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2.
J Infect Dev Ctries ; 15(10): 1404-1407, 2021 10 31.
Article in English | MEDLINE | ID: covidwho-1518655

ABSTRACT

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects mainly the lungs causing pneumonia and complications like acute respiratory distress syndrome. Pneumothorax is a rare manifestation of the disease. This report is a description of a series of patients with COVID-19 and spontaneous pneumothorax, some of them with associated pulmonary cysts. METHODOLOGY: Cases were collected retrospectively. We included clinical data from medical records and described radiologic findings. Patients that developed pneumothorax during mechanical ventilation were excluded. RESULTS: Ten cases were included in this report, nine of them were male. The median age of our series was 62 years (IQR = 57-68). The median days since the onset of symptoms until the development of pneumothorax was 27 (IQR = 17-31), most cases developed after the second week of the diagnosis of pneumonia. Two cases required invasive mechanical ventilation, but pneumothorax occurred after ventilator weaning. Three cases showed subpleural pulmonary cysts. CONCLUSIONS: Cysts and pneumothorax are rare manifestations of SARS-CoV-2 pneumonia with mechanisms not completely understood. This report highlights the role of CT scan in diagnosis of COVID-19 complications.


Subject(s)
COVID-19/complications , Cysts/etiology , Lung/pathology , Pneumothorax/etiology , Aged , COVID-19/diagnostic imaging , COVID-19/epidemiology , Colombia/epidemiology , Cysts/diagnostic imaging , Cysts/epidemiology , Cysts/virology , Female , Humans , Lung/diagnostic imaging , Lung/virology , Male , Middle Aged , Pneumothorax/diagnostic imaging , Pneumothorax/epidemiology , Retrospective Studies , SARS-CoV-2/pathogenicity , Tomography, X-Ray Computed
3.
Biomedica ; 41(Sp. 2): 118-129, 2021 10 15.
Article in English, Spanish | MEDLINE | ID: covidwho-1478424

ABSTRACT

INTRODUCTION: Breastfeeding has a protective effect against acute respiratory and diarrheal infections. There are psychological and social effects due to physical isolation in the population in the mother-child group. OBJECTIVE: To assess the impact on infant mortality due to a decrease in the prevalence of breastfeeding during 2020 due to the physical isolation against the SARS CoV-2 (COVID-19) pandemic in Colombia. MATERIALS AND METHODS: We used the population attributable risk approach taking into account the prevalence of breastfeeding and its potential decrease associated with the measures of physical isolation and the relative risk (RR) of the association between exclusive breastfeeding and the occurrence of acute infection consequences in the growth (weight for height) of children under the age of five through a mathematical modeling program. RESULTS: We found an increase of 11.39% in the number of cases of growth arrest in the age group of 6 to 11 months with a 50% decrease in breastfeeding prevalence, as well as an increase in the number of diarrhea cases in children between 1 and 5 months of age from 5% (5.67%) on, and an increased number of deaths in children under 5 years (9.04%) with a 50% decrease in the prevalence of exclusive breastfeeding. CONCLUSIONS: A lower prevalence of breastfeeding has an impact on infant morbidity and mortality in the short and medium-term. As a public health policy, current maternal and childcare strategies must be kept in order to reduce risks in the pediatric population.


