Covid-19 vaccination: a mixed methods analysis of health system resilience in Latin America.

BACKGROUND: This paper discusses the stages of health system resilience (HSR) and the factors underlying differences in HSR during the covid-19 pandemic, especially the vaccination challenge. We studied the relationship between vaccination strategies and macro-context backgrounds in 21 Latin American countries. Our objective was to capture the impact of those aspects in the SR and identify potential improvements for future crises and for vaccination programs in general. METHODS: The study uses mixed-methods research to provide insights into how the countries' backgrounds and vaccination strategies impact the HSR. Particularly, we used explanatory sequential mixed methods, which entails a quantitative-qualitative two-phase sequence. The quantitative phase was conducted using cluster and variance analysis, in which the HSR was measured using as a proxy the covid-19 vaccination outcomes in three cut-offs of reaching 25%, 50%, and 75% of population coverage. This approach allows us to discriminate covid-19 vaccination progress by stages and contrast it to the qualitative stage, in which we performed a country-case analysis of the background conditions and the changes in vaccination strategies that occurred during the corresponding dates. RESULTS: The paper provides a rich comparative case analysis of countries, classifying them by early, prompt, and delayed performers. The results show that differences in vaccination performance are due to flexibility in adapting strategies, cooperation, and the ability to design multilevel solutions that consider the needs of various actors in the health ecosystem. These differences vary depending on the vaccination stage, which suggests the importance of acknowledging learning, diffusion, and feedback processes at the regional level. CONCLUSIONS: We identified the importance of societal well-being as an ideal country antecedent for high and sustained levels of performance in covid-19 vaccination. Whereas in other countries where the set-up and beginning phases were rough, the value of the operational decisions and the learning on the move regarding their own and their peers' trajectories were crucial and were reflected in performance improvement. A contribution of this study is that the above-mentioned analysis was done using vaccination coverage cut-off points that allow a performance view that takes into consideration the stages of the vaccination progress and the learning process that goes with it. As well as framing this into the HSR shock cycles that allow to differentiate the stages of resilience on which countries must act.

Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future.

Introduction: The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths. Methods: This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a mixed-methods sequential explanatory study in four South American countries based on structured interviews and focus groups with elite policy makers. Results: The results of our study demonstrate that structural and contextual barriers limited PPR activities at political, social, and economic levels in each country, as well as through the structure of the health care system. Respondents believe that top-level government officials had insufficient political will for prioritizing pandemic PPR and post-COVID-19 recovery programs within their countries' health agendas. Discussion: We recommend a regional COVID-19 task force, post-pandemic recovery, social and economic protection for vulnerable groups, improved primary health care and surveillance systems, risk communication strategies, and community engagement to place pandemic PPR on Argentina, Brazil, Colombia, and Peru and other South American countries' national public health agendas.

Analytical reference framework to analyze non-COVID-19 events.

BACKGROUND: The COVID-19 pandemic has disrupted the healthcare system, leading to delays in detection of other non-COVID-19 diseases. This paper presents ANE Framework (Analytics for Non-COVID-19 Events), a reliable and user-friendly analytical forecasting framework designed to predict the number of patients with non-COVID-19 diseases. Prior to 2020, there were analytical models focused on specific illnesses and contexts. Then, most models have focused on understanding COVID-19 behavior. There is a lack of analytical frameworks that enable disease forecasting for non-COVID-19 diseases. METHODS: The ANE Framework utilizes time series analysis to generate forecasting models. The framework leverages daily data from official government sources and employs SARIMA models to forecast the number of non-COVID-19 cases, such as tuberculosis and suicide attempts. RESULTS: The framework was tested on five different non-COVID-19 events. The framework performs well across all events, including tuberculosis and suicide attempts, with a Mean Absolute Percentage Error (MAPE) of up to 20% and the consistency remains independent of the behavior of each event. Moreover, a pairwise comparison of averages can lead to over or underestimation of the impact. The disruption caused by the pandemic resulted in a 17% gap (2383 cases) between expected and reported tuberculosis cases, and a 19% gap (2464 cases) for suicide attempts. These gaps varied between 20 and 64% across different cities and regions. The ANE Framework has proven to be reliable for analyzing several diseases and exhibits the flexibility to incorporate new data from various sources. Regular updates and the inclusion of new associated data enhance the framework's effectiveness. CONCLUSIONS: Current pandemic shows the necessity of developing flexible models to be adapted to different illness data. The framework developed proved to be reliable for the different diseases analyzed, presenting enough flexibility to update with new data or even include new data from different databases. To keep updated on the result of the project allows the inclusion of new data associated with it. Similarly, the proposed strategy in the ANE framework allows for improving the quality of the obtained results with news events.

