Search

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.

Background: The implementation of new technologies in medical research, such as novel big storage systems, has recently gained importance. Electronic data capture is a perfect example as it powerfully facilitates medical research. However, its implementation in resource-limited settings, where basic clinical resources, internet access, and human resources may be reduced might be a problem., Methods: In this paper we described our approach for building a network architecture for data collection to achieve our objectives using a REDCap® tool in Colombia and provide guidance for data collection in similar settings., Conclusions: REDCap is a feasible and efficient electronic data capture software to use in similar contexts to Colombia. The software facilitated the whole data management process and is a way to build research capacities in resourced-limited settings., (Copyright © 2021. Published by Elsevier España, S.L.U.)

Introduction: People with mental health conditions frequently attend primary care centers, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centers in Colombia., Methods: Between February 2018 and March 2020, we implemented a technology-based model of care for depression and unhealthy alcohol use, following a modified stepped wedge methodology, in six urban and rural primary care centers in Colombia. The model included a series of steps aimed at screening patients attending medical appointments with general practitioners and supporting the diagnosis and treatment given by the general practitioner. We describe the model, its implementation and the characteristics of the screened and assessed patients., Results: During the implementation period, we conducted 22,354 screenings among 16,188 patients. The observed rate of general practitioner (GP)-confirmed depression diagnosis was 10.1% and of GP-confirmed diagnosis of unhealthy alcohol use was 1.3%. Patients with a depression diagnosis were primarily middle-aged women, while patients with unhealthy alcohol use were mainly young adult men., Discussion: The provision of training and technology-based strategies to screen patients and support the decision-making of GPs during the medical appointment enhanced the diagnosis and care provision of patients with depression and unhealthy alcohol use. However, time constraints, as well as structural and cultural barriers, were challenges for the implementation of the model, and the model should take into account local values, policies and resources to guarantee its long-term sustainability. As such, the long-term sustainability of the model will depend on the alignment of different stakeholders, including decision-makers, institutions, insurers, GPs, patients and communities, to reduce the amount of patients seeking medical care whose mental health conditions remain undetected, and therefore untreated, and to ensure an appropriate response to the demand for mental healthcare that was revealed by the implementation of our model., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

This paper aims to understand the meanings of food and nutrition policies for beneficiary mothers and for technicians designing and implementing said policies. The Grounded Theory method was employed. The data collection techniques adopted were the semi-structured interview and the focus group. The participants were beneficiaries of food and nutrition programs, with a minimum two-year experience, and technicians with five-year experience in designing or implementing these policies and programs. Food and nutrition policies are conceived and managed under a market logic, which has required an institutional framework that adopted this commercial model to provide public services, which is implemented in the scheme of outsourcing third parties, especially private companies, who implement these policies to achieve financial profitability. The market is imposed as the benchmark for the State's actions, and, therefore, the State's action is limited the oversight of outsourced actions, and food policies become devices for the diversion of public resources to the private sector.

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.)

This paper describes the results of the implementation, consolidation and future projection of the Best practice guidelines of the Registered Nurses' Association of Ontario (RNAO) in clinical and academic scenarios in Santander, Colombia. The tool proposed by the RNAO was used for the implementation of the guidelines in both clinical and academic settings. Preliminary results on the implementation of the guidelines are presented in this paper. In the clinical setting, the implementation of the guidelines has made it possible to start the process of standardizing care across the institution, with systematic follow-up based on indicators. This has allowed decision-making and visualization of the quality of nursing care provided by nurses in their different roles. In the academic scenario, implementing the guidelines has strengthened teaching and research functions, and, to a lesser extent, continuing education and social projection processes. In the consolidation phase, advances were achieved in 10 components, relevant to teachers, students, and practice scenarios of public / private health institutions, users (patients/caregivers), health personnel and other nursing programmes at a national and international level. Implementing the clinical practice guidelines has reduced the gap between the clinical and the academic scenarios, where collaborative and inter-institutional work is enhanced to obtain better patient outcomes, based on the available evidence., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

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.

