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Moreno-Serra R, Leon-Giraldo S, Jater-Maldonado N, Casas G, Bernal O. Trends in mental health before and after the onset of the COVID-19 pandemic: a longitudinal survey of a conflict-affected population in Colombia. Int J Ment Health Syst 2024; 18:4. [PMID: 38317169 PMCID: PMC10845752 DOI: 10.1186/s13033-024-00621-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Focusing on the Meta region in Colombia, we investigated the relationship between mental health, the COVID-19 pandemic, and social determinants of health influenced by over five decades of civil conflict. We studied the post-2016 peace agreement trends in mental health for the population of Meta, before and after the local onset of the pandemic. METHOD We conducted three rounds of a longitudinal health survey in years 2018 with N = 1309 (Women = 709; Men = 600); 2019 with N = 1106 (Women = 597; Men = 509); and 2020 with N = 905 (Women = 499; Men = 406). We measured mental health through the Self-Report Questionnaire (SRQ-20), investigating population trends in the average SRQ score and SRQ-positive frequency (SRQ + , indicating positive tendency towards experiencing mental health disorders). RESULTS Between 2018 and 2020, there were reductions in the mean SRQ-20 score by 1.74 points (95% CI -2.30 to -1.18) and in SRQ + frequency by 15 percentage points (95% CI -21.0 to -9.0) for the Meta population. Yet specific subgroups have become more vulnerable to mental illness during the pandemic, for example older age groups (e.g., increase in mean SRQ score among over 60 s by 2.49 points, 95% CI 0.51 to 4.46) and people living with children younger than five years-old (e.g., increase in mean SRQ score by 0.64 points, 95% CI 0.07 to 1.20). Increased mental health vulnerability among specific subgroups may be related to differences in the likelihood of knowing people who tested positive for COVID-19 or died from itf having been in quarantine. CONCLUSION Our findings support the importance of public policies in Colombia (and other low- and middle-income countries) that address the social determinants of mental illness whose influence was likely exacerbated by the pandemic, including persistent job insecurity leading to work and financial pressures, and inadequate support networks for isolated individuals and vulnerable caregivers.
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Affiliation(s)
| | - Sebastian Leon-Giraldo
- School of Government, Universidad de los Andes, Bogotá, Colombia.
- Interdisciplinary Centre of Development Studies, Universidad de los Andes, Bogotá, Colombia.
| | | | - German Casas
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Oscar Bernal
- School of Government, Universidad de los Andes, Bogotá, Colombia
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Bernal O, Garcia-Betancourt T, León-Giraldo S, Rodríguez LM, González-Uribe C. Impact of the armed conflict in Colombia: consequences in the health system, response and challenges. Confl Health 2024; 18:4. [PMID: 38172982 PMCID: PMC10762784 DOI: 10.1186/s13031-023-00561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION In Colombia, research on health and conflict has focused on mental health, psychosocial care, displacement, morbidity, and mortality. Few scientific studies have assessed health system functioning during armed conflicts. In a new period characterized by the implementation of the peace agreement with the Revolutionary Armed Forces of Colombia (FARC) armed group, understanding the effects of armed conflict on the health system, the functions, and institutions shaped by the conflict is an opportunity to understand the pathways and scope of post-conflict health policy reforms. Therefore, this study was conducted to assess the effects of armed conflict on the health system, response, and mechanisms developed to protect medical missions during armed conflict in Colombia. METHODS This research was conducted using a qualitative approach with semi-structured interviews and focus group discussions. The qualitative guide collected information in four sections: (1) conflict and health system, effects and barriers in health service provision, (2) actions and coordination to cope with those barriers, (3) health policies and armed conflict, and (4) post-accord and current situation. Twenty-two people participated in the interviews, including eight policymakers at the national level and seven at the local level, including two NGOs and five members of international organizations. An academic project event in December 2019 and four focus groups were developed (World Cafe technique) to discuss with national and local stakeholders the effects of armed conflict on the health system and an analytical framework to analyze its consequences. RESULTS The conflict affected the health-seeking behavior of the population, limited access to healthcare provision, and affected health professionals, and was associated with inadequate medical supplies in conflict areas. The health system implemented mechanisms to protect the medical mission, regulate healthcare provision in conflict areas, and commit to healthcare provision (mental and physical health services) for the population displaced by conflict. CONCLUSION The state's presence, trust, and legitimacy have significantly reduced in recent years. However, it is crucial to restore them by ensuring that state and health services are physically present in all territories, including remote and rural areas.
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Affiliation(s)
- Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, 11711, Colombia
| | | | - Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, 11711, Colombia.
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Del Pilar Villamil M, Velasco N, Barrera D, Segura-Tinoco A, Bernal O, Hernández JT. Analytical reference framework to analyze non-COVID-19 events. Popul Health Metr 2023; 21:16. [PMID: 37865751 PMCID: PMC10590025 DOI: 10.1186/s12963-023-00316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/05/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted the healthcare system, leading to delays in detection of other non-COVID-19 diseases. This paper presents ANE Framework (Analytics for Non-COVID-19 Events), a reliable and user-friendly analytical forecasting framework designed to predict the number of patients with non-COVID-19 diseases. Prior to 2020, there were analytical models focused on specific illnesses and contexts. Then, most models have focused on understanding COVID-19 behavior. There is a lack of analytical frameworks that enable disease forecasting for non-COVID-19 diseases. METHODS The ANE Framework utilizes time series analysis to generate forecasting models. The framework leverages daily data from official government sources and employs SARIMA models to forecast the number of non-COVID-19 cases, such as tuberculosis and suicide attempts. RESULTS The framework was tested on five different non-COVID-19 events. The framework performs well across all events, including tuberculosis and suicide attempts, with a Mean Absolute Percentage Error (MAPE) of up to 20% and the consistency remains independent of the behavior of each event. Moreover, a pairwise comparison of averages can lead to over or underestimation of the impact. The disruption caused by the pandemic resulted in a 17% gap (2383 cases) between expected and reported tuberculosis cases, and a 19% gap (2464 cases) for suicide attempts. These gaps varied between 20 and 64% across different cities and regions. The ANE Framework has proven to be reliable for analyzing several diseases and exhibits the flexibility to incorporate new data from various sources. Regular updates and the inclusion of new associated data enhance the framework's effectiveness. CONCLUSIONS Current pandemic shows the necessity of developing flexible models to be adapted to different illness data. The framework developed proved to be reliable for the different diseases analyzed, presenting enough flexibility to update with new data or even include new data from different databases. To keep updated on the result of the project allows the inclusion of new data associated with it. Similarly, the proposed strategy in the ANE framework allows for improving the quality of the obtained results with news events.
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Affiliation(s)
| | - Nubia Velasco
- School of Management, Universidad de los Andes, Bogotá, Colombia
| | - David Barrera
- Departamento de Ingeniería Industrial, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Oscar Bernal
- School of Government, Universidad de los Andes, Bogotá, Colombia
| | - José Tiberio Hernández
- Department of Systems and Computing Engineering, Universidad de Los Andes, Bogotá, Colombia
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Rodríguez Caicedo N, León-Giraldo S, González-Uribe C, Bernal O. Access to health services during the Colombian armed conflict: a challenge for the population with disabilities in the department of Meta. BMC Health Serv Res 2023; 23:628. [PMID: 37312099 PMCID: PMC10265762 DOI: 10.1186/s12913-023-09472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/28/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The Colombian armed conflict has left millions of victims and has restricted access to different services provided by the government, especially for people with disabilities. This article studies the barriers faced by the victim population with disabilities when they want to access the health system in the department of Meta, Colombia, and offers a perspective from the experiences of people with disabilities who have been victims of the armed conflict in the country. METHODS To carry out this qualitative study, focus groups were conducted to capture the experiences and feelings of this population in the context of violence and high conflict. RESULTS The results show the barriers encountered by the victim population with disabilities, their families, and their caregivers when they want to access medical or health services. CONCLUSIONS Many problems affect the population with disabilities and the victim population in Colombia today. The Colombian government has not been able to establish adequate policies to eliminate or even reduce access to services such as health, education, housing, and social protection.
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Affiliation(s)
| | - Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, 11711 Colombia
| | | | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, 11711 Colombia
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, García T, González-Uribe C, Moreno-Serra R, Bernal O. Mental health disorders in population displaced by conflict in Colombia: Comparative analysis against the National Mental Health Survey 2015. Rev Colomb Psiquiatr (Engl Ed) 2023; 52:121-129. [PMID: 37453820 DOI: 10.1016/j.rcpeng.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/21/2021] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. METHODS Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire-25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. RESULTS 1089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. CONCLUSIONS The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.
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Affiliation(s)
| | - Germán Casas
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | | | - Tatiana García
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Universidad Autónoma de Barcelona, Barcelona, Spain
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Ramadan M, Gutierrez JC, Feil C, Bolongaita S, Bernal O, Villar Uribe M. Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: a cross-sectional study of 12 low-income and middle-income countries. BMJ Open 2023; 13:e065223. [PMID: 36720573 PMCID: PMC9890757 DOI: 10.1136/bmjopen-2022-065223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association with intermediate health outputs such as coverage and access to care. DESIGN Observational cross-sectional study using matched subnational data from service provision assessment surveys and demographic health surveys from 2007 to 2019. SETTINGS 138 subnational areas with available survey data in 12 LMICs (Afghanistan, Bangladesh, Democratic Republic of Congo, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania and Uganda). OUTCOMES Eight intermediate MCH outcomes/outputs were explored: (1) met need for family planning by modern methods; (2) attendance of four or more antenatal care visits; (3) perceived financial barriers to care; (4) perceived geographical barriers to care; (5) diphtheria-pertussis-tetanus (DPT) third dose coverage; (6) DPT dropout-rate; (7) care-seeking for pneumonia; and (8) oral rehydration solutions coverage. RESULTS Overall, moderate-to-poor PHC performance was observed across the 12 countries, with substantial heterogeneity between the different subnational areas in the same country as well as within the same subnational area across both capacity and quality subdomains. The analysis of the relationship between PHC service delivery and child health outcomes revealed that recent supervision (b=0.34, p<0.01) and supervisors' feedback (b=0.28, p<0.05) were each associated with increased care-seeking for pneumonia. We also observed the associations of several measures of capacity and quality with DPT immunisation. The analysis of maternal health outcomes yielded only a few statistically significant results at p<0.05 level, however, none remained significant after adjusting for other covariates. CONCLUSION The results of this analysis illustrate the heterogeneity in the capacity and quality of PHC service delivery within LMICs. Countries seeking to strengthen their PHC systems could improve PHC monitoring at the subnational level to better understand subnational bottlenecks in service delivery.
