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This paper addresses the professionalization of dentistry in Colombia during the first half of the twentieth century. To fully comprehend such a process, we must consider the tensions between the practice of non-certified and certified dentistry. As an outcome of such tensions, dentists began to acquire professional autonomy. We analyze applications for license files to practice dentistry without a degree, some of which were of women. The findings show the informal transfer of knowledge outside formal apprenticeship and the unrestricted practice of dentistry by many non-professionals but "permitted" dentists who faced a centralized and powerful professional bureaucracy.

Objective: To characterize the scientific production of the Revista Alergia Mexico., Methods: A descriptive study was carried out that took into consideration the bibliometric information of the Revista Alergia México hosted in PubMed (MEDLINE) and Scopus., Results: The total number of articles published during 1991 to 2021 according to Pubmed was 1,115 (annual mean: 37.2 ± 12.3). Scopus registered 1,541 articles during 1972 to 2021 (annual mean: 30.8 ± 14.9); in both sources, original articles (49 and 78%, respectively) and review articles (21 and 12%, respectively) were the most published document modalities; the most relevant topics included asthma (32%), allergic rhinitis (16%) and drug allergy (9%). Public institutions in Mexico were the institutions with the highest number of published articles. The country with the highest number of published papers was Mexico (54%), followed by Colombia (5%) and Spain (4%). The 2020 citation index according to Scopus was 0.9; an H-index of 15; and an impact factor of 0.150. During the period 2016 - 2020, the annual rejection rate ranged from 7% to 30%., Conclusions: Promoting the internationalization of the journal, publishing articles in the English language and achieving the impact factor are among some of the main needs of the Revista Alergia Mexico.

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding the enforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases. Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.

Objective: It has been recommended that professionals who are planning to perform uterine transplantation should first carry out animal experiments. This paper describes the procedure for uterine transplant in sheep, as well as short and medium-term results., Methods: Experimental surgery study in sheep subjected to uterine explantation and transplant. Four 40-50 kg sheep received uteri transplantation (orthotopic) from four live donors. End-to-side vascular anastomosis was used, the vagina was sutured on one plane and the uterus was fixed to the pelvic wall. Complications and 180-day evolution are described., Results: Transplant surgery was accomplished in the 4 sheep. Surgical time in the first procedure was 240 minutes, while the last procedure lasted 185 minutes. Warm ischemia time was reduced from 42 to 22 minutes. One sheep died on the seventh postoperative day due to an intraoperative complication unrelated to the vascular anastomosis. A second sheep developed local vaginal infection treated with metronidazole and evolved satisfactorily. No transplant rejection had occurred in the remaining 3 sheep after 6 months., Conclusions: The ovine model allowed surgical training in experimental uterine transplant surgery. For the authors, it offered an opportunity to gain knowledge and make progress towards future uterus transplantation in women with uterine factor infertility in Colombia., Competing Interests: None declared, (Copyright© 2020 This is an open-access article distributed under the terms of the Creative Commons Attribution License by-nc-nd/4.0.)

Introduction: Taking into account the difficulty of performing malaria microscopic diagnosis in rural areas, rapid diagnostic tests (RDT) are a good alternative, but it is important to verify their diagnostic performance. Objective: To evaluate the diagnostic performance of the RDTs used in five Colombian departments by comparing them with the microscopic diagnosis and using PCR as the reference standard. Materials and methods: Thick blood film and RDTs were used to diagnose symptomatic individuals; additionally, the filter paper was impregnated with blood for the molecular test. Results: We included 314 samples whose percentage of positivity for malaria was 49% by PCR, 48% by microscopy and 46% by RDT; parasitemia ranged between 180 and 23,800 p/μL of blood. The concordance of the results from the microscopy units and those of the PCR (National Laboratory of Reference) was as follows: Cohen’s kappa coefficient, 0.975 (95% CI: 0.950-0.999); sensitivity, 97% (95% CI 95-100); specificity 100% (95% CI: 100-100), and kappa index of species, 0.958 (IC95%: 0.912-1.00). The concordance between the Pf/Pv RDT (at the microscopy units) and the PCR (National Laboratory of Reference) was as follows: kappa coefficient, 0.878 (95% CI: 0.784-0.973); sensitivity, 94% (95% CI: 87-100); specificity, 95% (95% CI: 90-100), and kappa index of species, 1.0 (95% CI: 1.00-1.00). The concordance between the Pf/Pan RDT versus PCR was: Cohen’s kappa coefficient, 0.920 (95 % CI: 0.865- 0.974); sensitivity, 94% (95% CI: 90-98); specificity, 99% (95% CI 95-100), and kappa index of species, 0.750 (IC95% 0,637-0,863). Conclusion: The results of this study support the use of RDTs in Colombia; however, more training of the personnel is required to accurately differentiate Plasmodium species.