Introducción. La lactancia materna tiene un efecto protector frente a infecciones respiratorias y diarreicas agudas. Hay efectos psicológicos y sociales por el aislamiento físico en la población en el grupo materno-infantil. Objetivo. Evaluar el eventual impacto en la mortalidad infantil de la disminución en la prevalencia de la lactancia materna durante el 2020 a causa del aislamiento físico por la pandemia del SARS CoV-2 (COVID-19) en Colombia. Materiales y métodos. Se utilizó el enfoque de riesgo atribuible poblacional, teniendo en cuenta la prevalencia de la lactancia materna y su potencial disminución asociada con las medidas de aislamiento físico y el riesgo relativo (RR) de la asociación entre la lactancia materna exclusiva y el efecto de la aparición de infecciones agudas en el crecimiento (peso para la altura) de niños menores de cinco años mediante un programa de modelamiento matemático. Resultados. Se registró un aumento del número casos de detención del crecimiento en el grupo etario de 6 a 11 meses de 11,39 % al disminuir en 50 % la prevalencia de la lactancia materna, así como un mayor número de casos por diarrea en los cinco primeros meses a partir del 5 % (5,67 %), y un incremento en el número de muertes en menores de 5 años (9,04 %) al disminuirse en 50 % la prevalencia de la lactancia materna. Conclusiones. Se registró un impacto en la morbilidad y la mortalidad infantil a corto y mediano plazo al disminuir la prevalencia en la lactancia materna. Como política pública en salud, deben mantenerse las estrategias actuales de atención materno-infantil para disminuir riesgos en la población infantil.


Subject(s)
Breast Feeding/statistics & numerical data , COVID-19/epidemiology , Pandemics , Child Mortality , Child, Preschool , Colombia/epidemiology , Diarrhea, Infantile/epidemiology , Female , Growth Disorders/epidemiology , Humans , Infant , Infant Mortality , Models, Theoretical , Prevalence , SARS-CoV-2 , Social Isolation
4.
Rev Colomb Obstet Ginecol ; 72(2): 162-170, 2021 06 30.
Article in English, Spanish | MEDLINE | ID: covidwho-1456600

ABSTRACT

Objective: To make an approximation to the prevalence of sleep disorders in Colombian menopausal women during the COVID-19 pandemic Materials and Methods: Cross-sectional study as part of the Quality of Life in Menopause and Colombian Ethnic Groups research project [CAVIMEC+COVID STUDY]. The population consisted of women born and residing in Colombia, 40 to 59 years of age, who signed an informed consent and agreed to participate by completing an online form, freely and anonymously, in the first five days of June 2020. Sleep disorders were identified using the third item on the Menopause Rating Scale. Sociodemographic characteristics, presence and severity of sleep disorders and menopause status were explored. Descriptive statistics are provided. Results: Overall, 984 women aged 47.0 [IQR: 42.0-53.5] years were included: 84.5% mestizo, 13.7% Afro-Colombian, 1.7% indigenous; 39.3% were postmenopausal; 70% lived in the Caribbean region of Colombia. Sleep disorders were reported by 637 women (64.7%), and 112 (11.3%) had severe sleep disorders. Among postmenopausal women, 65.1% reported sleep disorders with 10.1% reporting severe disorders, while 64.5% of premenopausal reported sleep disorders, and 12.2% severe disorders. Conclusions: Sleep disorders could be a frequent problem among premenopausal as well as postmenopausal women in the pandemic time. This issue should be explored during gynecological visits in order to offer solutions. Population studies that confirm these observations are required.


Subject(s)
COVID-19 , Sleep Wake Disorders/epidemiology , Adult , Colombia/epidemiology , Cross-Sectional Studies , Female , Humans , Menopause , Middle Aged , Prevalence
5.
Infect Genet Evol ; 95: 105038, 2021 11.
Article in English | MEDLINE | ID: covidwho-1433673

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genetic diversity has the potential to impact the virus transmissibility and the escape from natural infection- or vaccine-elicited neutralizing antibodies. Here, representative samples from circulating SARS-CoV-2 in Colombia between January and April 2021, were processed for genome sequencing and lineage determination following the nanopore amplicon ARTIC network protocol and PANGOLIN pipeline. This strategy allowed us to identify the emergence of the B.1.621 lineage, considered a variant of interest (VOI) with the accumulation of several substitutions affecting the Spike protein, including the amino acid changes I95I, Y144T, Y145S and the insertion 146 N in the N-terminal domain, R346K, E484K and N501Y in the Receptor binding Domain (RBD) and P681H in the S1/S2 cleavage site of the Spike protein. The rapid increase in frequency and fixation in a relatively short time in Magdalena, Atlantico, Bolivar, Bogotá D.C, and Santander that were near the theoretical herd immunity suggests an epidemiologic impact. Further studies will be required to assess the biological and epidemiologic roles of the substitution pattern found in the B.1.621 lineage.


