Pluriversidad y ontologías múltiples. Otras miradas a la política pública del deporte en Colombia / Pluriversidade e múltiplas ontologias. Outras visões sobre a política pública de esporte na Colômbia / Pluriversity and multiple ontologies. Other views on the public policy of sport in Colombia

El artículo se centra en el segundo momento de la investigación indicadores para el deporte en Colombia, problematizándolos como rastros de la política pública. Busca la crítica y proposi-ción de marcos coherentes con horizontes tales como desarrollo humano, convivencia, paz y objetivos del Plan. Las fuentes utilizadas fueron El Plan Decenal del Deporte 2009-2019 y los planes de desarrollo e informes de gestión de las cinco principales ciudades entre 2012-2015. Hasta esta fase se constató la predominancia de indicadores cuantitativos, así como la necesi-dad de construir otros que superen la lógica instrumental y permitan avanzar en la búsqueda de recortes de la realidad más pertinentes con los objetivos del Plan, en un país que en su constitución se reconoce como pluriétnico y multicultural.

Summary the article focuses on the second moment of the research indicators for the sport in Colombia, problematizandolos as traces of public policy. Search for criticism and proposition of mark consistent with horizons such as human development, coexistence, peace and goals of the Plan. The sources used were the ten-year sports Plan 2009-2019, development plans, and annual reports of five major cities between 2012-2015. Up to this stage is found the predomi-nance of quantitative indicators, as well as the need to build others that exceed the instrumen-tal logic and contribute to advance the objectives of the Plan, in a country that in the search for more relevant reality cuts in its Constitution is recognized as multi-ethnic and multicultur-al.

O artigo enfoca o segundo momento de indicadores de pesquisa para o esporte na Colômbia, problematizandolos como vestígios de políticas públicas. Busca de crítica e proposição de marca consistente com horizontes como desenvolvimento humano, a coexistência, a paz e metas do plano. As fontes utilizadas foram o esporte dez anos plano 2009-2019 e planos de desenvolvimento e relatórios anuais das cinco principais cidades entre 2012-2015. Até esta fase encontra-se o predomínio de indicadores quantitativos, bem como a necessidade de cons-truir outros que excedem a lógica instrumental e contribuir para avançar os objetivos do plano, em um país que, na busca de uma realidade mais relevante, cortes em sua constituição é reconhecida como multi-étnica e multicultural.

Suicide in University students in Bogotá, Colombia, 2004-2014. / Suicidio en estudiantes universitarios en Bogotá, Colombia, 2004­2014.

We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004 - 2014). Of these, 69% occurred in males and 31% in females. The age range was 17 - 27 years, with 62% of the cases in the 19 - 22 year-old group. The most common mechanisms employed were suffocation and poisoning, followed by intentional falls, use of a firearm, and drug overdose. The selected location was the place of residence in 52% of cases and the university campus in 16% of cases. The distribution of students by area of knowledge showed a predominance of social and human science (44%) followed by engineering (22%). A history of difficulties in family and affective relationships was common among victims, as was a history of exposure to intolerance of differences in sexual orientation. The individuals surveyed expressed a wide range of interpretations of the significance of suicide, both positive (courage, self-affirmation, autonomy) and negative (defeat, despair, and an inability to adapt).

Suicidio en estudiantes universitarios en Bogotá, Colombia, 2004-2014 / Suicide in University students in Bogotá, Colombia, 2004-2014

Resumen Estudio cualitativo, exploratorio, descriptivo y retrospectivo en cinco universidades de Bogotá, Colombia, para conocer la magnitud, las principales características y significados y el impacto del suicidio de estudiantes universitarios. Se realizaron 66 entrevistas semiestructuradas a personal institucional. Se identificaron 45 casos de suicidio consumado en el período 2004 - 2014. El 69% de los casos fueron hombres y el 31% mujeres. El rango de edad estuvo entre 17 y 27 años; 62% entre 19 y 22 años. Las formas más frecuentes de cometer el suicidio fueron el ahorcamiento y el envenenamiento, seguidos del lanzamiento al vacío, el uso de armas de fuego y el consumo de sustancias psicoactivas. El 52% de los casos eligió el lugar de residencia para cometer el hecho; el 16% eligió el campus universitario. Áreas de conocimiento: el 44% pertenecía a ciencias sociales y humanas y el 22% a ingenierías. Motivos y procesos desencadenantes del suicidio identificados, el principal grupo se relaciona con lo familiar, en especial desintegración familiar, ruptura de relaciones de pareja e intolerancia a opciones sexuales diferentes. Los entrevistados expresaron diversos significados del suicidio, tanto positivos: acto de valor y ejercicio de la autonomía, como negativos: impotencia, desadaptación y derrota.