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Affiliation(s)
- Marwa Ramadan
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
| | | | - Cameron Feil
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
| | - Sarah Bolongaita
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
| | - Oscar Bernal
- Health, Nutrition and Population, The World Bank Group, Washington, DC, USA
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García‐Tornel Á, Seró L, Urra X, Cardona P, Zaragoza J, Krupinski J, Gómez‐Choco M, Mas Sala N, Catena E, Palomeras E, Serena J, Hernandez‐Perez M, Boned S, Olivé‐Gadea M, Requena M, Muchada M, Tomasello A, Molina CA, Salvat‐Plana M, Escudero M, Jimenez X, Davalos A, Jovin TG, Purroy F, Abilleira S, Ribó M, Perez de la Ossa N, Jacobi MR, Sanjuan E, Santana K, Molina C, Rubiera M, Rodríguez N, Pagola J, Rodriguez‐Luna D, Maisterra O, Santamarina E, Muchada M, Juega J, Boned S, Franco AP, García‐Tornel Á, Gadea MO, Deck M, Requena M, Sala V, de la Ossa NP, Muñoz L, Millán M, Gomis M, López‐Cancio E, Dorado L, Hernández‐Pérez M, Ciurans J, Samaniego D, Canento T, Martin L, Planas A, Broto J, Sorrentino A, Paré M, Zhu N, Garrido A, Grau L, Crespo AM, Presas S, Almendrote M, Ramos A, Lucente G, Ispierto L, Lozano M, Becerra JL, Jiménez M, Rolán DV, Guanyabens N, Sanchez‐Ojanguren J, Martínez‐Piñeiro A, Forcén S, Gea M, Álvarez M, Ramos A, Lizarbe MD, Sara, Guerra R, Bragado I, Arbex A, Rodríguez L, Bustamante A, Portela PC, García HQ, Rodríguez BL, Cayuela N, Miró J, Marzal C, Paipa A, Campoy S, Núñez A, Arroyo P, Besora S, Adell V, Campdelacreu J, Martí MA, González B, Vila LB, Crespo MF, Berbel A, Urbaneja CV, Guillen N, Vidal N, Santamaria PVV, Navarro DH, Simó M, Falip M, Matas E, Ochoa NM, Gifreu A, Muñoz A, Romero L, Portell E, Perez GH, Esteve FR, Teixidor S, Talavera AS, Gómez R, Nuin XU, Vargas M, Chamorro Á, Amaro S, Llull L, Renú A, Rudilosso S, del Valle RS, Ariño H, Solà N, la Puma D, Gil F, Gómez JB, Matos N, Falgàs N, Borrego S, Sánchez A, Balasa M, Montejo C, Guasp M, Reyes D, Cervilla PS, Contador JM, Monge VAV, Ramos O, Manzanera LSR, Rodríguez A, Campello AR, Ballester GR, Trujillano ML, Steinhauer EG, Godia EC, Santiago AJO, Conde JJ, Fábregas JM, Guisado D, Prats L, Camps P, Delgado R, Domeño AM, Marín R, Cànovas D, Estela J, Ros M, Aranceta S, Espinosa J, Rubio M, Lafuente C, Barrachina O, Anguita A, Reverter A, García C, Sansa G, Hervas M, Crosas M, Delgado T, Krupinski J, Folch DSH, Gamito GM, Alvarez JT, Subirana T, Molina J, Besora S, Romero LC, Valls GG, Jover M, Sotova JJ, Sánchez SMG, Valenzuela S, Gómez‐Choco M, Mengual JJ, Font MÀ, Ruiz MIG, Zubizarreta I, González SF, Gubieras L, Cobos CE, Romo LM, Caballol N, Cano L, Leal JS, Blas YS, Izarra MT, Trigo IB, Viturro SB, Albiñana LP, Garrido MR, Cazcarra CM, Uscamaita KE, Márquez F, Coll C, Villlas MIL, Vila BS, Perna BA, Domínguezl DL, de Lera M, Foraster AC, Monge VAV, Bojaryn U, García FP, Benabdelhak I, Capdevila GM, Montesinos JS, Vázquez D, Hervás JV, González C, Quílez A, Pascual MV, Ruiz M, Riba Y, Villar MPG, García C, Roig XU, Mora MB, Guinjoan AP, Borras J, Martínez AM, Marés R, Viñas i Gaya J, Seró L, Flores A, Rodríguez DP, Castilho G, Ortega AM, Reverté S, Zaragoza J, Baiges JJ, Zaragoza J, Ozaeta GM, Escalante S, Belloch PE, Payo I, Salvado JS, Sala NM, Soler Insa JM, Vilamala ET, Navarro JA, Tabuenca HC, Sánchez TC, Ros M, Matos N, Roldán E, Rubiol EP, Franquet E, Fuentes L, Donaire J, Martí E, Giménez L, Vázquez JG, Ambrós ENCG, Rodríguez P, Oletta JF, Mellado PP, Catena, Gómez B, Raileau V, Ruíz EC, Pardina O, Mercadal J, López‐Diéguez M, Pérez P, Gabarró L, Orriols M, Molina JC, Canet JJ, Roca M, Álvaro M, Boneu F, Giménez G, Albà J, Gibert F, Garcia J, Barragan P, Jurado G, Pascual V, Ortega JS, Solano JAM, Fernández V, Torres M, Alvaredo ABM, Parejo LR, Aragonés JM, Bullón A, Loste C, González P, Bejarano N, Sanchez F, Lucchetti G, Pla X, Gimeno J, Reynaga E, Barcons M, Celedón G, Ortiz J, Anastasovski G, Mascaró O, de los Ríos JD, Feliu M, Ribera A, Ruiz C, Corominas G, Nunes DD, Roca C, Latorre N, Yataco L, Cruz M, Blanco N, Castejón S, Calderón DC, Sunyer CP, Garcia JE, Martin RP, de Luis Sanchez A, Vivas DE, Molina JV, Palome GP, Chaume LT, Vilella AV, Bustamante M, Boltes A, Rodríguez F, Arrieta I, Molist JC, Andreu B, Soler EP, Buscà NG, López MD, Farreres JB, Ruiz VC, Batiste DM, Cartagena MPS, de Vega EC, Real JB, Roman HP, Socolich C, Camp JMA, Orgaz ATC, Felip MPF, Morón N, Bacca S, Molina M, Casarramona F, Elias L, Bukaei MZ, Gutierrez JAM, Escuin JL, Olaizola C, Vargas YL, Oyonarte JJ, Soultana R, Golpe ES, Salvador E, Vila G, Serrano M, Claverol MNL, Lamolla M, Amate M, Rodriguez A, Romero R, del Carpio M, Hernandez AI, Martín J, Rosas MC, Nogueroles A, Encarnación S, Robles A, Herrera JA, Gavilán R, Mameghani T, Araujo G, Morales MAG, Segui ERA, Climent EF, Pujol FP, Seira MJG, Pía LG, Nuñez FS, Peñalver CA, Lopes CV, Tasa ER, Vilchez CR, Zambrana MS, Ribas BS, Panés IV, Planavila MV, Lorenzo AV, Guixes MS, Medina J, Sambrano D, Zamarreño J, Pirela C, Vélez P, Cajamarca L, Pérez H, Martínez Y, Gonçalves JA, Regordosa C, Mormeneo C, Griu L, Colina MF, Farik E, Duch DC, Badenas C, Bernal O, Agramunt N, Morales S, Reynoso V, Guerrero M, Cid PR, Folqué M, Pedroza C, Hachem A, Martínez ÍS, García XV, Amorós ML, Subirós XC, Benet MC, Eendenburg CV, Osuna T, Santos DG, Pallisera DM, Oliva LG, Sanchez DG, Basurto X, Vivoda L, Van der Kleyn R, Robles DL, Barranco AC, Almendros MC, Oliveras MP, Álvarez AF, Rybyeva M, Viñas A, Barcons M, Tavera JDA, Burbano P, López C, Cruz D, Bisbe P, Fernández N, Palacio JC, Fraiz E, Aguiló O, Amorodjo R, Velázquez J, Sánchez E, Español J, de Celis JP, Coll A, Díaz G, Vergés i Sala M, Capdevila MÁC, Ferrini YY, Gorriz A, Navarro DC, Velásquez D, Soler JP, González J, Higuera JD, Cuellar L, Miniello LM, Pujol L, Cracan S, Angela MVM, Anabel LL, Molist MG, Anna D, Muñoz SS, Yolanda F, Pujalte C, Marín ET, Casas YF, Luque SH, Sendra JM, Valero FM, Olga CE, Carles GDL, Enric LD, Paramio C, Xavier, Xavier CE, Jaime EM, Jordi CM, Antonio CA, Elena CNM, Lluis CRP, Anna DF, Pere FSJ, Ana FG, Antoni FBJ, Carlos GHJ, Sergio HP, Zulma IT, Rafael MR, Albert OG, Marta OC, Soledad QGM, RodriguezJavier R, Joaquin RS, Ramon RMJ, Pere SV, Jose SAM, Angeles SGM, Francisco TE, José TGP, Isabel VCM, Jose VLJ, Angeles LCM, Isaac LG, Arnulfo MAJ, Olga MF, Teresa SGM, Miquel TM, Mercedes VLM, Manuel PRJ, Marta RF, Dominica RT, Jose SG, Meritxell SG, Sheila AR, Falip AG, Vanessa AO, Stella BP, Miriam CM, Monica CF, Estefani CM, Nuria DM, Laura DM, Margarita FP, Sylvia FC, Georgina GT, del Mar GGA, de Jesus LAD, Pilar LS, Monica LV, Jordi MC, de la Cruz Raquel M, Arantxa MB, Marcos OO, Núria PS, Sergi PM, Carlos RGJ, Virginia RP, Anna SP, Mireia SV, Rossana SL, Judit TR, Anna TC, Maria VA, Teresa AGM, Silvia BV, Maria CGR, Antonio ECJ, Agusti EM, Helena GF, Sar HL, Sonia JD, Angel MGM, Pau OS, Noemi PF, Jesus SF, Carlos SAA, Giovanna TL, Sandra VH, Marta TG, Ada AV, Sonia AA, Laura AN, Mar AB, Cristina AM, Angels AO, Jeannette AC, Miriam AP, Vanessa ACM, Remedios AGE, Silvia AS, Izaskun AS, Nuria BG, Sergio BB, Teresa BT, Roser BP, Ariadna BP, Isabel BG, Nuria BS, Laia BA, Salvador CC, Arnau CC, Iren CM, Nuria CB, Daniel CF, Marc CS, Teresa CM, Cristina CB, Sandra CC, Borrego AJLC, Orri AC, Vilanova GC, Sole AC, Torres MC, Estepa NC, de Sostoa Graell M, del Rio Lopez L, Sandra BDC, Carmen DB, Lucia DMA, Carme DPM, Javier DCP, Laura DM, Khadija EA, Pau EM, David EC, Daniel FP, Sergi FQ, Sergio FE, Anna FA, del Valle Africa F, del Valle Mª Luisa F, Maria FQS, Teresa FRM, Rut GF, Alicia GG, Laura GC, Marina GR, Gemma C, Manuela GA, Xavier GG, Beatriz GF, Marta GG, Ricardo GG, Flor GL, Maria GO, Marta GB, Susana GR, Albert GE, Gemma HS, Dolça HC, Lluis HA, Marta HR, Paula IB, Alessandro I, Marta IC, Etxetxikia JU, Jordi JG, Rajaa KA, Gustavo LG, Anna LM, de Jesus LAD, Lourdes LMM, Aida LC, Monica LB, Laura LM, Cristian LR, Pedro LR, Tania LM, Ruth LM, Jessica LC, Alexia LN, Antonio MDJ, Morales MTP, Albert MC, Natanael MCD, David MG, Paula MG, Quesada M, Marzà Fusté Mireia CM, Marta ML, Jordi MM, Pastalle MP, Silvia MV, Emma MM, Christian MP, Olga MF, Helena MC, Mireia MV, Guillem MS, Aldara MQ, Natalia NR, Asuncion NIM, Pilar NMM, Judith OM, Roger PR, Xenia PT, Ivana PB, Anna PG, Mireia PO, Alejandra PRM, Raquel PY, Anna PM, Sergi PM, Alba PC, Lourdes QB, Cristina RB, Helena RF, del Carmen RGM, Joaquim RP, Inma RF, Amalia RF, Mariola RF, Raquel RM, Yolanda RN, Alicia RI, Albert RG, Silvia RB, de Eugenio Ramon R, Priscila RBARL, Julia SL, Carolina SJA, Daniel SS, Jordi SS, Marta SS, Enriqueta SP, Maria SB, Ruth SD, Ignacio TM, Cristina TV, Ines TSE, Soledad TT, Lluis TF, Marina TR, Anna TG, Nuria TE, Florenc U, Garazi VB, De la Paz Angel V, Fernando VG, Ingrit VG, Natalia VM, Eva VC, Jose VJM, Angela VF, Carla VG, Elisabeth VV, Jose CJF, Agusti GV, Albert GG, Laura JM, Jose MC, Felix MO, Jose MBM, Manuel ML, Jesus MRM, Carles MG, Ricardo MH, Eva MO, Ramon PP, Camilo PC, Antonio PAJ, Pol QM, Jordi RM, Sonia AA, Celia AA, Lorena AF, Joan BP, Laia BA, Francisco CV, Jaume CH, Gloria CGM, Gonzalo CM, Xavier CE, Enric CG, Montserrat CS, Carlos DS, Javier ER, del Mar ECM, Joaquin FA, Carlos FG, Patricia FP, Laura FE, Cristina FG, Marta GP, Ainhoa GG, Rafael HS, Dolça HC, Marta HR, Sonia JA, Pedro JR, Angeles LCM, Alejandro LL, Aleix LO, Rosa MRM, Daniel MM, Marta MM, Noelia ME, Olga MF, Sandra MJ, Matilde MR, Jessica NR, Maria NIR, Raquel NV, Alba PTM, Montserrat PVC, Alba PC, Angels RM, Alejandro RT, Merce RO, Mariola RF, Baltasar SG, Paola SP, Enriqueta SP, Cristina SB, Angeles SGM, Meritxell TF, Gemma TB, Jose TA, Agusti EM, Purificacion FM, Luis HP, Laura JM, Pedro LF, Alfonso LG, Felix MO, Jose MBM, Carles MG, Eva MO, Ricardo PL, Ramon PP, Joan QA, Miguel VL, Consuelo AD, Jeannette AC, Miguel AM, Anna AC, Raquel BG, Antonio BC, Del Mar CGM, Montserrat CO, Daniel CF, Marc CS, Isabel CMC, Alexander CB, Gloria CGM, Gonzalo CM, Sergio CC, Alexandre CO, Lidia CP, Rita CO, Carles DE, Javier DCP, del Mar ECM, Raquel FM, Luis GLP, Marta GP, Vallve GA, Manuela GA, Xavier GG, Carlos GM, Elena HV, Dolça HC, Cristina HG, Rafael MR, Marta MM, Daniel MM, Sergi MB, Xavier MP, Isabel MD, Maria MC, Pastalle MP, de la Cruz Raquel M, Olga MF, Javier MSF, Roger PR, Alba PTM, Feliciano PB, Monica PA, Cristina RB, Obed RP, Javier RPF, Mar RT, Sandra RP, Laura SS, Yolanda SM, Sheila SM, Eduardo SC, Soledad TT, Lluis TF, José TGP, Ricard TT, Narcis VD, Olga VE, Nuria VP, Andres BG, Marc BP, Cristina BS, Victor BA, Gemma BB, Estel BC, Alejandro CG, Esther CC, Sanchez CF, Toledo EJF, Roger ER, Xavier ERF, Mireia FS, Jordi GL, Daniel GL, Jorge HL, Alicia JLS, Joel LO, Samuel LY, Marta LV, Soto LS, Nicolas MC, Jesus MCD, Arich MP, Susana MS, Raul MM, Isabel MHM, Jose OFM, Bàrbara PB, Pedro PS, Judith RC, Marc RL, Verònica RL, Silvina RL, Gerard SC, Marc SL, Manel SR, Meritxell SG, Albert SC, Noemí SD, Gabriel SMG, Miquel TM, Maria VPA, Silvia VM, Salvat‐Plana M, Roig J, Hidalgo V, Vivanco‐Hidalgo RM, Gallofré M, Cobo E. Workflow times and outcomes in patients triaged for a suspected severe stroke. Ann Neurol 2022; 92:931-942. [DOI: 10.1002/ana.26489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/21/2022] [Accepted: 08/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Álvaro García‐Tornel
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Laia Seró
- Department of Neurology Hospital Universitari Joan XXIII Tarragona Spain