Subject(s)
Amino Acid Substitution , COVID-19/epidemiology , Genome, Viral , Mutation , SARS-CoV-2/genetics , Spike Glycoprotein, Coronavirus/genetics , COVID-19/transmission , COVID-19/virology , Colombia/epidemiology , Epidemiological Monitoring , Evolution, Molecular , High-Throughput Nucleotide Sequencing , Humans , Phylogeny , Phylogeography , Protein Domains , SARS-CoV-2/classification , SARS-CoV-2/pathogenicity , Severity of Illness Index
6.
Int J Med Inform ; 155: 104589, 2021 11.
Article in English | MEDLINE | ID: covidwho-1433353

ABSTRACT

BACKGROUND: During the COVID 19 pandemic, direct-to-consumer telehealth (DTC) services allowed patients real-time virtual access to healthcare providers, especially those with an established relationship. In Colombia, this care modality was implemented between 2019 and 2020, under national considerations, it was implemented for outpatient care in a highly complex university hospital in Cali, Colombia. METHODS: A descriptive study with prospective information collection was used to describe the implementation of the outpatient teleconsultation care model for patients. We constructed the clinical and process indicators with which we evaluated the model. FINDINGS: A total of 56,560 patients from our institution were treated by virtual outpatient consultation during the first nine months of the health emergency declared by COVID 19 in Colombia. The strategy made it possible to achieve coverage more significant than 100% in Cali and the departments of Colombia. Attention by teleconsultation was 19% of the total ambulatory care. The effectiveness in carrying out scheduled teleconsultations had an overall result of 91.5%. The accessibility results demonstrated the need to strengthen connectivity and accessibility to payments and strengthen technology adoption in the institution, health personnel, and patients. INTERPRETATION: Implementing an outpatient teleconsultation model allowed the continuity of the management with comprehensive coverage nationwide from a highly complex hospital in southwestern Colombia. The indicators' analysis should help strengthen the policies of access to telemedicine, especially with the consequences of the pandemic in low- and middle-income countries. Latin American evidence is necessary to establish the safety profile of telemedicine and the costs associated with the provision.


Subject(s)
COVID-19 , Remote Consultation , Ambulatory Care , Colombia/epidemiology , Hospitals , Humans , Pandemics , Prospective Studies , SARS-CoV-2
8.
Int J Environ Res Public Health ; 17(23)2020 12 03.
Article in English | MEDLINE | ID: covidwho-1389353

ABSTRACT

This is a mixed-methods research study carried out on a cohort of airport workers during the SARS-CoV-2 pandemic. We used quantitative and qualitative methods to describe the infection and risk perception of SARS-CoV-2 in a cohort of workers at the International Airport El Dorado/Luis Carlos Galán Sarmiento in Bogotá, Colombia. An incidence of SARS-CoV-2 infection of 7.9% was found in the workers. A high perception of risk was associated with activities such as using public transport. Risk perception is strongly influenced by practices related to work conditions and environments. These findings could help us understand the pandemic's dynamics and the conceptions of the risk of transmission to promote policies on health and safety in this group of workers.


Subject(s)
Airports , COVID-19/epidemiology , Risk Assessment , Adult , Colombia/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
9.
PLoS One ; 16(9): e0256566, 2021.
Article in English | MEDLINE | ID: covidwho-1381283

