Colombian National Research Articles

Colombian National Bilingual Plan: A vehicle for equity or an instrument for accountability?

ABSTRACT Equality and equity have become dominant discourses within educational policy documents during the last decade. Colombia, for example, has introduced a language policy initiative that purports to provide educational equity opportunities for all through English language environments and opportunities within schools. Drawing on Ball’s (1993. “What is Policy?” Discourse 13 (2): 10–17, 2012a. Global Education Inc. London: Routledge, 2013. The Education Debate (2nd ed.). Chicago, IL: The Policy Place.) approach to policy analysis, this article critically interrogates the Colombian National Bilingual Program (PNB, in Spanish) by analysing the ways in which the concepts of (in)equality and (in)equity are addressed. We argue in this article that the PNB misrepresents the concept of equity, presenting a policy that aims to address it but fails to do so. Hence, this study reveals how rhetoric is used to position educators and institutions as accountable for the equal access to learning opportunities and environments that the policy promises. This article builds on the premise that contemporary educational reforms challenge the autonomy of educators, institutions, and local authorities by strengthening their accountability while governmental institutions centralise their authority.

A genomic snapshot of Salmonella enterica serovar Typhi in Colombia.

Little is known about the genetic diversity of Salmonella enterica serovar Typhi (S. Typhi) circulating in Latin America. It has been observed that typhoid fever is still endemic in this part of the world; however, a lack of standardized blood culture surveillance across Latin American makes estimating the true disease burden problematic. The Colombian National Health Service established a surveillance system for tracking bacterial pathogens, including S. Typhi, in 2006. Here, we characterized 77 representative Colombian S. Typhi isolates collected between 1997 and 2018 using pulse field gel electrophoresis (PFGE; the accepted genotyping method in Latin America) and whole genome sequencing (WGS). We found that the main S. Typhi clades circulating in Colombia were clades 2.5 and 3.5. Notably, the sequenced S. Typhi isolates from Colombia were closely related in a global phylogeny. Consequently, these data suggest that these are endemic clades circulating in Colombia. We found that AMR in S. Typhi in Colombia was uncommon, with a small subset of organisms exhibiting mutations associated with reduced susceptibility to fluoroquinolones. This is the first time that S. Typhi isolated from Colombia have been characterized by WGS, and after comparing these data with those generated using PFGE, we conclude that PFGE is unsuitable for tracking S. Typhi clones and mapping transmission. The genetic diversity of pathogens such as S. Typhi is limited in Latin America and should be targeted for future surveillance studies incorporating WGS.

Bearing capacity of bolted-mortar infill connections in bamboo and yield model formulation

Bolted-mortar infill connections in bamboo structures are one of the most challenging aspects of the design and construction of these structures, due to the uncertainty in the evaluation of the connection strength. The shape of bamboo cross-sections (round, hollow and tapered) and the interaction between bamboo, mortar infill, and steel bolts or dowels are not clearly understood. Therefore, the main objective of this research was to develop an analytical method to estimate the strength of Bolted mortar infill (BMI) bamboo connections, based on the modified yield model theory (EYM). The proposed model consists of 5 controlling yield modes used to predict a BMI bamboo connection behaviour under load applied parallel and perpendicular to the fiber direction, based on the strength and geometry of materials. To validate the proposed model, a comprehensive experimental program that consisted of 112 tests for evaluating dowel-bearing strength on the Guadua bamboo, 126 test for determining bearing strength of the mortar filling, 61 test for evaluating bolt bending yield strength and 70 BMI connections were performed for 10 different configurations of dowel diameter and load angle direction. After calibration procedures, the model adequately predicted the connection strength for the different connection configurations with an average difference between the predicted and tested and Colombian National Code (NSR-10) values of 15.7% and 11.6%, respectively. In general, the predicted values of the proposed model, underestimate the connections capacity. This research aims to improve the design procedures and national regulations for BMI connections of Guadua Angustifolia Kunth and other bamboo species.

