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The shift from mass tourism to more personalized travel denotes great importance in the construction of tourist itineraries. Given the negative impacts of transport and tourism on the environment, sustainability criteria play an important role. The Tourist Trip Design Problem is related to the design of itineraries for tourists. Planning is complex in tourist regions of developing countries where the information associated with tourist activities is difficult to access, vague, and incomplete. With this information, tourists must plan their trip, and the conditions and limitations they establish for it are flexible and imprecise. Fuzzy optimization can address problems with this type of information and constraints. Therefore, in this paper, an analysis of the tourism supply chain is carried out, taking as a case study the Department of Sucre on Colombia's Caribbean coast. A Multiconstraint Multimodal Team Orienteering Problem with Time Windows and fuzzy constraints is developed to model the tourism trip design problem that maximizes profit and minimizes CO2 emissions. The model is tested using datasets from the literature and the real world. The results demonstrate consistency with the fuzzy approach and generate a set of low-emission solutions. [ABSTRACT FROM AUTHOR]

Isostichopus sp. is a variety of Isostichopus badionotus, proposed as a new species, which has been intensely fished in the Colombian Caribbean, arousing interest for its aquaculture. This study evaluated the effect of two culture densities (1–3 larvae ml−1), two temperatures (23°C and 26°C) and two microalgae diets (Isochrysis galbana, Chaetoceros calcitrans, Nannochloropsis oculata 1:1:1 and I. galbana, C. calcitrans 1:1) on the survival, development and growth of its larvae. Larval culture lasted 22 days until metamorphosis to doliolaria larvae, and 7 days later, the first juveniles were observed with a size of 621.8 ± 12.7 µm (±SE). The highest growth rates, survival and percentage of doliolaria larvae were obtained with 1 larva ml−1 (29.2 µm/day and 31.5% doliolaria larvae) and 26°C (28.4 µm/day and 10% doliolaria larvae). However, in the two diets examined, the larvae showed low growth rates (between 1.3 and 8.5 µm/day), stagnation in development and high mortality. Our results indicate that it is feasible to culture larvae from Isostichopus sp. to juveniles, recommending the use of 1 larva ml−1 and 26°C. However, to meet the nutritional needs of the larvae the inclusion of microalgae Pavlova sp. and Tetraselmis chuii in the diet is recommended. This paper reports for the first time the successful production of sea cucumber juveniles of this species in Colombia. [ABSTRACT FROM AUTHOR]

The global COVID-19 outbreak has demanded drastic actions and policies from the governments and local authorities to stem the spread of the virus. Most of the measures involve behavioural changes from citizens to reduce their social contact to a minimum. Thus, these actions influence individual activity patterns and transport systems in different ways. This paper studies the short-term impacts on the transport system caused by the different policies adopted by the Colombian government and local authorities to contain the COVID-19 spread. Using official and secondary data concerning the seven most populated cities in Colombia, we analyse the impacts on three components of the transport system: air transport, freight transport, and urban transport. Results show that national policies and local decisions have decreased the demand for motorised trips across the cities, diminishing congestion levels, reducing transit ridership, and creating a reduction in transport externalities. The country banned air transport for passengers and only allowed air cargo for medical and necessary supplies, which will have negative consequences for the economics of the airline industry. During the first three months of the COVID-19, freight was the most resilient transport component. However, freight trips diminished around 38%, affecting mainly the supply chain of nonessential products. During the pandemic, governments need to provide subsidies to maintain the system supply to avoid crowdedness and promote active transport by allocating less-used street space to cyclists and pedestrians. In the short term, transportation service providers will face a financial crisis, deepened by the pandemic, which will require government assistance for their recovery. [ABSTRACT FROM AUTHOR]

Introduction. Parkinson's disease (PD) is one of the most prevalent age-related neurodegenerative disorders. The progression of PD produces an important disease burden in patients due to functional impairment, which also has repercussions on caregivers. In addition, it has become a challenge for health systems, especially in developing countries, which have limited resources. Multidisciplinary teams with a community approach have proved effective in high-income countries; however, there is no reported literature in low- and middle-income countries about this kind of initiative. Objective. This paper aims to document the experience of patients, caregivers, and experts in a community approach as an innovative model in a middle-income country. Methods. A quantitative descriptive research was conducted. The selection criteria were having a PD diagnosis, attending with a caregiver to Saturdays in Motion (SIM), or being a clinical expert invited to SIM. PD patients and their caregivers answered three surveys on their points of view with respect to SIM: SIM and their quality of life (QoL) and PDQ-39 and Zarit, whereas clinical experts completed two questions related to the SIM program. Descriptive statistics were used to summarize the results of the surveys and clinical tests. Results. Forty-eight, twenty-four, and twenty-one subjects answered surveys one, two, and three, respectively. In total, four clinical experts were interviewed. 87.9% of the patients consider that SIM activities improved their QoL. The most affected areas in PDQ-39 were those related to the social area. Around 66.6% of the caregivers reported a mild burden on Zarit and think that SIM enhances the PD patient's QoL. Clinical experts highlighted the sense of community and empathy. Conclusion. Our preliminary experience shows a multidisciplinary model with a community approach which redefines the traditional relationship between patients, caregivers, and clinical experts. This aim of this initiative is that education and empowerment patients and caregivers reach a better perception of QoL. [ABSTRACT FROM AUTHOR]

This paper presents a mineralogical and physicochemical characterization of a Colombian clay found in an area with the greatest exploitation potential of smectites and possible use as an adsorbent for the removal of chromium. The clay was characterized by using X-ray diffraction (XRD), cation exchange capacity (CEC), X-ray fluorescence (XRF), Fourier transform infrared spectroscopy (FT-IR), thermal analysis (TGA/DSC), and nitrogen adsorption at 77 K. The homoionized clay was used as an adsorbent for the removal of Cr(III) in an aqueous solution. The homoionized clay was modified with hexadecyltrimethylammonium bromide (HDTMA-Br), and the organoclay obtained was evaluated for the adsorption of Cr(VI) in aqueous solution. The XRD analysis showed that the clay from Armero-Guayabal is primarily constituted by smectite (48 wt%) followed by quartz mineral (21 wt%). The chemical analysis of bulk clay showed that the predominant oxides are SiO2 (55.81 wt%), Al2O3 (16.25 wt%), and Fe2O3 (7.51 wt%), and the nitrogen adsorption indicated that the bulk clay has a specific surface area of 45.1 m2/g. Homoionized clay and organoclay achieved Cr(III) and Cr(VI) removals greater than 85.05 ± 2.04% (pH between 3 and 4) and 82.93 ± 1.03% (pH between 3 and 5), respectively, proving the potential of these materials for the removal of heavy metals in an aqueous solution. [ABSTRACT FROM AUTHOR]