Desigualdad de resultados pruebas Saber-11 antes y durante la pandemia covid-19 (2014-2021) / Inequality in the results of Saber-11 Tests before and during the COVID-19 pandemic (2014 - 2021) / Desigualdade dos resultados dos testes do Saber-11 antes e durante a pandemia de Covid-19 (2014-2021)

Resumen (analítico) Se realizó un análisis descriptivo de la desigualdad en los resultados de las pruebas Saber-11 en el periodo 2014-2021 del departamento de Boyacá, Colombia, y los efectos de la pandemia del covid-19 en tales resultados, según áreas de conocimiento y nivel socioeconómico. Esta investigación se realizó con base en los datos de las pruebas Saber-11 obtenidos en la página del Instituto Colombiano para la Evaluación de la Educación. Se observó que en Boyacá el mejor desempeño lo obtienen los estudiantes de los colegios privados y de estratos 3, 4 y 5. Se evidencia el aumento de la brecha educativa en el departamento durante la pandemia del covid-19, producto de las desigualdades en el acceso a la educación y los problemas de conectividad en los territorios.

Abstract (analytical) The authors conducted a descriptive analysis of inequality in the results of the standardized Saber-11 tests for students conducted in the period 2014-2021 in the department of Boyacá, Colombia and the effects of the COVID-19 pandemic on these results. The results were analyzed in accordance with areas of knowledge and students' socioeconomic level. This research was carried out using data from the Saber-11 tests that was obtained from the Instituto Colombiano para la Evaluación de la Educación website. It was observed that in Boyacá, the best academic results were obtained by students from private schools and those from the middle and upper classes (Strata 3, 4 and 5). An in-crease in the education gap in Boyacá during the COVID-19 pandemic was evidenced by the authors as a result of inequalities with access to education and connectivity problems in the state.

Resumo (analítico) Neste artigo, foi feita uma análise descritiva da desigualdade nos resultados dos testes do Saber-11 no período 2014-2021 do departamento de Boyacá-Colômbia, com o objectivo de analisar os resultados dos testes do Saber-11 e os efeitos do Covid-19 pandemia, de acordo com as áreas de conhecimento e nível socioeconómico. Esta investigação foi realizada com base nos dados dos testes do Saber-11º ano obtidos no site do Instituto Colombiano para la Evaluación de la Educación. Observouse que no departamento de Boyacá o melhor desempenho foi obtido por estudantes de escolas públicas e dos estratos 3, 4 e 5. Evidencia-se um aumento da lacuna educacional no departamento durante a pandemia de Covid-19, como resultado das desigualdades no acesso à educação e dos problemas de conectividade nos territórios.

