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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.

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.)

Objective: Placing central venous catheters is essential when managing critically ill children. This paper was thus aimed at identifying the major complications involved in this and determining the incidence of mechanical and infection-related complications associated with central venous catheterization in critically ill children., Material and Methods: A descriptive study was undertaken between October 2011 and March 2012 of all new central venous catheters inserted in critically ill children. The definition of central venous catheter infection was based on CDC criteria., Results: During the study period 200 central venous catheters were placed, 51 % in male patients, mostly infants; 71 % required mechanical ventilation and 56.5 % medication for hemodynamic support. Respiratory tract infections were the leading diagnosis on admission in 33 % of the cases. Complications were reported in 8.5 % of the children (52 % of these being due to mechanical complication and 48 % to infection). Mechanical complication incidence was 4.5% and eight central venous catheters fulfilled CDC criteria for central line associated blood stream infection (4 % incidence, i.e. 5 per 1,000 catheter/day rate)., Conclusions: Despite some complications arising from its use, central venous catheter placement is a safe procedure. Mechanical and infection incidence associated with central venous catheter placement should be known, not only because it differs from that regarding adult patients but also because this can help to establish preventative measures for reducing such complications and improving the care of critically ill children.

Objective: This paper analyses a study of the current state of occupational assessment of disabled people; it took place in 14 public and private institutions involved in promoting the inclusion of this population in the workforce. The study was aimed at providing definitions, demonstrating the pertinent processes, instruments, professionals, stages of the process and support involved in helping disabled people to become included in the workforce., Methodology: The study involved a group of experts adopting a methodology which designed, implemented and analysed a data collection instrument seeking qualitative and quantitative data concerning target populations, assessment purposes, the instruments used, timing and other relevant factors for programmes aimed at disabled people becoming included in the workforce. The 14 Colombian institutions having most experience regarding this topic participated in the study (the oldest having 40 years' experience and the most recent 8 years in this field)., Results: The results indicated widespread heterogeneity regarding the occupational assessment components explored. It was found that the objectives proposed for each process differed, depending on each institution's philosophy and structure, the model's characteristics and those of the intraprofessional teams. They also highlighted the broad range of instruments and timing (i.e. 1 to 180 days) of sub-processes used as tools for occupational assessment (of the disabled)., Conclusions: These findings constitute a foundation justifying the compilation of a Manual for the Occupational Assessment of Disabled People in Colombia, recognising accumulated cognitive, social and professional capital (i.e. established tradition in this field).

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.

Homicides occur the world over, but they are not homogeneously distributed by geographical areas (continents, countries, regions), either over long or short periods of time, or in social groups, namely age, gender, social class or ethnicity. Why are there more homicides in some countries than in others? Why do killings increase in some countries, while they decrease in others? There are two fundamental schools of thought for social explanations of crime and violence: those attributing its origins to poverty and inequality and those blaming institutionalization or social norms. To discuss these theories, this paper analyzes and compares the changes in Colombia, Venezuela and Brazil in the first decade of the twenty-first century, where the homicide rate has decreased, increased and remained the same, respectively. Using the measurement of six variables (poverty, inequality, unemployment, national wealth, human development and the rule of law) and the technique of trajectory analysis, the results revealed that institutionalization is more to blame for the change than poverty and inequality. The text concludes that poverty and inequality affect crime and homicides, although not directly, but mediated by the institutions instead.

Objective: This paper was aimed at ascertaining the magnitude of disability in the Boyacá Department by establishing its distribution and dependent relationships., Materials and Methods: This was a cross-sectional study which involved using the instrument proposed by DANE for recording, localizing and characterizing disability. The instrument's 89 questions were subjected to univariate and bivariate analysis., Results: A greater prevalence of disability was found amongst females; it was geographically located in scattered rural areas and amongst those having low educational attainment and poor attendance at school. A deficiency in body, hand, arm and leg movements predominated, as did difficulty in walking, running and jumping., Conclusions: There was a statistically significant dependence (calculated by Pearson's chi-square test) between disability and social, cultural and biological factors.

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.