In this paper, a nonlinear fractional-order chikungunya disease model that incorporates asymptomatic infectious individuals is proposed and analyzed. The main interest of this work is to investigate the role of memory effects on the dynamics of chikungunya. Qualitative analysis of the model's equilibria showed that there exists a threshold quantity which governs persistence and extinction of the disease. Model parameters were estimated based on the 2015 weekly reported cases in Colombia. The Adams-Bashforth-Moulton method was used to numerically solve the proposed model. We investigated the role of asymptomatic infectious patients on short- and long-term dynamics of the diseases. We also determined threshold levels for the efficacy of preventative strategies that results in effective management of the disease. We believe that our model can provide invaluable insights for public health authorities to predict the effect of chikungunya transmission and analyze its underlying factors and to guide new control efforts. [ABSTRACT FROM AUTHOR]

The potato is one of the main agricultural products in Colombia and is the second most important crop in the country. The production of this tuber represents 3.3% of the country's agricultural gross domestic product (GDP). More than 100,000 producer families subsist on cultivation at the national level, the vast majority of which are smallholdings. However, smallholders are not able to exploit the full potential of this activity, and one of the main factors that does not allow for improving productivity is the inefficient use of land in agricultural activities. This leads to issues such as erosion, overexploitation of soil resources, reduced productivity, and, depending on the time of year, even an excess of potato supply. Therefore, a multicriteria methodology is proposed based on the key elements of the potato crop production cycle and its environment, made up of farmers from the municipality of Ventaquemada, located in Boyacá, where potato cultivation is a traditional practice. This department is the second-largest potato-producing department in the country. A review of the literature was carried out to determine and characterise the area of the selected department, and based on the above, the relevant criteria were defined and the alternatives to be evaluated were identified. Second, the proposed model is evaluated with its respective prioritisation process of both the criteria and the alternatives according to the analytic hierarchy process (AHP) methodology. Finally, the results of the model are presented, prioritizing the type of tillage, irrigation method, seed type, and its disinfection process for potato cultivation. This takes into account topographic and climatic conditions, the ecosystem, soil type, implementation costs, among other factors specific to the case study. [ABSTRACT FROM AUTHOR]

Carrot production is expensive since approximately 51% of the total costs are allocated to the nutrition of the crop. Bacterial inoculants are a promising alternative for crop fertilization. This research aimed to evaluate the effect of Gluconacetobacter diazotrophicus on the performance of carrot cultivar "Royal Chantenay" and its interaction with nitrogen and phosphorus fertilization. An experimental design of sub-subdivided plots was applied, where the largest plot consisted of the reference strain (ATCC 49037) and a native Colombian isolate of the bacterium (GIBI029); two concentrations of the bacterium were applied in the subplots (8.8 × 107 and 18 × 107 CFU/mL), and the levels of nitrogen and phosphorus were sorted within each one of them. The best positive effect was observed with the application of G. diazotrophicus ATCC49037 and GIBI029 at a concentration of 18 × 107 CFU/mL without the application of phosphorus or nitrogen in which yields of 37,417 and 30,606 kg/ha were obtained, respectively, exceeding the national average production in Colombia. In contrast, conventional treatment had a yield of 27,909 kg/ha. Additionally, higher quality was evidenced in the product weight with values of 126.48 g (ATCC49037) and 104.98 g (GIBI029), compared with the conventional treatment (93.19 g). G. diazotrophicus was shown to exhibit growth-promoting properties not only in crops such as sugarcane but also in economically important vegetable crops. The results obtained may contribute to the development of a novel microbial inoculant for vegetables under agroecological conditions in tropical areas. [ABSTRACT FROM AUTHOR]

This article presents a Generation Expansion Model of the power system taking into account the operational constraints and the uncertainty of long-term electricity demand projections. The model is based on a discretization of the load duration curve and explicitly considers that power plant ramping capabilities must meet demand variations. A model predictive control method is used to improve the long-term planning decisions while considering the uncertainty of demand projections. The model presented in this paper allows integrating technical constraints and uncertainty in the simulations, improving the accuracy of the results, while maintaining feasible computational time. Results are tested over three scenarios based on load data of an energy retailer in Colombia. [ABSTRACT FROM AUTHOR]

Korsakoff's syndrome (KS) is an insidious and progressive neuropsychiatric disorder that affects specific neurocognitive functioning, especially in tasks that require sustained attention, memory, executive functions, and visuospatial functioning. Usually, this disease generates neuropsychiatric complications that worsen the quality of life (QOL) of patients in the medium term. We present a case of a 63-year-old male who presented with a diagnosis of advanced Korsakoff's syndrome and has a clinical history of recurrent memory loss and a history of alcohol abuse. The patient showed difficulty manipulating immediate information, associated with a possible frontal lobe dysfunction, and inability to remember material given through the auditory pathway. The patient showed a psychiatric clinical picture which is constantly worsening his and his immediate caregiver's QOL. The data obtained demonstrate that the patient presents a progressive cognitive impairment, which in the short term is correlated with Korsakoff-type dementia. It is suggested to carry out functional neurorehabilitation plans aimed at improving the QOL of the patient, his immediate caregiver, and future people with this type of diagnosis. [ABSTRACT FROM AUTHOR]

African swine fever (ASF) and classical swine fever (CSF) are two major transboundary animal diseases of swine with important socioeconomic consequences at farm, subnational and national level. The objective of this study was to evaluate the direct cost of outbreaks and their control at country/regional level in four countries: namely CSF in Colombia in 2015–2016, the retrospective cost of ASF in the Philippines in 2019 and in a province of Vietnam in 2020 and a hypothetical ASF scenario in one region in North Macedonia, using the newly developed Outbreak Costing Tool (OutCosT). The tool calculates the costs of 106 different items, broken down by up to four types of farms, and by who assumes the cost (whether veterinary services, farmers or other stakeholders). The total cost of CSF in Colombia was US$ 3.8 million, of which 88% represented the cost of the vaccination campaign. For ASF, there were wide differences between countries: US$ 8,26,911 in Lao Cai (Vietnam), US$ 33,19,666 in North Macedonia and over US$ 58 million in the Philippines. While in the Philippines and Vietnam, 96–98% of the cost occurred in the affected farms, the highest expenditure in North Macedonia scenario was the movement control of the neighbouring and at‐risk farms (77%). These important differences between countries depend on the spread of the disease, but also on the production systems affected and the measures applied. Apart from the financial cost, these diseases have other negative impacts, especially in the livelihoods of smallholder farms. The OutCosT tool also allows users to evaluate qualitatively other important aspects related to the epidemics, such as the impact on human health, the environment, animal welfare, socioeconomic vulnerability, trading and political response. OutCosT, which is a FAO corporate tool (available online at: https://www.fao.org/fileadmin/user%5fupload/faoweb/animal‐health/OutCosT%5fPIG.xlsx), can be an important tool to support country authorities to rapidly respond to a swine disease outbreak by estimating the associated costs and for advocacy purposes to mobilize resources at national or international levels. [ABSTRACT FROM AUTHOR]

