Medidas poblacionales para la seguridad vial: más allá de la responsabilidad individual / Population measures to improve road safety: Beyond individual responsibility

Las lesiones causadas por el tránsito (LCT) se encuentran dentro de las principales causas de mortalidad y discapacidad a nivel mundial, hecho reflejado en el puesto que ocupan dentro de las primeras diez causas de vida ajustados por discapacidad, con importantes costos e impacto económico y social para las sociedades que las padecen. En 2004, la Organización Mundial de la Salud (OMS) lanzó el primer informe sobre prevención de LCT. Sin embargo, en años posteriores esa situación no mejoró, por lo cual las Naciones Unidas lanzó la Década de Acción para la Seguridad Vial (2011-2020), donde se invitaba a los gobiernos a diseñar e implementar acciones para reducir la carga asociada a este problema; entre estas se encuentra diseño y mejoramiento de vías, atención oportuna pos siniestro, control de la velocidad, medidas de control administrativo, diseño y mejoramiento de estándares vehiculares, entre otras. Las medidas basadas en enfoque poblacional han demostrado ser más poderosas que las medidas que inducen cambios de comportamiento individual.

Injuries caused by traffic (ICT) are among the main causes of mortality and disability worldwide, reflected in the fact that they occupy the first ten causes of disability adjusted life years with economic and social cost impacts for the societies that suffer from them. In 2004, the World Health Organization (WHO) released the first Prevention Report about ICT. Nevertheless, in subsequent years this situation has not improved, motivating the United Nations to launch the Decade of Action for Road Safety (2011-2020), where governments were invited to design and implement actions to reduce the burden associated with this problem: designing and improving of roads, increasing timely post-crash care, speed control, administrative control measures, designing and improving vehicle safety standards, among others. Population-based measures have been shown to be more powerful than measures that induce individual behavior changes.

Analysis of Inequalities and Inequities in Maternal Mortality in Chocó, Colombia.

We used a mixed design study to analyze the inequalities and inequities in Maternal Mortality (MM) for Chocó (Colombia) between 2010-2018. The quantitative component consisted of an analytical ecological design, where proportions, ratios, measures of central tendency and rates ratios, rate difference, Gini and concentration indices were calculated to measure inequalities. The qualitative component had a phenomenological and interpretive approach. One hundred thirty-one women died in Choco between 2010-2018. The Maternal Mortality Ratio was 224/100.000 live births. The Gini coefficient was 0.35, indicating inequality in the distribution of the number of MM with respect to live births. The health service offers have been concentrated in the private sector in urban areas (77%). The exercise of midwifery has played an important role in maternal and perinatal care processes, especially in territories where the State has been absent. Nevertheless, it occurs in complex circumstances such as the armed conflict, lack of transportation routes, and income deficits, affecting the timelines and care quality for these vulnerable groups. MM in Chocó has been a consequence of deficiencies in the health system and weaknesses in its infrastructure (absence of a high level of maternal-perinatal care). This is in addition to the territory's geographical characteristics, which increase vulnerability and health risks for women and their newborns. In Colombia, as well as in other countries, many maternal and newborn deaths are preventable because their causes are due to social injustices.

Sistematización de Experiencias: una reflexión sobre sus potencialidades para la salud pública

Objetivo: Presentar los resultados de una revisión sobre la investigación y metodología de Sistematización de Experiencias y su pertinencia en la salud pública. Métodos: Se realizó una revisión de literatura en dos etapas usando los siguientes operadores booleanos: "sistematización de experiencias" AND "metodología" OR "investigación" OR "salud" OR "educación popular" OR "trabajo social" OR "Latinoamérica" OR "Investigación Acción Participativa", en las bases de datos MedLine y Scielo, complementada con la búsqueda en el catálogo general de las bibliotecas de la Pontificia Universidad Javeriana y la Universidad Nacional de Colombia. Se dejó fecha e idioma abierto. Se empleó N-Vivo versión 12 para el procesamiento de la información. Resultados: Se obtuvieron 183 referencias, entre artículos, libros, literatura gris, tesis (pregrado, maestría o doctorado) y material audiovisual. De estos, se seleccionaron 88 para revisión de texto completo. Se generaron seis categorías relacionadas con la definición, metodología, instrumentos, objetivos, limites-tensiones y ventajas de la Sistematización de Experiencias. Conclusiones: La Sistematización de Experiencias es una metodología cualitativa surgida en el contexto latinoamericano que permite la reconstrucción de la historia y el conocimiento de las prácticas para fortalecer y transformar la realidad local. En el campo de la salud pública, la SE permite reinterpretar las nociones y problemáticas en salud de las personas y colectividades; comprender sus experiencias, necesidades y expectativas en salud; e identificar la agencia de las personas para mejorar e incidir en el bienestar y la calidad de vida de sus comunidades.

