RESUMO
Resumen Introducción : la gripa que ocurrió entre 1918-1919 causó la mayor mortalidad en la historia de las pandemias, se estima que 50 millones de personas fallecieron. Se realizó un estudio histórico-epidemiológico a partir de fuentes documentales contrastadas con un análisis estadístico de 142963 registros de defunción consignados en los libros parroquiales de 94 municipios de Boyacá y los censos de los años 1912, 1918 y 1928. Desarrollo : a partir de las fuentes primarias obtenidas, se reconstruye la realidad socio-sanitaria de Boyacá y el desarrollo cronológico de la pandemia en el departamento. La gripa era conocida en Boyacá antes de la pandemia. Durante el periodo pandémico (1918-1919) se encontraron 20102 decesos en los libros parroquiales, 3305 registrados como gripa, de los cuales el 80.9 % ocurrieron en los últimos 3 meses de 1918, siendo los menores de 4 años el grupo poblacional más afectado. Conclusiones : después de la pandemia, la gripa se hace endémica en Boyacá. En el periodo pandémico, la tasa promedio de mortalidad en los municipios ubicados sobre los 2000 msnm es tres veces mayor a aquellos que se encuentran por debajo de esta altura. Las condiciones de pobreza y hacinamiento acentuaron la letalidad de la pandemia, por lo que fueron ineficientes las acciones de las direcciones de higiene para enfrentarla. Las juntas de socorros y la Junta Patriótica de Sanidad son las únicas que realizaron acciones efectivas.
Abstract Introduction : The flu of 1918-1919 caused the highest mortality in the history of pandemics; there is an estimate that 50 million people died. We conducted a historical-epidemiological study from documentary sources, contrasted with a statistical analysis of 142,963 deaths recorded in the church books of 94 municipalities of Boyaca and the census of the years 1912, 1918 and 1928. Development : From the historical records consulted, we reconstructed the social health reality of Boyaca, as well as the chronological development of the pandemic. Boyaca knew the flu before the pandemic (1918-1919). During it, the church books recorded 20,102 deaths; the flu was responsible for 3,305. Of those cases, 80.9 % occurred in the last three months of 1918; the most affected population were children of less than four years of age. Conclusions : After the pandemic, the flu became endemic in Boyaca. In the pandemic period, the average mortality rate in municipalities located above 2000 MASL was three times higher than those below this height. The conditions of poverty and overcrowding accentuated the lethality of the pandemic; the hygiene directives to face them were inefficient. The relief and the Patriotic Health Board were the only ones that carried out effective actions.
Resumo Introdução : a gripe de 1918-1919 causou a maior mortalidade na história das pandemias, estima-se que 50 milhões de pessoas faleceram. Se realizou um estudo histórico-epidemiológico a partir de fontes documentais contrastadas com uma análise estatística de 142.963 atestados de óbito consignados nos livros paroquiais de 94 municípios de Boyacá e os censos dos anos 1912, 1918 e 1928. Desenvolvimento : a partir das fontes primárias obtidas, se reconstrói a realidade socio sanitária de Boyacá e o desenvolvimento cronológico da pandemia no departamento. A gripe era conhecida em Boyacá antes da pandemia. Durante o período pandémico (1918-1919) se encontraram 20 102 decessos nos livros paroquiais, 3.305 registrados como gripe, dos quais o 80. 9% ocorreram nos últimos 3 meses de 1918, sendo os menores de 4 anos, o grupo populacional mais afetado. Conclusões : depois da pandemia, a gripe se faz endémica em Boyacá. No período pandémico a taxa média de mortalidade nos municípios localizados sobre os 2000 msnm, é três vezes maior àqueles que se encontram por debaixo desta altura. As condições de pobreza e amontoamento acentuaram a letalidade da pandemia, sendo ineficientes as ações das direções de higiene para enfrenta-la. As juntas de socorros e a Junta Patriótica de Sanidade, são as únicas que realizam ações efetivas.
Assuntos
Humanos , Pandemias , Relatos de Casos , Epidemiologia , Colômbia , HistóriaRESUMO
Con un enfoque de análisis histórico se hace una reflexion sobre los conceptos y hechos más relevantes que han llevado al desarrollo y estructuración del modelo de Sistema General de Seguridad Social en Salud (SGSSS) y de los modelos curriculares de formación médica en Colombia, para establecer los puntos que constituyen controversia y los aspectos que ameritan un acuerdo de voluntades que podrían llevar a mejorar en beneficio de los dos sectores tanto la formación de médicos generales como la calidad del sistema de prestación de servicios de Salud.
The following is a historical perspective of the most relevant concepts and events that resulted in the development and structuring of the model for the Social Security System in Healthcare, and of the curricular models for medical training in Colombia. This review highlights the controversial issues and the aspects that warrant agreements that would lead to improvements for the benefit of the two areas, namely, training of general practitioners and the quality of healthcare provision.
