais de saúde em cursos com instrutor e 34.012 em cursos de autoaprendizagem sobre temas relevantes, atuais e prioritários de saúde pública. Destacam-se a oportunidade e o acesso a regiões remotas que o Campus obteve, por meio de processos de formação sem custo para o usuário final. A experiência destaca a relevância do Campus na redução da lacuna de atualização do talento humano da área da saúde, mediante processos de educação virtual com diversidade nas modalidades e ofertas de formação. Conclusões. A reconstrução da experiência da Colômbia mostrou a evolução e o fortalecimento do CVSP para oferecer processos de formação com qualidade, a fim de responder aos problemas e necessidades do país. A consolidação do Campus deve-se ao trabalho colaborativo entre as universidades e a Organização Pan-Americana da Saúde.

Síndrome de burnout en el personal de enfermería en hospitales del departamento del Atlántico / Burnout syndrome in the nursing personal in health care institutions of the Atlantic department

RESUMEN Objetivo Determinar la prevalencia del síndrome de burnout en el personal de enfermería en hospitales del Departamento del Atlántico (Colombia). Materiales y Métodos Se realizó un estudio cuantitativo, descriptivo transversal, en 117 profesionales y 229 auxiliares de enfermería de cuatro hospitales del Departamento del Atlántico (Colombia), dos públicos y dos privados. Se empleó una encuesta anónima con datos sociodemográficos y la escala de Maslach. Resultados La prevalencia global del síndrome de burnout o desgaste profesional fue de 65%. En profesionales de enfermería, fue de 63,2% y en auxiliares de enfermería, de 65,9%. El 13,3% de los participantes presentó un grado elevado de burnout para el cansancio emocional; el 9,2%, para la despersonalización; y el 62,7% obtuvo puntuaciones bajas para la realización personal. En los profesionales de enfermería, el 12,7% obtuvo una puntuación alta para cansancio emocional; 7,4% para despersonalización, y 64,2% obtuvo puntuaciones bajas para la realización personal. Por su parte, en los auxiliares de enfermería el comportamiento en algunas subescalas fue muy similar; el 14,5% obtuvo una puntuación alta para cansancio emocional; 12,8%, para despersonalización y 59,8% obtuvo puntuaciones bajas para la realización personal. Conclusiones La presencia del síndrome de burnout en la población estudiada es alta. Es similar tanto en enfermeros como en auxiliares de enfermería. La dimensión más afectada fue la realización personal en ambos grupos estudiados, lo cual corresponde a sentimientos altos del "quemado".

ABSTRACT Objective To determine the prevalence of burnout syndrome in the nursing staff in four hospitals located in the State of Atlántico (Colombia). Material and Methods A descriptive cross-sectional study was conducted and included as participants 117 nursing professionals and 229 nursing auxiliaries from four hospitals located in the State of Atlantico (Colombia), two public and two privates. An anonymous self-study survey was used on sociodemographic, labor data and Maslach Scale. Results The overall prevalence of Burnout Syndrome or professional burnout was 65%. In nursing professionals it was 63,2% and in nursing auxiliaries 65,9%. At least 13,3% of the participants had a high degree of Burnout from emotional exhaustion, 9.2% for depersonalization, and 62,7% had low scores for personal fulfillment. In nursing professionals, 12,7% had a high score for emotional exhaustion, 7,4% for depersonalization, and 64,2% obtained low scores for personal fulfillment. On the other hand, in nursing auxiliaries the behavior in some subscales was very similar, 14,5% had a high score for emotional exhaustion, 12,8% for depersonalization and 59,8% had low scores for personal fulfillment. Conclusions The presence of burnout syndrome is high in the studied population, it is similar in both, nurses and nursing auxiliaries. The most affected dimension was the personal fulfillment in both groups, which corresponds to high feelings of the "burned".