Clinical and neurodevelopmental outcomes based on brain imaging studies in a Colombian cohort of children with probable antenatal Zika virus exposure.

Our aim was to describe the neuroimaging and clinical evaluations of children with antenatal Zika-virus (ZIKV) exposure. The Colombian National Institute of Health performed serial clinical evaluations of children with probable antenatal ZIKV exposure (i.e., born to ZIKV symptomatic mothers or born with birth defects compatible with ZIKV infection, regardless of laboratory results) over 2 years that included head circumference (HC), eye examination, and neurodevelopmental assessments. Clinical neuroimaging studies (head computed tomography and/or brain magnetic resonance imaging) were analyzed for abnormalities, two-dimensional measurements were made of the right and left frontal and occipital cortical thickness. Two abnormal patterns were defined: Pattern 1 (sum of four areas of cortex <6cm) and Pattern 2 (sum of four areas of cortex ≥6cm and < 10cm). Thirty-one children had a neuroimaging study; in 24, cortical thickness was measured. The median age at the first visit was 8 (range: 6-9) months and 22 (range: 19-42) months at the last evaluation. In the 24 cases with cortical measurements, three were normal, 12 were in Pattern 1, and nine were in Pattern 2. Children within Pattern 1 had lower mean HC at birth and in follow-up (both p < .05) and a higher frequency of structural eye abnormalities (p < .01). A trend towards poorer neuromotor development was seen in Pattern 1, although not statistically significant (p=.06). Brain imaging classification based on cortical measurements correlate with ophthalmologic abnormalities and HC. Cortical thickness may be a marker for clinical outcomes in children with congenital ZIKV infection.

Fay-Herriot Model-Based Prediction Alternatives for Estimating Households with Emigrated Members

Abstract This article proposes a new methodology for estimating the proportions of households that had experience of international migration at the municipal level in Colombia. The Colombian National Statistical Office usually produces estimations of internal migration based on the results of population censuses, but there is a lack of disaggregated information about the main small areas of origin of the population that emigrates from Colombia. The proposed methodology uses frequentist and Bayesian approaches based on a Fay-Herriot model and is illustrated by one example with a dependent variable from the Demographic and Health Survey 2015 and covariables available from the population census 2005. The proposed alternative produces proportion estimates that are consistent with sample sizes and the main internal immigration trends in Colombia. Additionally, the estimated coefficients of variation are lower than 20% for municipalities for both frequentist and Bayesian approaches and large demographically-relevant capital cities and therefore estimates may be considered to be reliable. Finally, we illustrate how the proposed alternative leads to important reductions of the estimated coefficients of variations for the areas with very small sample sizes.

Peripheral neuropathy in leprosy: Clinical manifestations and disability in a Colombian national referral center.

To aim of the paper was to describe the neurological features of the physical examination in patients with Hansen’s disease who were treated in Bogotá, Colombia. We carried out a descriptive study of all patients with a Hansen’s disease diagnosis treated at a referral center between 2003-2018. There were 327 eligible electronic health records (EHRs) with a final sample of 282 subjects. Leprosy was most common in males (57.45%), median age at the diagnosis was 54 years, and lesions of the lower limbs were more common (75.1%). The median time from disease onset to consult was 12 months. Most of them were classified as having lepromatous leprosy (39.7%). Pain over the median nerve trunk was the most common manifestation of disease (28%), followed by pain over the radial trunk (22%). Sensitive alterations were more common than motor ones. Specifically, the posterior tibial nerve was affected in nearly half of subjects. Dual impairment was more common in the ulnar nerve (13.8%). Some disability was apparent in 23.8% of subjects; predominantly grade 1 disability. Findings regarding age, leprosy type, and the frequency of individual nerve compromise were consistent with reports from other countries. Nerve trunk thickening was infrequent, which might be a consequence of subjectiveness in the examination and sample differences in sex distribution, degree of disability and time since disease onset. The frequency of morbidity and disability found in this sample, though low when compared with other series, fails to meet public health goals, including those limiting disability in younger subjects.