Técnicas bibliométricas en dinámicas de producción científica en grupos de investigación. Caso de estudio: Biología-UPTC / Technical bibliometrics in dynamics of production scientific of the research groups. Case Study-UPTC, Biology / Técnicas bibliométricas dinâmicas na produção em grupos de investigação científica. Estudo de caso: UPTC-Biologia

Resumen Introducción. Los estudios bibliométricos se han convertido en un instrumento fundamental de apoyo a la gestión de la política científica en diferentes países; sus indicadores forman parte de evaluaciones de la actividad científica implementados por organismos de Ciencia y Tecnología, como Colciencias en Colombia. Objetivo. Presentar algunas técnicas bibliométricas: indicadores de producción, circulación y colaboración, analizando la producción científica de grupos de investigación, referenciando un caso de estudio, durante el período 2001-2014 que permita a otras unidades académicas e instituciones, seguir una guía metodológica para este tipo de investigaciones. Materiales y métodos. La información analizada se obtuvo del GrupLAC (plataforma Red-ScienTI de Colciencias), para los grupos de investigación pertenecientes al área de Biología, vinculados a la UPTC. Se presentan resultados de producción de grupos, circulación e impacto de las publicaciones y análisis de coautorías. Resultados. Se encontraron 162 artículos (11,57 artículos en promedio por año, y 1,45 artículos en promedio por grupo), 37,7% fueron con coautoría nacional y 62,3%, internacional; 24,7% fueron publicados en revistas categorizadas (u homologadas) en A2. Se encuentra un alto porcentaje en el índice de transitoriedad (72,15%), lo que indica poca producción por cada investigador. Se presenta un alto número de publicaciones en revistas que no tienen factor SJR. Conclusión. Existe baja producción de artículos por grupo; la estrategia de publicar con más de un autor se incrementa a través del tiempo; bajo porcentaje de artículos con factor de impacto SJR y alto porcentaje de autores con única publicación en 2001-2014.

Abstract Introduction. Bibliometric studies have become an essential tool of support the management of scientific policy of different countries, their bibliometric indicators form part of the evaluation process of scientific activity implemented by organizations of Science and Technology, as Colciencias, in the case Colombian. Objective. Present some bibliometric techniques: indicators of production, circulation, and collaboration, analyzing the production scientific of research groups; referencing a case study. Materials and Methods. The information of articles analyzed, was obtained of the GrupLAC (platform Red-ScienTI of Colciencias), for research groups belonging area of biology, linked to Uptc. Present results of the production of the groups, and circulation and impact of publications, as well as the collaborations visualized through the coauthorship. Results. Were found 162 articles (11.57 articles on average per year, and 1.45 articles on average per group), 37.7% were in national coauthorship, and 62.3%, international; 24.7% were published in journals categorized (or homologated) in A2. Of concern is the high percentage of transiency index (72.15%), indicating little production by the members of the research groups. Presents a high number of publications in journals which not have factor SJR. Conclusion. Exists low production of article per group, and the publishing strategy with more of one author, increasing over the years, low percentage of article with impact factor SJR and high percentage of authors with only one publication in 2001-2014.

Resumo Introdução. Os estudos bibliométricos tornaram-se uma ferramenta importante para apoiar a gestão da política de científica en diferentes países, seus indicadores fazem parte do processo de avaliação da atividade científica executados por agências de Ciência e Tecnologia, como Colciencias Colômbia. Objetivo. Apresentar algumas técnicas bibliométricas: indicadores de produção, circulação e colaboração, analyzer na produção científica dos grupos de pesquisa, fazendo referência a um estudo de caso, durante o período de 2001-2014, permitindo que outras unidades e instituições académicas, siga uma guia metodológica para este tipo de pesquisa. Materiais e Métodos. A informação analisada foi obtido a partir de GrupLAC (plataforma Rede-ScienTI de Colciencias), pour grupos de pesquisa pertencente à área da biologia, ligado a Uptc. Os resultados são apresentados da produção dos grupos, y circulação e impacto das publicações, bem como collaborations que são exibidos através da coautoria. Resultados. 162 artigos (11.57 artigo média, por ano, e, em média, 1.45 artigos por grupo), 37.7% estavam com o co-autor, e 62.3% internacional; 24.7% foram publicados em periódicos classificados (ou homologados) em A2. De preocupação é o alto percentual de taxa de transitoriedade (72.15%), indicando pouca produção pelos membros dos grupos de pesquisa, e ao elevado número de publicações em revistas como a baixa impacto SJR. Conclusão. Baixa produção de artigos por grupo e da estratégia de liberar mais de um autor com aumento da tendência ao longo dos anos, baixa percentagem de artigos e factor de impacto SJR elevada percentagem de autores com uma publicação no 2001-2014.