Uso del cine como herramienta de aprendizaje en salud pública / The use of cinema as a learning strategy in public health

Introducción: El abordaje de las epidemias/pandemias debe llevarse a cabo desde una enseñanza transversal que involucre un pensamiento completo. Objetivo: Evaluar diferentes herramientas pedagógicas para el aprendizaje significativo activo en el aula. Métodos: Estudio de caso (n = 10), sin grupo de control, en el contexto de un seminario internacional. Se empleó una encuesta de percepciones y creencias ante pandemias, a través de la estrategia didáctica para observar, reflexionar y aplicar mediante el cine, y otros insumos para apoyar el aprendizaje. Resultados: Los docentes se mostraron favorables a la utilización del cine en el aula durante la propuesta metodológica, y apoyaron los instrumentos empleados para el aprendizaje y la dinámica docente en situaciones epidemiológicas. Asimismo, mejoró el proceso pedagógico, el análisis de los fenómenos desde la perspectiva local, la capacidad de objetivar situaciones que fomenten un pensamiento complejo y el uso de la interdisciplinariedad en el aula. Conclusiones: La incorporación del género de cine pandémico, acompañado de la estrategia ORA, el uso de cuestionario de percepciones y creencias, y otros insumos, mejora el proceso de enseñanza-aprendizaje, favorece el abordaje de problemas de pensamiento complejo, y mejora la empatía entre docentes y estudiantes en el aula(AU)

Introduction: Approach to epidemics/pandemics must be carried out from transversal teaching that involves complete thinking. Objective: To assess different pedagogical tools for active meaningful learning in the classroom. Methods: Case study (n= 10), without a control group, carried out in the context of an international seminar. A survey of perceptions and beliefs during pandemics was used by means of the didactic strategy to observe, reflect and apply through cinema and other elements to support learning. Results: The professors supported the use of cinema in the classroom during the methodological proposal, as well as the instruments used for learning and teaching dynamics in epidemiological situations. Likewise, there was an improvement of the pedagogical process, the analysis of phenomena from the local perspective, the ability to objectify situations that promote complex thinking, and the use of interdisciplinarity in the classroom. Conclusions: The incorporation of the pandemic cinema genre, accompanied by the observation-relation-application strategy, the use of a perceptions and beliefs questionnaire, as well as other elements, improves the teaching-learning process, favors the approach to complex thinking problems, and improves empathy between professors and students in the classroom(AU)

Determinantes sociales de salud y su relación con desnutrición infantil en dos comunidades étnicas colombianas / Social determinants and malnutrition of infants from two Colombian indigenous communities

RESUMEN Objetivo Identificar la relación entre los determinantes sociales de la salud y el estado nutricional de los niños pertenecientes a dos comunidades indígenas de la Costa Caribe colombiana, los wayús y los zenús. Métodos Estudio transversal que aborda el estado nutricional de los wayús y los zenús en edad preescolar y escolar. Incluyendo, además, estimación de determinantes sociales de la salud, referida por cuidadores de menores, que aborda algunos aspectos de ejes de desigualdad de tipo estructural (etnia, territorio, edad y sexo) e intermedios: vivienda, entorno y redes, mediante instrumentos de salud familiar. Se estandarizaron métricas de talla, peso e insumos de familiograma y ecomapa. Se estimaron medidas descriptivas de tipo frecuentistas y de medidas de tendencia central. Se estimó la odds ratio y su relación con variables independientes. Resultados La prevalencia de desnutrición global en la etnia Wayú fue del 59,1% IC (47,569,8) y en la etnia Zenú del 22,4% IC (15,9-30,4) para una p<0,001. Esta diferencia se relaciona con factores de riesgo intermediarios de saneamiento: inadecuadas excretas con OR=2.54; IC (1.42-4.53) p=0.002, la falta de empleo OR=1.94; IC (1.09-3.46) P=0.03 y falta de acceso a servicios de salud occidental OR=2.42; IC (1.34-4.40) p=0.005. Conclusiones La mejora en la nutrición requiere intervenir determinantes intermedios relacionados con saneamiento, modelo de salud, intersectorialidad de políticas en salud más enfoque étnico-cultural y territorial.