Verifying the compliance with the ethical principles of health research legitimizes its exercise in the eyes of the society and allows for the resolution of ethical dilemmas that emerge from new research interests and methods. Resolution 8430 of 1993 is one of the main ethical guidelines governing health research on human beings in Colombia. Considering that the resolution has not been revised or updated since its promulgation it becomes necessary to evaluate its current validity and adequacy to address the potential ethical dilemmas in the existing country’s health research. Some gaps, contradictions, and aspects that require a deep review are detailed in this paper from a wide conception of health research areas and methods. After discussing the main weaknesses and inaccuracies, some alternatives are proposed to adjust the resolution to the present needs in health research with human beings.

Introduction: Knowledge of the geographical distribution of Leishmania species allows guiding the sampling to little-studied areas and implementing strategies to define risk zones and priority areas for control., Objective: Given that there is no publication that collects this information, the search, review, and compilation of the available scientific literature that has identified species in Colombia is presented in this paper., Materials and Methods: A bibliographic search was performed in PubMed, Web of Knowledge, Google Scholar, SciELO and LILACS with the terms "(Leishmania OR Leishmaniasis) AND species AND Colombia", without restrictions on publication year, language or infected organism; records of national scientific events and repositories of theses from Colombian universities were also included., Results: Eighty-six scientific documents published between 1985 and 2017 were found in which the species of Leishmania and their geographical origin were indicated. The species reported, in descending order of frequency, were: Leishmania (Viannia) panamensis, L. (V.) braziliensis, L. (V.) guyanensis, L. (Leishmania) infantum, L. (L.) amazonensis, L. (L.) mexicana, L. (V.) colombiensis, L. (V.) lainsoni and L. (V.) equatorensis; the last three were found with the same frequency. Leishmania species were reported from 29 departments., Conclusion: Information on the distribution of Leishmania species in Colombia is limited; therefore, it is necessary to gather existing data and propose studies that consolidate the distribution maps of Leishmania species in Colombia. This would allow the detection of areas where species have not been identified as well as the comparison of existing parasite and vector distributions.

This paper attempts to zone yellow fever risk in La Macarena (department of Meta, Colombia) in terms of environmental hazards and socio-economic vulnerabilities. An ecological study was carried out, in which data published from 2007 to 2013 on conditions of the municipality were integrated into a geographic information system. Through a superposition of map layers, magnitudes of hazard and vulnerability proportional to the degree of severity were obtained. As a result the spatial heterogeneity of the risk of yellow fever was described, suggesting that the areas surrounding populated centers, roads and rivers present the highest probability of transmission. It is concluded that the cartographic representation of the spatial distribution of risk in the municipality constitutes a methodological contribution to health risk zoning - in concrete geographical areas and based on hazards and vulnerabilities - which facilitates decision-making in public health.

Chorangioma is a tumor of vascular origin placental, the most frequent among primary placental non-trophoblastic tumors; however, it is found in about 1% of placental pathology case studies. Chorangioma represents a benign neoplasm with proliferation of capillaries and villous stroma associated to multiple gestations, preeclampsia and birth defects in the fetus. This paper reports the case of a 38-year pregnant woman (29 gestation weeks). She had eleven pregnancies, nine deliveries and one abortion. During perinatal assessment patient showed severe polyhydramnios and acute fetal distress. The histopathologic examination of the placenta showed a mass with hemorrhagic areas. The microscopic examination revealed proliferation of small fetal capillary vessels and CD34-positive immunostain. Histopathological study of primary non-trophoblastic tumors should differentiate chorangiosis from other entities, as the chorangiomatosis and choriocarcinoma, and this study should report the presence or absence of mesenchymal dysplasia because it is associated with genetic diseases. This neoplasm is associated with processes of fetal-placental hypoxia that must be assessed in patients with a history of fetal growth restriction, preeclampsia and multiple gestations.

