Seroprevalence and seroconversion rates to SARS-CoV-2 in interns, residents, and medical doctors in a University Hospital in Bogotá, Colombia / Tasas de seroprevalencia y seroconversión al SARS-CoV-2 en internos, residentes y médicos en un Hospital Universitario de Bogotá, Colombia

Abstract Objectives: To determine the prevalence of antibodies to SARS-CoV-2 and the incidence of seroconversion in the first month of follow-up among interns, residents, and medical doctors attending patients at a University Hospital in Bogota (Colombia). Design or methods: A cross-sectional and a prospective study were performed during June, July, and August 2020 to assess seroprevalence and seroconversion rates using CLIA IgG for SARS-CoV-2. LFA IgG and IgM and ELFA IgM were also determined to explore concordance with CLIA IgG. Results: At baseline, 8 (2.28% 95%CI 1.16-4.43%) participants were IgG positive for SARS-CoV-2 by CLIA. At the end of the study, 21 (5.98% 95%CI 3.94-8.97%) individuals seroconverted by CLIA IgG. In all, 29 individuals had IgG by CLIA and of these 11 (3.13% 95%CI 1.76-5.52%) were asymptomatic. No associations with risk factors for infection were identified. CLIA IgG had moderate concordance (>962 samples) with LFA IgG and ELFA IgM, but minimal with LFA IgM. Conclusions: Our report is the first in Latina America on seroprevalence and seroconversion rates in medical healthcare workers. The relatively high rate (>3%) of asymptomatic health care workers with evidence of previous SARS-CoV-2 infection underscores the need to screen this population for infection to prevent infection/disease spread.

Resumen Objetivos: Determinar la prevalencia de anticuerpos frente al SARS-CoV-2 y la incidencia de seroconversión en el primer mes de seguimiento en internos, residentes y médicos que atienden pacientes en un Hospital Universitario de Bogotá (Colombia). Diseño y métodos: Se realizó un estudio transversal y prospectivo durante junio, julio y agosto de 2020 para evaluar las tasas de seroprevalencia y seroconversión utilizando CLIA IgG para SARS-CoV-2. También se determinaron LFA IgG e IgM y ELFA IgM para explorar la concordancia con CLIA IgG. Resultados: Al inicio del estudio, 8 (2,28% IC del 95% 1,16-4,43%) participantes fueron IgG positivos para SARS-CoV-2 por CLIA. Al final del estudio, 21 (5,98% IC 95% 3,94-8,97%) individuos seroconvirtieron por CLIA IgG. En total, 29 individuos tenían IgG por CLIA y de estos 11 (3,13% 95% IC 1,76-5,52%) eran asintomáticos. No se identificaron asociaciones con factores de riesgo de infección. El CLIA IgG tuvo una concordancia moderada (> 962 muestras) con LFA IgG y ELFA IgM, pero mínima con el LFA IgM. Conclusiones: Nuestro informe es el primero en América Latina sobre tasas de seroprevalencia y seroconversión en trabajadores médicos de la salud. La tasa relativamente alta (> 3%) de trabajadores de la salud asintomáticos con evidencia de infección previa por SARS-CoV-2 resalta la necesidad de realizar pruebas de detección de infección en esta población para prevenir la propagación de la infección.

Healthcare access barriers for FARC ex-combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters.

BACKGROUND: Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs-Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services. METHODS: Semi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk's Domains of Healthcare Access framework. RESULTS: Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system. CONCLUSIONS: FARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.

Teoría fundamentada / Grounded theory

RESUMEN La teoría fundamentada es un método cualitativo que enfatiza la inducción o emergencia de información de los datos para establecer una teoría o modelo. Desde la descripción clásica de Strauss y Glaser, se reconocen desarrollos o escuelas y se discuten algunas de las particularidades y diferencias entre ellos. La teoría fundamentada es un método versátil, organizado y riguroso, cuya aplicación en salud incluye campos diversos como la salud pública, la clínica y la educación.

ABSTRACT Grounded theory is a qualitative method that emphasises the induction or emergence of information from data, in order to establish a theory or model. From the classic description by Strauss and Glaser, different developments or schools are recognised, and some of the peculiarities and differences among them are discussed. Grounded theory is a versatile, organised and rigorous method, the application of which in health includes diverse fields such as public health, clinics and education.

[Web Visit Patterns for the Clinical Practice Guidelines for Management of Depressive Disorder and Alcohol Abuse-Dependence]. / Patrones de consulta en la web de las guías de práctica clínica sobree manejo del trastorno depresivo y el abuso-dependencia del alcohol.

INTRODUCTION: Clinical practice guidelines (CPG) are a set of recommendations for professionals, patients, and families, in order to make decisions about health care. The CPG respond to the need for concise, accurate, practical, and up to date information. In the field of mental health, Colombia has developed three GPC; alcohol (GPC-OH), depression (GPC-TDA), and schizophrenia. OBJECTIVES: To describe the Web Portal traffic related to psychiatry guidelines, with emphasis on the number of visits, distribution throughout Colombian cities, and estimating user behaviour patterns. METHODS: An evaluation was made of the traffic at the Clinical Practice Guidelines Web Portal of the Ministry of Health and Social Protection between 2013 and 2015 (two years of observation since the inauguration of the Portal). RESULTS: Out of the 45 GPC published on the website, the CPG-OH represented 1.21% of all page views of the Portal. CPG-TDA reached 1.52% (accumulated percentage of 2.73%), being the eighth most consulted guideline, with CPG-OH being number 16. The highest mean monthly number of visits for this group of guideliness was for the CPG-OH for health professionals (353 visits/month), and the lowest was for the CPG-AD for patients and relatives (24 single visits/month). Bogotá D.C. was the city where health carers accessed the guidelines more often. The guidelines for patients and relatives were consulted more in Villavicencio, Cúcuta, Manizales, Pereira, and Pasto. CONCLUSIONS: The web portal partially fulfills the purpose of circulating the CPG in Colombia. The visits to the CPG of mental health is quite low, and requires better dissemination strategies that allow the use of information and communication technology.

Sesgos en diseños analíticos / Research Bias in Analytical Studies

Los resultados de una investigación son, finalmente, la parte de mayor interés tanto para el investigador como para el lector; por eso es de especial interés que estos resultados sean válidos. Al evaluar si un resultado es válido, debemos tener en cuenta que éste puede estar afectado por el error aleatorio y por el error sistemático. El sesgo es una desviación (error) sistemática de la verdad y puede aparecer en cualquier momento de la investigación. Existen diversos tipos de sesgos: algunos propios de cada diseño de investigación y otros comunes a muchos diseños. Lo más importante es poder reconocerlos para así prevenirlos desde la fase del diseño o controlarlos durante el análisis en el caso del investigador o, en el caso de un lector interesado, reconocerlos para estimar en cierto modo si estos resultados son válidos o no. Se revisan los sesgos más frecuentes entre los diseños analíticos.

Investigation results are of major interest for both the investigator and the reader, this is the reason why their validity is important. While evaluating if a result is valid, we should keep in mind that this can be affected by the random error and by the systematic error. The bias is a systematic deviation (error) of the truth and can appear in any moment of the investigation. Many types of bias exist, some particular to each design and others common to many designs. It is of utmost importance to be able to recognize and then prevent them during the design phase or control them during the analysis in the case of the investigator or in the case of an interested reader to recognize them in order to estimate if the results are valid or not. We review the more common biases in analytical studies.