ABSTRACT Objetive To identify the relationship between the Health's Social Determinants and the nutritional status of children belonging to two indigenous communities on the Colombian Caribbean coast, the Wayú and the Zenú. Methods Cross-sectional study that addresses nutritional status in wayúes and zenúes at preschool and school age. Also including the estimation of health's social determinants, referred by minor's caregivers, which addresses some aspects of structural ¡nequality axes (ethnicity, territory, age, and sex) and intermediates: housing, environment, and networks, through health instruments family. Metrics for height, weight, and inputs for the familiogram and ecomap were standardized. Descriptive measures of frequencies and central tendency were estimated. Odds ratio and its relationship with ¡ndependent variables were estimated. Results The prevalence of global malnutrition in the Wayú ethnic group was 59.1% (47.5-69.8) and in the Zenú ethnic group 22.4% (15.9-30.4) for a p<0.001. This difference is related to intermedíate risk factors with sanitation: inadequate excreta with OR=2.54; CI (1.42-4.53) p=0.002, lack of employment OR=1.94; CI (1.09-3.46) P=0.03 and lack of access to western health services OR=2.42; IC (1.34-4.40) p=0.005. Conclusions Improvement in nutrition requires the intervention of intermediate determinants related to sanitation, health model, intersectoriality of health policies plus an ethnic-cultural and territorial focus.

Una mirada histórico-geográfica de las pandemias: para entender de manera compleja la COVID-19 / A Historical-Geographical View of Pandemics: to Understand COVID-19 in a Complex Way

RESUMEN El abordaje para la investigación de brotes/pandemias es una actividad desafiante, necesaria y retadora para los salubristas y epidemiólogos. Esta actuación permite que los servicios de epidemiología y de vigilancia profundicen el conocimiento de la enfermedad, recaben datos históricos de episodios pandémicos, caractericen vulnerables, planteen hipótesis e intervengan los factores de riesgos en un contexto ambiental y sociocultural determinado con una actuación local y una perspectiva global. Se considera un abordaje sindémico, de tal manera que conjugan aspectos de determinantes sociales interconectados y profundizando en la pandemia.

ABSTRACT The outbreak/pandemic investigation approach is a challenging, necessary and challenging activity for health professionals and epidemiologists. This approach allows epidemiology and surveillance services to deepen their knowledge of the disease, collect historical data on pandemic episodes, characterize vulnerabilities, develop hypotheses and intervene risk factors in a given environmental and sociocultural context with local action and a global perspective. A syndemic approach is considered, in such such a way that it combines aspects of interconnected social determinants and deepening in the pandemic.

COVID-19 en la Región Caribe Colombiana: un análisis documental / Covid19 in the Colombian Caribbean Region: A Documentary analysis

Resumen Introducción: El impacto social y sanitario que ha generado la pandemia COVID-19 a nivel global permite repensar aspectos de vigilancia epidemiológica y comunicación en tiempos de crisis. Objetivo: Describir el comportamiento de la pandemia COVID-19 en los departamentos y distritos especiales de la región caribe colombiana. Materiales y Métodos: Análisis documental e interpretativo a partir de fuentes secundarias de vigilancia nacional "SIVIGILA" y datos de entes territoriales. Resultados: Cartagena de Indias es la primera unidad territorial del Caribe en presentar casos por COVID-19, seguido de Santa Marta y Barranquilla. El mayor número de casos se registró en Barranquilla, Atlántico, Cartagena y Córdoba. Así mismo, la mayor tasa de muertes por 100 000 habitantes se registró en Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre y Cartagena. En el Caribe se implementaron estrategias de distanciamiento social como prohibición de eventos masivos y cierre de fronteras. Discusión: Para describir el comportamiento de la pandemia es importante que las autoridades sanitarias continúen asumiendo el reto para la detección, sistematización y manejo oportuno de los casos. El comportamiento de la pandemia ha sido similar en los departamentos del Caribe Colombiano, hay una homogeneidad al momento de acatar las normas del gobierno, y cada región adaptó diferentes estrategias dentro de un marco general para reducir la incidencia de la enfermedad. Se recomienda fortalecer la similitud entre los datos reportados por el Ministerio de Salud, SIVIGILA y los entes territoriales. El talento humano en salud cualificado puede soportar este ejercicio a fin de superar la actuación mediática y avanzar hacia la gobernanza.