This study aims to explore the perceptions of the Venezuelan immigrant population in Medellín, Colombia, regarding their employment, working and health conditions (physical, mental and psychosocial). A qualitative study was conducted (focused ethnography perspective). Semi‐structured interviews were carried out with 31 Venezuelans and 12 key informants from different social organisations that work with the immigrant population. A narrative content analysis was carried out (Atlas.Ti 8.0 software). The migratory process for Venezuelans is caused for political, economical and social aspects in Venezuela and Colombia is offered as the first destination for labour establishing. Access to the labour market is limited to certain occupations, in many cases in the informal economy. Participants referring low salaries, working long hours and reduced social benefits. Occupational risks are evidenced by low experience in the labour market. Some health problems are perceived, and a good part of the interviewed population referred to signs and symptoms related to mental health problems. Barriers to access health and social protection services were found. Finally, future expectations depend on their adaptation to Colombia, the improvement of social conditions in Venezuela or having chances of improving their social and living conditions in another country. A high labour and social vulnerability were found in Venezuelan participants that impact on physical and mental health. Political and strategies from a public health perspective are required and the implementation of systems for monitoring and evaluating the labour and health situation in the working immigrant population. [ABSTRACT FROM AUTHOR]

Infection with the classical swine fever virus (CSFV) causes a disease in pigs that ranges from a hyperacute form in which animals die in a few hours to subclinical disease. Due to this wide range of virulence, several complementary surveillance strategies should be implemented for the early detection of the disease. The objective of the present study was to determine the sensitivity of the surveillance system to detect CSFV outbreaks in a free zone (Zone 1) and in a zone undergoing an eradication process (Zone 2) in Colombia. Stochastic scenario tree models were used to describe the population and surveillance structures and to determine the probability of CSFV detection. The total sensitivity of the surveillance system in the case of a single infected farm in Zone 1 was 31.4% (CI 95%: 7.2-54.1) and in the case of 5 infected farms was 85.2% (CI 95%: 67.3-93.7), while in Zone 2 the sensitivities were 27.8% (CI 95%: 6.4-55.1) and 82.5% (CI 95%: 65-92.9), respectively. The on-farm passive surveillance shows the highest sensitivity for detection of a single CSFV infected farm in both zones (22.8% in Zone 1 and 22.5% in Zone 2). The probability of detection was higher in a family / backyard premise than on a commercial farm in both zones. The passive surveillance at slaughterhouse had a sensitivity of 5.3% and 4.5% for the detection of a single infected farm in Zone 1 and 2, respectively. Active surveillance presented a range of sensitivity between 2.2% and 4.5%. In conclusion, the sensitivity of the surveillance in the two studied zones was quite high, one of reasons for this good sensitivity being the sentinel network based on the voluntary participation of 5,500 collaborators that were trained for the identification and notification of diseases of national interest. [ABSTRACT FROM AUTHOR]

Measuring the quality of life in family caregivers of people in palliative care is essential to document the impact of care on the caregiver. This study aimed to adapt and validate a Latin American‐Spanish version of the QOLLTI‐F scale in family caregivers of palliative care patients. This study was conducted between May and November 2019 in Medellin, Colombia. We develop three phases: translation and semantic adaptation (n = 17), face and content validity (n = 21), construct validity, internal consistency (n = 208) and test–retest reliability (n = 35). Main family caregivers of stage‐IV cancer patients receiving palliative treatment, participated. In the translation and semantic adaptation, some items were adjusted following the caregivers' recommendations. In face validity, Fleiss' Kappa was over 0.65 for family caregivers. In content validity, Fleiss' Kappa ranged from 0.54 to 1 for experts. In construct validity, the original version seven‐factor structure did not show appropriate model fit indices. The data revealed instead a new 3‐factor structure related to (1) impact of care‐giving, (2) social and healthcare interactions and (3) meaning of life. Cronbach's alpha was 0.83 for the overall scale. Test–retest reliability was 0.87 between measurements 1 and 2. This study found that The Latin American‐Spanish version of the QOLLTI‐F scale is an understandable, useful, and relevant tool for family caregivers of people with cancer receiving palliative care. Future research is needed to confirm the factor structure identified in this study. [ABSTRACT FROM AUTHOR]

Quinoa has a high nutraceutical potential because of the presence of secondary metabolites called saponins, which have industrial and medicinal uses and protect against attacks by pathogens. These compounds are found especially in the seed coat and give the grain a bitter taste; therefore, they must be eliminated before consumption. Despite the potential use in Colombia, there are few studies aimed at quantifying this metabolite. Therefore, the objective of this research was to evaluate two extraction methodologies (physical and chemical) and two methods for quantifying saponins in five quinoa genotypes grown in Colombia. The most efficient extraction method was the physical method. The saponin contents of the five genotypes were variable. The cluster analysis differentiated the genotypes into two groups: low saponin content (<4.49 mg/g seed) and high saponin content (>14.76 mg/g seeds). Blanca de Jericó had the lowest saponin content (<0.40%), and Amarilla de Maranganí had the highest content (>0.18%). Identifying more efficient methodologies for extracting and quantifying saponins will allow a better characterization of the germplasm and selection of genotypes with desirable characteristics for both consumption and industrial use. [ABSTRACT FROM AUTHOR]

With the technological advancements of the modern era, the easy availability of image editing tools has dramatically minimized the costs, expense, and expertise needed to exploit and perpetuate persuasive visual tampering. With the aid of reputable online platforms such as Facebook, Twitter, and Instagram, manipulated images are distributed worldwide. Users of online platforms may be unaware of the existence and spread of forged images. Such images have a significant impact on society and have the potential to mislead decision-making processes in areas like health care, sports, crime investigation, and so on. In addition, altered images can be used to propagate misleading information which interferes with democratic processes (e.g., elections and government legislation) and crisis situations (e.g., pandemics and natural disasters). Therefore, there is a pressing need for effective methods for the detection and identification of forgeries. Various techniques are currently employed for the identification and detection of these forgeries. Traditional techniques depend on handcrafted or shallow-learning features. In traditional techniques, selecting features from images can be a challenging task, as the researcher has to decide which features are important and which are not. Also, if the number of features to be extracted is quite large, feature extraction using these techniques can become time-consuming and tedious. Deep learning networks have recently shown remarkable performance in extracting complicated statistical characteristics from large input size data, and these techniques efficiently learn underlying hierarchical representations. However, the deep learning networks for handling these forgeries are expensive in terms of the high number of parameters, storage, and computational cost. This research work presents Mask R-CNN with MobileNet, a lightweight model, to detect and identify copy move and image splicing forgeries. We have performed a comparative analysis of the proposed work with ResNet-101 on seven different standard datasets. Our lightweight model outperforms on COVERAGE and MICCF2000 datasets for copy move and on COLUMBIA dataset for image splicing. This research work also provides a forged percentage score for a region in an image. [ABSTRACT FROM AUTHOR]