| | | | - Pere Cardona
- Stroke Unit Hospital Universitari Bellvitge, L'Hospitalet de Llobregat Spain
| | - Josep Zaragoza
- Department of Neurology Hospital Verge de la Cinta Tortosa Spain
| | | | - Manuel Gómez‐Choco
- Department of Neurology Complex Hospitalari Hospital Moisés Broggi Sant Joan Despí Spain
| | - Natalia Mas Sala
- Department of Neurology Hospital Sant Joan de Déu ‐ Fundació Althaia Manresa Spain
| | - Esther Catena
- Department of Neurology Consorci Sanitari Alt Penedès‐Garraf Spain
| | | | - Joaquin Serena
- Stroke Unit Hospital Universitari Josep Trueta Girona Spain
| | | | - Sandra Boned
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Marta Olivé‐Gadea
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Requena
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
- Department of Interventional Neurorradiology. Hospital Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Marian Muchada
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Alejandro Tomasello
- Department of Interventional Neurorradiology. Hospital Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Carlos A. Molina
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
| | - Mercè Salvat‐Plana
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | | | | | - Antoni Davalos
- Stroke Unit Hospital Germans Trias i Pujol Badalona Barcelona Spain
| | - Tudor G Jovin
- Neurological Institute Cooper University Hospital Camden New Jersey
| | - Francesc Purroy
- Stroke Unit. Department of Neurology Hospital Universitari Arnau de Vilanova de Lleida Lleida Spain
| | - Sonia Abilleira
- Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS) CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Marc Ribó
- Stroke Unit. Department of Neurology. Hospital Universitari Vall d'Hebron. Departament de Medicina Universitat Autònoma de Barcelona Barcelona Spain
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Moreno-Serra R, Anaya-Montes M, León-Giraldo S, Bernal O. Addressing recall bias in (post-)conflict data collection and analysis: lessons from a large-scale health survey in Colombia. Confl Health 2022; 16:14. [PMID: 35395772 PMCID: PMC8994310 DOI: 10.1186/s13031-022-00446-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background Much applied research on the consequences of conflicts for health suffers from data limitations, particularly the absence of longitudinal data spanning pre-, during- and post-conflict periods for affected individuals. Such limitations often hinder reliable measurement of the causal effects of conflict and their pathways, hampering also the design of effective post-conflict health policies. Researchers have sought to overcome these data limitations by conducting ex-post surveys, asking participants to recall their health and living standards before (or during) conflict. These questions may introduce important analytical biases due to recall error and misreporting. Methods We investigate how to implement ex-post health surveys that collect recall data, for conflict-affected populations, which is reliable for empirical analysis via standard quantitative methods. We propose two complementary strategies based on methods developed in the psychology and psychometric literatures—the Flashbulb and test-retest approaches—to identify and address recall bias in ex-post health survey data. We apply these strategies to the case study of a large-scale health survey which we implemented in Colombia in the post-peace agreement period, but that included recall questions referring to the conflict period. Results We demonstrate how adapted versions of the Flashbulb and test-retest strategies can be used to test for recall bias in (post-)conflict survey responses. We also show how these test strategies can be incorporated into post-conflict health surveys in their design phase, accompanied by further ex-ante mitigation strategies for recall bias, to increase the reliability of survey data analysis—including by identifying the survey modules, and sub-populations, for which empirical analysis is likely to yield more reliable causal inference about the health consequences of conflict. Conclusions Our study makes a novel contribution to the field of applied health research in humanitarian settings, by providing practical methodological guidance for the implementation of data collection efforts in humanitarian contexts where recall information, collected from primary surveys, is required to allow assessments of changes in health and wellbeing. Key lessons include the importance of embedding appropriate strategies to test and address recall bias into the design of any relevant data collection tools in post-conflict or humanitarian contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-022-00446-0.
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Affiliation(s)
- Rodrigo Moreno-Serra
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, YO10 5DD, UK.
| | - Misael Anaya-Montes
- Centre for Health Economics, University of York, Alcuin A Block, Heslington, YO10 5DD, UK
| | - Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de Los Andes, Colombia, Carrera 1° N° 19-27, Bloque AU, piso 3, Bogotá, Colombia
| | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de Los Andes, Colombia, Carrera 1° N° 19-27, Bloque AU, piso 3, Bogotá, Colombia
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9
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González-Uribe C, Olmos-Pinzón A, León-Giraldo S, Bernal O, Moreno-Serra R. Health perceptions among victims in post-accord Colombia: Focus groups in a province affected by the armed conflict. PLoS One 2022; 17:e0264684. [PMID: 35235591 PMCID: PMC8890648 DOI: 10.1371/journal.pone.0264684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/15/2022] [Indexed: 11/19/2022] Open
Abstract
The peace agreement with the Colombian guerrilla group Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo represented an opportunity for peacebuilding and victims' reparation, rather than the end of the internal armed conflict. In this context, this study aimed to uncover the consequences of conflict on victims' health and on health service provision, and their perceived health status during the post-accord stage in the Meta region, located in the country's eastern plains. Historically, this region has been one of the territories most affected by the presence of conflict-related groups and armed confrontations. Through focus groups, this research explored the health perceptions and experiences of victims of armed conflict. Ten focus groups were conducted with men and women, victims of the armed-conflict, in four municipalities with different degrees of armed conflict intensity. The focus group transcripts were coded using NVivo. The results show that the way women have experienced conflict and the effects of conflict on mental health in general for men, women, and children were recurrent themes in the dialogue of victims. Likewise, it highlights the need to understand the barriers that the current health model imposes on the right to health itself. From the victim's perspective, they experience stigmatization, discrimination, and revictimization when accessing health services. These barriers co-occur along with structural limitations of the health system that affect the general population.
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Affiliation(s)
| | - Antonio Olmos-Pinzón
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
- Interdisciplinary Centre of Development Studies, Universidad de los Andes, Bogotá, Colombia
| | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
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10
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León-Giraldo S, Casas G, Cuervo-Sanchez JS, González-Uribe C, Bernal O, Moreno-Serra R, Suhrcke M. Health in Conflict Zones: Analyzing Inequalities in Mental Health in Colombian Conflict-Affected Territories. Int J Public Health 2021; 66:595311. [PMID: 34744562 PMCID: PMC8565266 DOI: 10.3389/ijph.2021.595311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Colombia’s civil conflict and persistent socio-economic disparities have contributed to mental health inequalities in conflict-affected territories. We explore the magnitude of mental health inequalities, contributing socio-economic factors, and sociodemographic characteristics that explain these differences. Methods: The study draws on data collected in 2018, using the household survey Conflicto, Paz y Salud (CONPAS) applied to 1,309 households in Meta, Colombia. Logistic regression and decomposition analysis were used to analyze the risk of mental health disorders, measured with the Self-Reporting Questionnaire -20 (SRQ-20). Results: Individuals with lower socio-economic status are at a higher risk for mental health disorders. Forced displacement accounts for 31% of the measured mental health inequalities. Disparities in employment, education level, disability and conflict incidence between municipalities are other contributing factors. Women and people with disabilities are respectively 2.3 and 1.2 times more prone to present a mental health disorder. Conclusion: It is necessary to tackle the identified risk factors and sociodemographic circumstances that contribute to mental health inequalities in conflict-affected territories, as these hinder adequate/equitable access to mental health services.
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Affiliation(s)
- Sebastián León-Giraldo
- Interdisciplinary Centre of Development Studies, Universidad de Los Andes, Bogotá, Colombia.,Alberto Lleras Camargo School of Government, Universidad de Los Andes, Bogotá, Colombia
| | - Germán Casas
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia.,Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de Los Andes, Bogotá, Colombia
| | | | - Marc Suhrcke
- Centre for Health Economics, University of York, York, United Kingdom.,Luxembourg, Institute of Socio-Economic Research (LISER), Luxembourg
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11
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León-Giraldo S, Cuervo-Sánchez JS, Casas G, González-Uribe C, Kreif N, Bernal O, Moreno-Serra R. Inequalities in catastrophic health expenditures in conflict-affected areas and the Colombian peace agreement: an oaxaca-blinder change decomposition analysis. Int J Equity Health 2021; 20:217. [PMID: 34587942 PMCID: PMC8482681 DOI: 10.1186/s12939-021-01555-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016. METHODS The study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method. RESULTS The incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability. CONCLUSIONS Conflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.
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Affiliation(s)
- Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de Los Andes, Carrera 1 No 19 - 27, Bloque Aulas, tercer piso, Bogotá, Colombia
- Interdisciplinary Centre of Development Studies, Universidad de Los Andes, Bogotá, Colombia
| | - Juan Sebastián Cuervo-Sánchez
- Alberto Lleras Camargo School of Government, Universidad de Los Andes, Carrera 1 No 19 - 27, Bloque Aulas, tercer piso, Bogotá, Colombia
| | - Germán Casas
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | | | - Noemi Kreif
- Centre for Health Economics, University of York, York, UK
| | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de Los Andes, Carrera 1 No 19 - 27, Bloque Aulas, tercer piso, Bogotá, Colombia.
