Estimating the burden of disease and the economic cost attributable to chikungunya, Colombia, 2014.

BACKGROUND: Chikungunya (CHIK) virus disease is expected to be a considerable cause of disability and economic burden in Latin America given its chronic sequelae, particularly its chronic inflammatory rheumatism. There have been no previous studies assessing CHIK costs and disability in Latin America. METHODS: We calculated incidence rates for CHIK during the 2014 outbreak in Colombia using epidemiological data provided by the Colombian National Institute of Health, using demographic data from the National Administrative Department of Statistics. The burden of disease was estimated through disability adjusted life years (DALYs) lost and the costs were estimated based on the national recommendations for CHIK acute and chronic phase attention. RESULTS: There were a total of 106 592 cases, with incidence rates ranging from 0 to 1837.3 cases/100 000 population in different departments. An estimate was made of total DALYs lost of 40.44 to 45.14 lost/100 000 population. The 2014 outbreak estimated costs were at least US$73.6 million. CONCLUSIONS: Our estimates raise concerns about the effects of continued CHIK spread in Colombia and other Latin-American countries. The lack of transmission control for this disease and potential for spread means that there will be significant acute and chronic disability and related costs in the short and long term for Latin American health care systems.

Panorama de las enfermedades transmisibles en Colombia desde la perspectiva del Plan Decenal de Salud Pública 2012-2021: [Editorial] / Panorama of communicable diseases in Colombia from the perspective of the Public Health 2012-2021 Ten-Year Plan: [Editorial]

Las enfermedades transmisibles en Colombia han demostrado históricamente diferentes comportamientos 1 , debido a inequidades sociales 2,3 y condiciones precarias de saneamiento básico, entre otros factores que han dado lugar a altas tasas de morbimortalidad poblacional 4-7. Colombia adoptó el Plan Decenal de Salud Pública 2012- 2021 (PDSP), mediante resolución número 1841 (2013) del Ministerio de Salud, apostando políticamente por la equidad en salud, entendida como: « ausencia de diferencias en salud entre grupos sociales consideradas innecesarias, evitables e injustas ¼ 8 . Esto implica que la equidad sanitaria se logra cuando todos alcanzan su potencial de salud independientemente de sus condiciones culturales y socioeconómicas. El PDSP es producto del Plan Nacional de Desarrollo 2010-2014, y busca reducir la inequidad en salud, planteando 3 objetivos para lograrlo, avanzar hacia la garantía del goce efectivo del derecho a la salud, mejorar las condiciones de vida que modifican la situación de salud y disminuyen la carga de enfermedad existente y no tolerar la mortalidad, la morbilidad y las discapacidades evitables 9 , para alcanzar mayor equidad en salud y desarrollo humano sostenible, construir capital humano y disminuir vulnerabilidades sociales, incorporando políticas nacionales e internacionales dirigidas a grupos poblacionales como niños, niñas, adolescentes, jóvenes y personas mayores, mujeres víctimas de maltrato y otras clases de violencia de género, víctimas del conflicto, personas con discapacidad y grupos étnicos. Cuenta con 8 dimensiones prioritarias, que incluyen la vida saludable y enfermedades transmisibles (VSET), entre otras, cada una a su vez con objetivos, estrategias, metas e indicadores

Communicable diseases in Colombia have historically shown different behaviours 1 , due to social inequities 2,3 and precarious basic sanitation conditions, among other factors that have led to high morbidity and mortality rates in the population 4-7. Colombia adopted the Ten-Year Public Health Plan 2012-2021 (PDSP), through resolution number 1841 (2013) of the Ministry of Health, making a political commitment to health equity, understood as: "the absence of differences in health between social groups considered unnecessary, avoidable and unfair "8 . This implies that health equity is achieved when everyone reaches their health potential regardless of their cultural and socio-economic conditions. The PDSP is a product of the National Development Plan 2010-2014, and seeks to reduce inequity in health, setting out 3 objectives to achieve this: to move towards guaranteeing the effective enjoyment of the right to health, to improve living conditions that modify the health situation and reduce the existing burden of disease, and not to tolerate avoidable mortality, morbidity and disability 9 , to achieve greater equity in health and sustainable human development, build human capital and reduce social vulnerabilities, incorporating national and international policies aimed at population groups such as children, adolescents, youth and the elderly, women victims of abuse and other kinds of gender-based violence, victims of conflict, people with disabilities and ethnic groups. It has 8 priority dimensions, including healthy living and communicable diseases (STDs), among others, each in turn with objectives, strategies, targets and indicators.

