Risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation: results from the contact tracing strategy of the CoVIDA epidemiological surveillance study in Bogotá, Colombia, in 2020-2021.

OBJECTIVES: To estimate the risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation, participants of the CoVIDA study, in Bogotá D.C., Colombia. SETTING: The CoVIDA study was the largest COVID-19 intensified sentinel epidemiological surveillance study in Colombia thus far, performing over 60 000 RT-PCR tests for SARS-CoV-2 infection. The study implemented a contact tracing strategy (via telephone call) to support traditional surveillance actions performed by the local health authority. PARTICIPANTS: Close contacts of participants from the CoVIDA study. PRIMARY AND SECONDARY OUTCOME MEASURES: SARS-CoV-2 testing results were obtained (RT-PCR with CoVIDA or self-reported results). The secondary attack rate (SAR) was calculated using contacts and primary cases features. RESULTS: The CoVIDA study performed 1257 contact tracing procedures on primary cases. A total of 5551 close contacts were identified and 1050 secondary cases (21.1%) were found. The highest SAR was found in close contacts: (1) who were spouses (SAR=32.7%; 95% CI 29.1% to 36.4%), (2) of informally employed or unemployed primary cases (SAR=29.1%; 95% CI 25.5% to 32.8%), (3) of symptomatic primary cases (SAR of 25.9%; 95% CI 24.0% to 27.9%) and (4) living in households with more than three people (SAR=22.2%; 95% CI 20.7% to 23.8%). The spouses (OR 3.85; 95% CI 2.60 to 5.70), relatives (OR 1.89; 95% CI 1.33 to 2.70) and close contacts of a symptomatic primary case (OR 1.48; 95% CI 1.24 to 1.77) had an increased risk of being secondary cases compared with non-relatives and close contacts of an asymptomatic index case, respectively. CONCLUSIONS: Contact tracing strategies must focus on households with socioeconomic vulnerabilities to guarantee isolation and testing to stop the spread of the disease.

Prediction of SARS-CoV-2 infection with a Symptoms-Based model to aid public health decision making in Latin America and other low and middle income settings.

Symptoms-based models for predicting SARS-CoV-2 infection may improve clinical decision-making and be an alternative to resource allocation in under-resourced settings. In this study we aimed to test a model based on symptoms to predict a positive test result for SARS-CoV-2 infection during the COVID-19 pandemic using logistic regression and a machine-learning approach, in Bogotá, Colombia. Participants from the CoVIDA project were included. A logistic regression using the model was chosen based on biological plausibility and the Akaike Information criterion. Also, we performed an analysis using machine learning with random forest, support vector machine, and extreme gradient boosting. The study included 58,577 participants with a positivity rate of 5.7%. The logistic regression showed that anosmia (aOR = 7.76, 95% CI [6.19, 9.73]), fever (aOR = 4.29, 95% CI [3.07, 6.02]), headache (aOR = 3.29, 95% CI [1.78, 6.07]), dry cough (aOR = 2.96, 95% CI [2.44, 3.58]), and fatigue (aOR = 1.93, 95% CI [1.57, 2.93]) were independently associated with SARS-CoV-2 infection. Our final model had an area under the curve of 0.73. The symptoms-based model correctly identified over 85% of participants. This model can be used to prioritize resource allocation related to COVID-19 diagnosis, to decide on early isolation, and contact-tracing strategies in individuals with a high probability of infection before receiving a confirmatory test result. This strategy has public health and clinical decision-making significance in low- and middle-income settings like Latin America.

Costos directos de las hospitalizaciones por diabetes mellitus en el Instituto Mexicano del Seguro Social / Direct service costs of diabetes mellitus hospitalisations in the Mexican Institute of Social Security