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12
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, García T, González-Uribe C, Moreno-Serra R, Bernal O. Mental Health Disorders in Population Displaced by Conflict in Colombia: Comparative Analysis against the National Mental Health Survey 2015. Rev Colomb Psiquiatr (Engl Ed) 2021; 52:S0034-7450(21)00089-5. [PMID: 34246471 DOI: 10.1016/j.rcp.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Colombia is one of the countries with the highest levels of internal displacement resulting from armed conflict. This population has greater chances of experiencing a mental health disorder, especially in territories historically affected by armed conflict. Our objective was to compare the levels of possible mental health disorder in people experiencing internal displacement in Meta, Colombia, a department historically affected by armed conflict, compared to the internally displaced population in the National Mental Health Survey of 2015. METHODS Analysis of data collected in the National Mental Health Survey (ENSM) of 2015, study with representative data at national level and the Conflict, Peace and Health survey (CONPAS) of 2014, representative study of the degree of impact of the conflict on the municipality, conducted in the department of Meta, Colombia. To measure possible mental health disorder, the Self-Report Questionnaire - 25 (SRQ-25) was used. Internal displacement is self-reported by people surveyed in both studies. An exploratory analysis is used to measure possible mental health disorders in the displaced population in the ENSM 2015 and CONPAS 2014. RESULTS 1,089 adults were surveyed in CONPAS 2014 and 10,870 adults were surveyed in the ENSM 2015. 42.9% (468) and 8.7% (943) of people reported being internally displaced in CONPAS 2014 and ENSM 2015, respectively. In both studies, internally displaced populations have greater chances of experiencing any mental health disorder compared to non-displaced populations. For CONPAS 2014, 21.8% (95%CI, 18.1-25.8) of this population had a possible mental health disorder (SRQ+) compared to 14.0% (95%CI, 11.8-16.3) in the ENSM 2015. Compared with the ENSM 2015, at the regional level (CONPAS 2014), displaced people had a greater chance of presenting depression by 12.4% (95%CI, 9.5-15.7) compared to 5.7% (95%CI, 4.3-7.4) in the ENSM 2015, anxiety in 21.4% (95%CI, 17.7-25.3) compared to 16.5% (95%CI, 14.2-19.1) in the ENSM 2015, and psychosomatic disorders in 52.4% (95%CI, 47.5-56.7) in CONPAS 2014 compared to 42.2% (95%CI, 39.0-45.4) in the ENSM 2015. At the national level (ENSM 2015), displaced people had greater possibilities of presenting, compared to the regional level, suicidal ideation in 11.9% (95%CI, 9.3-14.1) compared to 7.3% (95%CI, 5.0-10.0) in CONPAS 2014 and bipolar disorder in 56.5% (95%CI, 53.2-59.7) compared to 39.3% (95%CI, 34.8-43.9) in CONPAS 2014. CONCLUSIONS The greater possibilities of displaced populations at the regional level of experiencing a mental health disorder, compared to this same population at the national level, may represent and indicate greater needs in mental health care services in territories affected by conflict. Therefore, and given the need to facilitate access to health services in mental health for populations especially affected by armed conflict, there is a need to design health care policies that facilitate the recovery of populations affected by war and, simultaneously, that reduce inequities and promote the fulfilment of one of the most important and, at the same time, least prioritised health objectives in international development: mental health.
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Affiliation(s)
- Sebastián León-Giraldo
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia; Centro de Estudios Sobre Desarrollo CIDER, Universidad de los Andes, Bogotá, Colombia.
| | - Germán Casas
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia; Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Tatiana García
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Oscar Bernal
- Escuela de Gobierno Alberto Lleras Camargo, Universidad de los Andes, Bogotá, Colombia
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Bernal O, Lopez R, Montoro E, Avedillo P, Westby K, Ghidinelli M. Introduction and scaling up of new drugs for drug-resistant TB: experiences from the Americas. Int J Tuberc Lung Dis 2021; 24:1058-1062. [PMID: 33126939 DOI: 10.5588/ijtld.20.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The number of multidrug-resistant tuberculosis (MDR-TB) cases reported in the Americas has increased by 21.2%, from 3737 in 2016 to 4791 in 2018. The WHO has been recommending changes on the treatment of DR-TB, moving from long-duration treatment with injectables to a short oral regimen with new drugs such as bedaquiline (BDQ) and delamanid (DLM), in selected cases and only under programmatic conditions. Injectables are no longer recommended by the WHO due to lower efficacy and the increasing seriousness of adverse events. The introduction of new oral drugs for DR-TB received a boost with a global donation of BDQ to some eligible countries, which continues with the countries purchasing drugs through the Pan American Health Organization Strategic Fund. The main challenges in the scaling up of new drugs for DR-TB include low DR-TB detection rate, the slow pace in transitioning to molecular testing and delays in the introduction of new oral short regimens for MDR-TB. The Americas need to accelerate the scale up of new oral treatments, improve detection rates, increase molecular diagnosis of resistance, and ensure the registration and introduction of the shorter treatment regimen in national MDR-TB guidelines.
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Affiliation(s)
- O Bernal
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - R Lopez
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - E Montoro
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - P Avedillo
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - K Westby
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - M Ghidinelli
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
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León-Giraldo S, Casas G, Cuervo-Sánchez JS, González-Uribe C, Olmos A, Kreif N, Suhrcke M, Bernal O, Moreno-Serra R. A light of hope? Inequalities in mental health before and after the peace agreement in Colombia: a decomposition analysis. Int J Equity Health 2021; 20:39. [PMID: 33468165 PMCID: PMC7816354 DOI: 10.1186/s12939-021-01381-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background The present study seeks to evaluate the change in mental health inequalities in the department of Meta after the signing of Colombia’s Peace Agreement in 2016 with the FARC guerrilla group. Using a validated survey instrument composed of 20 questions (‘SRQ-20’), we measure changes in mental health inequalities from 2014, before the signing of the agreement, to 2018, after the signing. We then decompose the changes in inequalities to establish which socioeconomic factors explain differences in mental health inequalities over time. Methods Our study uses information from the Conflicto, Salud y Paz (CONPAS) survey conducted in the department of Meta, Colombia, in 1309 households in 2018, with retrospective information for 2014. To measure inequalities, we calculate the concentration indices for both years. Through the Oaxaca change decomposition method, we disaggregate changes in mental health inequalities into its underlying factors. This method allows us to explain the relationship between changes in mental health inequalities and changes in inequalities in several sociodemographic factors. It also identifies the extent to which these factors help explain the changes in mental health inequalities. Results Mental health inequalities in Meta were reduced almost by half from 2014 to 2018. In 2018, the population at the lower and middle socioeconomic levels had fewer chances of experiencing mental health disorders in comparison to 2014. The reduction in mental health differences is mostly attributed to reductions in the influence of certain sociodemographic variables, such as residence in rural zones and conflict-affected territories, working in the informal sector, or experiencing internal displacement. However, even though mental health inequalities have diminished, overall mental health outcomes have worsened in these years. Conclusions The reduction in the contribution of conflict-related variables for explaining mental health inequalities could mean that the negative consequences of conflict on mental health have started to diminish in the short run after the peace agreement. Nevertheless, conflict and the presence of other socioeconomic inequalities still contribute to persistent adverse mental health outcomes in the overall population. Thus, public policy should be oriented towards improving mental health care services in these territories, given the post-accord context.
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Affiliation(s)
- Sebastián León-Giraldo
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia.
| | - Germán Casas
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | | | - Antonio Olmos
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Noemi Kreif
- Centre for Health Economics, University of York, York, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, York, UK
| | - Oscar Bernal
- Alberto Lleras Camargo School of Government, Universidad de los Andes, Bogotá, Colombia
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Bernal O, López R, Montoro E, Avedillo P, Westby K, Ghidinelli M. [Social determinants and the Sustainable Development Goals' tuberculosis target in the AmericasDeterminantes sociais e a meta para a tuberculose dos Objetivos de Desenvolvimento Sustentável nas Américas]. Rev Panam Salud Publica 2020; 44:e153. [PMID: 33362288 PMCID: PMC7748296 DOI: 10.26633/rpsp.2020.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Determine patterns of tuberculosis (TB) incidence indicators and number of deaths from TB within the framework of target 3.3 of the Sustainable Development Goals (SDGs) and their correlation with social determinants. METHODS Ecological study methodology was used, in which the population is the unit of analysis. Social determinants were analyzed using a negative binomial regression model and strength of association. RESULTS In the Americas, there was an average annual reduction in the TB incidence rate of 0.3% from 2009 to 2018; however, from 2015 to 2018, the rate increased, from 27.6 to 28.8 per 100,000 population. With regard to social determinants, the groups of countries with the lowest human development index (HDI) and gross domestic product (GDP) have a higher incidence of TB. TB risk in the country with the lowest HDI is six times that of the country with the highest HDI. CONCLUSIONS At the current rate of reduction in the incidence rate and number of deaths from TB, the Region of the Americas will not meet the targets in the SDGs and in the End TB Strategy. Rapid implementation and expansion of interventions for TB prevention and control are required to attain the targets. This involves, among other actions, reducing access barriers to diagnosis and treatment and strengthening initiatives to address social determinants.
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Affiliation(s)
- Oscar Bernal
- Organización Panamericana de la SaludWashington DCOrganización Panamericana de la Salud, Washington DC.
| | - Rafael López
- Organización Panamericana de la SaludWashington DCOrganización Panamericana de la Salud, Washington DC.
| | - Ernesto Montoro
- Organización Panamericana de la SaludWashington DCOrganización Panamericana de la Salud, Washington DC.
| | - Pedro Avedillo
- Organización Panamericana de la SaludWashington DCOrganización Panamericana de la Salud, Washington DC.
| | - Keisha Westby
- Organización Panamericana de la SaludWashington DCOrganización Panamericana de la Salud, Washington DC.
| | - Massimo Ghidinelli
- Organización Panamericana de la SaludWashington DCOrganización Panamericana de la Salud, Washington DC.
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Osborn J, Roberts T, Guillen E, Bernal O, Roddy P, Ongarello S, Sprecher A, Page AL, Ribeiro I, Piriou E, Tamrat A, de la Tour R, Rao VB, Flevaud L, Jensen T, McIver L, Kelly C, Dittrich S. Prioritising pathogens for the management of severe febrile patients to improve clinical care in low- and middle-income countries. BMC Infect Dis 2020; 20:117. [PMID: 32041536 PMCID: PMC7011354 DOI: 10.1186/s12879-020-4834-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background Severe febrile illness without a known source (SFWS) is a challenge for clinicians when deciding how to manage a patient, particularly given the wide spectrum of potential aetiologies that contribute to fever. These infections are difficult to distinguish clinically, and accurate diagnosis requires a plethora of diagnostics including blood cultures, imaging techniques, molecular or serological tests, and more. When laboratory services are available, a limited test menu hinders clinical decision-making and antimicrobial stewardship, leading to empiric treatment and suboptimal patient outcomes. To specifically address SFWS, this work aimed to identify priority pathogens for a globally applicable panel for fever causing pathogens. Method A pragmatic two-pronged approach combining currently available scientific data in an analytical hierarchy process and systematically gathered expert input, was designed to address the lack of comprehensive global aetiology data. The expert re-ranked list was then further adapted for a specific use case to focus on community acquired infections in whole blood specimens. The resulting list was further analysed to address different geographical regions (Asia, Africa, and Latin America), and Cohen kappa scores of agreement were calculated. Results The expert ranked prioritized pathogen list generated as part of this two-pronged approach included typhoidal Salmonella, Plasmodium species and Mycobacterium tuberculosis as the top 3 pathogens. This pathogen list was then further adapted for the SFWS use case to develop a final pathogen list to inform product development. Subsequent analysis comparing the relevance of the SFWS pathogen list to multiple populations and geographical regions showed that the SFWS prioritized list had considerable utility across Africa and Asia, but less so for Latin America. In addition, the list showed high levels of agreement across different patient sub-populations, but lower relevance for neonates and symptomatic HIV patients. Conclusion This work highlighted once again the challenges of prioritising in global health, but it also shows that taking a two-pronged approach, combining available prevalence data with expert input, can result in a broadly applicable priority list. This comprehensive utility is particularly important in the context of product development, where a sufficient market size is essential to achieve a sustainable commercialized diagnostic product to address SFWS.