This analysis gives information about length–weight relationships (LWR) for 31 fish species from different aquatic environments in the Magdalena‐Cauca River basin. Some of these species are endemic of the region and important as fishing resources. Fish were caught between 2005 and 2016, employed different fishing gears depending on the aquatic environments (portable electrofishing equipment, cast nets and gillnets). Standard length and total weight of all captured specimens were measured. New registers of LWR are presented for 26 species and new maximum values of size are given for 13 species. This study provides information for the estimation of body size models, which is important to advance our knowledge of fish and to generate recommendations that contribute to the management of these species in the aquatic systems of the Colombian Andes. [ABSTRACT FROM AUTHOR]

In Colombia, like many countries in the world, due to the increase in population of elderly people, mistreatment has increased, which has physical, psychological and social consequences for the individual and major repercussions on society. The detection of abuse is a complex task, among other aspects, due to the concealment of victims and the lack of valid, reliable detection instruments that are in keeping with the sociocultural context. Professionals responsible for dealing with these situations must have an instrument that allows early detection. The objective of this study was to adapt and validate the Family Abuse Screening Questionnaire for Elderly People in Colombia. A cross‐sectional study with mixed methods was carried out in two stages from 2017 to 2018. In the first stage, linguistic and semantic adaptation was carried out using translation, synthesis, back translation, expert analysis and pilot testing with 30 abused and non‐abused elderly people. In the second stage, the validity and reliability of the questionnaire were obtained by means of an exploratory factor analysis and Cronbach's Alpha, using STATA 13. In the results, we provided a Socially and Culturally Adapted Family Abuse Screening Questionnaire for elderly people in Colombia with a Cronbach's Alpha of 0.82, sensitivity value of 86.9% (p < 0.05) and a specificity value of 84% (p < 0.05), detecting abuse with 4 or more positive responses to abuse. The application of the screening questionnaire by health and social services professionals will prevent further damage to social and physical health in the elderly people in Colombia, as well as reduce the costs of care in institutions. [ABSTRACT FROM AUTHOR]

The perception that immigrants represent a burden to national health systems can hinder the development of policies for their inclusion in health coverage. In order to inform the development of such policies, data on the healthcare needs and healthcare spending for immigrants is required. The objective of this article is to compare the clinical characteristics and healthcare‐related expenditures of Venezuelan immigrants and non‐migrants living with HIV in Colombia. We analysed data from the Colombian High‐cost Diseases Fund from February 1, 2018 to January 31, 2019, identifying the hospital and non‐hospital expenditures per patient for Venezuelan immigrants and non‐migrant patients, in both the state‐subsidised and the contributory coverage schemes. We employed binomial negative regression models to compare expenditures between the two groups. In the contributory scheme, the average annual per‐capita expenditure for immigrants was USD $ 859.07 (SD: ± $793.37) for non‐hospital care. For non‐migrants, the average costs were 1,796.53. In the state‐subsidised scheme expenditures were higher on average, but still lower for immigrants than for non‐migrants. After adjusting by clinical and sociodemographic characteristics, non‐hospital per capita expenditures were lower for immigrants as compared with non‐migrants (25,37% lower in the state‐subsidised scheme, and 33,75% lower in the contributory scheme). Hospital expenditures were also lower, but the small sample size limited analysis. To conclude, Venezuelan immigrants living with HIV do not represent a major economic burden to the health system in Colombia. Further studies are required in order to understand if the lower healthcare expenditures of this population are the result of limitations in healthcare access, of clinical characteristics that were not assessed in this study, or of other unmeasured aspects. [ABSTRACT FROM AUTHOR]

Sunn hemp (SH; Crotalaria juncea L.) is a fast-growing, annual, warm-season tropical legume that could complement less productive cool-season forages such as tall fescue during summer. Little is known about seasonal forage mass and nutritive value partitioning in SH plant components when SH is managed for forage. We determined partitioning of forage mass and nutritive value (crude protein (CP), in vitro true digestibility (IVTD), neutral detergent fiber (NDF), acid detergent fiber (ADF), and neutral detergent fiber digestibility (NDFD)) concentrations in SH leaves and stems harvested 35, 45, and 55 days after planting (DAP) at Bradford Research Center, Columbia, MO, in a 2-year field study. Leaf and stem mass increased with increasing DAP and was greatest (P ≤ 0.05) at 55 DAP followed by 45 and 35 DAP. Stems contributed most to the total forage mass beyond 45 DAP. Across years, CP was greatest (P ≤ 0.05) in leaves (281 g kg−1 DM) and lowest for stems (81 g kg−1 DM) at 55 DAP. The lowest NDF (P ≤ 0.05) was observed in leaves (251 g kg−1 DM) and stems (585 g kg−1 DM) at 35 DAP. Acid detergent fiber was lowest (P ≤ 0.05) for SH leaves (178 g kg−1 DM) and stems (484 g kg−1 DM) at 35 DAP. Digestibility of leaves was greater than that of stems and generally decreased with maturity. The nutritive value of leaves was consistently greater than that of stems and decreased with maturity, except for CP of leaves, which was maintained throughout the season. Results suggested that SH leaves can maintain forage mass and greater quality than its stem throughout the growing season. [ABSTRACT FROM AUTHOR]

Dengue is a single-stranded RNA virus belonging to the Flaviviridae family. It is an endemic virus in tropical countries. In Colombia, 4 serotypes are present, and the disease is a burden for public health, social programs, and the economic sectors. The main vector is Aedes aegypti, and most infections are asymptomatic or minimally symptomatic. The hemorrhagic appearances of severe dengue are due to plasma leakage as a result of increased vascular permeability, severe thrombopenia, and hemoconcentration. In 2020, 78,979 cases of dengue were reported in Colombia. 38,836 (49.2%) of them were warning-free signs, 39,246 (49.7%) with warning signs, and 897 (1.1%) of severe dengue. As it is well-known, viral diseases are immune system activators, triggering off a loss of tolerance in it. Dengue is not an exception, and it is able to explain different autoimmune phenomena including macrophage activation. Mechanisms have been described by which an exacerbated response of the disease is triggered through the increase of infected cells, formation of immune complexes, and complement pathway activation, which lead to a cross-reaction of viral antigens with epithelial cells with platelets with subsequent endothelial dysfunction and bleeds. The first description of Evans syndrome was made in 1951 by Robert Evans. This syndrome is characterized by the combination of autoimmune hemolytic anemia, immune thrombocytopenia, and, less common/usual, immune neutropenia. This disease's etiology is unknown, and the dysregulation of the immune system is among its possibilities. Here, we present the case of an unusual hematological and immunological complication of a patient who developed Evans syndrome during severe dengue, taking into account the concomitantly limited literature available for these two diseases, the need for a broader diagnostic approach, multidisciplinary intervention, and a more complex therapeutic approach. [ABSTRACT FROM AUTHOR]