Impairment, disability, and handicap associated with hearing problems and voice disorders among Colombian teachers

Objectives: 1. define the occurrence of work-related hearing problems and voice disorders among teachers that have contacted the Colombian National Board of Disability Assessment (NBDA) for follow-up; 2. identify individual associated factors of hearing problems and voice disorders among teachers; 3. assess the limitations and restrictions due to hearing problems and voice disorders among these participants.&#x0D; Methods: Retrospective study. The National Database of the Colombian NBDA was reviewed. Information on distributions of occupation, individual characteristics, and diagnosis code (ICD-10) was analyzed.&#x0D; Results: Communication disorders among teachers that have contacted the Colombian NBDA for follow-up included voice disorders, with a prevalence of 51%, and hearing problems, with a prevalence of 7%. Female teachers who have contacted the Colombian NBDA for follow-up were 4 times more likely to be identified as having voice disorders compared with their male colleagues.&#x0D; Conclusions: While teachers that have contacted the Colombian NBDA for follow-up have a high occurrence of voice disorders, hearing problems are more likely to be stated as a debilitating condition. One possible explanation is that teachers who contacted the Colombian NBDA for follow-up continued working even when many voice symptoms were evident, while hearing problems would prevent a teacher from interacting with students, thereby affecting the teaching-learning process sooner. Nevertheless, with both voice and hearing problems, work performance and social interaction is affected, and, therefore, quality of life is reduced.

Diagnostic performance of two different maternal near-miss approaches in a High Obstetric Risk Unit

ABSTRACT Maternal near-miss (MNM) is a maternal quality care indicator. The World Health Organization (WHO) defines it as a state in which a woman nearly dies but survives due to a complication during pregnancy, birth, or puerperium. The Latin American Federation of Obstetrics and Gynecology (FLASOG) and the Colombian National Health Institute (INS) established recommendations for the event’s epidemiological surveillance; nonetheless, the operational definitions of the cases are different. This retrospective study examined the approaches of FLASOG and INS versus the WHO approach (gold standard) for the assessment of MNM in a high obstetric risk unit. Patients admitted with at least one criterion of the WHO, FLASOG, or INS approach for the definition of MNM from March 2016 to March 2017 were included. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were evaluated, as well as the Receiver Operating Characteristics (ROC) curve of the FLASOG and INS. MNM classification compared to WHO system as reference. The results highlight that the WHO classification establishes very high boundaries for some of the diagnostic criteria and the lack of standardization of the MNM criteria among the different proposals in Latin America hinders the applicability in Colombia and other countries with a similar situation.

Food insecurity and the double burden of malnutrition in Colombian rural households.

This study aimed to examine in Colombian rural households the association between different severity levels of household food insecurity and the presence of the double burden of malnutrition (SCOWT), defined as the coexistence of a stunted child under 5 years of age and an overweight or obese (OWOB) mother. A secondary data analysis was conducted using cross-sectional data from the Colombian National Nutritional Survey (ENSIN) 2015. Household food insecurity status was assessed by using the Latin-American and Caribbean Food Security Scale (ELCSA). The household SCOWT status (child stunting and OWOB mother) was determined using anthropometric data from a mother and her child. Rural Colombia. Totally, 2·350 mother-child pairs living in the same household. Sixty-two per cent of the households were food-insecure and SCOWT was present in 7·8 % of the households. Moderate (OR: 2·39, 95 % CI (1·36, 4·21)) and severe (OR: 1·86, 95 % CI (1·10, 3·15)) food insecurity was associated with SCOWT in an unadjusted logistic regression. Only moderate food insecurity remained significantly associated with SCOWT in a multivariate logistic regression (adjusted OR: 2·41, 95 % CI (1·24, 4·68)). Colombian rural areas are not exempt from the worldwide concern of increasing OWOB rates while stunting is still persistent. These results highlight the need of implementing double-duty rural actions targeting the most vulnerable households to SCOWT, particularly in terms of overcoming food insecurity beyond hunger satisfaction to prevent all forms of malnutrition.