Objective: To show the results of a literature review about the investigation and methodology of Systematization of Experiences and its relevance in public health. Method: A literature review was carried out in two stages. The following Boolean operators were used: "systematization of experiences" AND "methodology" OR "research" OR "health" OR "popular education" OR "social work" OR "Latin America" OR "Participatory Action Research", in the MedLine and Scielo databases, was complemented by a search in the general catalog of the libraries of the Pontificia Universidad Javeriana and the Universidad Nacional de Colombia. Date and language were left open. N-Vivo version 12 was used for the processing and description of the information. Results: A total of 183 references were obtained from articles, books, gray literature, thesis (undergraduate, master's or doctorate) and audiovisual material. Of these, 88 were selected for full text review. Six categories were created related to the definition, methodology, instruments, objectives, limits-tensions and advantages of the Systematization of experiences. Conclusions: The Systematization of Experiences is a methodological strategy that contributes to qualitative research created within the context of Latin America, which allows us to recover the history and knowledge of practices while also strengthening and transforming the local reality. In the field of public health, it allows us to reinterpreting the notions and problems of individuals and communities; understanding their experiences, needs and expectations in health; and identify people's agency to improve and positively influence the well-being and quality of life of the community.

Effect of Different Types of "Dry Way" Additions in Porous Asphalt Mixtures.

Polymers are widely used to improve the mechanical performance of asphalt mixtures. Among them, styrene butadiene styrene (SBS) is the most commonly used, especially in the wet modification of virgin bitumen. This method, which is extensively utilized, has several advantages, but also some disadvantages, concerning its performance (such as the risk of instability or a lack of homogeneity) and logistical management (such as the need for special equipment, the transport of materials, and the dependence on the refinery that modifies the bitumen). This paper analyses the use of the most conventional types of polymers (two types of SBS, one type of BS, and rubber from end-of-life tires), dry added, as an alternative method. They have been used in porous asphalt mixtures. This type of bituminous mixture is usually designed with commercial polymer-modified bitumen, due to the mechanical requirements, and it is very sensitive to the properties of the binder used. The mechanical behavior of experimental porous asphalt mixtures has been significantly improved, especially in the case of SBS, although the performance did not reach that of commercial polymer-modified bitumen. The results have shown that the dry method is a suitable and feasible option to manufacture modified mixtures, especially considering its advantages, from a logistical viewpoint, in comparison with the wet method.

Multimorbilidad y resultados clínicos de una población pediátrica con sospecha de COVID-19 atendida en un hospital mexicano / Multimorbidity and clinical results of a pediatric population with suspected COVID-19 treated in a Mexican hospital

Resumen Introducción: Datos de varios países del mundo sugieren que los niños con COVID-19 podrían presentar síntomas diferentes y menos graves que los adultos. Sin embargo, los patrones epidemiológicos y clínicos en este grupo poblacional son poco claros. Métodos: El presente es un estudio observacional, con una caracterización inicial transversal-analítica, y con un componente longitudinal o de seguimiento a un grupo de menores con sospecha y/o diagnóstico confirmado de COVID-19, que presentaron desenlaces como mejoría, traslado a un nivel superior de atención o defunción por sintomatología respiratoria. Los niños recibieron atención médica en el Hospital General Regional con Medicina Familiar N.° 1 (HGR C/MF N.° 1), y se les realizó prueba de reacción en cadena de la polimerasa en tiempo real (RT-PCR). Resultados: Se estudiaron 98 niños como casos sospechosos para COVID-19, a quienes se les realizó RT-PCR. Del total, 24 resultaron positivos y 74 fueron negativos. La mediana de edad de los participantes fue 64,4 meses (0 a 203 meses), 55 menores eran de sexo masculino, 59 niños tuvieron manejo ambulatorio, y de estos, 14 presentaron resultado positivo. Entre los que requirieron manejo hospitalario (39), 10 niños dieron positivo para SARS-CoV-2, 84,7% alcanzaron mejoría y fueron dados de alta, 4 fueron trasladados a hospitales de nivel superior de atención. De los 98 niños en estudio, 11 fallecieron, 7 con resultado negativo y 4 con resultado positivo para SARS-CoV-2. Conclusiones: Los principales síntomas de la población pediátrica en este estudio fueron fiebre, tos y malestar general. De los niños que fallecieron, 4 presentaron resultado positivo para SARS-CoV-2, no obstante, estos presentaban otras comorbilidades.