Tuberculosis (TB) and the acquired immune deficiency syndrome (AIDS) are closely related diseases because TB is considered one of the opportunistic diseases for AIDS. When investigating the resurgence of TB it is very important epidemiologically to take into account the influence of AIDS prevalence on TB. This paper develops a procedure establishing HIV prevalence in TB for people in Armenia, Quindío, by using a mathematical model. This was done by building two deterministic models and relating them through a linear transfer function model. To parameters involved in these models had to be estimated to relate them; a technique was then built from unbiased estimators of minimum variance and secondary information for the parameters of each disease, taking into account the town's Secretariat of Health's secondary information. The model for Armenia led to concluding that tuberculosis resulted from people who had suffered from tuberculosis 4 periods (trimesters) ago and those sick from AIDS 2 periods ago, including the present. The procedure described in this work was seen to be applicable to the pathologies to which it is related.

Objectives: Contributing towards improving knowledge about access to health services in Colombia following health-sector reform, highlighting the main results and gaps in research., Methods: Original papers were systematically reviewed through a comprehensive search and analysis of original papers published between 1994 and 2009. After selection criteria had been applied, 27 papers were included in the review. Analysis was based on Aday Aday & Andersen and Gold's theoretical frameworks, distinguishing between potential and actual healthcare access and considering the characteristics of the population, health services and insurers influencing service use., Results: There was little explanatory analysis of service use applying determinant models; this was also partial (limited to geographical areas, diseases or specific groups). Likewise, only a few studies analysed contextual factors influencing service use (health policies and health providers and insures) or social actors' perspectives. The available studies did not seem to indicate increased actual access (except for subsidised system users) but, on the contrary the existence of barriers relating to population (insurance coverage, income and education) and health service factors (geographic and organizational accessibility and quality of care)., Conclusions: This review led to identifying important limitations in the analysis of healthcare access in Colombia and highlighted the need for further research on actual access and the better incorporation of context variables and actors perspectives in understanding the impact of reform on health service use.

Objectives: To assess the susceptibility status of 13 natural populations of Aedes aegypti (collected from sites in Colombia where dengue is a serious public health problem) to the pyrethroids, deltamethrin and lambda-cyhalothrin, and to the organochlorine, DDT, and to identify any biochemical mechanisms associated with resistance., Methods: Immature forms of the vector were collected from natural breeding spots at each site and then raised under controlled conditions. Using the F2 generation, bioassays were performed using the World Health Organization's 1981 methodology (impregnated paper) and United States Centers for Disease Control and Prevention's 1998 methodology (impregnated bottles). In populations where mortality rates were consistent with decreased susceptibility, levels of nonspecific esterases (NSE), mixed-function oxidases (MFO), and acetylcholinesterase (AChE) were measured using colorimetric tests., Results: All of the mosquito populations that were tested showed resistance to the organochlorine DDT. In the case of the pyrethroids, widespread resistance to lambda-cyhalothrin was found, but not to deltamethrin. Assessing the biochemical resistance mechanisms showed that 7 of the 11 populations had elevated NSE, and one population, increased MFO., Conclusions: Physiological cross-resistance between DDT and lambda-cyhalothrin in the A. aegypti populations tested was dismissed. Physiological resistance to lambda-cyhalothrin appears to be associated with increased NSE. The differences in susceptibility levels and enzyme values among the populations were associated with genetic variations and chemicals in use locally.

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.

Mycotoxins have become a worldwide problem due to their high incidence and levels of occurrence in human food and animal feed. The conditions for colonising substrates by mycotoxigenic fungus and later contamination by mycotoxins play an important role in surveillance and control strategies. The main mycotoxigenic funguses are the Aspergillus spp., Penicillium spp. and Fusarium spp genera, the main mycotoxins of interest for human health being aflatoxins, trichothecenes, ochratoxin A, fumonisins and zearalenone. These mycotoxins' toxic action mechanisms constitute a risk for both human and animal health, causing diseases in both populations. The situation in Colombia is complex due to the lack of research having been carried out; the few studies made to date have demonstrated the high levels of contamination of food and feed in the country. This paper discusses mycotoxins' potential risk to public health, the difficulties involved in diagnosis and legislation and suggests policy implications for food safety.

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.