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Espinel Z, Chaskel R, Berg RC, Florez HJ, Gaviria SL, Bernal O, Berg K, Muñoz C, Larkin MG, Shultz JM. Venezuelan migrants in Colombia: COVID-19 and mental health. Lancet Psychiatry 2020; 7:653-655. [PMID: 32711697 PMCID: PMC7377810 DOI: 10.1016/s2215-0366(20)30242-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Zelde Espinel
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Roberto Chaskel
- Department of Psychiatry, Hospital Militar Central, Bogotá, Colombia; Department of Psychiatry, Universidad El Bosque, Bogotá, Colombia; School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Ryan C Berg
- Latin America Studies Program, American Enterprise Institute, Washington DC, USA
| | - Hermes Jose Florez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Silvia L Gaviria
- Department of Psychiatry, Universidad CES, Medellín, Colombia; Department of Psychiatry, Universidad de Antioquia, Medellín, Colombia
| | - Oscar Bernal
- Department of Government, Universidad de Los Andes, Bogotá, Colombia
| | - Kim Berg
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carlos Muñoz
- Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Marisa G Larkin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - James M Shultz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Felipe Gaia D, Bernal O, Castilho E, Baeta Neves Duarte Ferreira C, Dvir D, Simonato M, Honório Palma J. First-in-Human Endo-Bentall Procedure for Simultaneous Treatment of the Ascending Aorta and Aortic Valve. JACC Case Rep 2020; 2:480-485. [PMID: 34317269 PMCID: PMC8311619 DOI: 10.1016/j.jaccas.2019.11.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/10/2019] [Accepted: 11/25/2019] [Indexed: 11/29/2022]
Abstract
We describe the endovascular management of a middle-aged woman who developed a bleeding suprasternal fistula after conventional aortic valve replacement. The patient's condition was considered inoperable. A customized stent attached to a transcatheter valve was successfully used to treat the individual, this being the first-in-human case of the promising Endo-Bentall procedure. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Diego Felipe Gaia
- Cardiovascular Surgery Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Oscar Bernal
- Interventional Cardiology Department, Centro Medico La Costa, Asuncion, Paraguay
| | - Edilberto Castilho
- Cardiovascular Surgery Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | | | - Danny Dvir
- Interventional Cardiology Department, University of Washington, Seattle, Washington
| | - Matheus Simonato
- Cardiovascular Surgery Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - José Honório Palma
- Cardiovascular Surgery Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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Roddy P, Dalrymple U, Jensen TO, Dittrich S, Rao VB, Pfeffer DA, Twohig KA, Roberts T, Bernal O, Guillen E. Quantifying the incidence of severe-febrile-illness hospital admissions in sub-Saharan Africa. PLoS One 2019; 14:e0220371. [PMID: 31344116 PMCID: PMC6657909 DOI: 10.1371/journal.pone.0220371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022] Open
Abstract
Severe-febrile-illness (SFI) is a common cause of morbidity and mortality across sub-Saharan Africa (SSA). The burden of SFI in SSA is currently unknown and its estimation is fraught with challenges. This is due to a lack of diagnostic capacity for SFI in SSA, and thus a dearth of baseline data on the underlying etiology of SFI cases and scant SFI-specific causative-agent prevalence data. To highlight the public health significance of SFI in SSA, we developed a Bayesian model to quantify the incidence of SFI hospital admissions in SSA. Our estimates indicate a mean population-weighted SFI-inpatient-admission incidence rate of 18.4 (6.8–31.1, 68% CrI) per 1000 people for the year 2014, across all ages within areas of SSA with stable Plasmodium falciparum transmission. We further estimated a total of 16,200,337 (5,993,249–27,321,779, 68% CrI) SFI hospital admissions. This analysis reveals the significant burden of SFI in hospitals in SSA, but also highlights the paucity of pathogen-specific prevalence and incidence data for SFI in SSA. Future improvements in pathogen-specific diagnostics for causative agents of SFI will increase the abundance of SFI-specific prevalence and incidence data, aid future estimations of SFI burden, and enable clinicians to identify SFI-specific pathogens, administer appropriate treatment and management, and facilitate appropriate antibiotic use.
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Affiliation(s)
- Paul Roddy
- Médecins Sans Frontières – Febrile Illness Diagnostic Programme, New York, United States of America
- * E-mail:
| | - Ursula Dalrymple
- University of Oxford, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford, United Kingdom
| | - Tomas O. Jensen
- Médecins Sans Frontières – Febrile Illness Diagnostic Programme, New York, United States of America
| | - Sabine Dittrich
- Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland
- University of Oxford – Nuffield School of Medicine, Oxford, United Kingdom
| | - V. Bhargavi Rao
- Médecins Sans Frontières – Manson Unit (MSF UK), London, United Kingdom
| | - Daniel A. Pfeffer
- University of Oxford, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford, United Kingdom
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Katherine A. Twohig
- University of Oxford, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford, United Kingdom
| | - Teri Roberts
- Médecins Sans Frontières – Febrile Illness Diagnostic Programme, New York, United States of America
- Médecins Sans Frontières – Access Campaign, Geneva, Switzerland
| | - Oscar Bernal
- Médecins Sans Frontières – Febrile Illness Diagnostic Programme, New York, United States of America
| | - Ethan Guillen
- Médecins Sans Frontières – Febrile Illness Diagnostic Programme, New York, United States of America
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Martinez-Martin P, Wetmore JB, Rodríguez-Blázquez C, Arakaki T, Bernal O, Campos-Arillo V, Cerda C, Estrada-Bellmann I, Garretto N, Ginsburg L, Máñez-Miró JU, Martínez-Castrillo JC, Pedroso I, Serrano-Dueñas M, Singer C, Rodríguez-Violante M, Vivancos F. The Parkinson's Disease Sleep Scale-2 (PDSS-2): Validation of the Spanish Version and Its Relationship With a Roommate-Based Version. Mov Disord Clin Pract 2019; 6:294-301. [PMID: 31061837 DOI: 10.1002/mdc3.12749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 12/13/2022] Open
Abstract
Background Because of the prevalence and impact of sleep disorders in Parkinson's disease (PD), valid instruments for their evaluation and monitoring are necessary. However, some nocturnal sleep disorders may go unnoticed by patients themselves. Objectives To validate a pan-Spanish version of the Parkinson's Disease Sleep Scale Version 2 (PDSS-2) and to test the relationships between the PDSS-2 and a PDSS-2 roommate version. Methods PD patients (n = 399) from seven Spanish-speaking countries were included. In addition to the tested PDSS-2 scales, valid measures for sleep disorders and both motor and nonmotor manifestations were applied. Acceptability, dimensionality, reliability, precision, and construct validity were explored, as well as discrepancies and agreement between the PDSS-2 and the roommate version. Results PDSS-2 showed negligible floor and ceiling effects. Four factors (57% of the variance) were identified. Reliability parameters were satisfactory: alpha = 0.84; item homogeneity coefficient = 0.27; corrected item total correlation = 0.28 to 0.61; and test-retest reliability (average kappa = 0.70; intraclass correlation coefficient [ICC] = 0.83). The standard error of measurement was 5.84, and correlations with other scales assessing nocturnal sleep were high (rS = 0.62-0.56). In comparison to the patient-based total score, the by proxy total score showed no significant difference, high correlation (rS = 0.70), and acceptable agreement (ICC = 0.69), but there were discrepancies in two or more points in 18% of item scores. Conclusions The Spanish version of the PDSS-2 has shown satisfactory clinimetric attributes. Acceptability and precision data are presented for the first time. The PDSS-2 roommate version could be useful to complement the patient-based evaluation, but additional studies are needed.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology Carlos III Institute of Health Madrid Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) Carlos III Institute of Health Madrid Spain
| | - John B Wetmore
- National Center of Epidemiology Carlos III Institute of Health Madrid Spain
| | - Carmen Rodríguez-Blázquez
- National Center of Epidemiology Carlos III Institute of Health Madrid Spain.,Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED) Carlos III Institute of Health Madrid Spain
| | - Tomoko Arakaki
- Parkinson Disease and Other Movement Disorders Unit Hospital José María Ramos Mejía, Neurology University Center of Buenos Aires University Buenos Aires Argentina
| | - Oscar Bernal
- Movement Disorders Clinic Hospital Militar Central Bogotá Colombia
| | | | - Christopher Cerda
- Movement Disorder Clinic University Hospital Monterrey Nuevo León México
| | | | - Nélida Garretto
- Parkinson Disease and Other Movement Disorders Unit Hospital José María Ramos Mejía, Neurology University Center of Buenos Aires University Buenos Aires Argentina
| | - Letty Ginsburg
- Movement Disorders Division Miller School of Medicine, University of Miami Miami Florida USA
| | | | | | - Ivonne Pedroso
- Movement Disorders Clinic International Center for Neurological Restoration (CIREN) Havana Cuba
| | - Marcos Serrano-Dueñas
- Medicine Faculty, Pontifical Catholic University of Ecuador Movement Disorders Unit, Neurological Service, Carlos Andrade Marín Hospital Quito Ecuador
| | - Carlos Singer
- Movement Disorders Division Miller School of Medicine, University of Miami Miami Florida USA
| | | | - Francisco Vivancos
- Movement Disorders Unit, Neurology department La Paz University Hospital Madrid Spain
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Arcerito M, Changchien E, Falcon M, Parga MA, Bernal O, Moon JT. Robotic Fundoplication for Gastroesophageal Reflux Disease and Hiatal Hernia: Initial Experience and Outcome. Am Surg 2018; 84:1945-1950. [PMID: 30606353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, represents a common clinical presentation. The repair of large paraesophageal hiatal hernias is still a challenge in minimally invasive surgery. Between March 2014 and August 2016, 50 patients (18 males and 32 females) underwent robotic fundoplication (17 sliding and 33 paraesophageal hernias). The mean age of the patients was 58 years. Biosynthetic mesh was used in 28 patients with paraesophageal hernia. The mean operative time was 115 minutes (90-132) in the sliding hiatal hernia group, whereas it was 200 minutes (180-210) in the paraesophageal hiatal hernia group. The mean hospital stay was 36 hours (24-96). Eight patients experienced mild dysphagia which resolved after four weeks. No postoperative dysphagia was recorded at 30-month median follow-up. We experienced one recurrence in the sliding hernia group and two recurrences in the paraesophageal hernia group, with two patients treated robotically. Robotic fundoplication in treating sliding hiatal hernia is feasible and safe but is more challenging in the large paraesophageal group. Improved patient outcomes hinge on the operative technique used and increasing surgeon experience. The increased dexterity that robotic surgery affords enables the esophageal surgeon to more adeptly apply the traditional principles of laparoscopic fundoplication.
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Arcerito M, Changchien E, Falcon M, Parga MA, Bernal O, Moon JT. Robotic Fundoplication for Gastroesophageal Reflux Disease and Hiatal Hernia: Initial Experience and Outcome. Am Surg 2018. [DOI: 10.1177/000313481808401242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gastroesophageal reflux disease, associated with sliding or large paraesophageal hiatal hernia, represents a common clinical presentation. The repair of large paraesophageal hiatal hernias is still a challenge in minimally invasive surgery. Between March 2014 and August 2016, 50 patients (18 males and 32 females) underwent robotic fundoplication (17 sliding and 33 paraesophageal hernias). The mean age of the patients was 58 years. Biosynthetic mesh was used in 28 patients with paraesophageal hernia. The mean operative time was 115 minutes (90–132) in the sliding hiatal hernia group, whereas it was 200 minutes (180–210) in the paraesophageal hiatal hernia group. The mean hospital stay was 36 hours (24–96). Eight patients experienced mild dysphagia which resolved after four weeks. No postoperative dysphagia was recorded at 30-month median follow-up. We experienced one recurrence in the sliding hernia group and two recurrences in the paraesophageal hernia group, with two patients treated robotically. Robotic fundoplication in treating sliding hiatal hernia is feasible and safe but is more challenging in the large paraesophageal group. Improved patient outcomes hinge on the operative technique used and increasing surgeon experience. The increased dexterity that robotic surgery affords enables the esophageal surgeon to more adeptly apply the traditional principles of laparoscopic fundoplication.