The scope of this paper was to analyze the trends, impact on life expectancy and effect of the main associated socioeconomic factors with the death rate by homicide in Colombia between 2000 and 2014 at the state level, by gender and age groups. Standardized mortality rates and years of life lost among those under 85 years of age were calculated and multivariate regression analysis was performed using negative binomial fixed effects regression models with panel data to analyze the associated socioeconomic factors with the incidence of homicide. The reduction of the death rate by homicide in Colombia was corroborated, which was generalized at state level, though it did not occur homogenously. A higher mortality risk was found among males, particularly between 15 and 49 years of age. Economic growth and inequality were negatively associated with death rates by homicide; unemployment was positively associated; and poverty had no effect on the mortality rate. Investigating the main associated factors with homicidal violence is complex, but is indispensable due to its impact on economic and social development, given that it mainly affects the population of productive age, with broad public health consequences and at a high cost to healthcare services.

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 describes and analyzes the psychiatric reform process in three Latin American countries (Brazil, Chile and Colombia) based on the Caracas Declaration of 1990. It compares the psychiatric reform processes in these three countries and highlights the role of national mental health laws in these processes. Our goal when investigating the experiences in other countries of Latin America is to draw conclusions for the Argentine psychiatric reform and for the future of such reforms in the region.

Motorized mobility is closely linked to liquid fuels such as gasoline and diésel and therefore, to the environment. Besides the problems associated with global warming, the use of these fuels also generates polluting compounds affecting the population health. Among all primary pollutants, particulate matter (PM) less than or equal to 2.5 microns (PM25) in size, is regarded as one of the most dangerous compounds because it can penetrate the region lung gas exchange. The records for the Área Metropolitana del Valle de Aburrá (AMVA) often show that the average levels of air quality were found to be harmful to the health of metropolitan habitants. This is mainly attributed to the high concentrations of PM25 generated by heavy-duty vehicles that use diésel fuel. Although the properties of diesel fuel have a direct effect on breathable PM, there are other strategies influencing both nature and amount of emissions. For example, the improvement of the technological level of the engines and the driving pattern, as well as the incorporation of electric vehicles. This paper shows some considerations in order to propose possible strategies to solve the environmental problem of the city and the country.

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.

Objective: To describe the way in which the Constitutional Court of Colombia has interpreted the use of the writ for the protection of constitutional rights in work-related illnesses. The paper explains in which cases the court has defended the use of this action and the key judicial precedents on the subject., Method: Analysis of a representative sample of the decisions of the Constitutional Court regarding writs for the protection of constitutional rights in work-related illnesses between 1992 and 2014. We coded 58 rulings, providing descriptive statistics and analyzing the main judicial precedents., Results: The Court has assumed a protectionist position in support of workers. In 79.3 % of the cases, the Court revoked the decisions of lower courts and granted the action to employees. The Court has defended that employers cannot dismiss workers who suffered from a labor accident or illness without approval from the labor office; these workers have to be reincorporated and relocated, if needed, in a new working place. The Court has also stated that workers do not have to bear the uncertainty of not knowing which entity should cover their health and economic costs during recovery; health promoting companies (EPS, the Spanish acronym) or occupational risk managers (ARL, the Spanish acronym) should cover these costs while courts have a definite ruling., Discussion: The institutional structure of labor risks in which EPS takes-over sicknesses and accidents from a common origin, and ARL the ones from a labor origin, incentivize EPS and ARL rejection of the services and, therefore, the use of the legal action of writ for the protection of constitutional rights. In spite of the clarity of judicial precedents, the same judicial controversies keep re-emerging, and lower courts continue to fail to comply with the precedents established by the Court.