ABSTRACT

BACKGROUND: Adequate testing is critically important for control of the SARS-CoV-2 pandemic. Antibody testing is an option for case management and epidemiologic studies, with high specificity and variable sensitivity. However, characteristics of local populations may affect performance of these tests. For this reason, the National Institute of Health (INS) and regulatory agencies in Colombia require verification of diagnostic accuracy of tests introduced to the Colombian market. METHODS: We conducted a validation study of the Abbott SARS-CoV-2 test for qualitative detection of IgG using the Abbott Architect i2000SR. Participants and retrospective samples were included from patients with suspected SARS-CoV-2 infection, age ≥18 years, and ≥8 days elapsed since initiation of symptoms. Pre-pandemic plasma samples (taken before October 2019) were used as controls. We estimated the sensitivity, specificity and agreement (kappa) of the Abbott IgG test compared to the gold standard (RT-PCR). RESULTS: The overall sensitivity was 83.1% (95% CI: 75.4-100). Sensitivity among patients with ≥14 days since the start of symptoms was 85.7%, reaching 88% in samples collected from patients with COVID-19 symptoms onset >60 days. Specificity was 100% and the kappa index of agreement was 0.804 (95% CI: 0.642-0.965). CONCLUSIONS: Our findings show high sensitivity and specificity of the Abbott IgG test in a Colombian population, which meet the criteria set by the Colombian INS to aid in the diagnosis of COVID-19. Data from our patient groups also suggest that IgG response is detectable in a high proportion of individuals (88.1%) during the first two months following onset of symptoms.


Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing/instrumentation , COVID-19/blood , Immunoglobulin G/blood , Pandemics , SARS-CoV-2/metabolism , Adult , Aged , COVID-19/epidemiology , Colombia/epidemiology , Female , Humans , Male , Middle Aged , Prospective Studies , Retrospective Studies , Sensitivity and Specificity
10.
BMC Infect Dis ; 21(1): 878, 2021 Aug 27.
Article in English | MEDLINE | ID: covidwho-1376574

ABSTRACT

BACKGROUND: Healthcare Workers (HCW) are repeatedly exposed to SARS-CoV-2 infection. The aim of this study was to identify factors associated with SARS-CoV-2 infection among HCW in one of the largest cities in Colombia. METHODS: We conducted a case-control study, where cases had a positive reverse transcription-polymerase chain reaction and controls had a negative result. Participants were randomly selected and interviewed by phone. Analyses were performed using logistic regression models. RESULTS: A total of 110 cases and 113 controls were included. Men (AdjOR 4.13 95% CI 1.70-10.05), Nurses (AdjOR 11.24 95% CI 1.05-119.63), not using a high-performance filtering mask (AdjOR 2.27 95% CI 1.02-5.05) and inadequate use of personal protective equipment (AdjOR 4.82 95% CI 1.18-19.65) were identified as risk factors. Conversely, graduate (AdjOR 0.06 95% CI 0.01-0.53) and postgraduate (AdjOR 0.05 95% CI 0.005-0.7) education, feeling scared or nervous (AdjOR 0.45 95% CI 0.22-0.91), not always wearing any gloves, caps and goggles/face shields (AdjOR 0.10 95% CI 0.02-0.41), and the use of high-performance filtering or a combination of fabric plus surgical mask (AdjOR 0.27 95% CI 0.09-0.80) outside the workplace were protective factors. CONCLUSION: This study highlights the protection provided by high-performance filtering masks or double masking among HCW. Modifiable and non-modifiable factors and the difficulty of wearing other protective equipment needs to be considered in designing, implementing and monitoring COVID-19 biosafety protocols for HCW.


Subject(s)
COVID-19 , SARS-CoV-2 , Case-Control Studies , Colombia/epidemiology , Health Personnel , Humans , Male
12.
Int J Hyg Environ Health ; 238: 113833, 2021 09.
Article in English | MEDLINE | ID: covidwho-1370536