Objetivo: Estimar para el Instituto los costos directos de las hospitalizaciones por diabetes mellitus y sus complicaciones en el Instituto Mexicano del Seguro Social. Método: Se estimaron los costos hospitalarios de la atención a pacientes con diabetes mellitus utilizando los grupos relacionados por el diagnóstico en el Instituto Mexicano del Seguro Social (IMSS) entre 2008 y 2013, y los egresos hospitalarios de los códigos E10-E14 correspondientes a diabetes mellitus. Los costos se agruparon según características demográficas y afección principal, y se estimaron en dólares estadounidenses de 2013. Resultados: Se registraron 411.302 egresos hospitalarios por diabetes mellitus, con un costo de 1563 millones de dólares. El 52,44% correspondieron a hombres y el 77,26% fueron por diabetes mellitus tipo 2. El mayor costo es atribuible a las complicaciones circulatorias periféricas (34,84%) y a las personas con 45-64 años de edad (47,1%). En el periodo analizado, los egresos disminuyeron un 3,84% y los costos totales un 1,75%. Las complicaciones que provocaron mayor variación de los costos fueron la cetoacidosis (50,70%), las oftálmicas (22,6%) y las circulatorias (18,81%). Conclusiones: La atención hospitalaria de la diabetes mellitus representa un importante reto financiero para el IMSS, y más aún lo es el incremento en la frecuencia de las hospitalizaciones en población en edad productiva, que afecta a la sociedad en su conjunto, lo que sugiere la necesidad de fortalecer las acciones de control de las personas diabéticas con miras a prevenir complicaciones que requieran atención hospitalaria

Objective: To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security Methods: The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. Results: 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). Conclusions: Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care

[Direct service costs of diabetes mellitus hospitalisations in the Mexican Institute of Social Security]. / Costos directos de las hospitalizaciones por diabetes mellitus en el Instituto Mexicano del Seguro Social.

OBJECTIVE: To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security METHODS: The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. RESULTS: 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). CONCLUSIONS: Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care.

Ciudades sostenibles y saludables: estrategias en busca de la calidad de vida / Healthy and sustainable cities: strategies in the search for quality of life / Cidades sustentáveis e saudáveis: estratégias visando qualidade de vida

Este artículo discute la relación que hay en los planteamientos del desarrollo sostenible y de las ciudades saludables como estrategias que surgen de la promoción de la salud. Para ello, la participación social e intersectorial hace de la gobernanza un requisito indispensable en la construcción de ciudades sostenibles y saludables que permitan lograr una mayor equidad en salud y a su vez una mejor calidad de vida de la población.

This paper discusses the relationship between the proposals of sustainable development and healthy cities as strategies arising from health promotion. To achieve this, social and inter-sect oral participation makes governance an essential requirement for the construction of sustainable and healthy cities that lead to more health equity and improve the quality of life of their populations.

Este artigo discute a relação entre as teorias de desenvolvimento sustentável e as de cidades saudáveis como estratégias originadas da promoção da saúde. A participação social e entre vários setores faz com que a governança seja um requisito necessário na construção de cidades sustentáveis e saudáveis, onde mais equidade na saúde e melhor qualidade de vida para a população sejam possíveis.

Identidad, vivencias y retos de un semillero de investigación para la salud pública en Colombia / Identity, experiences and challenges of a research seedbed for public health in Colombia / Identidade, vivências e desafios de um núcleo de investigação para a saúde pública na Colômbia

Objetivo: se presentan la experiencia, historia, cultura, dificultades y retos de un semillero de investigación en salud pública y epidemiología en Colombia. Métodos: se hizo un estudio etnográfico con participación de estudiantes y profesores vinculados con la estructura social y evolución del semillero. Mediante observación participante y análisis documental se establecieron los aspectos de la experiencia del semillero, puestos en común para la triangulación de información por los investigadores; de allí, surgieron las categorías del estudio denominadas: identidad, aprendizajes significativos y retos. Resultados: el Semillero de Investigación en Salud Pública y Epidemiología (SISPE) es un espacio abierto para estudiantes con mente abierta, interesado en formar líderes investigadores con excelencia académica, responsabilidad social y calidad humana. Posibilita el aprendizaje y la formación integral; la reflexión y la crítica respetuosa; el compartir; el cultivo de la creatividad y el ser. Articula procesos de formación investigativa, investigación formativa, clubes de revista, cine foros, seminarios y actividades culturales. Conclusiones: el semillero posibilita el acercamiento temprano a procesos de formación investigativa y emplea un modelo alternativo y creativo que fomenta el interés por la ciencia y el cultivo intelectual. Sobresale el papel protagónico de los estudiantes como líderes de su proceso formativo.