Abstract Introduction: Data from several countries around the world suggest that children with COVID-19 may present different and less severe symptoms than adults. However, the epidemiological and clinical patterns in this population group have been unclear. Methods: This is an observational study, with an initial cross-analytical characterization, and with a longitudinal or follow-up component in a group of minors with suspected and or confirmed case of COVID-19, which have outcomes such as improvement, transfer to a higher level of care or death due to respiratory symptoms. The children received medical attention at the Regional General Hospital with Family Medicine No 1 (HGR C / MF No 1), and underwent a Real Time Polymerase Chain Reaction test (RT-PCR). Results: 98 children were studied as suspected cases for COVID-19, who underwent RT-PCR. Of the total 24 were positive and 74 were negatives. The median age was 64.4 months (0 to 203 months), 55 minors were male, 59 children had outpatient management, and of these, 14 had a positive result. Among those who required hospital management (39), 10 children were positive for SARS-CoV-2, 84.7% achieved improvement and were discharged, and four were transferred to a higher level of care hospital. Of the 98 children in the study, 11 died, seven had a negative result and four a positive result for SARS-CoV-2. Conclusions: The main symptoms of the pediatric population in this study were fever, cough and general discomfort. Four of those who died had a positive result for SARS-CoV-2, however, they had other comorbidities.

Laboratory Characterization of Porous Asphalt Mixtures with Aramid Fibers.

Recent studies have shown that fibers improve the performance of porous asphalt mixtures. In this study, the influence of four different fibers, (a) regular aramid fiber (RegAR), (b) aramid fiber with latex coating (ARLat), (c) aramid fiber with polyurethane coating (ARPoly), (d) aramid fiber of length 12 mm (AR12) was evaluated on abrasion resistance and toughness of the mixtures. The functional performance was estimated using permeability tests and the mechanical performance was evaluated using the Cantabro test and indirect tensile strength tests. The parameters such as fracture energy, post cracking energy, and toughness were obtained through stress-strain plots. Based on the analysis of results, it was concluded that the addition of ARLat fibers enhanced the abrasion resistance of the mixtures. In terms of ITS, ARPoly and RegAR have positively influenced mixtures under dry conditions. However, the mixtures with all aramid fibers were found to have adverse effects on the ITS under wet conditions and energy parameters of porous asphalt mixtures with the traditional percentages of bitumen in the mixture used in Spain (i.e., approximately 4.5%).

The challenge of asymptomatic carriers of COVID-19: A rapid review of literature / El desafío de los portadores asintomáticos de COVID-19: una revisión rápida de la literatura

ABSTRACT Objectives To describe the epidemiological and sociodemographic characteristics of asymptomatic carriers reported in the literature, and to review the strategies used for diagnosis and control. Methods Systematic literature review approach. As inclusion criteria, all studies published between January 1 and June 26, 2020, conducted in humans, that reported people who remained asymptomatic of COVID-19. Descriptors were adapted to the interfaces of eight bibliographic databases were configured: PubMed, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos and Embase. Results About 45% of the articles reported adult population, thirteen reported mixed population (adult and pediatric). 3 525 asymptomatic people were reported, with an average of 37,1 years [0.5-82 years]. Although the effectiveness of the control and prevention measures was not reported, the identification, isolation and follow-up of contacts stands out as a potential effective mechanism to prevent the transmission. Conclusions The use of this information could be relevant to guide evidence-based public health policies and the protection of populations and the improvement of health care that contributes to stopping this pandemic.

RESUMEN Objetivos Describir las características epidemiológicas y sociodemográficas de los portadores asintomáticos reportadas en la literatura y revisar las estrategias utilizadas para el diagnóstico y control. Métodos Se realizó una revisión sistemática de la literatura. Se incluyeron todos los estudios publicados entre el 1.° de enero y el 26 de junio de 2020 realizados en humanos que informaron personas que permanecieron asintomáticas por COVID-19. Se adaptaron descriptores a las interfaces de ocho bases de datos bibliográficas: Pub-Med, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos y Embase. Resultados Aproximadamente el 45% de los artículos reportaron población adulta, trece estudios informaron población mixta (adultos y pediátricos). Se identificaron 3 525 personas asintomáticas, con un promedio de 37,1 años [0,5-82 años]. Si bien no se reportó efectividad de medidas de control y prevención, la identificación, aislamiento y seguimiento de los contactos se destaca como un potencial mecanismo efectivo para prevenir la transmisión. Conclusiones El uso de esta información podría ser relevante para orientar las políticas de salud pública basadas en la evidencia y la protección de las poblaciones y la mejora de la atención médica que contribuya a detener esta pandemia.