Abstract Background: The social and health impact generated by the COVID-19 pandemic allows us to re-think aspects of epidemiological surveillance and communication in struggle-times. Objective: To describe the behavior of the COVID-19 pandemic in the departments and special districts of the Colombian Caribbean region. Methodology: This is a documentary and interpretive analysis from secondary sources of National Surveillance "SIVIGILA" and data from local governments. Results: Cartagena de Indias is the first territorial area in the Caribbean to present cases COVID-19, followed by Santa Marta and Barranquilla. The highest number of cases was registered in Barranquilla, Atlántico, Cartagena and Córdoba. Likewise, the highest death rate per 100,000 inhabitants was observed in Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre and Cartagena. In the Caribbean, social distancing was implemented, as well as the limitation of mass gatherings and border closure. Discussion: To describe the pandemic behavior, it is important that health authorities continue to assume the challenges of detection, systematization, and timely handling of cases. The COVID-19 performance has been similar in the Colombian Caribbean. There is a homogeneity regarding the government regulations compliance and each region adapted different strategies to reduce the incidence of the dicease. It is recommended to strengthen the concordance between the data reported by the Ministry of Health, SIVIGILA, and the territorial entities. Qualified human talent can support this exercise in order to overcome the media performance through the strengthening of governance.

Polimorfismos de los genes del sistema leptina-melanocortina asociados con la obesidad en la población adulta de Barranquilla / Polymorphisms of leptin-melanocortin system genes associated with obesity in an adult population from Barranquilla

Introducción. La obesidad se considera un grave problema de salud pública y por ello se hacen esfuerzos en la búsqueda de genes como el LEP, el LEPR y el MC4R del sistema leptina-melanocortina, el cual opera en la regulación neuroendocrina de la ingestión y el equilibrio energético e influye en la patogenia de la enfermedad. Los resultados contradictorios en torno a la asociación de estos genes con la obesidad plantean la necesidad de nuevas investigaciones. Objetivo. Analizar los polimorfismos rs2167270 del gen LEP, rs1137101 del gen LEPR y rs17782313 del gen MC4R asociados con la obesidad y sus variables clínicas y bioquímicas en una muestra de pacientes adultos de Barranquilla. Materiales y métodos. Se estudiaron 111 personas obesas y 155 no obesas como controles. Los polimorfismos se determinaron mediante reacción en cadena de la polimerasa (PCR) en tiempo real. Se tomaron las medidas antropométricas, se evaluó la presión arterial y se hicieron pruebas bioquímicas. Resultados. No se encontraron diferencias estadísticas en la frecuencia alélica y genotípica de los polimorfismos en los grupos estudiados. En cuanto a las variables clínicas y bioquímicas, el genotipo CC del polimorfismo rs17782313 del gen MC4R, se asoció con un aumento de la presión arterial sistólica y, el alelo T y su genotipo homocigoto, con una disminución del colesterol HDL en los obesos. No se evidenció ningún efecto de los otros polimorfismos en estas variables. Conclusiones. Los polimorfismos rs2167270 del gen LEP, rs1137101 del gen LEPR y rs17782313 del gen MC4R, no se asociaron con obesidad en la población analizada. Se encontró que el polimorfismo rs17782313 del gen MC4R influyó en el aumento de la presión arterial sistólica y la disminución del colesterol HDL en las personas obesas.

Introduction: Obesity is considered a serious public health problem. Efforts have been directed to search for candidate genes such as LEP, LEPR, and MC4R involved in the leptin- melanocortin system. The neuroendocrine regulation of these genes on energy intake and balance influences the pathogenesis of this disease. Contradictory results regarding the association of these genes with obesity raise the need for new research. Objective: To analyze the association between obesity and LEP rs2167270, LEPR rs1137101, and MC4R rs17782313 polymorphisms and the clinical and biochemical variables in obese adults from Barranquilla, Colombia. Materials and methods: We analyzed 111 obese adults and 155 non-obese individuals as controls. The polymorphisms were determined by real-time PCR. Besides, anthropometric measures, blood pressure, and biochemical tests were evaluated. Results: No statistical differences were found in allele and genotype frequencies of gene polymorphisms between groups. The CC genotype of MC4R rs17782313 polymorphism was associated with increased systolic blood pressure and T allele and TT genotype, with decreased HDL cholesterol in obese adults. The effect of the other polymorphisms on these variables was not evidenced. Conclusions: LEP rs2167270, LEPR rs1137101, and MC4R rs17782313 polymorphisms were not associated with obesity in the population under study. MC4R rs17782313 polymorphisms were associated with an increase in systolic blood pressure and a decrease in HDL cholesterol.