Introduction. Melanoma is the most aggressive type of skin cancer, with poor prognosis in advanced stages. The incidence and mortality rates have increased in recent years. Single nucleotide polymorphisms p.R24P, p.M53I, p.G101W, p.V126D, and p.A148T in the CDKN2A (HGNC ID: 1787) gene have been associated with the development of melanoma in different populations; however, this association has not been studied in Colombia. Methods. Cutaneous melanoma patients and healthy controls (85 cases and 166 controls) were included in this study. These subjects were screened through HRM-qPCR assay and detected variants in exon 1 and 2 of CDKN2A gene and confirmed with Sanger sequencing. Chi-square test was used to compare allele and genotype distributions between cases and controls. Odds ratio (OR) with 95% confidence interval (CI) was calculated to determine the association between polymorphisms and haplotypes with melanoma susceptibility. Statistical and haplotype analyses were performed using Stata® and R-Studio®. Results. Fifty-four percent of women were identified both in cases and controls. The frequencies of melanoma subtypes were 36,47% lentigo maligna, 24,71% acral lentiginous, 23,53% superficial extension, and 15,29% nodular. Variants in the CDKN2A gene were 11.76% in cases and 8.43% in controls. The most frequent was p.A148T in 5.88% of cases and in 4.82% of controls. GGTTG haplotype showed statistically significant differences between cases and controls (p value = 0.04). Conclusion. CDKN2A polymorphisms p.G101W, p.R24P, p.M53I, and A148T are not associated with melanoma susceptibility in the Colombian population; further studies regarding genetic interaction and additive effects between more variants are required. [ABSTRACT FROM AUTHOR]

Purpose: To describe the implementation of a postfracture care program in a private hospital in Colombia, the results achieved after the program's first year, and the challenges encountered.Methods: A cross-sectional descriptive study of the first year's outcomes. The program was implemented following best practices described in the "Capture the Fracture" framework. We assessed the management of fractures before the launch of the program. A multidisciplinary group was established to collaborate on the diagnosis and treatment of patients with osteoporotic fractures. A full-time program coordinator was appointed. We analyzed the program's clinical outcomes and limitations.Results: One-hundred and ninety patients were included in the study, with an average age of 76.7. Hip fracture was the most frequent one (33.6%). After the first year of implementing the program, 39.4% of patients received osteoporosis treatment, with an adherence rate of 73%. The incidence of subsequent falls was 5.8% and 1% for new fractures.Conclusions: The implementation of a program for patients' care with fragility fractures is challenging for healthcare institutions. The role of a full-time coordinator is critical for the proper operation of such programs. [ABSTRACT FROM AUTHOR]

Background: Malaria in pregnancy (MiP) has been associated with adverse pregnancy outcomes. There is limited information on MiP in low transmission regions as Colombia. This study aimed to describe the epidemiology of MiP through active surveillance of infections by microscopy and polymerase chain reaction (PCR).Methods: A cross-sectional study was conducted between May 2016 and January 2017 in five municipalities (Apartadó, Turbo, El Bagre, Quibdó, and Tumaco) in Colombia. Pregnant women self-presenting at health centers for antenatal care visits, seeking medical care for suspected malaria, or delivery, were enrolled. Diagnosis of Plasmodium spp was made in peripheral and placental blood samples by microscopy and PCR.Results: A total of 787 pregnant women were enrolled; plasmodial infection was diagnosed by microscopy in 4.2% (95% CI 2.8-5.6; 33/787) or by nPCR in 5.3% (95% CI 3.8-6.9; 42/787) in peripheral blood. Most of the infections were caused by P. falciparum (78.5%), and 46% were afebrile (asymptomatic). Women in the first and second trimester of pregnancy were more likely to be infected (aOR = 3.06, 95%CI = 1.6 - 5.8). To live in the urban/peri-urban area (aOR = 3.04, 95%CI = 1.4 - 6.56), to have a history of malaria during last year (aOR = 5.45, 95%IC = 2.16 - 13.75), and the infrequent bed net usage (aOR = 2.8, 95%CI = 1.31 - 5.97) were associated with the infection. Pregnant infected women had a higher risk of anaemia (aOR = 2.18, 95%CI = 1.15 - 4.12) and fever (aOR = 14.2, 95%CI = 6.89 - 29.8).Conclusion: The screening for malaria during antenatal care in endemic areas of Colombia is highly recommended due to the potential adverse effects of Plasmodium spp. infection in pregnancy and as an important activity for the surveillance of asymptomatic infections in the control of malaria. [ABSTRACT FROM AUTHOR]

Introduction. Mutations in the BRAF, NRAS, and C-KIT genes have been associated with the histopathological characteristics of melanoma. Likewise, the incidence of each of these subtypes changes according to the geographical origin of the population analyzed. Objective. To determine the mutation frequency in exons 11 and 15 of the BRAF gene, exons 1 and 2 of the NRAS gene, and exons 11, 13, and 17 of the C-KIT gene and to relate it with histological subtypes in patients from a region with high levels of ultraviolet radiation. Methodology. The clinicopathological characteristics of 54 cutaneous melanoma samples were analyzed. Mutation analysis was performed via qPCR on paraffin-embedded tumor tissue samples using probes specific for the V600E mutation. Amplification of exons 11 and 15 of the BRAF gene, exons 1 and 2 of the NRAS gene, and exons 11, 13, and 17 of the C-KIT gene was performed for subsequent sequencing using the Sanger method. Result. The most frequent histological subtype in the analyzed sample was lentigo maligna/lentigo maligna melanoma (52%) followed by acral lentiginous melanoma (20%). The BRAF-V600 variant was the most frequent (63.6%). The most frequent (54%) mutation in NRAS was p.Lys5 ∗. In the C-KIT gene, only the Val560Ala mutation was found. Conclusion. Differences in histological subtypes and mutations in the BRAF, NRAS, and C-KIT genes were found in the analyzed population. This indicates that environmental and genetic factors significantly influence the introduction of the disease in this geographic region. [ABSTRACT FROM AUTHOR]