The challenge of asymptomatic carriers of COVID-19: A rapid review of literature / El desafío de los portadores asintomáticos de COVID-19: una revisión rápida de la literatura

ABSTRACT Objectives To describe the epidemiological and sociodemographic characteristics of asymptomatic carriers reported in the literature, and to review the strategies used for diagnosis and control. Methods Systematic literature review approach. As inclusion criteria, all studies published between January 1 and June 26, 2020, conducted in humans, that reported people who remained asymptomatic of COVID-19. Descriptors were adapted to the interfaces of eight bibliographic databases were configured: PubMed, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos and Embase. Results About 45% of the articles reported adult population, thirteen reported mixed population (adult and pediatric). 3 525 asymptomatic people were reported, with an average of 37,1 years [0.5-82 years]. Although the effectiveness of the control and prevention measures was not reported, the identification, isolation and follow-up of contacts stands out as a potential effective mechanism to prevent the transmission. Conclusions The use of this information could be relevant to guide evidence-based public health policies and the protection of populations and the improvement of health care that contributes to stopping this pandemic.

RESUMEN Objetivos Describir las características epidemiológicas y sociodemográficas de los portadores asintomáticos reportadas en la literatura y revisar las estrategias utilizadas para el diagnóstico y control. Métodos Se realizó una revisión sistemática de la literatura. Se incluyeron todos los estudios publicados entre el 1.° de enero y el 26 de junio de 2020 realizados en humanos que informaron personas que permanecieron asintomáticas por COVID-19. Se adaptaron descriptores a las interfaces de ocho bases de datos bibliográficas: Pub-Med, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos y Embase. Resultados Aproximadamente el 45% de los artículos reportaron población adulta, trece estudios informaron población mixta (adultos y pediátricos). Se identificaron 3 525 personas asintomáticas, con un promedio de 37,1 años [0,5-82 años]. Si bien no se reportó efectividad de medidas de control y prevención, la identificación, aislamiento y seguimiento de los contactos se destaca como un potencial mecanismo efectivo para prevenir la transmisión. Conclusiones El uso de esta información podría ser relevante para orientar las políticas de salud pública basadas en la evidencia y la protección de las poblaciones y la mejora de la atención médica que contribuya a detener esta pandemia.

The challenge of asymptomatic carriers of COVID-19: A rapid review of literature.

OBJECTIVES: To describe the epidemiological and sociodemographic characteristics of asymptomatic carriers reported in the literature, and to review the strategies used for diagnosis and control. METHODS: Systematic literature review approach. As inclusion criteria, all studies published between January 1 and June 26, 2020, conducted in humans, that reported people who remained asymptomatic of COVID-19. Descriptors were adapted to the interfaces of eight bibliographic databases were configured: PubMed, Ovid, SciELO, Ebsco, Scopus, LILACS, Epistemonikos and Embase. RESULTS: About 45% of the articles reported adult population, thirteen reported mixed population (adult and pediatric). 3 525 asymptomatic people were reported, with an average of 37,1 years [0.5-82 years]. Although the effectiveness of the control and prevention measures was not reported, the identification, isolation and follow-up of contacts stands out as a potential effective mechanism to prevent the transmission. CONCLUSIONS: The use of this information could be relevant to guide evidence-based public health policies and the protection of populations and the improvement of health care that contributes to stopping this pandemic.

Incorporation of Additives and Fibers in Porous Asphalt Mixtures: A Review.

Despite the numerous benefits for preserving the hydrological cycle, permeable pavement systems (PPSs) found their major application in parking spots and for light traffic scenarios due to their limited durability and strength. To make the PPSs suitable for heavy traffic conditions without significant distresses, research is shifting toward the adoption of novel binders and additives for designing multifunctional porous asphalt mixtures which make up the surface course of PPSs. Certain additives are well known for enhancing the durability of dense graded asphalt mixtures and improving fatigue and rutting resistance. However, the studies on the influence of additives on abrasion resistance and binder draindown, which are the common problems in porous asphalt mixtures (PAMs), are still not well established. This paper summarizes best practices performed on PAMs and recommends possible future research directions for its improvement. Particular emphasis is placed on strength and resilience of PAMs by incorporating additives like nanosilica, crumb rubber, warm-mix additives, fibers (such as cellulose, glass, steel, and synthetic fibers), and some eco-friendly materials. It was found that different additives seem to have different effects on the properties of PAMs. Moreover, the combination of additives has synergistic benefits for the performance of PAMs, especially in urban pavements.