Abstract We report the results of a retrospective, descriptive, qualitative study of suicide among university students in Bogotá, Colombia. The objective of this study was to document the magnitude, principal characteristics, and impact of this phenomenon in the selected population. A semi-structured survey was employed to collect information from 66 individuals linked to the universities. A total of 45 cases of suicide were documented in the study period (2004 – 2014). Of these, 69% occurred in males and 31% in females. The age range was 17 – 27 years, with 62% of the cases in the 19 – 22 year-old group. The most common mechanisms employed were suffocation and poisoning, followed by intentional falls, use of a firearm, and drug overdose. The selected location was the place of residence in 52% of cases and the university campus in 16% of cases. The distribution of students by area of knowledge showed a predominance of social and human science (44%) followed by engineering (22%). A history of difficulties in family and affective relationships was common among victims, as was a history of exposure to intolerance of differences in sexual orientation. The individuals surveyed expressed a wide range of interpretations of the significance of suicide, both positive (courage, self-affirmation, autonomy) and negative (defeat, despair, and an inability to adapt).

O papel do Centro Latino-Americano de Estudos de Violência e Saúde Jorge Careli (Claves) na produção científica e no enfrentamento da Violência no Brasil e na América Latina / The role of the Latin American Center for Studies on Violence and Health Jorge Careli (Claves) in scientific production and confronting violence in Brazil and Latin America

"Este prefácio tem duplo objetivo. O primeiro é olhar em perspectiva histórica para o contexto do surgimento do Claves, tentando identificar o momento político e os principais atores envolvidos na sua fundação, e reconhecer algumas das características originais do Centro. O segundo é fazer uma breve aproximação ao momento atual e a sua intensa dinâmica intelectual, acadêmica e social em relação à compreensão e ao enfrentamento da violência" (AU)

Entre los negocios y los derechos / Between business and rights

El artículo propone hacer una reflexión sobre los postulados y los valores que sustentan el actual Sistema de Seguridad Social en Salud en Colombia, a partir de cinco hechos significativos. El primero es el enriquecimiento de las Entidades Promotoras de Salud, que no priorizan el bienestar humano y se dedican a asuntos del ámbito financiero y administrativo; otro de los hechos, descubierto en el 2011, es la alianza entre las empresas encargadas de ordenar la atención médica de la población y administrar los recursos para financiarla, aumentar los cobros y aumentar así sus ganancias. Por otro lado, está el cierre de las camas de pediatría por ser mal negocio; datos recientes informan de la existencia de solo seis camas de alta complejidad por cada 10 000 niños. La falta de regulación en los precios de los medicamentos, permitido por el modelo de salud vigente, es otro asunto importante que afecta las posibilidades de adquisición de la población más desfavorecida. Y finalmente, el hecho más impactante: la muerte evitable y culpable de miles de personas, producida, entre otros, por la falta de atención oportuna, el llamado paseo de la muerte. Los cinco hechos enunciados develan algunas de los intereses y prácticas que se han desarrollado en los 20 años de existencia del modelo de salud colombiano. Hoy en muchos países se requiere un cambio en el sistema de salud y en el papel del Estado frente a ella, así como en los valores que inspiran a la sociedad en su conjunto.