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Affiliation(s)
- Massimo Arcerito
- Inland Empire Division, Department of Surgery, Riverside Community Hospital, University of California Riverside, Riverside, California
- Riverside Community Hospital, Riverside, California
| | - Eric Changchien
- Inland Empire Division, Department of Surgery, Riverside Community Hospital, University of California Riverside, Riverside, California
- Riverside Community Hospital, Riverside, California
| | - Monica Falcon
- Inland Empire Division, Department of Surgery, Riverside Community Hospital, University of California Riverside, Riverside, California
- Riverside Community Hospital, Riverside, California
| | | | - Oscar Bernal
- Riverside Community Hospital, Riverside, California
| | - John T. Moon
- Shawnee Mission Medical Center. Kansas City, Kansas
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Maldonado-Morán M, Muñoz J, Matta J, Arrieta V, Bernal O, Mejía J. A Rare Case of Septic Arthritis of Lumbar Facet Joint with Epidural Abscess, and Bacterial Meningitis Caused by Methicillin-Sensitive Staphylococcus aureus. IJNS 2018. [DOI: 10.1055/s-0038-1667285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
AbstractSeptic arthritis of the facet joint is an extremely rare condition, even more in young immunocompetent patients. There have been approximately only 40 cases of this entity reported worldwide. Here, the authors present a 16-year-old male patient with lower back pain, fever, and cephalea. Blood cultures and cerebrospinal fluid analysis confirmed methicillin-sensitive Staphylococcus aureus infection, and magnetic resonance imaging showed septic arthritis of the lumbar left facet joint L3 and epidural abscess. Intravenous oxacillin was administered, and the patient improved. No other treatment was required.
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Affiliation(s)
| | - Juan Muñoz
- Department of Neurosurgery, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Javier Matta
- Department of Orthopaedics, Spine Services, Universidad Militar Nueva Granada, Facultad de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Victor Arrieta
- Department of Orthopaedics, Spine Services, Universidad Militar Nueva Granada, Facultad de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Oscar Bernal
- Movement Disorder Specialist Neurology, University of Florida, Gainesville, Florida, United States
| | - Jairo Mejía
- Department of Neurology, Universidad Militar Nueva Granada, Bogotá, Colombia
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Marchiol A, Forsyth C, Bernal O, Valencia Hernández C, Cucunubá Z, Pachón Abril E, Vera Soto MJ, Batista C. Increasing access to comprehensive care for Chagas disease: development of a patient-centered model in Colombia. Rev Panam Salud Publica 2017; 41:e153. [PMID: 31384272 PMCID: PMC6645187 DOI: 10.26633/rpsp.2017.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/16/2017] [Indexed: 12/28/2022] Open
Abstract
Worldwide, over 6 million people are infected with Trypanosoma cruzi, the pathogen that causes Chagas disease (CD). In the Americas, CD creates the greatest burden in disability-adjusted life years of any parasitic infection. In Colombia, 437 000 people are infected with T. cruzi, of whom 131 000 suffer from cardiomyopathy. Colombia's annual costs for treating patients with advanced CD reach US$ 175 016 000. Although timely etiological treatment can significantly delay or prevent development of cardiomyopathy-and costs just US$ 30 per patient-fewer than 1% of people with CD in Colombia and elsewhere receive it. This represents a missed opportunity for increasing patients' healthy, productive years of life while significantly reducing the economic burden on the health care system. Key barriers are complexities and delays in the diagnosis and treatment process, lack of awareness of CD among both patients and health care professionals, and administrative barriers at the primary care level. In 2015, stakeholders from government, academia, nongovernmental organizations, and patient associations participated in a seminar in the city of Bogotá on eliminating barriers to diagnosis and treatment for CD. The seminar gave birth to a model of care for increasing patient access, including a patient road map that simplifies diagnostic and treatment processes, shifting them from specialists to primary care facilities. The patient road map was implemented in a pilot project in four endemic communities beginning in 2016, with the goal of testing and refining the model so it can be implemented nationally. This article describes key components in the development of a new, recently implemented model of care for CD in Colombia.
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Affiliation(s)
- Andrea Marchiol
- Drugs for Neglected Diseases initiative Latin America Drugs for Neglected Diseases initiative Latin America Rio de Janeiro Brazil Drugs for Neglected Diseases initiative Latin America, Rio de Janeiro, Brazil
| | - Colin Forsyth
- Drugs for Neglected Diseases initiative Latin America Drugs for Neglected Diseases initiative Latin America Rio de Janeiro Brazil Drugs for Neglected Diseases initiative Latin America, Rio de Janeiro, Brazil
| | - Oscar Bernal
- Drugs for Neglected Diseases initiative Latin America Drugs for Neglected Diseases initiative Latin America Rio de Janeiro Brazil Drugs for Neglected Diseases initiative Latin America, Rio de Janeiro, Brazil
| | - Carlos Valencia Hernández
- Drugs for Neglected Diseases initiative Latin America Drugs for Neglected Diseases initiative Latin America Rio de Janeiro Brazil Drugs for Neglected Diseases initiative Latin America, Rio de Janeiro, Brazil
| | - Zulma Cucunubá
- Red Chagas, Grupo de Parasitología Red Chagas, Grupo de Parasitología Bogotá Colombia Red Chagas, Grupo de Parasitología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Eduin Pachón Abril
- Ministry of Health and Social Protection Republic of Colombia Bogotá Colombia Ministry of Health and Social Protection, Republic of Colombia, Bogotá, Colombia
| | - Mauricio Javier Vera Soto
- Drugs for Neglected Diseases initiative Latin America Drugs for Neglected Diseases initiative Latin America Rio de Janeiro Brazil Drugs for Neglected Diseases initiative Latin America, Rio de Janeiro, Brazil
| | - Carolina Batista
- Drugs for Neglected Diseases initiative Latin America Drugs for Neglected Diseases initiative Latin America Rio de Janeiro Brazil Drugs for Neglected Diseases initiative Latin America, Rio de Janeiro, Brazil
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Villamil MDP, Barrera D, Velasco N, Bernal O, Fajardo E, Urango C, Buitrago S. Strategies for the quality assessment of the health care service providers in the treatment of Gastric Cancer in Colombia. BMC Health Serv Res 2017; 17:654. [PMID: 28915811 PMCID: PMC5603051 DOI: 10.1186/s12913-017-2440-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 07/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While, at its inception in 1993, the health care system in Colombia was publicized as a paradigm to be copied across the developing world, numerous problems in its implementation have led to, what is now, an inefficient and crisis-ridden health system. Furthermore, as a result of inappropriate tools to measure the quality of the health service providers, several corruption scandals have arisen in the country. This study attempts to tackle this situation by proposing a strategy for the quality assessment of the health service providers (Entidades Promotoras de Salud, EPS) in the Colombian health system. In particular, as a case study, the quality of the treatment of stomach cancer is analyzed. METHODS The study uses two complementary techniques to address the problem. These techniques are applied based on data of the treatment of gastric cancer collected on a nation-wide scale by the Colombian Ministry of Health and Welfare. First, Data Envelopment Analysis (DEA) and the Malmquist Index (MI) are used to establish the most efficient EPS's within the system, according to indicators such as opportunity indicators. Second, sequential clustering algorithm, related to process mining a field of data mining, is used to determine the medical history of all patients and to construct typical care pathways of the patients belonging to efficient and inefficient EPS's. Lastly, efforts are made to identify traits and differences between efficient and inefficient EPS's. RESULTS Efficient and inefficient EPS were identified for the years 2010 and 2011. Additionally, a Malmquist Index was used to calculate the relative changes in the efficiency of the health providers. Using these efficiency rates, the typical treatment path of patients with gastric cancer was found for two EPSs: one efficient and another inefficient. Finally, the typical traits of the care pathways were established. CONCLUSIONS Combining DEA and process mining proved to be a powerful approach understanding the problem and gaining valuable insight into the inner workings of the Colombian Health System, especially in terms of the treatment process performed by health care providers in critical illnesses such as cancer. However, no sufficiently compelling results were found to establish the contribution of such a combination to evaluate the quality in the delivery of health services.
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Affiliation(s)
- María del Pilar Villamil
- Department of Systems and Computing Engineering, University of Los Andes, Cr 1E No. 19A-10, Bogotá, Colombia
| | - David Barrera
- Department of Industrial Engineering, Pontificia Universidad Javeriana, Cr 7 No. 40 - 62, Bogotá, Colombia
| | - Nubia Velasco
- School of Management, University of Los Andes, Calle 21 No. 1-20, Bogotá, Colombia
| | - Oscar Bernal
- Escuela de Gobierno, University of Los Andes, Cr 1E No. 19A-10, Bogotá, Colombia
| | - Esteban Fajardo
- Department of Industrial Engineering, University of Los Andes, Cr 1E No. 19A-10, Bogotá, Colombia
| | - Carlos Urango
- Department of Systems and Computing Engineering, University of Los Andes, Cr 1E No. 19A-10, Bogotá, Colombia
| | - Sebastian Buitrago
- Department of Industrial Engineering, University of Los Andes, Cr 1E No. 19A-10, Bogotá, Colombia
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Bernal O, Latorre Castro ML, García Ubaque JC, Zamora D, Otero Wandurraga JA, Palencia F, Caballero Suárez MV, Castro Ospino IC, Castillo-Rodríguez L. Vigilancia y análisis de zonas de frontera, puertos de entrada y de población inmigrante1. Rev Salud Publica (Bogota) 2017; 19:259-267. [DOI: 10.15446/rsap.v19n2.53685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 06/14/2017] [Indexed: 11/09/2022] Open
Abstract
Objetivo Realizar una revisión de la literatura sobre los sistemas de información devigilancia sanitaria y epidemiológica en zonas de frontera y puntos de entrada enColombia.Materiales y Métodos Se desarrolló una revisión sistemática de literatura mediantela metodología Prisma, términos MeSH y DECS. Para ello, se consultaron, las basesde datos PubMed y BVS entre el 2000 y el 2014. Se incluyeron 51 documentos deacuerdo con los criterios de inclusión-exclusión, a partir de los cuales se discutieronlas categorías propuestas: servicios de salud, salud mental, estado de salud y determinantessociales.Resultados El análisis permite evidenciar que la vigilancia epidemiológica y sanitariade fronteras y puntos de entrada en el ámbito mundial, está enfocado principalmenteen ejes como salud mental, eventos transmisibles y eventos de condiciones no transmisibles.Adicionalmente, se da importancia a la atención integral en los servicios desalud y al análisis del estado de salud de la población inmigrante bajo el enfoquediferencial territorial, étnico y cultural. Sin embargo, hay pocas experiencias con unenfoque intersectorial, así como de determinantes sociales, en los territorios con condicionesde zonas de fronteras y/o puntos de entrada.Conclusiones Las diferencias de contexto, sistemas de salud, sistemas de informacióny prioridades de cada país, hacen que el intercambio y la cooperación entre lasfronteras tengan serios retos. Debido a esto, es necesario contar con instrumentos decooperación entre países limítrofes y análisis e información, con base en el modeloDeterminantes Sociales de la Salud.
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Cucunubá ZM, Manne-Goehler JM, Díaz D, Nouvellet P, Bernal O, Marchiol A, Basáñez MG, Conteh L. How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis. Soc Sci Med 2017; 175:187-198. [PMID: 28107703 DOI: 10.1016/j.socscimed.2017.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/01/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
Limited access to Chagas disease diagnosis and treatment is a major obstacle to reaching the 2020 World Health Organization milestones of delivering care to all infected and ill patients. Colombia has been identified as a health system in transition, reporting one of the highest levels of health insurance coverage in Latin America. We explore if and how this high level of coverage extends to those with Chagas disease, a traditionally marginalised population. Using a mixed methods approach, we calculate coverage for screening, diagnosis and treatment of Chagas. We then identify supply-side constraints both quantitatively and qualitatively. A review of official registries of tests and treatments for Chagas disease delivered between 2008 and 2014 is compared to estimates of infected people. Using the Flagship Framework, we explore barriers limiting access to care. Screening coverage is estimated at 1.2% of the population at risk. Aetiological treatment with either benznidazol or nifurtimox covered 0.3-0.4% of the infected population. Barriers to accessing screening, diagnosis and treatment are identified for each of the Flagship Framework's five dimensions of interest: financing, payment, regulation, organization and persuasion. The main challenges identified were: a lack of clarity in terms of financial responsibilities in a segmented health system, claims of limited resources for undertaking activities particularly in primary care, non-inclusion of confirmatory test(s) in the basic package of diagnosis and care, poor logistics in the distribution and supply chain of medicines, and lack of awareness of medical personnel. Very low screening coverage emerges as a key obstacle hindering access to care for Chagas disease. Findings suggest serious shortcomings in this health system for Chagas disease, despite the success of universal health insurance scale-up in Colombia. Whether these shortcomings exist in relation to other neglected tropical diseases needs investigating. We identify opportunities for improvement that can inform additional planned health reforms.