Objective: The experience, history, culture, difficulties and challenges of a seedbed for public health research and epidemiology in Colombia are presented. Methods: An ethnographic study was carried out with the participation of students and teachers linked to the social structure and evolution of the seedbed. Participant observation and documental analysis were used as technical instruments for the description of the experience, and triangulation of the information was made by the researchers. Three categories emerged, namely: identity, significant learning and challenges. Results: The Seedbed of Research for Public Health and Epidemiology is an open space for students with open mind. It is interested in preparing research leaders with academic excellence, social responsibility and human quality. It enables comprehensive learning and training; reflection and respectful criticism; the ability to share and stimulus to creativity and being. It articulates processes of research training, formative research, journal clubs, film forums, seminars and cultural activities. Conclusions: The seedbed allows an early contact of the student with research processes. It uses an alternative and creative model that stimulates interest in science and intellectual cultivation. The leading role of students in their training processes is to be emphasized.

Objetivo: apresentam-se a experiência, história, cultura, dificuldades e reptos de um núcleo de investigação em saúde pública e epidemiologia na Colômbia. Métodos: fez-se um estudo etnográfico com participação de estudantes e professores vinculados com a estrutura social e evolução do núcleo. Mediante observação participante e análise documentário se estabeleceram os aspectos da experiência do núcleo, postos em comum para a triangulação de informação pelos pesquisadores; de ali, surgiram as categorias do estudo denominadas: identidade, aprendizagens significativas e desafios. Resultados: o núcleo de Saúde Pública e Epidemiologia (SISPE) é um espaço aberto para estudantes com mente aberta, interessado em formar líderes investigadores com excelência acadêmica, responsabilidade social e qualidade humana. Possibilita a aprendizagem e a formação integral; a reflexão e a crítica respeitosa; o compartilhar; o cultivo da criatividade e o ser. Articula processos de formação investigativa, investigação formativa, clubes de revista, cinema foros, seminários e atividades culturais. Conclusões: o núcleo possibilita a aproximação temporã a processos de formação investigativa e emprega um modelo alternativo e criativo que fomenta o interesse pela ciência e o cultivo intelectual. Sobressai o papel protagónico dos estudantes como líderes de seu processo formativo.

Lecciones aprendidas de gestión del conocimiento para la salud pública: algunos espacios observados en Colombia / Lessons learnt from knowledge management to public health: some spaces observed in Colombia / Lições aprendidas de gerenciamento do conhecimento para a saúde pública: alguns espaços observados em Colômbia

Introducción: transferir conocimiento para la salud pública es un asunto posible, según los diferentes espacios contextúales y culturales existentes en una sociedad de conocimiento. Metodología: este estudio presenta lecciones aprendidas de tres casos de gestión del conocimiento con base en la experiencia, las condiciones comunes y los procesos de liderazgo social autogestionado promovidos en espacios locales, concertado con actores y agentes locales de organizaciones en Antioquia, Colombia, mediante análisis comparativo y técnicas de exploración documental. Resultados: la gestión social del conocimiento como mecanismo local de promoción de las evidencias informadas en salud pública puede y debe ser intercambiada a través de espacios observados, como las redes de conocimiento, los observatorios y los tanques de pensamiento. Conclusión: las lecciones aprendidas confluyen en promover procesos de participación social para la construcción colectiva de conocimiento y abordar debates sobre la igualdad de oportunidades regionales en Colombia.

Introduction: According to a different contextual and cultural knowledge society, knowledge transfer on public health is a possible issue nowadays. Methods: This implementation health research based on lessons learnt shows three cases of knowledge management supported by experience, common conditions and self-management social leadership processes developed in local spaces with stakeholders in Antioquia, Colombia through comparative analysis and documented scoping review. Results: Social Knowledge Management as a local mechanism on promotion the informed evidence on public health can be interchanged by observed spaces like knowledges networks, observatories, think tanks. Conclusion: Lessons learnt conduct in promote social participation processes for the collective building knowledge and concrete debates about equity for regional chances in Colombia.

Introdução: transferir conhecimento para a saúde pública é um assunto possível, segundo os diferentes espaços contextuais e culturais existentes em uma sociedade de conhecimento. Metodologia: este estudo apresenta lições aprendidas em três casos de gerenciamento do conhecimento com base na experiência, as condições comuns e os processos de liderança social auto gerenciado, promovidos em espaços locais, marcados com atores e agentes de organizações em Antioquia, Colômbia, mediante análise comparativa e técnicas de exploração documentária. Resultados: o gerenciamento social do conhecimento como mecanismo local de promoção das evidências informadas em saúde pública pode e deve ser trocado através de espaços observados, como as redes de conhecimento, os observatórios e os tanques de pensamento. Conclusão: as lições aprendidas levam a promover processos de participação social para a construção coletiva de conhecimento e abordar debates sobre a igualdade de oportunidades regionais na Colômbia.