Introduction: In Colombia, there are no specific studies on the prevalence of heroin use. This paper reviews the patterns of substance use in a consumer group in the city of Medellín and its metropolitan area, showing that consumption is becoming a threat to public health due to the particular forms of consumption, among which risk practices are included., Objective: To evaluate the use of heroin in the city of Medellín and its metropolitan area., Methods: The study took a mixed approach using multiple-case study to cover each of the variables and categories proposed; 42 heroin users of treatment centers in the city of Medellín and its metropolitan area were accessed between July and September 2008, using the "snowball", technique. Information was collected by a structured, face to face interview, asking about the type of heroin consumed, routes of administration, frequency of consumption, equipment used, consumption practices and rituals that accompany these practices. Quantitative data were analyzed using the EPI-Info statistical package 2,000 and Atlas ti qualitative, version 5.5, for Windows., Results: Consumers were predominantly male, single, aged between 18 and 23 years, childless and many had not completed college. Most respondents were in the middle socioeconomic stratum, had a family history of psychoactive substance use and had started heroin use between 15 and 17 years. There are special forms to name heroine, consumers, and rituals to consume the substance. The article gives details of the heroin consumed, the paraphernalia and associated practices., Conclusions: The use of heroin is an emerging reality in Colombia. Qualitative-quantitative studies are necessary to allow us to acknowledge and understand more about this phenomenon in order to decrease the impact on public health.

This paper reviews the three approaches adopted by the Colombian Constitutional Court to justify the protection of the right to health, and questions whether other rights that are not constitutionally defined, i.e. the right to a precise diagnosis, the right to access medical records, and the right to informed consent, also belong to the right to health or if they are distinctly different rights with a defined constitutional character.

This paper analyzes the main advances in health coverage and health services demand in Colombia using the 1997 and 2003 living standards surveys. The study showed an increase in health coverage associated with expansion of the subsidized care system, although a large proportion of the population is still not entitled to health care. The type of entitlement also directly affects the demand for services. There was an increase in preventive medical consultations in 2003 and a decrease in the use medical care for acute illness, due mainly to lack of money. Access to medicines increased from 1997 to 2003, as reflected by a decrease in out-of-pocket expenditure on medicines.

Background: The burden of illness of cervical cancer has not decreased enough in developing countries. For that reason is important to improve coverage, access and effectiveness of cervical cancer screening programs. The objective of this paper is to analyze women's access to the cervical cytology programme of the Secretary of Health of Medellín (Colombia)., Methods: An analysis was made of 1,519 records of women from a cross-sectional study conducted in an urban area of Medellin (Colombia). Descriptive analysis was conducted and a Logit model was estimated for analysing recent cervical cytology (cytology performed less than 36 months prior to the survey)., Results: 68.7% of women had a recent cytology, 17.2% did not have recent cytology and 14.2% of women attended for the first time to the service. The probability of having a recent cytology increased with age, women with family history of cervical cancer, women with personal history of sexually transmitted infections, women with some education and women who are (or were) married or in a stable union., Conclusions: The demand for cytology appears to be concentrated; a limited number of women assist frequently while others don't practice it or stop assisting.

Introduction: Three of the seven species that comprise the pia series of the Lutzomyia verrucarum group have been recorded in Colombia, including L. pia, L. limafalcaoae and L. emberai., Objective: The aim of this paper is to report the occurrence of an anthropophilic morphospecies of the pia series in the country., Materials and Methods: Sand flies were collected with a mouth aspirator on protected human bait in a secondary forest in the municipality of Envigado, department of Antioquia. The entomological survey was performed from 18:00 to 22:00 hours in June and December, 2004., Results: Captured specimens were identified as L. tihuiliensis, which can be distinguished easily from other species of the pia series by its basally pigmented pleura, the length of the labro-epipharynx, (3)350 microm, and the length of the second palpomere, (3)170 microm. In addition to the previous characters, the sand flies collected exhibit a longer common sperm duct than the individual ducts with the ratio of the lengths of the common/individual ducts (3)2., Conclusion: The finding of L. tihuiliensis raises to 21 the number of species of the Lutzomyia verrucarum group recorded to date in Colombia, including two endemic species of the pia series. From a biogeographical point of view, the presence of four species of the pia series in Colombia is of great interest for the study of the origin of the taxon.