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Affiliation(s)
- Zulma M Cucunubá
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's Campus), Imperial College London, London, United Kingdom; London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; Grupo de Parasitología - RED CHAGAS, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jennifer M Manne-Goehler
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
| | - Diana Díaz
- Grupo de Parasitología - RED CHAGAS, Instituto Nacional de Salud, Bogotá, Colombia
| | - Pierre Nouvellet
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's Campus), Imperial College London, London, United Kingdom; Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's Campus), Imperial College London, London, United Kingdom
| | - Oscar Bernal
- School of Government, Universidad de los Andes, Bogotá, Colombia
| | - Andrea Marchiol
- Drugs for Neglected Diseases Initiative - Latin America, Rio de Janeiro, Brazil
| | - María-Gloria Basáñez
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's Campus), Imperial College London, London, United Kingdom; London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Lesong Conteh
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's Campus), Imperial College London, London, United Kingdom; Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's Campus), Imperial College London, London, United Kingdom.
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Abstract
Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25–96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females. Polypropylene mesh was used for reconstruction. All but, two patients were completed robotically. Mean operative time was 52 minutes per hernia repair (45–67). Five patients were admitted overnight based on their advanced age. Regular diet was resumed immediately. Postoperative pain was minimal and regular activity was achieved after an average of four days. One patient recurred after three months in our earlier experience and he was repaired robotically. Mean follow-up time was 12 months. These data, compared with laparoscopic approach, suggest similar recurrence rates and postoperative pain. We believe comparative studies with laparoscopic approach need to be performed to assess the role robotic surgery has in the treatment of inguinal hernia repair.
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Affiliation(s)
- Massimo Arcerito
- University of California Riverside, Riverside, California
- Department of Surgery, Mission Surgical Clinic, Riverside, California
| | - Eric Changchien
- University of California Riverside, Riverside, California
- Department of Surgery, Mission Surgical Clinic, Riverside, California
| | - Oscar Bernal
- Riverside Community Hospital, Riverside, California
| | | | - John Moon
- University of California Riverside, Riverside, California
- Department of Surgery, Mission Surgical Clinic, Riverside, California
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Arcerito M, Changchien E, Bernal O, Konkoly-Thege A, Moon J. Robotic Inguinal Hernia Repair: Technique and Early Experience. Am Surg 2016; 82:1014-1017. [PMID: 27779996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25-96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females. Polypropylene mesh was used for reconstruction. All but, two patients were completed robotically. Mean operative time was 52 minutes per hernia repair (45-67). Five patients were admitted overnight based on their advanced age. Regular diet was resumed immediately. Postoperative pain was minimal and regular activity was achieved after an average of four days. One patient recurred after three months in our earlier experience and he was repaired robotically. Mean follow-up time was 12 months. These data, compared with laparoscopic approach, suggest similar recurrence rates and postoperative pain. We believe comparative studies with laparoscopic approach need to be performed to assess the role robotic surgery has in the treatment of inguinal hernia repair.
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Otero J, Cohen DD, Herrera VM, Camacho PA, Bernal O, López-Jaramillo P. Sociodemographic factors related to handgrip strength in children and adolescents in a middle income country: The SALUS study. Am J Hum Biol 2016; 29. [PMID: 27427286 DOI: 10.1002/ajhb.22896] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine sociodemographic factors associated with handgrip (HG) strength in a representative sample of children and adolescents from a middle income country. METHODS We evaluated youth between the ages of 8 and 17 from a representative sample of individuals from the Department of Santander, Colombia. Anthropometric measures, HG strength, and self-reported physical activity were assessed, and parents/guardians completed sociodemographic questionnairres. Multinomial logistic regression models were used to estimate the association between sociodemographic and anthropometric characteristics and tertiles of relative HG strength. We also produced centile data for raw HG strength using quantile regression. RESULTS 1,691 young people were evaluated. HG strength increased with age, and was higher in males than females in all age groups. Lower HG strength was associated with indicators of higher socioeconomic status, such as living in an urban area, residence in higher social strata neighborhoods, parent/guardian with secondary education or higher, higher household income, and membership in health insurance schemes. In addition, low HG strength was associated with lower physical activity levels and higher waist-to-hip ratio. In a fully adjusted regression model, all factors remained significant except for health insurance, household income, and physical activity level. CONCLUSIONS While age and gender specific HG strength values were substantially lower than contemporary data from high income countries, we found that within this middle income population indicators of higher socioeconomic status were associated with lower HG strength. This analysis also suggests that in countries undergoing rapid nutrition transition, improvements in socioeconomic conditions may be accompanied by reduction in muscle strength.
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Affiliation(s)
- Johanna Otero
- Fundación Oftalmológica de Santander (FOSCAL), Dirección médica de Investigación, Desarrollo e Innovación Tecnológica, Floridablanca, Colombia
| | - Daniel Dylan Cohen
- Universidad de Santander (UDES), Programa de Fisioterapia, Bucaramanga, Colombia
| | - Victor Mauricio Herrera
- Universidad Autónoma de Bucaramanga, Facultad de Ciencias de la Salud, Bucaramanga, Colombia
| | - Paul Anthony Camacho
- Fundación Oftalmológica de Santander (FOSCAL), Dirección médica de Investigación, Desarrollo e Innovación Tecnológica, Floridablanca, Colombia
| | - Oscar Bernal
- Universidad de Los Andes, Escuela de Gobierno, Bogotá, Colombia
| | - Patricio López-Jaramillo
- Fundación Oftalmológica de Santander (FOSCAL), Dirección médica de Investigación, Desarrollo e Innovación Tecnológica, Floridablanca, Colombia.,Universidad de Santander (UDES), Programa de Fisioterapia, Bucaramanga, Colombia
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Ramírez A, Velasco S, Bernal O, Vera-Chamorro JF, Olagnero G. Situational Analysis and Expert Evaluation of the 1000 Days: Nutritional and Health Status in 4 Countries in Latin America. Health (London) 2016. [DOI: 10.4236/health.2016.85047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ramírez A, Bernal O, Rodríguez J, Pinzón JD. Morbidity Due to Obesity, Hypertension and Diabetes II Attributable to Non-Breastfeeding and Low Birth Weight during the 1000 Days of Life: Estimation of the Population Attributable Fraction. Health (London) 2016. [DOI: 10.4236/health.2016.85041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
La salud en Colombia es ahora un derecho fundamental que tiene que ser provisto y protegido por el Estado. A partir de metodologías de análisis de sistemas de salud propuestospor la OMS y el Banco Mundial, se evidencian las falencias, fortalezas y dificultades del sistema de salud con respecto ala ley estatutaria aprobada en febrero de 2015. Éstas incluyen la fragmentación y especialización de los servicios, barreras de acceso, incentivos no alineados con la calidad, débil gobernanza, múltiples actores con poca coordinación y sistema de información que no mide resultados. Es necesario un acuerdo social, un equilibrio y control de la tensión por parte del Estado entre el beneficio particular y el beneficio colectivo.
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Bernal O, Barbosa S. [Challenges of the right to health in the Colombian model]. Salud Publica Mex 2015; 57:433-440. [PMID: 26545005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 07/22/2015] [Indexed: 06/05/2023] Open
Abstract
Health in Colombia is now a fundamental right that has to be provided and protected by the government. We evaluated the strengths and difficulties of the health system with respect to the statutory law enacted in February 2015, using methodologies for analysis of health systems proposed by the WHO and the World Bank. The challenges include the fragmentation and specialization of services, access barriers and incentives that are not aligned with the quality, weak governance, multiple actors with little coordination and information system that does not measure results. The government needs to find a necessary social agreement, a balance between the particular and the collective benefit.
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Affiliation(s)
- Oscar Bernal
- Maestría en Salud Pública, Escuela de Gobierno, Universidad de los Andes, Bogotá, Colombia
| | - Samuel Barbosa
- Escuela de Gobierno, Universidad de los Andes, Bogotá, Colombia
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Shultz JM, McLean A, Herberman Mash HB, Rosen A, Kelly F, Solo-Gabriele HM, Youngs Jr GA, Jensen J, Bernal O, Neria Y. Mitigating flood exposure: Reducing disaster risk and trauma signature. Disaster Health 2013; 1:30-44. [PMID: 28228985 PMCID: PMC5314872 DOI: 10.4161/dish.23076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 11/26/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022]
Abstract
Introduction. In 2011, following heavy winter snowfall, two cities bordering two rivers in North Dakota, USA faced major flood threats. Flooding was foreseeable and predictable although the extent of risk was uncertain. One community, Fargo, situated in a shallow river basin, successfully mitigated and prevented flooding. For the other community, Minot, located in a deep river valley, prevention was not possible and downtown businesses and one-quarter of the homes were inundated, in the city's worst flood on record. We aimed at contrasting the respective hazards, vulnerabilities, stressors, psychological risk factors, psychosocial consequences, and disaster risk reduction strategies under conditions where flood prevention was, and was not, possible. Methods. We applied the "trauma signature analysis" (TSIG) approach to compare the hazard profiles, identify salient disaster stressors, document the key components of disaster risk reduction response, and examine indicators of community resilience. Results. Two demographically-comparable communities, Fargo and Minot, faced challenging river flood threats and exhibited effective coordination across community sectors. We examined the implementation of disaster risk reduction strategies in situations where coordinated citizen action was able to prevent disaster impact (hazard avoidance) compared to the more common scenario when unpreventable disaster strikes, causing destruction, harm, and distress. Across a range of indicators, it is clear that successful mitigation diminishes both physical and psychological impact, thereby reducing the trauma signature of the event. Conclusion. In contrast to experience of historic flooding in Minot, the city of Fargo succeeded in reducing the trauma signature by way of reducing risk through mitigation.
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Affiliation(s)
- James M Shultz
- Center for Disaster & Extreme Event Preparedness (DEEP Center); University of Miami Miller School of Medicine; Miami, FL USA
| | - Andrew McLean
- School of Medicine and Health Sciences; University of North Dakota; Fargo, ND USA
| | - Holly B Herberman Mash
- Department of Psychology; Center for the Study of Traumatic Stress; Uniformed Services University of the Health Sciences; Bethesda, MD USA
| | - Alexa Rosen
- Center for Disaster & Extreme Event Preparedness (DEEP Center); University of Miami Miller School of Medicine; Miami, FL USA
| | - Fiona Kelly
- Clinical & Health Psychology; University of Edinburgh; Scotland, UK
| | - Helena M Solo-Gabriele
- Department of Civil, Architectural, and Environmental Engineering; College of Engineering; University of Miami; Miami, FL USA
| | - Georgia A Youngs Jr
- Department of Emergency Management; North Dakota State University; Fargo, ND USA
| | - Jessica Jensen
- Department of Emergency Management; North Dakota State University; Fargo, ND USA
| | - Oscar Bernal
- School of Medicine; Universidad de Los Andes; Bogota, Colombia
| | - Yuval Neria
- Trauma and PTSD Program; Department of Psychiatry & The New York State Psychiatric Institute; Columbia University; New York NY USA
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37
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Bernal O, Forero JC, Villamil MDP, Pino R. [Data availability and morbidity profile in Colombia]. Rev Panam Salud Publica 2012; 31:181-7. [PMID: 22569691 DOI: 10.1590/s1020-49892012000300001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 08/01/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To characterize morbidity in the Colombian population by diagnosis, sex, age, region, and health coverage system, and evaluate the availability and quality of information on diseases in the country. A descriptive, cross-sectional study to analyze morbidity treated in outpatient visits, hospitalization, and emergencies in Colombia during the 2004-2008 five-year period. METHODS Based on Colombia's personal health records (Registro Individual de Prestación de Servicios-RIPS), diagnoses were classified according to World Health Organization cause groups. Each cause group for services utilization was differentiated by geographical region, sex, and type of affiliation to the health system. RESULTS Communicable disease diagnoses were more concentrated in younger age groups, while noncommunicable diseases were more frequent in older age groups. External causes (accidents, self-inflicted injuries, and violence) were a major cause of morbidity and more frequently affected the population aged 5-44 years. Communicable diseases were more prevalent in females (39.98%) than in males (28%), while males were more affected by external causes than females (18.5% and 7.3%, respectively). CONCLUSIONS Although diagnoses of noncommunicable diseases have increased in Colombia, infections continue to have an important presence in all age groups and health services delivery settings. This situation requires a review of health policies, not only to orient them toward improving the health of the population, but also toward bridging the services gap that exists among the country's different regions. Furthermore, although RIPS are a valuable source of health data, they need to be strengthened with a view to achieving information coverage for all or at least the vast majority of Colombians.