Assuntos
HumanosRESUMO
To quantify age-specific excess-mortality rates and transmissibility patterns for the 1918-20 influenza pandemic in Boyacá, Colombia, we reviewed archival mortality records. We identified a severe pandemic wave during October 1918-January1919 associated with 40 excess deaths per 10,000 population. The age profile for excess deaths was W shaped; highest mortality rates were among infants (<5 y of age), followed by elderly persons (>60 y) and young adults (25-29 y). Mean reproduction number was estimated at 1.4-1.7, assuming 3- or 4-day generation intervals. Boyacá, unlike cities in Europe, the United States, or Mexico, experienced neither a herald pandemic wave of deaths early in 1918 nor a recrudescent wave in 1920. In agreement with reports from Mexico, our study found no death-sparing effect for elderly persons in Colombia. We found regional disparities in prior immunity and timing of introduction of the 1918 pandemic virus across populations.
Assuntos
Influenza Humana/história , Pandemias/história , Adolescente , Adulto , Distribuição por Idade , Criança , Colômbia/epidemiologia , História do Século XX , Humanos , Influenza Humana/epidemiologia , Influenza Humana/mortalidadeRESUMO
OBJECTIVE: To describe the epidemiological and social impact of the flu pandemic of 1918-1919 in 41 municipalities of Boyacá, Colombia. METHODOLOGY: Descriptive, analytical-empiric, historic study with an epidemiological focus. The volume and structure of the population is established and determines the mortality rates for the variables of time, person and place. RESULTS: The pandemic began in October 1918 in Bogotá and reached Boyacá by road. The three chronological waves found in the literature were not identified. We found a significant difference in the behavior of the flu pandemic in the departmnent of Boyacá with that described in Europe and North America by the specialized literature.
Assuntos
Surtos de Doenças/história , Influenza Humana/história , Causas de Morte , Clima , Colômbia/epidemiologia , Demografia , Surtos de Doenças/estatística & dados numéricos , História do Século XX , Humanos , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Jornais como Assunto/história , Conglomerados Espaço-TemporaisRESUMO
OBJETIVO: Describir el impacto epidemiológico y social de la pandemia de gripa de 1918-1919 en 41 municipios de Boyacá, Colombia. METODOLOGÍA: Estudio descriptivo empírico-analítico, histórico, con enfoque epidemiológico. Se estableció el volumen y estructura de la población y se determinaron tasas de mortalidad para las variables de tiempo, persona y lugar. RESULTADOS: La pandemia se inició en octubre de 1918 en Bogotá y se extendió a Boyacá por carretera. No se encontraron las tres oleadas cronológicas descritas en la literatura. Encontramos diferencias significativas en el comportamiento de la pandemia de gripa en el departamento de Boyacá en comparación con lo descrito en Europa y Norteamérica por la literatura especializada.(AU)
Assuntos
História do Século XX , Saúde Pública/história , História da Medicina , Influenza Humana/epidemiologia , Influenza Humana/história , Influenza Humana/mortalidade , Surtos de Doenças/história , ColômbiaRESUMO
OBJETIVO: Describir el impacto epidemiológico y social de la pandemia de gripa de 1918-1919 en 41 municipios de Boyacá, Colombia. METODOLOGÍA: Estudio descriptivo empírico-analítico, histórico, con enfoque epidemiológico. Se estableció el volumen y estructura de la población y se determinaron tasas de mortalidad para las variables de tiempo, persona y lugar. RESULTADOS: La pandemia se inició en octubre de 1918 en Bogotá y se extendió a Boyacá por carretera. No se encontraron las tres oleadas cronológicas descritas en la literatura. Encontramos diferencias significativas en el comportamiento de la pandemia de gripa en el departamento de Boyacá en comparación con lo descrito en Europa y Norteamérica por la literatura especializada.
OBJECTIVE: To describe the epidemiological and social impact of the flu pandemic of 1918-1919 in 41 municipalities of Boyacá, Colombia. METHODOLOGY: descriptive, analytical-empiric, historic study with an epidemiological focus. The volume and structure of the population is established and determines the mortality rates for the variables of time, person and place. RESULTS: The pandemic began in October 1918 in Bogotá and reached Boyacá by road. The three chronological waves found in the literature were not identified. We found a significant difference in the behavior of the flu pandemic in the department of Boyacá with that described in Europe and North America by the specialized literature.
Assuntos
História do Século XX , Humanos , Surtos de Doenças/história , Influenza Humana/história , Causas de Morte , Clima , Colômbia/epidemiologia , Demografia , Surtos de Doenças/estatística & dados numéricos , Influenza Humana/epidemiologia , Influenza Humana/mortalidade , Publicação Periódica , Conglomerados Espaço-TemporaisRESUMO
The influenza pandemic of 1918-1919 was one of the most severe recorded in Colombia. There were 1,900 deaths in the capital, Bogota. The poor and unprotected were the most affected. Care of victims was the responsibility of the Junta de Socorros, a private body. Based on different primary sources (mostly official documents, Junta de Socorros reports, newspapers, and medical journals) this article explores how the 1918 influenza pandemic altered Bogotá's social dynamics, with particular attention to its impact on disease and mortality rates and to an analysis of how the city's sanitary conditions and political-institutional decisions and the reactions of different social sectors influenced the response of this human community to the pandemic.