Introduction: Plasmodium falciparum is a highly polymorphic parasite, which allows it to evade the host's immune response, spread drug resistance and favours transmission., Objectives: To analyse the genetic diversity of P. falciparum populations in samples from four endemic localities in Colombia., Materials and Methods: 123 blood samples were collected on filter paper from patients with non-complicated P. falciparum malaria during 2002 to 2004. The samples were genotyped using polymerase chain reaction with specific primers for the polymorphic region of block 2 of the msp1 gene and the 108 codon of the dhfr gene., Results: In msp1 block 2, 95.9% (118/123; 95% CI: 90.8-98.7) of the samples harboured MAD20; 6.5% K1 (8/123; 95% CI: 2.8-12.4) and 2.4% RO33 (3/123; 95% CI: 0.5-6.9). For the dhfrgene the mutant allele N 108 was found in all the samples amplified, T 108 in 3.2% and the wild type S108 in 34.1%. Taking together all the results from both genes, 61.8% (76/123; 95% CI: 52.6-70.4) of the samples were simple infections and 38.2% (47/123; 95% CI: 29.6-47.4) were mixed infections. MAD20/N108-S108 (30.1%) was the most frequent combination among the latter., Conclusions: Simple infections, i.e, a single allelic type in each one of the genes studied, prevailed among the circulating parasite populations. In this study the genetic composition of P. falciparum parasite populations was very homogeneous.

An ethical analysis was performed during the development of a research project titled "Culture, nourishment and malaria in the Kuna aboriginals of Urabá, Colombia." This project had 2 objectives; (1) to investigate the prevalence of malaria and its relationship with hypovitaminosis A and nutritional status, and (2) to understand the community's conceptions and practices towards malaria. The current paper summarizes reflections concerning the application of ethical principles and moral values during the course of the malaria research project. Two intercultural relationships were clearly defined: the culture of the Tule (Kuna) Indians, with a traditional medical system, and the culture of the research group, focused on the biomedical model. The rationale and the discussion proposed during the writing of the project proposal was presented as well as the dilemmas that developed during the project within the communities. These problems required rapid decision-making in situations for which the scientists had not been adequately prepared. A need was indicated for application of ethical principles to permeate the analysis throughout the research process in a horizontal manner, such that the human dignity of the participants and the ethnicity of the community are preserved above the purposes of the project. In the research process, mediation between the ethics of conviction and the ethics of consequences must take precedence, with both outcomes tied to an informed consent in place during the process. The establishment of national and local research ethics committees was indicated as necessary to preserve the lifestyle and culture of the ethnic groups. These values were seen as endangered given the trading pressures and health policies in a globalized world.

This paper discusses the experiences and conceptual and theoretical lessons learned during interaction between researchers, policy-makers, program beneficiaries, and other actors in a research project on social protection, health, and forced displacement in Bogotá, Colombia. The article begins by presenting the methodological approach and a description of interaction between various actors. This experience provides the basis for a conceptual discussion on the factors and determinants of research use. The article also highlights the need for taking an epistemological view beyond the positivist and rationalist underpinnings of the dominant explanations concerning interaction between researchers and decision-makers.

This paper examines published information and gray literature about taxonomy and ecology of echinoderm species of the Colombian Pacific Coast. Unpublished collection data of specimens kept in the Marine Sciences Museum of the University of Valle are also considered. Sixty-six species are found in coastal ecosystems and shallow bottoms of ten geographical, coastal and insular localities of the Pacific coast of Colombia. Main habitats having echinoderms are: rocky cliffs and shores, coral reefs, sand beaches, mud substrates, mangroves, and shallow bottoms of mud, sand, gravel and rocks. Regular Echinoidea and Asteroidea are the most diverse and abundant groups, mainly in subtidal rocky shallow bottoms and coral reefs. Ophiuroidea are abundant below rocky boulders. Irregular Echinoidea are abundant on sand beaches. The relatively high number of species shows that this geographical area presents a high diversity of echinoderms compared with other tropical shallow and littoral zones of the world. Rocky substrates and coral reefs are the ecosystems with the highest numbers of echinoderm species and individuals. A conservation status assessment is difficult because the lack of periodical sampling and few data about deep zones. In general, the species reported in the last 25 years, have not experimented important changes in their populations, although in some specific places, populations may decrease because human activities in coastal areas increase sedimentation rates change some rocky substrates to mud or sand.