Strategies for the quality assessment of the health care service providers in the treatment of Gastric Cancer in Colombia.

BACKGROUND: While, at its inception in 1993, the health care system in Colombia was publicized as a paradigm to be copied across the developing world, numerous problems in its implementation have led to, what is now, an inefficient and crisis-ridden health system. Furthermore, as a result of inappropriate tools to measure the quality of the health service providers, several corruption scandals have arisen in the country. This study attempts to tackle this situation by proposing a strategy for the quality assessment of the health service providers (Entidades Promotoras de Salud, EPS) in the Colombian health system. In particular, as a case study, the quality of the treatment of stomach cancer is analyzed. METHODS: The study uses two complementary techniques to address the problem. These techniques are applied based on data of the treatment of gastric cancer collected on a nation-wide scale by the Colombian Ministry of Health and Welfare. First, Data Envelopment Analysis (DEA) and the Malmquist Index (MI) are used to establish the most efficient EPS's within the system, according to indicators such as opportunity indicators. Second, sequential clustering algorithm, related to process mining a field of data mining, is used to determine the medical history of all patients and to construct typical care pathways of the patients belonging to efficient and inefficient EPS's. Lastly, efforts are made to identify traits and differences between efficient and inefficient EPS's. RESULTS: Efficient and inefficient EPS were identified for the years 2010 and 2011. Additionally, a Malmquist Index was used to calculate the relative changes in the efficiency of the health providers. Using these efficiency rates, the typical treatment path of patients with gastric cancer was found for two EPSs: one efficient and another inefficient. Finally, the typical traits of the care pathways were established. CONCLUSIONS: Combining DEA and process mining proved to be a powerful approach understanding the problem and gaining valuable insight into the inner workings of the Colombian Health System, especially in terms of the treatment process performed by health care providers in critical illnesses such as cancer. However, no sufficiently compelling results were found to establish the contribution of such a combination to evaluate the quality in the delivery of health services.

Variable neighborhood search to solve the vehicle routing problem for hazardous materials transportation.

This work focuses on the Heterogeneous Fleet Vehicle Routing problem (HFVRP) in the context of hazardous materials (HazMat) transportation. The objective is to determine a set of routes that minimizes the total expected routing risk. This is a nonlinear function, and it depends on the vehicle load and the population exposed when an incident occurs. Thus, a piecewise linear approximation is used to estimate it. For solving the problem, a variant of the Variable Neighborhood Search (VNS) algorithm is employed. To improve its performance, a post-optimization procedure is implemented via a Set Partitioning (SP) problem. The SP is solved on a pool of routes obtained from executions of the local search procedure embedded on the VNS. The algorithm is tested on two sets of HFVRP instances based on literature with up to 100 nodes, these instances are modified to include vehicle and arc risk parameters. The results are competitive in terms of computational efficiency and quality attested by a comparison with Mixed Integer Linear Programming (MILP) previously proposed.

Significado psicológico del concepto investigación en investigadores: Psychological meaning of the concept of "research" in researchers

Esta investigación se planteó como objetivo establecer el significado psicológico de la "actividad de investigar", para un grupo de profesionales de las Ciencias Sociales. Se usó la técnica de Redes Semánticas Naturales, versión definida por Valdez (2004), que hace énfasis en el análisis del significado psicológico construido a partir de las vivencias. El instrumento fue aplicado a 46 asistentes de un evento académico en el área de Ciencias Sociales, elegidos mediante un muestreo no probabilístico intencional. Los resultados muestran un total de 220 palabras diferentes asociadas al término investigación (valor J). Los dos términos de mayor peso semántico fueron indagación (106) y búsqueda (101), en contraste con las palabras análisis y disciplina, cuyo peso semántico fue 33. A través de una prueba de independencia entre las variables sociodemográficas y el grupo SAM, se evidenció que no existe relación significativa con el género y la edad.