ABSTRACT

The coronavirus disease 2019 (COVID-19) is still spreading fast in several tropical countries after more than one year of pandemic. In this scenario, the effects of weather conditions that can influence the spread of the virus are not clearly understood. This study aimed to analyse the influence of meteorological (temperature, wind speed, humidity and specific enthalpy) and human mobility variables in six cities (Barranquilla, Bogota, Cali, Cartagena, Leticia and Medellin) from different biomes in Colombia on the coronavirus dissemination from March 25, 2020, to January 15, 2021. Rank correlation tests and a neural network named self-organising map (SOM) were used to investigate similarities in the dynamics of the disease in the cities and check possible relationships among the variables. Two periods were analysed (quarantine and post-quarantine) for all cities together and individually. The data were classified in seven groups based on city, date and biome using SOM. The virus transmission was most affected by mobility variables, especially in the post-quarantine. The meteorological variables presented different behaviours on the virus transmission in different biogeographical regions. The wind speed was one of the factors connected with the highest contamination rate recorded in Leticia. The highest new daily cases were recorded in Bogota where cold/dry conditions (average temperature <14 °C and absolute humidity >9 g/m3) favoured the contagions. In contrast, Barranquilla, Cartagena and Leticia presented an opposite trend, especially with the absolute humidity >22 g/m3. The results support the implementation of better local control measures based on the particularities of tropical regions.


Subject(s)
COVID-19 , SARS-CoV-2 , Colombia/epidemiology , Humans , Neural Networks, Computer , Pandemics , Weather
13.
Public Health ; 198: 123-128, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1366668

ABSTRACT

OBJECTIVES: Conducting contact tracing (CT) programs in low- and middle-income countries is challenging, and there is no evidence of their effectiveness in Latin America. We evaluated the effectiveness of CT on reducing fatality from COVID-19 in Colombia. STUDY DESIGN: The study design is a retrospective cohort study with nation-wide data of suspected and confirmed cases of severe acute respiratory syndrome (SARS-CoV-2) infection and their registered contacts. METHODS: We analyzed confirmed and suspected COVID-19 cases and their chains of contact using a nation-wide registry from March 28, 2020 to January 13, 2021. To estimate the effect of CT on fatality, we adjusted a multilevel negative binomial model using the number of deaths and the number of people within a chain of contacts as the outcome variable and offset variable, respectively. Sensitivity analysis was conducted using different cutoff values of contacts traced and a logistic model for the effect of CT on death at an individual level. RESULTS: We analyzed 1.4 million cases, 542,936 chains of contact, and 46,087 deaths. Only, 5.8% of total cases and contacts were included in a chain of a case and five or more contacts. We found that tracing of at least five contacts per case reduces fatality by 48% (95% confidence interval: 45-51), and, at the current levels of tracing in Colombia, it prevents 1.8% of deaths. Results obtained from the sensitivity analysis were consistent with the reduction of fatality at an individual level and higher protective effect with the higher number of contacts traced. CONCLUSIONS: In Colombia, tracing of at least five contacts per case reduces fatality from COVID-19. The coverage and intensity of tracing needs to be increased as a strategy to mitigate fatality in Colombia.


Subject(s)
COVID-19 , Contact Tracing , Colombia/epidemiology , Humans , Retrospective Studies , SARS-CoV-2
15.
Rev Colomb Obstet Ginecol ; 72(2): 162-170, 2021 06 30.
Article in English, Spanish | MEDLINE | ID: covidwho-1362784

ABSTRACT

Objective: To make an approximation to the prevalence of sleep disorders in Colombian menopausal women during the COVID-19 pandemic Materials and Methods: Cross-sectional study as part of the Quality of Life in Menopause and Colombian Ethnic Groups research project [CAVIMEC+COVID STUDY]. The population consisted of women born and residing in Colombia, 40 to 59 years of age, who signed an informed consent and agreed to participate by completing an online form, freely and anonymously, in the first five days of June 2020. Sleep disorders were identified using the third item on the Menopause Rating Scale. Sociodemographic characteristics, presence and severity of sleep disorders and menopause status were explored. Descriptive statistics are provided. Results: Overall, 984 women aged 47.0 [IQR: 42.0-53.5] years were included: 84.5% mestizo, 13.7% Afro-Colombian, 1.7% indigenous; 39.3% were postmenopausal; 70% lived in the Caribbean region of Colombia. Sleep disorders were reported by 637 women (64.7%), and 112 (11.3%) had severe sleep disorders. Among postmenopausal women, 65.1% reported sleep disorders with 10.1% reporting severe disorders, while 64.5% of premenopausal reported sleep disorders, and 12.2% severe disorders. Conclusions: Sleep disorders could be a frequent problem among premenopausal as well as postmenopausal women in the pandemic time. This issue should be explored during gynecological visits in order to offer solutions. Population studies that confirm these observations are required.