Understanding the current epidemiologic dynamic of tuberculosis (TB) in any society requires a holistic approach. In the current paper, the history and behavior of the TB is summarized for Bogotá, Colombia. In prehispanic periods the occurrence of TB was low. During the Conquest and the Colony periods, a moderate increase of pulmonary and abdominal TB was observed. In the 1870s, a great increase in cases of pulmonary TB was associated with the accelerated urbanization process. Since the 1920s, the occurrence of pulmonary TB shifted to the status of an endemic disease. After 1920, its occurrence was relatively steady until the 1970s, when its occurence greatly decreased. More recently, however, an increase in case numbers has been observed. The occurrence of TB in each period is associated with clearly defined social and environmental phenomena.

Background: The displacement of populations as the result of an armed conflict generally entails a worsening of the living and health conditions of those undergoing such a displacement. This paper is aimed at analyzing the health-related needs perceived by men and women displaced by the armed conflict and their main strategies to address those needs., Methods: A qualitative study was carried out by means of semi-structured individual interviews to 31 displaced men and women in the transition stage. A narrative analysis of the contents was conducted, segmenting the information by age and sex. The area under study was made up of five localities in the city of Bogotá., Results: The negative effects on their mental health and psychosocial stability, access to food and, to a lesser degree, gastrointestinal and respiratory disorders, are the main health problems reported by both groups of informants. The difficulty of accessing health care services comes up as an added problem. The precarious economic situation underlies the health care-related needs and problems. To solve their health problems, in addition to the health care services, they employ other strategies within their reach. Expressed needs are coherent with the problems perceived. Some differences between women and men and age groups were observed concerning the definition of the problems and employed strategies., Conclusion: In the health field, actions are required in order to improve their access to services in addition to specific strategies for the psychosocial rehabilitation of the displaced population which take into account the differences existing within this group.

This paper analyzes the effects of health reform in Colombia on public health programs at the local level, particularly the Expanded Program of Immunization (EPI) and the tuberculosis control program. The research was developed in three health districts in two States by analysis of documents, direct observation, and longitudinal follow-up of the transition process. The health districts were unprepared for the change, resulting in insufficient technical skills among staff as well as lack of awareness of important elements in the new system, associated with a reduction in immunization coverage and tuberculosis case detection. Structural problems in the new system included loss of immunization opportunities and lack of examination of tuberculosis contacts. The potentialities of the new system were the local development of a new organizational structure and the improvement of the information system; a limiting factor was exposure of the health system to local political interests. The general conclusion is that the transition period takes far longer than anticipated and requires a much greater information flow to both the local level and the community. There are transitory but also structural maladjustments that require a political response.

Objective: To identify the reproductive timing, intensity, and rhythm of the Embera, (Eyabida, Dobida, and Chamibida subgroups) and Zenues ethnic groups., Material and Methods: A sociodemographic study was conducted during 1996-1997 in Antioquia, Colombia, on a non-random population sample, stratified by ethnic group, to compare reproductive behaviors within and between these ethnic groups. Statistical analysis for independent samples was conducted using the software program Epi-Info. Analysis included the Student's t test for difference of means, and the chi-squared test for difference of proportions., Results: Reproductive behavior was characterized by ages at first intercourse of 14.5 and 15.8 years; the average interval before pregnancy was 1 to 1.3 years, followed by 48% to 73.3% of short-spaced intergenesic intervals. Reproductive stress was 50% during reproductive life, reaching an accelerated rhythm at 30-34 years of age, with a high fecundity ratio averaging 10.5 births, except for the better educated Chamibida that had 4 births on average., Conclusions: Mainstream health policies directed at controlling birthrates are far from appropriate because they do not take into account the specific reproductive behaviors of these ethnic groups. The English version of this paper is available at: http://www.insp.mx/salud/index.html

With the aim of determining the dynamics of malaria transmission in the village of Charambirá (Chocó), Colombia, studies on the age structure of Anopheles neivai (a known vector on the Pacific Coast) were undertaken, based on its gonadotrophic status. Mosquitoes were captured indoors at sunset using human bait and bucal aspirators and then maintained in cylindrical cardboard boxes, with damp paper and feeding dispensaries, until dissection on the following day. Of the 200 specimens dissected during September-October 1986, 68 (34%) showed traces of less than two ovipositions, while the rest (66%) evidenced at least three ovipositions. The difference between the first group considered as "non-infective" and the second group considered as "potentially infective" was highly significant (X2 = 10.68; P = 0.001). The study showed that 1.5% of the dissected A. neivai had traces of ten ovipositions demonstrating high longevity and multiple bloodfeedings. The results suggest that there is a considerable risk of contracting malaria in Charambirá at dusk.