Objective: Analysing scientific production related to health research between 1993 to 2003 in Colombia to generate information allowing a more focused investment in public health research., Methods: Bibliometric indicators were used to analyse scientific production registered in MEDLINE and LILACS. Trends in the number of publications per year were analysed, as well as publications per research area, research centres and journal characteristics., Results: Health research production in Colombia is mainly published in international journals. Most published papers are linked to basic biomedical research overshadowing other areas of health research such as clinical or public health research. Universities are the main entities producing knowledge re health and their participation has increased during the last few years., Conclusions: Colombian health research production has increased during the last few years as shown by the increased numbers of Colombian papers in MEDLINE and LILACS during the period being studied. However, this production is still lower than that of other Latin American countries having similar socioeconomic and demographic conditions.

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.

Writing has dramatically evolved in the world; however, qualification of scientific production in Colombia has not, including the improper use of decree 1444/93 and 1279/02. The last of these decrees authorized Colciencias, the Colombian government institute created to support scientific research in Colombia, to establish rules for its implementation. Colciencias decided to evaluate scientific papers produced in Colombia based on the non-scientific method of the "impact factor", and considered that citations in MEDLINE/PubMed and PsylNFO were second line publications thus violating Colombian law. This affects not only the progress of scientific research in Colombia but also researchers' income and puts Colombia's scientific journals and publications at great disadvantage. Scientific papers indexed in qualified databases such as MEDLINE/PubMed must be judged according to law in order to prevent further injuries to the developing Colombian scientific production.

Objective: Child labor in marketplaces has not been sufficiently studied. It is present even in developed countries and it has been associated with problems in the physical, psychological, emotional and social development of children. This paper aims at determining the number of children working in the largest marketplace in the country and the risk factors to which they are exposed., Methodology: Children working in the marketplace were counted and classified by gender and occupation. Working places were analyzed under Fine's professional risk plan., Results: 376 children were found, 318 boys and 58 girls. 30% were carrying loads, 42% were selling merchandise, and 28% were doing minor jobs or accompanying relatives. The risk factors related with their personal security have the greatest danger level. They are followed by the ergonomic, psychosocial and biological factors., Conclusions: The risk factors affecting children's health the most in the short term are those related to personal security. They include vehicle traffic, inadequate materials storage that can be dangerous, and the physical burden that they have to suffer. According to the professional risk factors plan, this is a dangerous job for children. Child labor in marketplaces shall be regulated and the carrying of heavy loads prohibited.

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.

The Hazard Analysis and Critical Control Point system (HACCP), recommended by different international organizations as the Codex Alimentarius Commission, the World Trade Organization (WTO), the International Office of Epizootics (OIE) and the International Convention for Vegetables Protection (ICPV) amongst others, contributes to ensuring the innocuity of food along the agro-alimentary chain and requires of Good Manufacturing Practices (GMP) for its implementation, GMP's which are legislated in most countries. Since 1997, Colombia has set rules and legislation for application of HACCP system in agreement with international standards. This paper discusses the potential and difficulties of the legislation enforcement and suggests some policy implications towards food safety.

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurobehavioural disorder whose essential characteristic is a persistent pattern of inattention or hyperactivity and impulsiveness. Recent studies into prevalence carried out on the Antioquian population by our group found an overall prevalence of 15.8%, which confirms ADHD as one of the most frequent problems in infancy. The cause of this disorder is still not altogether clear; familial aggregation of ADHD points towards a genetic component. Although to date no model of inheritance has been defined, its high prevalence rate, the difficulties involved in its diagnosis and its effects on the cognitive functions, as well as the social and educational repercussions, make this disorder a problem in children's public health., Aims: Our aim was to carry out power simulations to detect genetic linkage., Patients and Methods: The Slink programme, which is part of Linkage package, was used in six families from the city of Medellín Antioquia, which is a region where a founding effect is likely to have taken place; this makes it a strategic zone for genetic linkage studies in complex diseases such as ADHD., Results: Assuming the population to be homogenous, the lod score (Z) is greater than 3 (Z>3) and individual lod score values of between 0 and 6 were obtained for each family., Conclusions: In this paper we discuss the benefits of having multigenerational families, in Antioquia, to conduct gene mapping studies and we examine the different strategies to be developed with the findings reported here.