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Background: In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission. Methods: We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI). Findings: A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5-47.7), critical care admission (47.2%; 95% CI, 18.5-65.8), and death (55.7%; 95% CI, 32.5-70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years. Interpretation: Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age. Funding: UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.
RESUMEN
Resumen Objetivo: Estimar la prevalencia de consumo semanal de alcohol en población joven y sus determinantes socioeconómicos en la subregión Montes de María, del Caribe colombiano. Metodología: Estudio analítico transversal de 10 667 jóvenes encuestados de 10 a 24 años. Se utilizaron tablas de frecuencias y medidas de tendencia central, dispersión y posición, con estratificación de la muestra por sexo y grupos edad. Se usó un modelo logístico de respuesta dicotómica para la prevalecía, explorando factores de riesgo. Resultados: La prevalencia de consumo de alcohol de alguna vez por semana es 9,4 %. La prevalencia en hombres es 14,5 % y en mujeres es 5,6 %. En menores de edad es 3,9 % y en mayores de edad es 19,0 %. El municipio de San Onofre presenta la mayor prevalecía (14,9 %). Además, ser hombre, ser empleado, tener una mala relación con los padres, tener familiares víctimas del conflicto o asesorías psicológicas previas incrementó el riesgo de consumo de alcohol. En las mujeres, pero no en los hombres, tener pensamientos suicidas se relacionó con un mayor riesgo de consumo de alcohol. Para ambos sexos, tener de 18 a 24 años, perder años escolares, consumir sustancias psicoactivas y comportarse como agresor en casos de matoneo escolar incrementan el riesgo de consumo de alcohol. Discusión: La prevalencia de consumo de alcohol de alguna vez a la semana de los jóvenes de Montes de María está a 1,5 puntos porcentuales de la prevalencia de consumo perjudicial a nivel nacional (11,07 %). Los jóvenes de 18 a 24 años tienen una prevalencia igual al consumo de alcohol riesgoso y perjudicial nacional para el mismo rango de edad (18,76 %). Los factores de riesgo encontrados denotan problemas familiares, desinterés escolar y problemas psicológicos. Conclusiones: Hay alta prevalencia de consumo de alcohol en jóvenes de Montes de María, donde es necesario afianzar programas preventivos de consumo de alcohol en edades tempranas.
Abstract Objective: to estimate the prevalence of weekly alcohol composition in the young population and its socioeconomic determinants, in the Montes de María sub-region, Colombian Caribbean. Methodology: analytic cross-sectional study with 10667 surveys on youngsters aged 10-24 years. Frequency grids and measures of central tendency, dispersion and position were used, classifying the sample by sex and age groups. A logistic model of dichotomous questions was used for the prevalence, studying risk factors. Results: the prevalence of alcohol consumption at least once a week is 9.4%. In males, the prevalence is 14.5%, and in women, it is 5.6%. Underage prevalence is 3.9% and adult prevalence is 19.0%. The municipality of San Onofre has the highest prevalence (14.9%). Additionally, the risk of alcohol consumption increased in male who were employees, had dysfunctional family relationship, relatives who were victims of the armed conflict or who received previous psychological attention. In women, but not in men, having suicidal thoughts was associated with higher risk of alcohol consumption. For all the participants, being between 18 and 24 years of age, having failed school years, consuming psychoactive substances being a school bully increased the risk of alcohol consumption. Discussion: the prevalence of atleast- once-a-week alcohol consumption in the youngsters of Montes de María is 1.5% below the national harmful alcohol consumption level (11.07%). The sample's youngsters aged 18-24 years have the same prevalence of high-risk and harmful alcohol consumption as the national level for the same age range (18.76%). The risk factors found reveal family issues, a lack of interest in school and psychological problems. Conclusions: there is a high prevalence of alcohol consumption in the youngsters of Montes de María and it is necessary to enforce programs to prevent alcohol consumption at young ages.