This research had the objective of establishing the psychological meaning associated with the "research activity" for Social Science Professionals. We used the Natural Semantic Network technique (Valdez, 2004), which emphasizes the analysis of the psychological meaning constructed from the experiences. The instrument was applied to 46 attendees of an academic event in the area of Social Sciences, in an intentional non-probabilistic sampling. The results show a total of 220 different words associated with the term "Research" (J value). The two terms of highest semantic weight were: Inquiry (106), Search (101), in contrast with the words Analysis and Discipline with semantic weight of 33. Through a test of independence between sociodemographic variables and the SAM group, no significant relationship with gender and age emerged.

Hemorragia fetomaterna masiva como causa de hidrops en gestación a término: reporte de caso y revisión de la literatura / Massive fetomaternal hemorrage cause hydrops in pregnancy at term: case report and literature revision

Objetivo: la hemorragia fetomaterna masiva es una complicación rara del embarazo, que puede causar anemia fetal severa y muerte fetal intrauterina. Se presenta un caso clínico con el objetivo de hacer una revisión de la fisiopatología del diagnóstico y del tratamiento Materiales y métodos: se presenta el caso clínico de una mujer en la semana 39 de embarazo, remitida al Hospital La Paz de Madrid, centro de referencia de atención materna y perinatal, por signos ecográficos de hidrops y de insuficiencia cardíaca derecha. El registro cardiotocográfico evidenció un patrón sinusoidal. La recién nacida presentó acidosis metabólica y anemia severa. El estudio anatomopatológico de la placenta fue sugestivo de anemia fetal crónica. El test de Kleihauer-Betke evidenció hemorragia fetomaterna de 90-100 ml. Se realizó una búsqueda bibliográfica en las bases de datos Medline vía Pubmed, EMBASE, LILACS y SciELO y la biblioteca Cochrane. Conclusión: el diagnóstico intrauterino es difícil, se debe sospechar cuando una mujer refiere reducción de movimientos fetales y cuando el registro cardiotocográfico muestra un patrón sinusoidal. En general, el estudio ecográfico es anodino, el Doppler de la arteria cerebral media puede ayudar en la identificación de los casos de anemia fetal, donde se evidencia un aumento del pico sistólico. Es importante la identificación precoz de los casos afectados para empezar un tratamiento sintomático de la anemia...

Objective: massive fetomaternal hemorrhage is a rarely occurring complication during pregnancy which can cause severe fetal anemia and intrauterine fetal death. A clinical case is presented here to review the pertinent pathophysiology, diagnosis and treatment. Materials and methods: the case of a 39 weeks pregnant woman admitted to La Paz Hospital in Madrid is reported; this hospital is the center for perinatal and maternal attention. The patient was referred due to sonographic signs of hydrops and right heart failure. Cardiotocographic records showed a sinusoidal pattern. The newborn presented metabolic acidosis and severe anemia. Pathologic examination of the placenta was suggestive of chronic fetal anemia. The Kleihauer-Betke test revealed a 90-100 ml fetomaternal hemorrhage. A literature search was made in Medline via Pubmed, EMBASE, LILACS and SciELO and the Cochrane Library. Conclusion: intrauterine diagnosis is difficult; massive fetomaternal hemorrhage should be suspected when a woman refers to reduced fetal movements and when the record shows a sinusoidal pattern in cardiotocography. Ultrasound is usually bland and Doppler of the middle cerebral artery may help in identifying cases of fetal anemia, revealing an increased systolic peak. Such cases must be identified early on to start symptomatic treatment of anemia...