Asociación entre incidencia de tuberculosis e Índice de Desarrollo Humano en 165 países del mundo / Association between tuberculosis incidence and the Human Development Index in 165 countries of the world

Objetivos. Evaluar la relación entre el índice de desarrollo humano (IDH) y la incidencia de tuberculosis (TB) en 165 países del mundo en el período 2005-2011. Materiales y métodos. Se realizó un estudio ecológico para el cual el IDH se obtuvo de la base de datos del Fondo de Naciones Unidas para el Desarrollo (PNUD) y la incidencia de TB del Programa Alto a la TB de la Organización Mundial de la Salud (OMS). Se evaluó la variación anual de las variables y se realizaron modelos de regresión no lineales (exponencial). Resultados. Al analizar los datos con los modelos de regresión no lineal, se observó que los países con mayores tasas de incidencia de TB fueron aquellos con menores valores de IDH, siendo significativa su asociación (p<0,01). De igual forma se observó que en los países, la variación en el tiempo se asoció significativamente con la variación en el IDH. Conclusiones. Se ha encontrado una relación inversa y significativa entre el IDH y la morbilidad por TB en los países estudiados, incluidos tanto los países de mayor carga de enfermedad como los de la región andina en Latinoamérica. Esta información refleja la influencia significativa de indicadores socioeconómicos como el IDH sobre la tasa de incidencia de la TB, especialmente en países endémicos, siendo inversa entre ambos tipos de variables; con el incremento o mejoría del IDH la tasa de incidencia de la enfermedad disminuyó o se encontró siendo significativamente menor.

Objectives. Assess relationship between the Human Development Index (HDI) and the incidence of tuberculosis (TB) in 165 countries in the World in the period 2005-2011. Materials and methods. An ecological study was done, using HDI data that were obtained from the United Nations Development Program (UNDP), and the incidence rates from the Stop TB Program of the World Health Organization (WHO). The annual variation of the variables was assessed and non-linear regression models (Exponential), were done. Results. At the non-linear regression models, it was observed that the relationship between epidemiological and HDI was significant, those countries with higher rates presented lower values of HDI (p<0.01). Additionally the variation in time was significantly associated with HDI variation. Conclusions. This information reflect the significant influence of socioeconomical indicators such as the HDI on the TB incidence rates in the World, particularly in endemic countries, being an inverse relationship between both types of variables; with an increase or improvement in the HDI, the disease incidence rate decreased or it is found lower.

La investigación científica en tuberculosis: Evaluación bibliométrica de las contribuciones de la literatura colombiana / Scientific research in tuberculosis: bibliometric assesment of the colombian contributions to the literature