Subject(s)
COVID-19 , Sleep Wake Disorders/epidemiology , Adult , Colombia/epidemiology , Cross-Sectional Studies , Female , Humans , Menopause , Middle Aged , Prevalence
16.
Biomedica ; 41(Sp. 2): 118-129, 2021 10 15.
Article in English, Spanish | MEDLINE | ID: covidwho-1346717

ABSTRACT

INTRODUCTION: Breastfeeding has a protective effect against acute respiratory and diarrheal infections. There are psychological and social effects due to physical isolation in the population in the mother-child group. OBJECTIVE: To assess the impact on infant mortality due to a decrease in the prevalence of breastfeeding during 2020 due to the physical isolation against the SARS CoV-2 (COVID-19) pandemic in Colombia. MATERIALS AND METHODS: We used the population attributable risk approach taking into account the prevalence of breastfeeding and its potential decrease associated with the measures of physical isolation and the relative risk (RR) of the association between exclusive breastfeeding and the occurrence of acute infection consequences in the growth (weight for height) of children under the age of five through a mathematical modeling program. RESULTS: We found an increase of 11.39% in the number of cases of growth arrest in the age group of 6 to 11 months with a 50% decrease in breastfeeding prevalence, as well as an increase in the number of diarrhea cases in children between 1 and 5 months of age from 5% (5.67%) on, and an increased number of deaths in children under 5 years (9.04%) with a 50% decrease in the prevalence of exclusive breastfeeding. CONCLUSIONS: A lower prevalence of breastfeeding has an impact on infant morbidity and mortality in the short and medium-term. As a public health policy, current maternal and childcare strategies must be kept in order to reduce risks in the pediatric population.


Introducción. La lactancia materna tiene un efecto protector frente a infecciones respiratorias y diarreicas agudas. Hay efectos psicológicos y sociales por el aislamiento físico en la población en el grupo materno-infantil. Objetivo. Evaluar el eventual impacto en la mortalidad infantil de la disminución en la prevalencia de la lactancia materna durante el 2020 a causa del aislamiento físico por la pandemia del SARS CoV-2 (COVID-19) en Colombia. Materiales y métodos. Se utilizó el enfoque de riesgo atribuible poblacional, teniendo en cuenta la prevalencia de la lactancia materna y su potencial disminución asociada con las medidas de aislamiento físico y el riesgo relativo (RR) de la asociación entre la lactancia materna exclusiva y el efecto de la aparición de infecciones agudas en el crecimiento (peso para la altura) de niños menores de cinco años mediante un programa de modelamiento matemático. Resultados. Se registró un aumento del número casos de detención del crecimiento en el grupo etario de 6 a 11 meses de 11,39 % al disminuir en 50 % la prevalencia de la lactancia materna, así como un mayor número de casos por diarrea en los cinco primeros meses a partir del 5 % (5,67 %), y un incremento en el número de muertes en menores de 5 años (9,04 %) al disminuirse en 50 % la prevalencia de la lactancia materna. Conclusiones. Se registró un impacto en la morbilidad y la mortalidad infantil a corto y mediano plazo al disminuir la prevalencia en la lactancia materna. Como política pública en salud, deben mantenerse las estrategias actuales de atención materno-infantil para disminuir riesgos en la población infantil.