Budget impact analysis of high-flow nasal cannula for infant bronchiolitis: the Colombian National Health System perspective

Background High-flow nasal cannula is a non-invasive ventilation system that was introduced as an alternative to continuous positive airway pressure), with a marked increase in its use in pediatric care settings. However, the expected budget impact of this intervention has not been explicitly estimated. This study aimed to evaluate the budget impact of the high-flow nasal cannula for acute bronchiolitis in Colombia. Methods A budget impact analysis was performed to evaluate the potential financial impact deriving from high-flow nasal cannula during 2020. The analysis considered a 5-year time horizon and Colombian National Health System perspective. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which a high-flow nasal cannula is reimbursed, from the cost of the conventional treatment without a high-flow nasal cannula (supplemental oxygen through a nasal cannula up to a maximum of 2 liters per minute). Univariate one-way sensitivity analyses were performed. Results In the base-case analysis the 5-year costs associated with high-flow nasal cannula and no- high-flow nasal cannula were estimated to be US$159,585,618 and US$172,751,689 respectively, indicating savings for Colombian National Health equal to US$13,166,071 if the high-flow nasal cannula is adopted for the routine management of patients with acute bronchiolitis. This result was robust in univariate sensitivity one-way analysis. Conclusion High-flow nasal cannula was cost-saving in emergency settings for treating infants with acute bronchiolitis. This evidence can be used by decision-makers in our country to improve clinical practice guidelines and should be replicated to validate their results in other middle-income countries.

PCV20 Cost-Effectiveness of a Tacrolimus-Mycophenolate Mofetil Regimen for Organ Rejection Prophylaxis in Heart Transplant Recipients in Colombia

Evidence of the cost-effectiveness of the calcineurin inhibitor tacrolimus is required to guide its inclusion in the Colombian National Benefit Plan as a treatment for organ rejection prophylaxis in heart transplant recipients. A model was developed to estimate the cost-effectiveness of tacrolimus-mycophenolate mofetil (TAC-MMF) versus cyclosporine-mycophenolate mofetil (CYC-MMF) for organ rejection prophylaxis in heart transplant recipients in Colombia. A Markov model with monthly cycle length was constructed to estimate costs and quality-adjusted life years (QALY) for each treatment alternative over a 15-year time horizon from the perspective of the Colombian third-party payer. The following states were considered: alive with a functioning graft, history of acute graft rejection, cardiac allograft vasculopathy, and death. The costs were estimated using the Social Security (Instituto del Seguro Social) Rates Manual and reports of the Medicine Price Information System, and the resources and cost-generating events were identified using a base case constructed with clinical experts. The rejection rate for each treatment alternative was taken from a previously undertaken meta-analysis. Information on vasculopathy and mortality was taken from observational studies with follow-up times beyond 1 month, and was later adjusted to probabilistic distributions to obtain a monthly probability of developing the outcome. The TAC-MMF regimen represented a 0.236 difference in QALY and a cost difference of US −$18,337 versus CYC-MMF over the 15-year time horizon (US $1 = Colombian peso ∼3763, November 2020), which makes the former a dominant intervention. The main differentiators of the treatment alternatives in the model were acute rejection rate, cardiac allograft vasculopathy, and treatment cost. In this regard, the cost of CYC treatment was higher than the cost of TAC treatment. Under the model assumptions, the TAC-MMF regimen could be a dominant option over the CYC-MMF regimen for organ rejection prophylaxis in heart transplant recipients in Colombia.