Percepciones y creencias al uso de película comercial tipo epidemia/pandemia en el aula: Insumos para orientar el aprendizaje / Perceptions and beliefs to the use of epidemic / pandemic commercial film in the classroom: Inputs to guide learning

RESUMÉN Objetivo: Valorar el uso de la película comercial "Contagión" como estrategia para la enseñanza del método epidemiológico aplicado al campo de epidemias/pandemias. Materiales y métodos: Se trata de un proyecto de aula que involucró diversas tecnologías emergentes y de comunicación para disponer de herramientas atractivas y pedagógicas que favorezcan aprendizaje significativo para abordaje de temáticas complejas. La actuación pedagógica involucró diversos insumos: inicialmente se presenta la caracterización de un cuestionario "ah doc" que valoró creencias y percepciones ante una epidemia/pandemia y cómo visibilizaban entes de salud locales e internacionales, los científicos, la comunidad y el uso de película en el escenario de aprendizaje. Participaron 131 estudiantes. Resultados: En síntesis, los estudiantes identifican que este tipo de película muestra una realidad para el 70,2% (acuerdo y totalmente de acuerdo),favorece conductas de protección en un 80,2 % y al 78,6 % le modifica su conocimiento con respecto a la protección de salud. Favorece un aprendizaje en el aula, y para el 42 % se expresa de manera indiferente un estereotipo muy alejado de los científicos. Con este insumo inicial se desarrolló la sesión introductoria de abordaje de puntos críticos en la metodología epidemiológica ante una epidemia/pandemia; lo que permitió ilustrar la acción epidemiológica versus el contexto real o simulado, destacando actuaciones que involucran actos humanos. Conclusiones: Los estudiantes expresaron actitud positiva respecto a la estrategia utilizada en el aula, que se constituye en un insumo pertinente, activo, crítico y eficaz para el aprendizaje en el aula.

ABSTRACT Objective: To assess the use of commercial film "Contagion" as a strategy for teaching the epidemiological method applied to the field of epidemics/pandemics. Materials and methods: This is a classroom project that involved various emerging and communication technologies in order to have attractive and pedagogical tools that encourage meaningful learning to address complex issues. The pedagogical action involved several inputs: Initially, the characterization of an "ah doc." questionnaire was presented, which evaluated beliefs and perceptions in the face of an epidemic/pandemic and how local and international health entities, scientists, the community and the use of film in the learning scenario made them visible, with 131 students participating. Results: In summary, students identified that this type of film shows a reality "in agreement and total agreement in 70.2 %, favors protective behavior in 80.2 % and 78.6 % modify their knowledge with respect to health protection. This positions that it favors a learning in the classroom and for 42 % it expresses in an indifferent way a stereotype very far from the scientists. With this initial input, the introductory session was held to address critical points in the epidemiological methodology in the face of an epidemic/pandemic, which made it possible to illustrate the epidemiological action versus the real or simulated context by highlighting actions involving human acts. Conclusions: Students expressed a positive attitude towards the strategy used in the classroom, which constitutes a relevant, active, critical and effective input for classroom learning.

Spatial distribution of the relative risk of Zika virus disease in Colombia during the 2015-2016 epidemic from a Bayesian approach.

OBJECTIVE: To determine the spatial distribution of the risk of Zika virus disease in each region of Colombia during the 2015-2016 epidemic. METHODS: An ecological study was designed to estimate the risks for each Colombian region using first-order neighbors, covariate effects, and three adjacent periods of time (beginning, development, and end of the epidemic) to analyze the spatial distribution of the disease based on a Bayesian hierarchical model. RESULTS: Spatial distribution of the estimated risks of Zika virus disease showed that it increased in a strip that crosses the central area of the country from west to east. Analysis of the three time periods showed greater risk of the disease in the central and southern zones-Arauca and Santander-where the increase in risk was four times higher during the peak phase compared with the initial phase of the outbreak. CONCLUSION: In the identified high-risk areas, integrated surveillance systems for Zika virus disease and its complications must be strengthened to provide up-to-date and accurate epidemiological information. This information would allow those involved in policy and decision making to identify new outbreaks and risk clusters, enabling more focused and accurate measures to target at-risk populations.