Subject(s)
Breast Feeding/statistics & numerical data , COVID-19/epidemiology , Pandemics , Child Mortality , Child, Preschool , Colombia/epidemiology , Diarrhea, Infantile/epidemiology , Female , Growth Disorders/epidemiology , Humans , Infant , Infant Mortality , Models, Theoretical , Prevalence , SARS-CoV-2 , Social Isolation
17.
Nat Commun ; 12(1): 4726, 2021 08 05.
Article in English | MEDLINE | ID: covidwho-1345558

ABSTRACT

Latin America has been severely affected by the COVID-19 pandemic but estimations of rates of infections are very limited and lack the level of detail required to guide policy decisions. We implemented a COVID-19 sentinel surveillance study with 59,770 RT-PCR tests on mostly asymptomatic individuals and combine this data with administrative records on all detected cases to capture the spread and dynamics of the COVID-19 pandemic in Bogota from June 2020 to early March 2021. We describe various features of the pandemic that appear to be specific to a middle income countries. We find that, by March 2021, slightly more than half of the population in Bogota has been infected, despite only a small fraction of this population being detected. The initial buildup of immunity contributed to the containment of the pandemic in the first and second waves. We also show that the share of the population infected by March 2021 varies widely by occupation, socio-economic stratum, and location. This, in turn, has affected the dynamics of the spread with different groups being infected in the two waves.


Subject(s)
COVID-19/epidemiology , COVID-19/transmission , COVID-19/diagnosis , Colombia/epidemiology , Communicable Disease Control/methods , Geography , Humans , SARS-CoV-2 , Seroepidemiologic Studies , Socioeconomic Factors
18.
PLoS One ; 16(8): e0255594, 2021.
Article in English | MEDLINE | ID: covidwho-1344156

ABSTRACT

INTRODUCTION: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. MATERIALS AND METHODS: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. RESULTS: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. CONCLUSIONS: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19.


Subject(s)
Alcohol Drinking/psychology , Alcoholics/psychology , Depression/therapy , Adult , Alcohol Drinking/adverse effects , Alcohol Drinking/prevention & control , Alcoholic Intoxication/psychology , Alcoholism/diagnosis , Colombia/epidemiology , Comorbidity , Delivery of Health Care , Depression/psychology , Depressive Disorder/psychology , Depressive Disorder/therapy , Female , Humans , Male , Mass Screening/methods , Mexico/epidemiology , Middle Aged , Peru/epidemiology , Primary Health Care/methods , Primary Health Care/trends , Referral and Consultation , Substance Abuse Detection/methods
19.
Int J Infect Dis ; 110: 410-416, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1330878

ABSTRACT

OBJECTIVES: To evaluate the genomic epidemiology of SARS-CoV-2 from Venezuelan migrants living in Colombia. METHODS: This study sequenced SARS-CoV-2 from 30 clinical specimens collected from Venezuelan migrants. Genomes were compared with the Wuhan reference genome to identify polymorphisms, reconstruct phylogenetic relationships and perform comparative genomic analyses. Geographic, sociodemographic and clinical data were also studied across genotypes. RESULTS: This study demonstrated the presence of six distinct SARS-CoV-2 lineages circulating among Venezuelan migrants, as well as a close relationship between SARS-CoV-2 genomic sequences obtained from individuals living in the Venezuelan-Colombian border regions of La Guajira (Colombia) and Zulia (Venezuela). Three clusters (C-1, C-2 and C-3) were well supported by phylogenomic inference, supporting the hypothesis of three potential transmission routes across the Colombian-Venezuelan border. These genomes included point mutations previously associated with increased infectivity. A mutation (L18F) in the N-terminal domain of the spike protein that has been associated with compromised binding of neutralizing antibodies was found in 2 of 30 (6.6%) genomes. A statistically significant association was identified with symptomatology for cluster C2. CONCLUSION: The close phylogenetic relationships between SARS-CoV-2 genomes from Venezuelan migrants and from people living at the Venezuela-Colombian border support the importance of human movements for the spread of COVID-19 and for emerging virus variants.


Subject(s)
COVID-19 , Transients and Migrants , Colombia/epidemiology , Humans , Phylogeny , SARS-CoV-2
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