Resumo Objetivo: Estimar a prevalência de consumo semanal de álcool na população jovem e seus determinantes socioeconômicos na sub-região Montes de María, do Caribe colombiano. Metodologia: foi um estudo analítico transversal de 10 667 jovens de 10 a 24 anos que foram indagados. Utilizaram-se grelhas de frequência e medidas de tendência central, dispersão e posição, com estratificação da amostra por sexo e grupos de idade. Utilizou-se um modelo logístico de resposta dicotómica para a prevalência, estudando fatores de risco. Resultados: a prevalência de consumo de álcool de alguma vez por semana é de 9,4%. A prevalência em homes é 14,5% e 5,6% em mulheres. Em menores de idade é 3,9% e em adultos é 19,0%. O município San Onofre tem a prevalência mais alta (14,9%). Além disso, ser homem, ser empregado, ter uma relação ruim com os pais, ter família vítima do conflito ou assessorias psicológicas anteriores aumentou o risco de consumo de álcool. Nas mulheres, não nos homens, ter pensamentos suicidas esteve relacionado com mais risco de consumo de álcool. Para todos, ter entre 18 e 24 anis, perder anos da escola, consumir substâncias psicoativas e ter comportamento agressor em casos de bullying na escola aumentam o risco de consumo de álcool. Discussão: a prevalência do consumo de álcool de alguma vez por semana dos jovens de Montes de Ma ría fica a 1,5 pontos de percentagem da prevalência do consumo prejudicial a nível nacional (11,07%). Os jovens de 18 a 24 anos têm uma prevalência igual ao consumo de álcool de risco e pre judicial nacional no mesmo intervalo de idade (18,76%). Os fa tores de risco achados revelam problemas familiares, desinteresse escolar e problemas psicológicos. Conclusões: há uma prevalên cia alta de consumo de álcool nos jovens de Montes de María, sendo necessário fortalecer programas de prevenção de consumo de álcool nas idades precoces.
RESUMEN
Objetivos: evaluar la calidad del Programa de Salud Administrada (PSA) de "Todo Corazón", el cual ofrece la Asociación Mutual SER ESS en Colombia, uno de los primeros en su género, a fin de manejar riesgos cardiovasculares con eficiencia y calidad. La evaluación se enfocó sobre el grado de satisfacción de los usuarios (en términos de accesibilidad, oportunidad, aceptación y adherencia, trato e información recibida, y percepción de beneficios) frente a los siguientes componentes del programa: suministro de medicamentos; talleres de información educación y comunicación (IEC); visitas domiciliarias por parte los agentes educativos; y consulta a enfermería, medico general y especialistas. Métodos: siguiendo un diseño de corte transversal, se diseñó, validó y aplicó un cuestionario, para entrevista estructurada, a una muestra de 260 personas, seleccionada aleatoriamente a partir del universo de usuarios del PSA conformado por 17,466 personas distribuidas en ocho departamentos. Resultados: en todos los componentes del PSA y aspectos del servicio evaluados, se observaron niveles de satisfacción superiores al 80 por ciento, con excepción de dos: (1) visitas domiciliarias, y (2) talleres de información, educación y comunicación. Conclusiones: los usuarios del PSA están altamente satisfechos con la mayoría de sus servicios. No obstante, hay oportunidades importantes para el mejoramiento de cada uno de los componentes específicos evaluados.
Objectives: To evaluate the quality of services provided by the Managed Health Program (MHP) ¨De Todo Corazón, one of the first of its kind, offered in Colombia by AsociaciónMutual SER ESS, in order to manage cardiovascular risks with efficiency and quality. The focus was on patient satisfaction (regarding accessibility, opportunity, acceptance and adherence,information provided, and perception of benefits) with the following components of the MHP: medicines supply; information education and communication (IEC) workshops; homevisits by educational agents; and health care provided by nurses, primary care doctors, and specialists. Methods: Following a crossectional design, a questionnaire for structured interviewwas designed, validated, and then applied to a random sample of 260 people, selected from a universe comprising 17,466 subjects registered in the MHP, and distributed over eight states. Results: Satisfaction levels above 80% were found in all of the components and aspects evaluated,except two: (1) home visits by educational agents, and (2) IEC workshops. Conclusions: The clientele served by the MHP is highly satisfied with most of its services, although thereare opportunities for improvement.