Access to personal mobility is a human right and as such, it implies the provision of wheelchair services for those with mobility impairments that need one. Lack of appropriately trained personnel is a major contributor to the gap in access to wheelchairs. Assistive technology provision is one of the core competencies of occupational therapists. The goal of this study was to assess the current wheelchair provision knowledge of final year occupational therapy students in Colombia as measured by the International Society of Wheelchair Professionals Basic Wheelchair Service Knowledge Test. A total of 83 students from 7 universities took the test. None of the students met the 70% passing threshold. The highest scores were in the assessment domain while the lowest in the fitting and user training domains. These results suggest that the current wheelchair provision education received in these programs do not meet the World Health Organization guidelines on appropriate wheelchair provision. The implementation of strategies to improve current wheelchair provision education in Colombian occupational therapy programs is granted. [ABSTRACT FROM AUTHOR]

Introduction. The Candida albicans complex is formed by Candida albicans, Candida dubliniensis, and a biovar of C. albicans named Candida africana. These yeasts are recognized as globally distributed clinical pathogens and share most phenotypic characteristics, which makes their discrimination by conventional methods difficult. Aim. To evaluate the efficacy of different brands of cigarettes in the preparation of tobacco agar, for the differentiation of these related yeasts. Methodology. Tobacco agar was prepared using six brands and four varieties of cigarettes, and 125 clinical isolates previously identified by PCR and Maldi-Tof were used. To determine whether the results of the microbiological tests were associated with similarities in the chemical components of cigarettes, thin-layer chromatography was performed. Results. Candida dubliniensis colonies presented hue differences according to the incubation temperature and the brand or variety of cigarette used, except in the tobacco agar produced with Marlboro Xpress cigarette, where its differentiation was not possible. The chromatograms showed few differences among apolar and medium polarity extract components. Conclusions. Tobacco agar is a low-cost tool used for the differentiation of Candida dubliniensis; however, incubation temperature and cigarette brand affect the performance of the media. No relationship was found between the microbiological results and the chemical similarity of the extracts of the cigarettes by chromatography. [ABSTRACT FROM AUTHOR]

Parathyroidectomy (PTX) is one of the most frequently performed surgeries in chronic kidney disease (CKD) patients. The objective of this study was to determine the intensive care unit (ICU) admission, mortality and hospital readmission rates within the 30-day postoperative period, and the total cost of the care episode and to determine possible prognostic factors in end-stage renal disease (ESRD) adult patients taken to PTX in the Colombian contributory health system. Methods. Retrospective cohort study of ESRD adult patients affiliated to the Colombian contributory health system, on dialysis for at least 3 months, undergoing PTX between January 1, 2012, and November 30, 2016. The clinical outcomes evaluated were rehospitalization at 30 days, hospital stay, and ICU requirement. The costs associated with the hospitalization event in which the PTX was performed from the perspective of the third payer were estimated. Results. The study included 478 patients. The mortality rate was 2.09 per 100 surgeries, the ICU admission rate was 32.64 per 100 surgeries, the 30-day hospital readmission percentage of the postoperative period was 16.74%, and the average length of hospital stay was 5.02 days. The median total costs of care for the entire procedure was USD $ 7,814.27 (p25-p75: 3,922.03–9,372.68), with significant regional differences. The geographical region was shown as a prognostic factor associated with clinical outcomes and the cost of care. Conclusions. There are large regional differences in readmission, ICU admission and mortality rates, and costs of dialysis ESRD patients undergoing PTX belonging to the Colombian contributory regime. The geographic region behaves as an independent predictor of clinical outcomes and costs. [ABSTRACT FROM AUTHOR]

Malaria continues being a high-impact disease regarding public health worldwide; the WHO report for malaria in 2018 estimated that ~219 million cases occurred in 2017, mostly caused by the parasite Plasmodium falciparum. The disease cost the lives of more than 400,000 people, mainly in Africa. In spite of great efforts aimed at developing better prevention (i.e., a highly effective vaccine), diagnosis, and treatment methods for malaria, no efficient solution to this disease has been advanced to date. The Fundación Instituto de Inmunología de Colombia (FIDIC) has been developing studies aimed at furthering the search for vaccine candidates for controlling P. falciparum malaria. However, vaccine development involves safety and immunogenicity studies regarding their formulation in animal models before proceeding to clinical studies. The present work has thus been aimed at evaluating the safety and immunogenicity of a mixture of 23 chemically synthesised, modified peptides (immune protection-inducing protein structure (IMPIPS)) derived from different P. falciparum proteins. Single and repeat dose assays were thus used with male and female BALB/c mice which were immunised with the IMPIPS mixture. It was found that single and repeat dose immunisation with the IMPIPS mixture was safe, both locally and systemically. It was observed that the antibodies so stimulated recognised the parasite's native proteins and inhibited merozoite invasion of red blood cells in vitro when evaluating the humoral immune response induced by the IMPIPS mixture. Such results suggested that the IMPIPS peptide mixture could be a safe candidate to be tested during the next stage involved in developing an antimalarial vaccine, evaluating local safety, immunogenicity, and protection in a nonhuman primate model. [ABSTRACT FROM AUTHOR]

Histoplasma capsulatum (H. capsulatum) is a thermal-dimorphic fungus, the causal agent of histoplasmosis. Its presence in the environment is related with chicken manure due to their high nitrogen and phosphorus content. In Colombia, chicken manure is the most used raw material in the composting process; however, there is no information about the capacity of H. capsulatum to survive and remain viable in a composted organic fertilizer. To address this question, this study shows three assays based on microbiological culture and the Hc100 nested PCR. First, a composting reactor system was designed to transform organic material under laboratory conditions, and the raw material was inoculated with the fungus. From these reactors, the fungus was not isolated, but its DNA was detected. In the second assay, samples from factories where the DNA of the fungus was previously detected by PCR were analyzed. In the raw material samples, 3 colonies of H. capsulatum were isolated and its DNA was detected. However, after the composting process, neither the fungus was recovered by culture nor DNA was detected. In the third assay, sterilized and nonsterilized organic composted samples were inoculated with H. capsulatum and then evaluated monthly during a year. In both types of samples, the fungus DNA was detected by Hc100 nested PCR during the whole year, but the fungus only grew from sterile samples during the first two months evaluated. In general, the results of the assays showed that H. capsulatum is not able to survive a well-done composting process. [ABSTRACT FROM AUTHOR]