[Implementation of a clinical guideline for detection of gestational diabetes in primary care]. / Diabetes gestacional: implementación de una guía para su detección en la atención primaria de salud.

BACKGROUND: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. AIM: To estimate the adherence of the guide in primary care centers. MATERIAL AND METHODS: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. RESULTS: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. CONCLUSIONS: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.

Diabetes gestacional: implementación de una guía para su detección en la atención primaria de salud / Implementation of a clinical guideline for detection of gestational diabetes in primary care

Background: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. Aim: To estimate the adherence of the guide in primary care centers. Material and Methods: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. Results: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. Conclusions: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.

Seroprevalencia en una zona de hiperendemia por dengue, Barranquilla, Colombia / Sero-Prevalence in a Hyperendemic Area of Dengue: Barranquilla-Colombia / Soroprevalência numa área de hiperendemia por dengue, Barranquilla-Colômbia

RESUMEN Objetivo: Estimar seroprevalencia de anticuerpos IgG e IgM para dengue y factores asociados. Método: estudio transversal, mediante la aplicación de encuesta y estimación serológica para IgG e IgM para dengue en mayores de 15 años con representabilidad por localidad y sexo. 478 sujetos encuestados en la ciudad de Barranquilla Colombia Análisis estadístico, mediante el programa SPSS®, versión 22. Se estimó la sero-prevalencia para el análisis univariado y el análisis bivariado mediante la odds ratio de proporciones con una p<0,05. Resultados: la seroprevalencia para IgG fue 88,2% (IC 95% =85,2-91,1) y para IgM de 11,8% (IC 95%= 8,80-14,75). Se encontró asociación estadística en edades de 30 a 49 y 50-69 años (OR=7,09 [2,6-19,3] y OR= 8,93 [2,9-27,0] respectivamente), pertenecer al régimen de salud subsidiado (OR=2,56[1,18-5,53]) y ocupación hogar (OR= 3,38[1,31-8,67]. Conclusiones: la alta seroprevalencia para IgG es explicada por la circulación de los cuatro serotipos en el país, los brotes epidémicos cada dos a tres años y los comportamientos y prácticas desfavorables relacionadas con el manejo de agua. Se requiere cambios de conducta frente al manejo de factores predisponentes, la atención oportuna de sintomáticos y vigilancia activa comunitaria e institucional ante casos sospechosos.

ABSTRACT Objective: estimate the sero-prevalence of IgG and IgM antibodies for dengue and associated factors. Method: A cross-sectional study was done by means of a survey and serological estimation for IgG and IgM for dengue in subjects over 15 years of age with representability by location and gender. In all, 478 subjects were surveyed in the city of Barranquilla, Colombia. The SPSS® program, version 22, was used for the statistical analysis. Sero-prevalence was estimated for univariate analysis and bivariate analysis using the odds ratio of proportions with p <0.05. Results: The sero-prevalence for IgG was 88.2% (95% CI = 85.2-91.1); for IgM, it was 11.8% (95% CI = 8.80-14.75). A statistical association was found between subjects ages 30 to 49 and those ages 50 to 69 (OR = 7.09 [2.6-19.3] and OR = 8.93 [2.9-27.0] respectively) who are part of the subsidized health system (OR = 2.56 [1.18-5.53]) and list homemaker as their occupation (OR = 3.38 [1.31-8.67]). Conclusions: The high sero-prevalence for IgG is explained by circulation of the four serotypes in the country, epidemic outbreaks every two to three years, and unfavorable behavior and practices related to water management. Behavioral changes are needed when it comes to dealing with predisposing factors, timely symptomatic care and active community and institutional surveillance in response to suspected cases.