Proposal of a New Porous Concrete Dosage Methodology for Pavements.

Although porous concrete pavement design methods are mainly focused on maintaining high permeability rates in order to improve their ability to manage stormwater runoff, the mixture strength is paramount for its durability and service life. This paper proposes a new mixture design method for porous concrete, named PCD (porous concrete design), derived from the ACI 522R-10 and ACI 211.3R-02 standards. The aim is to improve mechanical strength in porous concrete mixtures, while ensuring enough permeability for its use in urban roads. With PCD methodology it is possible to obtain mechanical strengths 30% higher than those produced with ACI methodologies, while maintaining permeability rates close to 2 cm/s, lower than those obtained with ACI methods but still enough to manage extreme storm events. Finally, with the analytical Hierarchy Process (AHP) multi-criteria decision-making methodology and also bearing in mind safety variables, the best porous concrete mixtures are the ones produced with PCD methodology.

Factores de riesgo asociados al control glucémico y síndrome metabólico en pacientes con diabetes mellitus tipo 2. Villavicencio, Colombia / Risk factors associated with glycemic control and metabolic syndrome in patients with type 2 diabetes mellitus. Villavicencio, Colombia

Resumen Introducción: La Diabetes Mellitus tipo 2 (DMT2) es una enfermedad crónica cuya prevalencia elevada hace que sea un importante problema de salud pública, social y económico en los países. Objetivo: Identificar factores de riesgo potencialmente asociados al control glucémico y Síndrome Metabólico (SM) de pacientes con DMT2 de una Institución prestadora de Servicios de Salud (IPS) de Villavicencio. Materiales y métodos: Estudio analítico transversal a partir de información secundaria. Se establecieron modelos multivariados basados en regresiones binomiales para analizar razones de prevalencia ajustadas en dos variables: síndrome metabólico y control glucémico. Resultados: Más del 90% de los individuos eran mayores de 49 años; 50,6% hombres; 46,6% presentó cifras de la prueba de hemoglobina glicosilada (HbA1c) mayor a 7%; 64,5% tenían SM. Los individuos con hiperglicemia tuvieron 3,1 veces más riesgo de tener inadecuado control glucémico (IC 95%:2,28-4,25, p<0,05); aquellos con hipotiroidismo presentaron 1,2 veces más riesgo de desarrollar SM (IC 95%:1,01-1,35; p<0,05) y aquellos con cardiopatía tuvieron 1,3 veces más riesgo de desarrollar SM. Conclusiones: A pesar de ser una población controlada y en proceso de monitoreo, alto porcentaje de pacientes presentó inadecuado control metabólico, aumentando el riesgo cardiovascular, esto sugiere optimizar procesos de seguimiento institucional.

Abstract Introduction: Type 2 diabetes mellitus (T2DM) is a chronic disease whose high prevalence makes it an important public, social and economic health problem in countries. Objective: To identify risk factors potentially associated with glycemic control and metabolic syndrome (MS) of patients with T2DM of a Health Services Institution (IPS) in Villavicencio, Colombia. Materials and methods: A transverse analytical study from secondary information was made. Multivariate models based on binomial regressions were established to analyze reasons of prevalence adjusted in two variables: metabolic syndrome and glycemic control. Results: More than 90% of individuals were over 49 years old; 50.6% were men; 46.6% showed the glycosylated hemoglobin test (HbA1c) figures greater than 7%; 64.5% had MS. Individuals with hyperglycemia had 3.1 times the risk of inadequate glycemic control (95% CI: 2,28-4,25, p<0.05); Those with hypothyroidism presented 1.2 times more risk of developing MS (95% CI: 1,01-1,35; p < 0.05) and those with heart disease had 1.3 times the risk of developing MS. Conclusions: Despite being a controlled population and in the process of monitoring, high percentage of patients presented inadequate metabolic control which increases cardiovascular risk. This suggests optimizing institutional follow-up processes.

Dengue, chikungunya and zika virus coinfection: results of the national surveillance during the zika epidemic in Colombia.