Introducción: La tuberculosis (TB) es un importante problema de salud tanto a nivel mundial como también en Colombia, por lo cual se requiere intensificar más acciones en salud y en investigación. Se realizó una evaluación bibliométrica de las contribuciones de la literatura colombiana sobre TB con el objeto de determinar el nivel de producción en la materia. Materiales y métodos: Estudio de producción colombiana en TB en las bases MEDLINE/ GOPUBMED (1809-2012), Scopus (1959-2012), SciELO Colombia (20042012) e IMBIOMED (2005-2012). Se incluyen todos los tipos de estudios, caracterizándolos por años, cooperación internacional (CI), ciudad de origen de la publicación (COP), revista de publicación (RP) y autores con mayor contribución (AMC). Resultados: En MEDLINE, se encontraron 232 artículos (0,12% del total en TB, 0,49/100.000 hab.), de los cuales 52,2% fueron 20052012, promedio 2007-2011 de 19,6±5,1. La CI se observó en 21,9%. Bogotá, Medellín y Cali publicaron 65,52% de los artículos, 16,4% en Biomédica, 5,2% en Revista de Salud Pública y 4,3% en IJTLD. En MEDLINE el AMC es Luís F. García (Universidad de antioquia). En scopus los resultados son similares a MEDLINE (n=168, 0,08%). En SciELO sólo existen 29 registros (de 30) y en IMBIOMED 35 (de 513, 6,8%). Discusión: La producción científica en TB en Colombia es baja, no solo al compararla con países desarrollos (EUA, 4,08 artículos/100.000 hab.) sino con otros en América Latina incluso de menor incidencia como chile (19 casos/100.000 hab.) pero con una productividad 2,2 veces mayor (1,09 artículos/100.000 hab.). Un mayor fomento de la investigación, desde pregrado, una mayor interacción entre organismos públicos y privados, así como mayor cooperación académica e internacional, podrían permitir disminuir dichas brechas, incrementar la publicación científica y que la aplicación de dichos conocimientos generados en el propio país contribuya a mejorar la epidemiología y los diferentes aspectos de la enfermedad.

Introduction: Tuberculosis (TB) is an important public health problem, globally as well in Colombia. For these reasons more actions in health and research should be intensified. A bibliometric assessment of the colombian contributions to the biomedical literature on TB with the objective to determinate the level of production on it was done. Methods: Bibliometric study of the colombian production on TB in the databases MEDLINE/GOPUBMED (1809-2012), SCOPUS (1959-2012), SCIELO Colombia (2004-2012) and IMBIOMED (2005-2012). Ah kind of studies, analyzing by years, international cooperation (IC), publication origin city (POC), publication journal (PJ) and authors with more contribution (AMC) were included. Results: at MEDLINE, 232 articles were found (0.12% from the total on TB, 0.49/100,000 hab.), from them 52.2% were 2005-2012, mean 2007-2011 of 19.6±5.1. IC was recorded in 21.9%. Bogotá, Medellín and Cali published 65.52% of the articles, 16.4% at Biomédica, 5.2% at Revista de Salud Pública and 4.3% at IJTLD. At MEDLINE the AMC was Luís F. García (Universidad de Antioquia). At SCOPUS results were similar to MEDLINE (n=168, 0.08%). At SciELO only 29 records were found (out of 30) and at IMBIOMED 35 (of 513, 6.8%). Discussion: scientific production on TB in Colombia is low, not just comparing it with developed countries (UsA, 4.08 articles/100,000 hab.) but also with others in Latin America with even lower TB incidence such as Chile (19 cases/100,000 hab.) but with a better productivity 2.2 times higher (1.09 articles/100,000 hab.). A higher promotion of research, beginning in undergraduate studies, better interaction between public and private organizations, as well more academic and international cooperation, would allow to decrease those gaps, increase scientific publication and let that the application of that generated knowledge in the same country contribute to improve the TB epidemiology and different aspects of disease.

[Association between tuberculosis incidence and the Human Development Index in 165 countries of the world]. / Asociación entre incidencia de tuberculosis e Índice de Desarrollo Humano en 165 países del mundo.

OBJECTIVES: Assess relationship between the Human Development Index (HDI) and the incidence of tuberculosis (TB) in 165 countries in the World in the period 2005-2011. MATERIALS AND METHODS: An ecological study was done, using HDI data that were obtained from the United Nations Development Program (UNDP), and the incidence rates from the Stop TB Program of the World Health Organization (WHO). The annual variation of the variables was assessed and non-linear regression models (Exponential), were done. RESULTS: At the non-linear regression models, it was observed that the relationship between epidemiological and HDI was significant, those countries with higher rates presented lower values of HDI (p<0.01). Additionally the variation in time was significantly associated with HDI variation. CONCLUSIONS: This information reflect the significant influence of socioeconomical indicators such as the HDI on the TB incidence rates in the World, particularly in endemic countries, being an inverse relationship between both types of variables; with an increase or improvement in the HDI, the disease incidence rate decreased or it is found lower.