The article presents some reflections on the provisions and values underlying the real Social Security System for Health in Colombia on the basis of five significant events. The first one is the enrichment of health promoting entities which do not give priority to the human wellbeing and devote themselves to financial and managing affairs. The second one, disclosed in 2011, is the alliance between the companies in charge of the medical care of the population and of administering the resources to finance this activity, in order to increase the charges and the profits as well. On the other hand, the dismantling of pediatric beds since it is bad business; in this regard, recent data reported that there are just 6 highly complex beds per each 10 000 children. Another event is the deregulation of drug prices authorized by the present model, which affects the purchasing possibilities of the more neglected population. Finally, the most striking event, that is, the preventable death of thousands of persons cause, among other things, by the lack of timely care, the so called death trip. The five events already stated reveal some of the interests and practices that the Colombian health model has developed for 20 years of existence. Currently, most countries require some changes in the health care systems and in the role of the state in this field, as well as in the values that guide the society as a whole.

Estudo multicêntrico da mortalidade por homicídios em países da América Latina / Multicentric study of deaths by homicide in Latin American countries

Realizou-se um estudo epidemiológico descritivo da mortalidade por homicídios em países da América Latina (Argentina, Brasil, Colômbia e México) de 1990 a 2007. Analisam-se óbitos por causas externas e homicídios, codificados nas 9ª. e 10ª. revisões da Classificação Internacional de Doenças/CID, considerando-se sexo, faixa etária e meio usado na agressão. Apresentam-se números, proporções e taxas ajustadas de mortalidade por homicídios. Usou-se o modelo de regressão linear na tendência das taxas de homicídios por grupos etários. No período, os países contabilizaram 4.086.216 mortes por causas externas e 1.432.971 homicídios. Na Argentina as causas externas cresceram 54,5%, mas diminuíram nos demais (37% no México; 31,8% na Colômbia e 8,1% no Brasil). As razões de mortalidade por homicídios para ambos os sexos foram de 9,1 na Colômbia, 4,4 no Brasil e 1,6 no México, tomando-se as taxas da Argentina como referência. A evolução das taxas de homicídios por faixa etária e sexo mostrou-se distinta nos países: em todos os grupos etários foi crescente no Brasil e decrescente na Colômbia. Destaca-se a necessidade de se priorizar os jovens do sexo masculino nas políticas públicas de atenção e prevenção e da região adotar políticas inclusivas, ampliar e consolidar sua democracia e os direitos dos seus habitantes.

This article is a descriptive epidemiological study of deaths by homicide in Latin American countries (Argentina, Brazil, Colombia and Mexico) from 1990 to 2007. Deaths due to external causes and homicides, as codified in the 9th and 10th revisions of the International Classification of Diseases/ICD, were analyzed considering sex, age and manner of assault. The numbers, ratios and adjusted rates for deaths by homicide are presented. A linear regression model was used to ascertain the trend of homicide rates by age group. During the period, 4,086,216 deaths from external causes and 1,432,971 homicides were registered in these countries. Deaths from external causes rose 54.5% in Argentina but fell in the other countries (37% in Mexico, 31.8% in Colombia, and 8.1% in Brazil). The ratio for deaths by homicide for both sexes was 9.1 in Colombia, 4.4 in Brazil and 1.6 in Mexico, using the Argentinian rates as a benchmark. There were differences in the evolution of homicide rates by age and sex in the countries: the rate rose in Brazil and fell in Colombia for all age groups. The need to prioritize young males in public policies related to health care and prevention is stressed, as well as the need for the region to adopt inclusive policies and broaden and consolidate democracy and the rights of inhabitants.

Mortalidad por homicidio en Medellín, 1980-2007 / Deaths by homicide in Medellin, 1980-2007

La ciudad de Medellín, Colombia, ha enfrentado un grave problema de violencia, particularmente homicida. Para avanzar en el conocimiento de la magnitud, distribución, principales características y posibles explicaciones de este problema, se realizó un estudio descriptivo-analítico retrospectivo para el período 1980-2007. Se revisaron bases de datos oficiales y registros hospitalarios; se realizó un grupo focal y se revisó la bibliografía disponible. Se encontró que la ciudad vivió una escalada de violencia homicida en el período, sumando un total de 84.863 homicidios. El 93% de las víctimas fue de sexo masculino y el 7% femenino. El grupo de edad más afectado fue el de 20-29 años. Los hombres de este grupo de edad registraron en 1991, el peor del período, una tasa sorprendente: 1.709 /100.000. Le siguió el subgrupo de 15-19 años, pero aún los grupos de edad de los extremos de la vida registraron tasas preocupantes. Las principales víctimas fueron los hombres jóvenes, de estratos medio-bajo y bajo, como se ha observado en otras ciudades y países de la región. Se identificaron las principales causas, los problemas de información y atención y las consecuencias del problema sobre el personal y los servicios de salud. Al final se plantean algunas tareas del sector salud en el enfrentamiento de la violencia homicida.