Our objective was to determine the frequency of zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) virus coinfection and describe the mortality cases that occurred during the epidemiologic surveillance of the ZIKV epidemic in Colombia. We analysed all cases of suspected ZIKV infection that were reported to the National Institute of Health (October 2015-December 2016). DENV, CHIKV and ZIKV RNA were detected in serum or tissue samples using polymerase chain reaction assay. Medical records of the fatal cases were reviewed. We identified that 23 871 samples were processed. The frequency of viral agents was 439 (1.84%) for DENV, 257 (1.07%) for CHIKV and 10118 (42.38%) for ZIKV. Thirty-four (0.14%) cases of coinfection were identified. The CHIKV-ZIKV coinfection was present in 28 cases (82.3%), DENV-CHIKV in three (8.8%) and DENV-ZIKV in three (8.8%). Seven (20.6%) coinfection cases were fatal (two DENV-CHIKV cases and five CHIKV-ZIKV cases). Two cases were foetal deaths and the others were related to neurological syndrome and sepsis. In conclusion, the frequency of arbovirus coinfection during epidemic of ZIKV was low, and CHIKV-ZIKV coinfection was the most common. Mortality was high among coinfection patients. The role of each virus in the mortality cases of coinfection warrants further studies.

[The risk of death by suicide in the Colombian population 2000-2013]. / Riesgo de muerte por suicidio en población Colombiana 2000-2013.

The scope of this article is to analyze the risk of death by suicide in Colombia based on the covariables of sex, age group, year, region and/or department from 2000 to 2013. The databases of deaths by suicide and population projections of DANE were used. A longitudinal and analytical study was conducted. From 2000 to 2013, annual trends of deaths by suicide by means of modeling of covariables were established and risk estimates were collected. The Poisson regression model (PRM) was used. IRR was used according to the MRP with a level of significance of (P <0.05). Colombians between the years 2000-2013, male, 15 to 34 years old, from the Central and Eastern regions and from the Departments of Vaupés, Huila and Quindío were those with the highest risk of death by suicide. The suicide rate decreased slightly as the years went by. The highest risk of suicide occurred among men of productive age, older adults, and in underdeveloped regions. Colombia requires a mental health policy that implements strategies for primary care, health promotion and disease prevention, aimed at promoting the quality of life, detection of suicidal ideation, treatment and rehabilitation of these people from a comprehensive rights and care approach.

Analizar el riesgo de muerte por suicidio en Colombia, a partir de covariables sexo, grupo etario, año, región y/o departamento de 2000 a 2013. Se utilizaron las bases de datos de muertes por suicidio y proyecciones poblacionales del DANE. Se realizó un estudio longitudinal y analítico. De 2000 a 2013, se establecieron las tendencias anuales de muertes por suicidio por covariables mediante modelación y se recogieron estimaciones de riegos Se utilizó el modelo de regresión de Poisson (MRP). Se emplearon IRR según el MRP con nivel de significancia (P < 0,05). Los colombianos entre los años 2000-2013, de sexo masculino, de 15 a 34 años, de las regiones Central y Oriental y de los Departamentos de Vaupés, Huila y Quindío fueron los que mayor riesgo tuvieron de morir por suicidio. La tasa de suicidios fue levemente decreciente conforme pasaron los años. El mayor riesgo de suicidio ocurrió en hombres en edad productiva, adultos mayores y en regiones poco desarrolladas. Colombia requiere una política de salud mental que implemente estrategias de atención primaria, promoción de la salud y prevención de la enfermedad, orientadas a fomentar la calidad de vida, detección de ideación suicida, tratamiento y rehabilitación a estas personas desde el enfoque de derechos y atención integral.

Barriers to Diagnosis Access for Chagas Disease in Colombia.

Chagas disease is the leading cause of nonischemic cardiomyopathy in Latin America. Timely access to diagnosis and trypanocidal treatment and preventive tools for millions of infected people continues to be a challenge. The purpose of this study was to identify potential barriers for the diagnosis of Chagas disease in Colombia from the perspective of healthcare providers. Using a simultaneous mixed-methods study design, we analyzed trends in access to screening and diagnosis for Chagas disease in Colombia and assessed the national barriers to access. The main barriers to access at the national level included a limited governmental public health infrastructure for the diagnosis of Chagas disease and limited physician awareness and knowledge of the disease. Data indicate that 1.5% of total expected cases based on national prevalence estimates were reported. Few public health laboratories have the capacity to perform complementary tests for the diagnosis of Chagas disease and almost 6 months elapse between the requests of the tests and the confirmation of the disease. This study shows that infected people must overcome a number of barriers to achieve diagnosis. Reducing barriers to early diagnosis of Chagas disease is an important goal in the fight against the disease.