Emergency surgery workforce and its inverse relationship with multidimensional poverty in Colombia

General surgeons, anesthesiologists, obstetricians and gynecologists (ob-gyns), and orthopedic surgeons are the vital disciplines to provide emergency surgery within a healthcare system. This paper aims to examine the relationship (if any) between multidimensional poverty (MDP) and GDP per-capita with the emergency surgery workforce density in Colombia. We performed an ecological study, where the observation units were the 32 Colombian departments. The total numbers of general surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons were obtained from the "Registro Unico Nacional de Talento Humano en Salud" (ReTHUS) registry. The 2020 population projections, the incidence of MDP and the GDP per capita were obtained from the Colombian National Administrative Department of Statistics. A spearman's correlation coefficient was calculated to measure the strength of the correlations between the surgical workforce density with MDP and GDP per-capita. There were significant moderate inverse linear correlations between the incidence of multidimensional poverty and workforce density. The correlation coefficients for the incidence of multidimensional poverty and the workforce density were - 0.5273, - 0.5620, - 0.4704, and - 0.4612 for surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons, respectively. Conversely, the correlation coefficients for the GDP per-capita and the workforce density were 0.4045, 0.3822, 0.4404, and 0.3742 for surgeons, anesthesiologists, ob-gyns, and orthopedic surgeons, respectively. This study found that Colombian trauma and emergency surgery workforce density was inversely and directly correlated with multidimensional poverty and GDP per-capita levels, respectively. The relationship of these economic indicators with the surgical capacity deserves further investigation.

Budget impact analysis of surfactant therapy for bronchiolitis in critically ill infants: the Colombian National Health System perspective

BackgroundSevere bronchiolitis requiring mechanical ventilation was associated with an absence of surfactant activity and phosphatidylglycerol, causing airway obstruction in acute bronchiolitis. Exogen surfactant in mechanically ventilated infants decreased duration of stay in the intensive care unit and had favorable effects on oxygenation and carbon dioxide removal. This study aimed to evaluate the budget impact of surfactant therapy for bronchiolitis in critically ill infants in Colombia.MethodsBudget impact analysis was performed to estimate the economic impact of surfactant therapy (ST) for the treatment of infants with a diagnosis of bronchiolitis, requiring mechanical ventilation. The analysis considered a 4-year time horizon and Colombian National Health System perspective. The model estimated drug costs associated with current scenario using humidified oxygen or adrenaline nebulization, and new scenario adding exogen surfactant. The size of the target population was calculated using epidemiological national data. Univariate one-way sensitivity analyses and scenario analyses were performed.ResultsIn the base-case analysis the 4-year costs associated to ST and no-ST were estimated to be US$ 55,188,132 and US$ 55,972,082 respectively, indicating savings for Colombian National Health equal to US$ 783,950 if ST is adopted for the routine management of patients with bronchiolitis requiring mechanical ventilation. In the one-way sensitivity analysis, only increases in the cost of the surfactant drug and cost or length of stay in the pediatric intensive unit reduce the potential savings of ST.ConclusionST was cost-saving in emergency settings for treating infants with severe bronchiolitis requiring mechanical ventilation. This shift in treatment approach proved to be economically favorable in the Colombian context.

Median Urinary Iodine Concentration in Colombian Children and Women is High and Related to Sociodemographic and Geographic Characteristics: Results from a Nationally Representative Survey

Salt iodization has been mandatory in Colombia for over half a century. The iodine status of the population has not been recently evaluated using nationally representative data. We estimated the median urinary iodine concentration (mUIC) of Colombian women and children overall and by individual and environmental characteristics. Using data from spot urine samples collected in the 2015 Colombian National Nutrition Survey, we estimated mUIC in 24,248 boys and girls aged 1 to <13 y and 9122 women of reproductive age (WRA). Within each group, we compared mUIC by levels of sociodemographic, anthropometric, and geographic factors by using adjusted median differences with 95% CIs from quantile regression models. mUICs were 395±3 μg/L among children and 381±3 μg/L among WRA. Schoolchildren 5 to <13 y old had higher mUIC (407±3 μg/L) than did preschoolers or toddlers. Girls had 21 μg/L (95% CI: -29, -14) lower mUIC than boys after adjustment. In addition, among children, mUIC was positively associated with household wealth and inversely associated with indigenous compared with mestizo ethnicity, living in the southern or Pacific compared with the central regions of Colombia, and altitude. Among WRA, mUIC was positively associated with obesity and inversely with age, indigenous compared with mestizo ethnicity, education, household wealth, living in southern compared with central Colombia, altitude, and alcohol intake frequency. Colombian children and WRA had mUIC well above conventional cutpoints of iodine excess. Whether excessive iodine affects other subpopulations and its functional consequences warrant urgent investigation.