The Colombian city of Medellin has faced a severe problem of violence and homicide. The goal of this retrospective, descriptive-analytical study was to assess the magnitude, distribution, most salient characteristics and possible explanations for the problem between 1980 and 2007. Data were obtained from official databases, hospital records and the available literature, and a focus group was set up. There was a dramatic rise in homicides in the city in the time interval studied, with a total of 84,863 documented murders. Ninety-three percent of the victims were male. The 20 to 29 year-old age group was the most affected. Males in this age group, during the worst year of the period (1991), registered an astounding murder rate of 1,709 per 100,000. Even males in the 15 to 19 year age group and the older brackets saw high murder rates. The most common victims were from the lower and lower-middle socioeconomic strata, as has been observed elsewhere in the region. Serious problems were identified in information and in the provision of services. The impact of homicide on the delivery of healthcare services is discussed and a series of tasks for the healthcare sector in the control of this type of violence is proposed.

[Multicentric study of deaths by homicide in Latin American countries]. / Estudo multicêntrico da mortalidade por homicídios em países da América Latina.

This article is a descriptive epidemiological study of deaths by homicide in Latin American countries (Argentina, Brazil, Colombia and Mexico) from 1990 to 2007. Deaths due to external causes and homicides, as codified in the 9th and 10th revisions of the International Classification of Diseases/ICD, were analyzed considering sex, age and manner of assault. The numbers, ratios and adjusted rates for deaths by homicide are presented. A linear regression model was used to ascertain the trend of homicide rates by age group. During the period, 4,086,216 deaths from external causes and 1,432,971 homicides were registered in these countries. Deaths from external causes rose 54.5% in Argentina but fell in the other countries (37% in Mexico, 31.8% in Colombia, and 8.1% in Brazil). The ratio for deaths by homicide for both sexes was 9.1 in Colombia, 4.4 in Brazil and 1.6 in Mexico, using the Argentinian rates as a benchmark. There were differences in the evolution of homicide rates by age and sex in the countries: the rate rose in Brazil and fell in Colombia for all age groups. The need to prioritize young males in public policies related to health care and prevention is stressed, as well as the need for the region to adopt inclusive policies and broaden and consolidate democracy and the rights of inhabitants.

[Deaths by homicide in Medellin, 1980-2007]. / Mortalidad por homicidio en Medellín, 1980-2007.

The Colombian city of Medellin has faced a severe problem of violence and homicide. The goal of this retrospective, descriptive-analytical study was to assess the magnitude, distribution, most salient characteristics and possible explanations for the problem between 1980 and 2007. Data were obtained from official databases, hospital records and the available literature, and a focus group was set up. There was a dramatic rise in homicides in the city in the time interval studied, with a total of 84,863 documented murders. Ninety-three percent of the victims were male. The 20 to 29 year-old age group was the most affected. Males in this age group, during the worst year of the period (1991), registered an astounding murder rate of 1,709 per 100,000. Even males in the 15 to 19 year age group and the older brackets saw high murder rates. The most common victims were from the lower and lower-middle socioeconomic strata, as has been observed elsewhere in the region. Serious problems were identified in information and in the provision of services. The impact of homicide on the delivery of healthcare services is discussed and a series of tasks for the healthcare sector in the control of this type of violence is proposed.