RESUMO Objetivo: estimar a soroprevalência de anticorpos IgG e IgM para dengue e fatores associados. Método: estudo transversal, realizado com a aplicação de questionário e estimativa sorológica para IgG e IgM para dengue em maiores de 15 anos com representabilidade por localidade e sexo. 478 sujeitos entrevistados na cidade de Barranquilla, Colômbia. Análise estatística por meio do programa SPSS®, versão 22. Foi estimada a soroprevalência para a análise univariada e a análise bivariada mediante a odds ratio de proporções com p<0,05. Resultados: a soroprevalência para IgG foi 88,2 % (IC 95 % =85,2-91,1) e para IgM de 11,8 % (IC 95%= 8,80-14,75). Constatou-se associação estatística em idades de 30 a 49 e 50 a 69 anos (OR=7,09 [2,6-19,3] e OR= 8,93 [2,9-27,0] respectivamente), pertencer ao sistema de saúde subsidiado (OR=2,56[1,18-5,53]) e ocupação do lar (OR= 3,38[1,31-8,67]. Conclusões: a alta soroprevalência para IgG é explicada pela circulação dos quatro sorotipos no país, os surtos epidêmicos a cada dois ou três anos e os comportamentos e práticas desfavoráveis relacionados com o uso da água. São requeridas mudanças de comportamento diante dos fatores predisponentes, atenção oportuna de sintomáticos e vigilância ativa comunitária e institucional ante casos suspeitos.

The Epidemiological Challenges of Breast Cancer among Premenopausal Women in Limited Resource Settings.

Breast cancer is the most common malignant tumor among women of reproductive age and is also the most costly according to European reports. In this context, the aim of the present review is to identify factors that make breast cancer in premenopausal women an epidemiological challenge in developing countries. Epidemiological aspects of breast cancer, including risk factors, early detection methods, and treatment, are addressed. Breast cancer in premenopausal women should be included in the political and strategic agendas in developing countries to direct the necessary resources for prevention, detection, and control.

Experiencia de Sensibilización de Talento Humano en Salud en Atención Primaria en Salud (APS) por medio del Campus Virtual de Salud Pública (CVSP) Nodo Colombia (2013-2015) / Training experience in Health Human Resources (HHR) in Primary Health Care (PHC) through the Virtual Campus of Public Health (VCPH) Node Colombia (2013-2015)

Objetivo: Ilustrar la experiencia de formación de Talento Humano en Salud (THS) en APS y RISS para Colombia por medio del Campus Virtual de Salud Pública (CVSP) de la OPS durante 2013 a 2015. Metodología: Se realizó una evaluación de procesos académicos de 2 cohortes durante 2013 a 2015 por medio del CVSP y mediante un equipo conformado por 5 universidades. La experiencia se dividió en 2 etapas según los procesos de formación: 1. Etapa de fortalecimiento de los equipos de formación, 2. Formación de talento humano en salud para todo el país. Resultados: En total, los 2 procesos contribuyeron a formar a 123 profesionales de la salud (2013-2015). Durante la primera etapa (2013-2014) se contribuyó principalmente a formar docentes vinculados de las distintas universidades, y se encontró una mayor adherencia en profesores de salud pública. Para la segunda etapa (2014-15), el curso se ofertó para todo el país, y mejoraron los procesos académicos en relación con el proceso anterior, y el proceso finalizó con 55 propuestas de mejoramiento en APS y RISS para cada uno de los contextos de cada participante. Conclusiones: El proceso educativo del curso y el trabajo en el CVSP se constituyen en una oportunidad para avanzar en nuevos procesos, los cuales contribuyen efectivamente a la formación de THS en APS y RISS en un país donde la temática es relevante y necesaria.

Objective: Illustrate the training experience in Health Human Resources (HHR) in PHC and IHSDNs for Colombia through the Virtual Campus of Public Health (VCPH) of the PAHO during 2013 to 2015. Methodology: an assessment of academic processes of 2 cohorts was conducted during 2013 and 2015 through VCPH, and by a team of five universities. The experience is divided into two stages according to the processes of formation: 1. Strengthening teaching equipment, 2. Training of HHR for the country. Results: In total, 123 health professionals were trained in the two processes (2013-2015). The first stage (2013-2014) was mainly linked to training teachers of different universities, process with a better performance on public health teachers. For the second stage (2014-2015) the course was offered for the entire country, improving the academic processes in relation to the above process, and ending the process with 55 proposals to improve PHC and IHSDNs for the contexts of each participant. Conclusions: The educational process of the course and work in the VCPH are constituted as an opportunity to advance new processes which effectively contribute to the formation of HHR in PCH and IHSDNs in a country where the subject is relevant and necessary.