Impacto de una actividad formativa en los conocimientos, actitudes y percepciones sobre tuberculosis de estudiantes de medicina de una universidad de Risaralda Colombia / Impact of one formative activity in the students`knowledge, attitudes and perceptions on tuberculosis from one university in Risaralda Colombia

La tuberculosis continúa siendo una de las principales enfermedades tropicales en términos de morbimortalidad. De allí la importancia de mejorar su prevención, a través de diferentes estrategias, incluida la educación médica continua. En el marco del Día Mundial de la lucha contra la tuberculosis se realizó un simposio eduactivo incluyendo charlas y una obra de teatro sobre diferentes aspectos de la enfermedad (duración 280 minutos). Antes de iniciar se aplicó una encuesta para evaluar conocimientos, actitudes y percepciones sobre tuberculosis, basada en guía para encuestas ACMS, de STOP Tuberculosis Partnership de la OMS. Al finalizar esta fue aplicada de nuevo. Se comparan las diferecias entre los resultados antes u después con la prueba X², confianza 95%. Se evaluó un total de 109 universitarios antes de iniciar (pre) y 103 después (pos) (total, 211 encuestas). Sobre las preguntas realizadas, la primera de ella fue "¿Cuán serio percibe usted el problema de la tuberculosis en su comunidad?". En la encuesta pre solo 50,9% lo consideró un problema muy serio. En la pos se incrementó a 94,1% (X²= 49,602; P<0,001). En la encuesta pre, 31,5% lo consideró como algo serio, 2,8% no tan serio, 8,3% no sabía y 6,5% no contestó. En la pos, el restante 5,9% correspondió solo a considerarlo como algo serio. En general se observó mejoría significativa sobre los conocimientos, actitudes y percepciones en síntomas, trasmisión, prevención, curación, que sentiría al ser diagnosticado y otros aspectos evaluados (P<0,05). Este tipo de abordajes, especialmente a nivel comunitario, debe ser replicado, con el fin de mejorar los conocimientos, actitudes y percepciones de la población no solo universitaria, sino también general, sobre la tuberculosis. Se requiere dar mayor información en las poblaciones afectadas y sus familiares sobre las formas de transmisión, para mitigar los mitos y el estigma, que es también prevalente

Tuberculosis continues to be one of the most principal tropical diseases in terms of its morbidity and mortality. Since there the importance to improve its prevention, through different strategies, included the continuing medical eduaction. In the context of the World Tuberculosis Day an educative symposium, including conferences and a theater play about different disease aspects (lasting 280 minutes), was done. Before start them, a questionnaire to assess knowledges, attitudes and perceptions about tuberculosis, based on the guide for surveys ACMS, of STOP Tuberculosis Partnership from the who, was applied. Finishing them this questionnaire was applied again. Differences between before and after results, using the X²-test, 95% confidence level, were compared. A total 109 universitary students (before) and 102 (after) were evaluated. About the applied questions, first of them was "How serious do you perceive the tuberculosis problem in your community?" In the pre-test survey only 50.9% considered it as a very serious problem. In the post-test it increased to 94.1% (X²=49.602; P<0.001). In the pre-test, 31.5% considered as something serious, 2.8% not so serious, 8.3% did not knew and 6.5% did not answered. In the post-test, resting 5.9% corresponded just no considered it as something serious. In genral a significant improvement about the knowledges, attitudes and perceptions in symptoms, transmission, prevention, cure, how feel about been diagnosed and other evaluated aspect was observed (P<0.05). This type of approach, especially at community level, should be replicated, with the goal to improve the knowledges, attitudes and perceptions of the population not just universitary, but also general, about tuberculosis. It is requerid to give more information in the affected populations and their families about the transmission, in order to mitigate the myths and stigma, which is also prevalent