The effects of the armed conflict on the life and health in Colombia

O presente trabalho trata das conseqüências do conflito armado interno (CAI) que a Colômbia tem vivido durante as últimas quatro décadas. Começa identificando o contexto e o momento atual do conflito. A seguir, são descritas algumas das formas, expressões e conseqüências do conflito armado interno com maior impacto sobre a vida, a qualidade de vida, a saúde e as doenças da população, e sobre os serviços de saúde no país. Especial ênfase é dada às altas taxas de mortalidade por homicídio, ao fenômeno do deslocamento forçado pela violência, aos sequestros e às minas antipessoais. Entre os grupos populacionais mais afetados, destacam-se homens jovens, mulheres, crianças e as minorias étnicas indígenas e afrodescendentes. Esta análise também se refere ao sério problema das contínuas infrações da Lei Humanitária Internacional e aos ataques contra a Missão Médica, assim como às conseqüências negativas do conflito sobre a prestação de serviços de saúde. Para concluir, são feitos alguns comentários gerais sobre a situação descrita e dadas algumas sugestões para o estudo do problema e possíveis ações partindo do setor saúde.

Efeitos do conflito armado sobre a vida e a saúde na Colômbia / The effects of the armed conflict on the life and health in Colombia

O presente trabalho trata das conseqüências do conflito armado interno (CAI) que a Colômbia tem vivido durante as últimas quatro décadas. Começa identificando o contexto e o momento atual do conflito. A seguir, são descritas algumas das formas, expressões e conseqüências do conflito armado interno, com maior impacto sobre a vida, a qualidade de vida, a saúde e as doenças da população e sobre os serviços de saúde no país. Especial ênfase é dada às altas taxas de mortalidade por homicídio, ao fenômeno do deslocamento forçado pela violência, aos seqüestros e às minas antipessoais. Entre os grupos populacionais mais afetados, destacam-se homens jovens, mulheres, crianças e as minorias étnicas indígenas e afrodescendentes. Esta análise também se refere ao sério problema das contínuas infrações da Lei Internacional Humanitária e aos ataques contra a Missão Médica, assim como às conseqüências negativas do conflito sobre a prestação de serviços de saúde. Para concluir, são feitos alguns comentários gerais sobre a situação descrita e dadas algumas sugestões para o estudo do problema e possíveis ações partindo do setor saúde.

This article is an approach to the consequences of the internal armed conflict that Colombia has lived during the last four decades. It starts with the identification of the conflict's context and its current characteristics. It then focuses on the different manifestations and consequences of the conflict and on their deep impact on the life, quality of life, health,disease, and health services of the population. In special we refer to the high homicide rates, forced internal displacement, kidnapping and the use of antipersonnel mines. Among the most affected groups are young men, women, children, and ethnic minorities such as indigenous and afro-american people. This analysis also refers to the frequent violations of International Human Rights and to the negative impact of violence on the provision of health services. Finally, general conclusions are drawn, and alternatives for studies on the problem and for possible solutions from the standpoint of the health sector are proposed.

A social-medical approach to violence in Colombia.

Violence is the main public health problem in Colombia. Many theoretical and methodological approaches to solving this problem have been attempted from different disciplines. My past work has focused on homicide violence from the perspective of social medicine. In this article I present the main conceptual and methodological aspects and the chief findings of my research over the past 15 years. Findings include a quantitative description of the current situation and the introduction of the category of explanatory contexts as a contribution to the study of Colombian violence. The complexity and severity of this problem demand greater theoretical discussion, more plans for action and a faster transition between the two. Social medicine may make a growing contribution to this field.

Para que la salud sea publica: algunas lecciones de la reforma de salud y seguridad social en Colombia / Public health: social security law balance

A diez años de la expedición de la ley 100 de 1993, que introdujo en Colombia una profunda reforma al sistema de salud y seguridad social, este artículo presenta algunos elementos para un balance y extrae algunas lecciones para su aplicación En la primera parte se presentan hechos y datos en los campos de la cobertura del aseguramiento, la inequidad en salud, la situación actual de la salud pública en el país y la percepción de la salud, la seguridad social y el papel del Estado en Colombia, que en general sugieren un balance negativo del modelo impulsado por la ley 100. En la segunda se enuncian algunos principios mínimos que el autor, con base en sus análisis sobre el modelo en cuestión, considera se deben tener en cuenta en el momento de construir o reconstruir modelos de salud y seguridad social en otros países. Son ellos los principios de: realidad, integralidad, coherencia, y participación social