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Affiliation(s)
- Oscar Bernal
- Universidad de los Andes, Facultad de Medicina, Área de Salud Pública, Bogotá, Colombia.
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Affiliation(s)
- Oscar Bernal
- School of Government, Universidad de los Andes, Carrera 1 No 19-27, Bloque AU, Tercer Piso, Bogotá, Colombia.
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Quintana L, Lizarazo C, Bernal O, Cordoba J, Arias C, Monroy M, Cotrino C, Montoya O. Control centers design for ergonomics and safety. Work 2012; 41 Suppl 1:3164-73. [PMID: 22317199 DOI: 10.3233/wor-2012-0578-3164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This paper shows the general design conditions about ergonomics and safety for control centers in the petrochemical process industry. Some of the topics include guidelines for the optimized workstation design, control room layout, building layout, and lighting, acoustical and environmental design. Also takes into account the safety parameters in the control rooms and centers design. The conditions and parameters shown in this paper come from the standards and global advances on this topic on the most recent publications. And also the work was supplemented by field visits of our team to the control center operations in a petrochemical company, and technical literature search efforts. This guideline will be useful to increase the productivity and improve the working conditions at the control rooms.
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Affiliation(s)
- Leonardo Quintana
- Ergonomics Studies Center, Javeriana University, Calle 40 No 5- 37, Bogota, Colombia.
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40
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Limotai N, Oyama G, Go C, Bernal O, Ong T, Moum SJ, Bhidayasiri R, Foote KD, Bowers D, Ward H, Okun MS. Addiction-Like Manifestations and Parkinson's Disease: A Large Single Center 9-Year Experience. Int J Neurosci 2011; 122:145-53. [DOI: 10.3109/00207454.2011.633722] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Roddy P, Thomas SL, Jeffs B, Nascimento Folo P, Pablo Palma P, Moco Henrique B, Villa L, Damiao Machado FP, Bernal O, Jones SM, Strong JE, Feldmann H, Borchert M. Factors associated with Marburg hemorrhagic fever: analysis of patient data from Uige, Angola. J Infect Dis 2010; 201:1909-18. [PMID: 20441515 DOI: 10.1086/652748] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Reliable on-site polymerase chain reaction (PCR) testing for Marburg hemorrhagic fever (MHF) is not always available. Therefore, clinicians triage patients on the basis of presenting symptoms and contact history. Using patient data collected in Uige, Angola, in 2005, we assessed the sensitivity and specificity of these factors to evaluate the validity of World Health Organization (WHO)-recommended case definitions for MHF. METHODS Multivariable logistic regression was used to identify independent predictors of PCR confirmation of MHF. A data-derived algorithm was developed to obtain new MHF case definitions with improved sensitivity and specificity. RESULTS A MHF case definition comprising (1) an epidemiological link or (2) the combination of myalgia or arthralgia and any hemorrhage could potentially serve as an alternative to current case definitions. Our data-derived case definitions maintained the sensitivity and improved the specificity of current WHO-recommended case definitions. CONCLUSIONS Continued efforts to improve clinical documentation during filovirus outbreaks would aid in the refinement of case definitions and facilitate outbreak control.
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Affiliation(s)
- Paul Roddy
- Médecins Sans Frontières-Spain, Barcelona, Spain
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42
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Herrero M, Rubens D, Bern C, Orfanos G, Bernal O, Alvar J, Parreño F, Bashaye S, Aparicio P, Palma PP, Flevaud L, Lima MA, Mulugeta A, Pedraza J, Argaw D. Natural History of a Visceral Leishmaniasis Outbreak in Highland Ethiopia. Am J Trop Med Hyg 2009. [DOI: 10.4269/ajtmh.2009.81.373] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Herrero M, Orfanos G, Argaw D, Mulugeta A, Aparicio P, Parreño F, Bernal O, Rubens D, Pedraza J, Lima MA, Flevaud L, Palma PP, Bashaye S, Alvar J, Bern C. Natural history of a visceral leishmaniasis outbreak in highland Ethiopia. Am J Trop Med Hyg 2009; 81:373-377. [PMID: 19706898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
In May 2005, visceral leishmaniasis (VL) was recognized for the first time in Libo Kemken, Ethiopia, a highland region where only few cases had been reported before. We analyzed records of VL patients treated from May 25, 2005 to December 13, 2007 by the only VL treatment center in the area, maintained by Médecins Sans Frontières-Ethiopia, Operational Center Barcelona-Athens. The median age was 18 years; 77.6% were male. The overall case fatality rate was 4%, but adults 45 years or older were five times as likely to die as 5-29 year olds. Other factors associated with increased mortality included HIV infection, edema, severe malnutrition, pneumonia, tuberculosis, and vomiting. The VL epidemic expanded rapidly over a several-year period, culminating in an epidemic peak in the last third of 2005, spread over two districts, and transformed into a sustained endemic situation by 2007.
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Affiliation(s)
- Mercè Herrero
- Disease Prevention and Control Programmes, World Health Organization, Addis Ababa, Ethiopia
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Roddy P, Marchiol A, Jeffs B, Palma PP, Bernal O, de la Rosa O, Borchert M. Decreased peripheral health service utilisation during an outbreak of Marburg haemorrhagic fever, Uíge, Angola, 2005. Trans R Soc Trop Med Hyg 2008; 103:200-2. [PMID: 18838150 DOI: 10.1016/j.trstmh.2008.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 08/28/2008] [Accepted: 09/01/2008] [Indexed: 11/15/2022] Open
Abstract
In 2005, a Marburg haemorrhagic fever (MHF) outbreak occurred in Uíge province, Angola, which had its epicentre in Uíge municipality. Concurrently, a health facility located a considerable distance from the outbreak's epicentre reported a drastic reduction in attendance, possibly due to a remote effect of the ongoing MHF outbreak. Health officials should devise strategies to ensure that communities far from a filovirus haemorrhagic fever epicentre are not adversely affected by interventions at the epicentre and, to the greatest extent possible, ensure that these peripheral communities receive essential medical care during an epidemic.
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Affiliation(s)
- P Roddy
- Médecins Sans Frontières-Spain, Barcelona, Spain.
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Guthmann JP, Checchi F, van den Broek I, Balkan S, van Herp M, Comte E, Bernal O, Kindermans JM, Venis S, Legros D, Guerin PJ. Assessing antimalarial efficacy in a time of change to artemisinin-based combination therapies: the role of Médecins Sans Frontières. PLoS Med 2008; 5:e169. [PMID: 18684011 PMCID: PMC2494566 DOI: 10.1371/journal.pmed.0050169] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Jean-Paul Guthmann and colleagues describe the output of MSF's work in antimalarial efficacy assessment during the last decade.
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46
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Jeffs B, Roddy P, Weatherill D, de la Rosa O, Dorion C, Iscla M, Grovas I, Palma PP, Villa L, Bernal O, Rodriguez-Martinez J, Barcelo B, Pou D, Borchert M. The Medecins Sans Frontieres intervention in the Marburg hemorrhagic fever epidemic, Uige, Angola, 2005. I. Lessons learned in the hospital. J Infect Dis 2008; 196 Suppl 2:S154-61. [PMID: 17940944 DOI: 10.1086/520548] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
When the epidemic of Marburg hemorrhagic fever occurred in Uige, Angola, during 2005, the international response included systems of case detection and isolation, community education, the burial of the dead, and disinfection. However, despite large investments of staff and money by the organizations involved, only a fraction of the reported number of cases were isolated, and many cases were detected only after death. This article describes the response of Medecins Sans Frontieres Spain within the provincial hospital in Uige, as well as the lessons they learned during the epidemic. Diagnosis, management of patients, and infection control activities in the hospital are discussed. To improve the acceptability of the response to the host community, psychological and cultural factors need to be considered at all stages of planning and implementation in the isolation ward. More interventional medical care may not only improve survival but also improve acceptability.
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Villa L, Morote S, Bernal O, Bulla D, Albajar-Vinas P. Access to diagnosis and treatment of Chagas disease/infection in endemic and non-endemic countries in the XXI century. Mem Inst Oswaldo Cruz 2007; 102 Suppl 1:87-94. [PMID: 17713680 DOI: 10.1590/s0074-02762007005000081] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 07/02/2007] [Indexed: 11/21/2022] Open
Abstract
In this article, Médicos Sin Fronteras (MSF) Spain faces the challenge of selecting, piecing together, and conveying in the clearest possible way, the main lessons learnt over the course of the last seven years in the world of medical care for Chagas disease. More than two thousand children under the age of 14 have been treated; the majority of whom come from rural Latin American areas with difficult access. It is based on these lessons learnt, through mistakes and successes, that MSF advocates that medical care for patients with Chagas disease be a reality, in a manner which is inclusive (not exclusive), integrated (with medical, psychological, social, and educational components), and in which the patient is actively followed. This must be a multi-disease approach with permanent quality controls in place based on primary health care (PHC). Rapid diagnostic tests and new medications should be available, as well as therapeutic plans and patient management (including side effects) with standardised flows for medical care for patients within PHC in relation to secondary and tertiary level, inclusive of epidemiological surveillance systems.
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Affiliation(s)
- Luís Villa
- Médicos Sin Fronteras, Barcelona, Catalunya, Espana
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Hernández Madrid A, Moreno G, Rondón J, Marín W, Castillo M, Bernal O, Tarancón B, Amador A, Moro C. Prevención de la fibrilación auricular en los pacientes con insuficiencia cardiaca. Rev Esp Cardiol (Engl Ed) 2006. [DOI: 10.1157/13092033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bernal O, Moro C. [Cardiac arrhythmias in women]. Rev Esp Cardiol 2006; 59:609-18. [PMID: 16790203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The aim of this study was to review published data on gender differences in cardiac electrophysiology and in the presentation and clinical treatment of arrhythmias. The evidence from studies published to date show that women have a higher mean resting heart rate, a longer QT interval, a shorter QRS duration, and a lower QRS voltage than men. Women have a higher prevalence of sick sinus syndrome, inappropriate sinus tachycardia, atrioventricular nodal reentry tachycardia, idiopathic right ventricular tachycardia, and arrhythmic events in the long-QT syndrome. In contrast, men have a higher prevalence of atrioventricular block, carotid sinus syndrome, atrial fibrillation, supraventricular tachycardia due to accessory pathways, Wolff-Parkinson-White syndrome, reentrant ventricular tachycardia, ventricular fibrillation and sudden death, and the Brugada syndrome. With regard to implantable devices, it has been reported that defibrillators offer similar benefits in men and women. Moreover, there is no gender difference in the percentage who respond well to resynchronization therapy: survival is similar in the two sexes. However, it should be noted that few women have participated in studies of all types of therapy, including catheter ablation, resynchronization therapy, and the use of implantable defibrillators.
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MESH Headings
- Adult
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Atrial Fibrillation/physiopathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electrocardiography
- Electrophysiology
- Female
- Heart Rate/physiology
- Humans
- Long QT Syndrome/physiopathology
- Male
- Pregnancy
- Pregnancy Complications, Cardiovascular/physiopathology
- Primary Prevention
- Randomized Controlled Trials as Topic
- Sex Factors
- Tachycardia, Supraventricular/physiopathology
- Wolff-Parkinson-White Syndrome/physiopathology
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Affiliation(s)
- Oscar Bernal
- Unidad de Arritmias, Departamento de Medicina, Hospital Ramón y Cajal, Universidad de Alcalá, Ctra. Colmenar Viejo km. 9.100, 28034 Madrid, Spain
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