In this work, we studied the effect of TiO2 sensitization with dry biomass extracted of cyanobacteria on the degradation of methylene blue dye (AM). Cyanobacterial cultures isolated from water samples were collected from the swamp of Malambo in Colombia; two main genera of cyanobacteria were identified, and they were cultivated with BG-11 culture medium. The concentrations of chlorophyll a in the exponential and stationary phases of growth were measured; the phycobilin content was quantified by spectrophotometry. Thin films of TiO2 were deposited by a doctor blade method, and they were sensitized by wet impregnation. Furthermore, a methylene blue (MB) photodegradation process was studied under visible light irradiation on the cyanobacterial biomass sensitized TiO2 material (TiO2/sensitizer); besides, the pseudo-first-order model was used to obtain kinetic information about photocatalytic degradation. The results showed that the BG-11+ treatment reported a higher amount of dry biomass and phycobiliproteins. After the sensitization process, the TiO2/sensitizer thin films showed a significant red shift in the optical activity; besides the thin film roughness decreasing, the TiO2/sensitizer showed photocatalytic activity of 23.2% under visible irradiation, and besides, the kinetic (kap) constant for TiO2/sensitizer thin films was 3.1 times greater than the kap value of TiO2 thin films. Finally, results indicated that cyanobacterial biomass is a suitable source of natural sensitizers to be used in semiconductor sensitization. [ABSTRACT FROM AUTHOR]

Historical photographs, newspapers, and interviews can provide useful information on the abundance, distribution, and habitat use of rare fish species and can be useful in the development of conservation and management plans for target species. We report on the historical occurrence of Atractosteus spatula (alligator gar) on the Middle Mississippi River (MMR) floodplain near Columbia, Illinois (Monroe County), approximately 280.5 river kilometers above the Ohio River (River Mile 168) during the spring of 1937. Based on measurements taken from a photograph of a captured specimen and Mr. Paul Lopinot's recollection of the specimen's weight, the alligator gar was approximately 2.0 m total length and weighed 60 kg. An additional 25–30 large alligator gar were observed on the floodplain approximately 3.6 km from the river. The loss of seasonally inundated floodplain habitat due to construction of an extensive agricultural levee system on the MMR may be a contributing factor to the decline of the alligator gar in the northern portion of its range. [ABSTRACT FROM AUTHOR]

Senecavirus A (SVA) belonging to the family Picornaviridae, genus Senecavirus was incidentally isolated in 2002 from the PER.C6 (transformed foetal retinoblast) cell line. However, currently, this virus is associated with vesicular disease in swine and it has been reported in countries such as the United States of America, Canada, China, Thailand and Colombia. In Brazil, the SVA was firstly reported in 2015 in outbreaks of vesicular disease in swine, clinically indistinguishable of Foot‐and‐mouth disease, a contagious viral disease that generates substantial economic losses. In the present work, it was standardized a diagnostic tool for SVA based on RNA reverse transcriptase droplet digital PCR (RT‐ddPCR) using one‐step and two‐step approaches. Analytical sensitivity and specificity were done in parallel with real‐time PCR, RT‐qPCR (one‐step and two‐step) for comparison of sensitivity and specificity of both methods. In the standardization of RT‐ddPCR, the double‐quenched probe and the temperature gradient were crucial to reduce background and improve amplitude between positive and negative droplets. The limit of detection and analytical specificity of techniques of one‐step techniques showed superior performance than two‐step methods described here. Additionally, the results showed 94.2% concordance (p < 0.001) for RT‐ddPCR and RT‐qPCR using the one‐step assay approach and biological samples from Brazilian outbreaks of Senecavirus A. However, ddRT‐PCR had a better performance than RT‐PCR when swine serum pools were tested. According to the results, the one‐step RT‐ddPCR and RT‐qPCR is highlighted to be used as an auxiliary diagnostic tool for Senecavirus A and for viral RNA absolute quantification in biological samples (RT‐ddPCR), being a useful tool for vesicular diseases control programs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between job strain and socio‐demographic characteristics, social support, job insecurity, use of patient assessment scales, and turnover of nursing staff in a Colombian hospital. Background: Nursing is an occupation with high probability of job strain. Use of patient assessment scales and turnover of nursing staff could increase exposure to psychosocial risk. Method: A cross‐sectional study of 222 nurses was conducted. A survey and the Job Content Questionnaire were used to obtain data at the individual level and free lists and institutional records were used at the hospital unit level. The associations of interest were evaluated with a logistic regression model with robust variance estimator. Results: Many nurses (50.9%) nurses reported job strain, which was positively associated with high use of patient assessment scales (OR = 2.73; 95% CI = 1.35–5.51) but negatively associated with social support (OR = 0.89; 95% CI = 0.80–0.98). Turnover was not statistically associated with job strain. Conclusion: Job strain among nurses was associated with a high use of patient assessment scales, but not with turnover of nursing staff. Implications for Nursing Management: The findings of this study suggest possible opportunities for managers to improve nursing processes, the work conditions of nursing staff, and the quality of institutions. [ABSTRACT FROM AUTHOR]

Background. Acid-base disorders have been previously described in patients with chronic hemodialysis, with metabolic acidosis being the most important of them; however, little is known about the potential changes in acid-base status of patients on dialysis living at high altitudes. Methods. Cross-sectional study including 93 patients receiving chronic hemodialysis on alternate days and living in Bogotá, Colombia, at an elevation of 2,640 meters (8,661 feet) over sea level (m.o.s.l.). Measurements of pH, PaCO2, HCO3, PO2, and base excess were made on blood samples taken from the arteriovenous fistula (AVF) during the pre- and postdialysis periods in the midweek hemodialysis session. Normal values for the altitude of Bogotá were taken into consideration for the interpretation of the arterial blood gases. Results. 43% (n= 40) of patients showed predialysis normal acid-base status. The most common acid-base disorder in predialysis period was metabolic alkalosis with chronic hydrogen ion deficiency in 19,3% (n=18). Only 9,7% (n=9) had predialysis metabolic acidosis. When comparing pre- and postdialysis blood gas analysis, higher postdialysis levels of pH (7,41 versus 7,50, p<0,01), bicarbonate (21,7mmol/L versus 25,4mmol/L, p<0,01), and base excess (-2,8 versus 2,4, p<0,01) were reported, with lower levels of partial pressure of carbon dioxide (34,9 mmHg versus 32,5 mmHg, p<0,01). Conclusion. At an elevation of 2,640 m.o.s.l., a large percentage of patients are in normal acid-base status prior to the dialysis session (“predialysis period”). Metabolic alkalosis is more common than metabolic acidosis in the predialysis period when compared to previous studies. Paradoxically, despite postdialysis metabolic alkalosis, PaCO2 levels are lower than those found in the predialysis period. [ABSTRACT FROM AUTHOR]