COLOCACIÓN DE IMPLANTE DENTAL CON RELLENO ÓSEO BIOGRAFT-G® EN HUESO CON TRAUMA DENTOALVEOLAR. REPORTE DE CASO / PLACEMENT OF DENTAL IMPLANTS WITH OSSEOUS FILLER (BIOGRAFT-G®) IN BONE WITH DENTAL ALVEOLAR TRAUMA. CASE REPORT

En la actualidad, para el odontólogo resulta un gran desafío poder restaurar la apariencia natural y la anatomía de dientes perdidos. En este trabajo se realiza el reporte de un caso clínico donde se restituye el incisivo central superior derecho, a causa de traumatismo dentomaxilofacial, por un implante Leader® combinado con el relleno óseo Biograft-G®. Se trata de una paciente de 19 años atendida en la consulta multidisciplinaria del Centro Nacional de Estomatología, La Habana, Cuba. La paciente portaba prótesis inmediata a causa de la pérdida del diente 11 por fractura de corona y raíz, con defecto óseo vestibular. A la paciente le ocurría fractura frecuente de la prótesis, viéndose afectada desde el punto de vista estético, social, psicoafectivo y funcional. Después de una evaluación multidisciplinaria y el consentimiento de la paciente, se procedió a la cirugía mediante la técnica de colgajo, colocación de implante Leader® y relleno con Biograft-G® para regenerar el defecto óseo, devolver contorno vestibular y lograr una rehabilitación definitiva. Con este tratamiento, la paciente obtuvo los resultados estéticos y funcionales deseados.

Today is a challenge to restore the natural appearance and anatomy of extracted teeth. In this paper we present a clinical case in which the right upper central incisor is restored, due to the presence of a dentomaxillofacial trauma, through a Leader® implant combined with Biograft-G® bone filler. The patient is a 19 year woman treated in the multidisciplinary consultation of the National Center of Stomatology, Havana, Cuba. The patient had an immediate prosthesis due to a fracture of the crown and root, with vestibular bone defect. The patient frequently fractured the prosthesis, which affected her in terms of aesthetics, social, psychological and functional incorporation. After a multidisciplinary evaluation and the patient's consent, the surgery was performed using the flap technique, the placement of the Leader® implant and the filling with Biograft-G® to regenerate the bone defect, to recover the vestibular contour and to achieve a definitive rehabilitation. With this treatment, the patient obtained the desired aesthetic and functional results.

El Instituto Nacional de Salud y El Ministerio de Salud y Protección Social en la aplicación de resultados de investigación en salud para el desarrollo de políticas públicas / Role of The National Institute of Health and The Ministry of Health and Social Protection in the application of results of health research for the development of public policies

La Dirección de Investigación en Salud Pública (DISP), del Instituto Nacional de Salud (INS), está comprometida con la generación de evidencias en Salud Pública con el objeto de contribuir al diseño e implementación de Políticas Públicas en el Sector Salud, el cual lidera el Ministerio de Salud y Protección Social de Colombia. A partir de los Decretos 4109 de 2011 y 2774 de 2012, el Instituto Nacional de Salud fue reestructurado (1,2) y la DISP asumió entre otras funciones fundamentales, investigar y orientar la gestión de conocimiento en Salud Pública y Biomedicina de acuerdo con las prioridades y necesidades del país. El INS a través de sus 100 años de historia, ha adquirido un gran conocimiento, experiencia y rigor metodológico en diversas áreas del conocimiento, hoy es un Centro de Investigación reconocido por Colciencias y de acuerdo con los resultados de la última Convocatoria (781) (3) de Grupos e Investigadores, cuenta con 13 grupos de investigación clasificados como A y B; además de tener el Comité de Ética y Metodologías de Investigación (CEMIN) (4) que desarrolla un proceso de revisión técnico y ético riguroso y cuando corresponde, con análisis de pares para garantizar la idoneidad, pertinencia y factibilidad de los proyectos que se formulan según las necesidades detectadas y/o solicitadas a nivel sectorial. El INS, como parte de su plan estratégico misional cuenta con nueve líneas de investigación institucionales, relacionadas con biología celular y molecular de enfermedades crónicas; biología celular y molecular de los agentes causantes de enfermedades transmisibles y de sus vectores; desarrollo e implementación de metodologías diagnósticas; epidemiología clásica y molecular y control de los agentes causantes de enfermedades transmisibles de importancia en salud pública y de sus vectores; resistencia a antibióticos, medicamentos y plaguicidas; riesgo e impacto de contaminantes ambientales en salud; vigilancia y control de enfermedades no transmisibles y nutrición, alimentación y seguridad alimentaria (5). En el marco del proceso de Investigación en Salud Pública, el INS hace parte de redes de conocimiento, alianzas estratégicas para generar y transferir conocimiento y participa de diversas convocatorias de Investigación, Desarrollo e Innovación incluida la de Colciencias, dirigidas a alianzas entre actores del Sistema de Ciencia, Tecnología e Innovación (SCTeI). (3,6).