This paper aims to address the importance of study, introduce and implement the issue of prevention and management of work disability in Colombia. Text structure responses to questions ranging from the current situation of workers and their health in Colombia, from the importance of studying this subject; the approach of the determinants of work disability; its definition, to the challenges settled for different actors in the Sistema Nacional de Seguridad Social involved in the process of prevention, care, rehabilitation, compensation, and return home.

The so-called social determination is a key concept for Latin American Social Medicine (LASM). LASM criticizes epidemiology frequently, mainly because of its reductionist vision and its distance from social reality. This paper makes an opposite analysis, in other words, 21st century epidemiology criticizes LASM, using the disciplinary development in Colombia as an example. The history of Colombian epidemiology is reviewed, noting that it has not had sufficient development and that LASM tends to reject quantitative methods based on the epidemiological practices used four decades ago. Additionally, some developments of the quantitative methods used in epidemiology are reviewed, explaining that many of the limitations indicated by LASM have been overcome. In conclusion, LASM uses social determination as part of its leftist political platform; however, current quantitative methods and the 21st century theoretical developments in epidemiology show a pragmatic superiority, useful for solving current public health issues.

Public health has developed based on multiple approaches, including the guidelines of the health systems, the community or the individuals. This paper intends to identify the conceptual models of public health that arise after analyzing health or disease categories, as well as the level at which social response occurs: the individual or a family, biophysical and social environment; hygienist or preventive mode. Considering that the concept of model is not only a representation of reality, but an ontological position that allows to understand society and the State, all models are part of a theory and converge with other theories to create a framework of analysis. In consequence, three models of the health-disease process are presented. First, the Canadian model that establishes four determinants -lifestyle, environment, biological factors and health services-. Second, the social determinants model of the World Health Organization (WHO) that establishes three determinants based on risk approach: structural, intermediate and proximal. Finally, the historical-social or social determination model, which looks for the roots of social inequalities that affect health. The development of the Colombia Health System has considered these health models. Today, the Comprehensive Health Care Policy, and its Comprehensive Health Care Model, bases its approach within a model of determinants established by the PAHO.

This paper presents an update on the carcinogenic effect of formaldehyde. First, generalities of its chemical composition are considered, followed by the description of some of its uses, both in the industry and in health institutions, as well as an account of the risk to which the general population is exposed, in particular health personnel, as a result of prolonged exposure to this chemical component. Emphasis is placed on the concentration of formaldehyde in everyday life and in the workplace, while the guidelines of decree 1477 of August 5, 2014, issued by the Ministry of Labor of Colombia, on occupational exposure to this chemical are analyzed to demonstrate that this decree does not consider the already known carcinogenic effects of formaldehyde, widely supported by scientific evidence, thus leaving a void for both occupational prevention and labor legislation.

Background: The Spanish version of the cognitive impairment in psychiatry scale screening scale has been developed as a response to the needs arising in clinical practice during the evaluation of mental illness patients, but the performance is not known in the Colombian population with bipolar disorder I. This paper tries to establish construct validity and stability of the scale in patients with bipolar disorder I in the city of Manizales., Methods: Construct validity was estimated by comparing the measurement in two divergent groups, a control group and a group with bipolar disorder I. It was also compared to a Neuropsychological battery measuring the same scale domains. The correlation between each one of the sub-tests of the scale and stability was evaluated through the reliability test-retest in the group with bipolar disorder I., Results: The scale showed discriminatory capacity in cognitive functioning between the control group and the group with bipolar disorder I. The correlation with the neuropsychological battery was estimated by the Spearman test showing results between 0.36 and 0.77, and the correlation between each sub-test of the scale showed correlations between 0.39 and 0.72. Test-retest was measured with the intraclass correlation coefficient (ICC) and their values were between 0.77 and 0.91., Conclusions: The Spanish version of screening scale in the cognitive disorder in psychiatry shows acceptable validity and reliability as a measurement tool in clinical psychiatric practice., (Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.)