Objective. To analyze the relationship between rural and urban homicide rates in Colombia between 1992 and 2015 and the fluctuations in these rates. Methods. Individual records of homicides and population aggregates in men and women aged 15-64 years were used. The adjusted rates of annual homicides were calculated for urban/rural areas and standardized by age. Rate Ratios (RRs) adjusted by region were calculated. A joinpoint analysis was performed to identify inflection points and the Annual Percentage Change (APC). Results. Four joinpoints were identified in rural and urban rates: after peaking in 1992, homicide rates fell until 1997, and then increased until 2002. From this point on there was a continuous reduction until 2015, although this reduction slowed down from 2005 onward. During almost the whole period, the rates of rural homicides were higher than those of urban homicides, although they equalized at the end of the period. Conclusions. Unlike in other countries, during the study period Colombian homicide rates, which coincided with the dynamics of the armed conflict, were higher in rural than in urban areas. In recent years, a predominance of urban homicides committed by younger men has been identified, which could pose a challenge to postconflict in Colombia. [ABSTRACT FROM AUTHOR]

Intake fraction was determined in this study to provide insight into population exposures to PM10 that is effectively inhaled due to emissions of an opencast coal mine. We applied the CALPUFF model to a coal mine in Northern Colombia, which has 6 active pits with an annual production of 33.7 million tons. We estimated the intake fractions for 7 towns through the integration of dispersion model results over the population data. The resulting average intake fractions were between 6.13 × 10-9 and 3.66 × 10-8 for PM10. 62.4% of the intake fractions in the domain were calculated within a 23 km radius from the coal mine and coved 44.3% of the total population in this area. We calculated an estimate point for morbidity impacts using standard epidemiological assumptions. It is estimated that there were annually 105835 restricted activity days and 336832 respiratory symptom cases due to the direct impact of the opencast coal mining. These data also provide a framework for improved understanding of the effect of coal mining in Colombia. [ABSTRACT FROM AUTHOR]

Background. A screening for malaria parasites was conducted with asymptomatic residents in Colombia. Methods. A descriptive study was carried out in December 2012 in four municipalities of Urabá region in Colombia. A convenience sample of 400 subjects was selected. Participants responded to a survey regarding epidemiological data and blood samples were taken from capillary blood obtained by finger prick for thick smear, rapid diagnostic test (RDT), and polymerase chain reaction (PCR). Results. 399 subjects aged 0.2-98 years were studied (median 22; 221 female (55%)). Episodes of malaria in the last year confirmed by thick film were reported by 47 participants (12%). In 399 samples tested by RDT 4 (1%) were positive (1 with P. falciparum, 3 with P. vivax), and 3 were confirmed by PCR. In 399 thick blood smears examined 5 (1.3%) were positive (2 with P. falciparum, 3 with P. vivax), and 3 were confirmed by PCR. In 227 samples, PCR showed 6 (2.6%) positive samples. The parasitaemia was below 1,440 parasites/μL. The best agreement between diagnoses was found between the RDT and thick blood smears (Kappa = 0.75). Conclusion. Plasmodial afebrile infection was found in 2% of the studied population, by three diagnostic methods, in residents from a low endemic malaria region in Colombia. [ABSTRACT FROM AUTHOR]

Background. The aim of this study was to establish the association of maternal, family, and contextual correlates of anthropometric typologies at the household level in Colombia using 2005 Demographic Health Survey (DHS/ENDS) data. Methods. Household-level information from mothers 18-49 years old and their children <5 years old was included. Stunting and overweight were assessed for each child. Mothers were classified according to their body mass index. Four anthropometric typologies at the household level were constructed: normal, underweight, overweight, and dual burden. Four three-level [households (n = 8598) nested within municipalities (n = 226), nested within states (n = 32)] hierarchical polytomous logistic models were developed. Household log-odds of belonging to one of the four anthropometric categories, holding 'normal' as the reference group, were obtained. Results. This study found that anthropometric typologies were associated with maternal and family characteristics of maternal age, parity, maternal education, and wealth index. Higher municipal living conditions index was associated with a lower likelihood of underweight typology and a higher likelihood of overweight typology. Higher population density was associated with a lower likelihood of overweight typology. Conclusion. Distal and proximal determinants of the various anthropometric typologies at the household level should be taken into account when framing policies and designing interventions to reduce malnutrition in Colombia. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective. To describe the design of the SABE Colombia study. The major health study of the old people in Latin America and the Caribbean (LAC) is the Survey on Health, Well-Being, and Aging in LAC, SABE (from initials in Spanish: SAlud, Bienestar & Envejecimiento). Methods. The SABE Colombia is a population-based cross-sectional study on health, aging, and well-being of elderly individuals aged at least 60 years focusing attention on social determinants of health inequities. Methods and design were similar to original LAC SABE. The total sample size of the study at the urban and rural research sites (244 municipalities) was 23.694 elderly Colombians representative of the total population. The study had three components: (1) a questionnaire covering active aging determinants including anthropometry, blood pressure measurement, physical function, and biochemical and hematological measures; (2) a subsample survey among family caregivers; (3) a qualitative study with gender and cultural perspectives of quality of life to understand different dimensions of people meanings. Conclusions. The SABE Colombia is a comprehensive, multidisciplinary study of the elderly with respect to active aging determinants. The results of this study are intended to inform public policies aimed at tackling health inequalities for the aging society in Colombia. [ABSTRACT FROM AUTHOR]

Aims: Rheumatoid arthritis (RA) is an autoimmune disease cause of disability and high costs. To determine the effectiveness of therapy with biologic- and disease-modifying antirheumatic drugs (DMARDs) in patients with RA and factors associated with the control of the disease.Methods: Retrospective cohort study of RA patients receiving treatment with DMARDs in a rheumatologic healthcare institution in five Colombian cities from December 2009 to August 2013. The effectiveness was assessed by Disease Activity Score-28 (DAS-28) and a lower value of 2.6 was considered remission.Results: A total of 827 patients were studied for an average observation period of 17.3 ± 11.0 months, with mean age 54.3 ± 13.1 years. The most frequently used DMARDs were methotrexate, leflunomide and chloroquine. The most frequently used biological DMARDs were etanercept and abatacept. Initially, 17.8% of the patients received some biological DMARDs in comparison with 28.7% at the end of the observation period. A median DAS28 of 3.5 was found, which was reduced by the end of the observation period to 2.8 (p < 0.001), and cases of patients who were in remission increased from 30.1% to 42.9%. Treatment with leflunomide (OR: 0.47; CI 95%: 0.35-0.64, p < 0.001) or rituximab (OR: 0.37; CI 95%: 0.17-0.83, p = 0.016) was associated with a lesser probability of reaching remission. To be treated in the city of Manizales (OR: 2.56; CI 95%: 1.36-4.82, p = 0.004) was associated with a high probability of remission.Conclusions: Biological and DMARDs therapy for RA was effective in a relevant proportion of Colombian patients as a consequence of management with strategies set on remission aims quantified using DAS28. Cost-effectiveness of the therapy must be evaluated. [ABSTRACT FROM AUTHOR]