The Public Health Research (DISP) directorate of the National Institute of Health (INS) is committed to the generation of evidence in public health with the aim of contributing to the design and implementation of public policies in the health sector, with the leadership of the Ministry of Health and Social Protection of Colombia. As of Decrees 4109 of 2011 and 2774 of 2012, INS was restructured and the DISP assumed, among other fundamental functions, to investigate and guide knowledge management in public health and biomedicine according to the priorities and needs of the country. Through its 100 years history, INS has acquired great expertise, knowledge, experience and methodological rigor in various areas of knowledge. It currently is a research center recognized by Colciencias; according to results of the last Groups and Researchers Call (781), it has 13 research groups classified as A and B. In addition, it has a Committee of Ethics and Research Methodologies (CEMIN) that develops a rigorous technical and ethical review process and when appropriate, with peer review to guarantee suitability, pertinence and feasibility of the projects that are formulated according to the needs detected and / or requested at a sectorial level. The INS, as part of its strategic mission plan, has nine institutional research lines related to cellular and molecular biology of chronic diseases; cellular and molecular biology of the causative agents of communicable diseases and their vectors; development and implementation of diagnostic methodologies; classical and molecular epidemiology and control of causative agents of communicable diseases of importance in public health and their vectors; resistance to antibiotics, medicines and pesticides; risk and impact of environmental contaminants in health; surveillance and control of non-communicable diseases and nutrition, food and food security. Within the framework of the public health research process, INS is part of knowledge networks, has strategic alliances to generate and transfer knowledge and participates in various calls for Research, Development and Innovation, including Colciencias, aimed at alliances between actors of the System of Science, Technology and Innovation (SCTeI).

Riesgo de muerte por suicidio en población Colombiana 2000-2013 / The risk of death by suicide in the Colombian population 2000-2013

Resumen Analizar el riesgo de muerte por suicidio en Colombia, a partir de covariables sexo, grupo etario, año, región y/o departamento de 2000 a 2013. Se utilizaron las bases de datos de muertes por suicidio y proyecciones poblacionales del DANE. Se realizó un estudio longitudinal y analítico. De 2000 a 2013, se establecieron las tendencias anuales de muertes por suicidio por covariables mediante modelación y se recogieron estimaciones de riegos Se utilizó el modelo de regresión de Poisson (MRP). Se emplearon IRR según el MRP con nivel de significancia (P < 0,05). Los colombianos entre los años 2000-2013, de sexo masculino, de 15 a 34 años, de las regiones Central y Oriental y de los Departamentos de Vaupés, Huila y Quindío fueron los que mayor riesgo tuvieron de morir por suicidio. La tasa de suicidios fue levemente decreciente conforme pasaron los años. El mayor riesgo de suicidio ocurrió en hombres en edad productiva, adultos mayores y en regiones poco desarrolladas. Colombia requiere una política de salud mental que implemente estrategias de atención primaria, promoción de la salud y prevención de la enfermedad, orientadas a fomentar la calidad de vida, detección de ideación suicida, tratamiento y rehabilitación a estas personas desde el enfoque de derechos y atención integral.

Abstract The scope of this article is to analyze the risk of death by suicide in Colombia based on the covariables of sex, age group, year, region and/or department from 2000 to 2013. The databases of deaths by suicide and population projections of DANE were used. A longitudinal and analytical study was conducted. From 2000 to 2013, annual trends of deaths by suicide by means of modeling of covariables were established and risk estimates were collected. The Poisson regression model (PRM) was used. IRR was used according to the MRP with a level of significance of (P <0.05). Colombians between the years 2000-2013, male, 15 to 34 years old, from the Central and Eastern regions and from the Departments of Vaupés, Huila and Quindío were those with the highest risk of death by suicide. The suicide rate decreased slightly as the years went by. The highest risk of suicide occurred among men of productive age, older adults, and in underdeveloped regions. Colombia requires a mental health policy that implements strategies for primary care, health promotion and disease prevention, aimed at promoting the quality of life, detection of suicidal ideation, treatment and rehabilitation of these people from a comprehensive rights and care approach.