Self-recognition of mental disorders and mental problems in the adult population from the Colombian National Mental Health Survey

Introduction and objectivesMental disorders are very prevalent in the general population. Despite this, it is estimated that only about a third of the people affected is able to recognise problems on their own and to access health services. The aim was to determine the factors associated with the lack of self-recognition of mental problems and disorders in the Colombian population. MethodsThe National Mental Health Survey (ENSM-2015) conducted in Colombia identified adults over 18 years that answered ‘yes’ to the question ‘Have you had a mental problem or disorder?’, had a positive score in mental disorders measured by the Composite International Diagnostic Interview (CIDI) 3.0, or in mental problems detected by the SRQ-20. A bivariate analysis, as well as a logistic regression, were performed with possible related variables. ResultsA sample of 10, 870 adults was obtained, of whom 12.25% (1332) had mental disorders and 30.2% (3282) had mental problems. Of those individuals with disorders and problems, 7.9% recognised themselves as affected. The variables associated with self-recognition of disorders or problems were, among others: being female (OR = 1.8; 95%CI, 1.4−2.3), family dysfunction (OR = 1.5; 95%CI, 1.2−2.0), to have experienced a traumatic event (OR = 1.8; 95%CI, 1.4−2.2), illegal substance consumption (OR = 0.5; 95%CI, 0.4−0.7), not being poor (OR = 1.9; 95%CI, 1.2−3.0), and not having chronic illnesses (OR = 1.6; 95%CI, 1.3−2.1). ConclusionsSelf-recognition is of great relevance to improve access to care by adults. The results provide associated variables that allow planning interventions that can promote the recognition of mental problems or disorders in this population.

Association of Leisure Activities With Cognitive Impairment and Dementia in Older Adults in Colombia: A SABE-Based Study.

Observational and interventional studies suggest that participation in leisure activities may help protect against cognitive decline in older people. This study aimed to examine the association between participation in leisure activities and cognitive impairment in older adults in Colombia. Data for this study were derived from the Colombian National Survey of Aging (SABE 2015), a cross-sectional survey with a sample size of 23,694 older adults representing the total population (mean age, 70.8 years; 57.3% females). Cognitive impairment was classified as cognitive impairment without dementia (CIWD) and dementia, according to the revised version of the Folstein Mini-Mental State Examination and the Lawton and Brody functional scale. Leisure activities were evaluated using six items of a questionnaire. Sex-stratified multinomial regression models were used to analyze the association of leisure activities with CIWD and dementia after adjusting for educational attainment, literacy, and other potential confounders. In adjusted models for men, leisure activities in later life were associated with a decreased risk of CIWD (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.68–0.78) and dementia (OR, 0,52; 95% CI, 0.48–0.58). For women, leisure activities in later life were associated with a decreased risk of CIWD (OR, 0.72; 95% CI, 0.66–0.78) and dementia (OR, 0.48; 95% CI, 0.43–0.53). The findings suggest that greater participation in leisure activities in later life may act as a protective factor against CIWD and dementia among older adults in Colombia, independent of educational attainment and literacy.

Cocalero women and peace policies in Colombia

BackgroundIllicit crop economies are shaped by gender arrangements that can play an important role in the experiences of illicit crop workers. In Colombia, the coca production -considered a war economy- granted peasant women a source of access to productive resources (land, credit and seeds) and paid work, conditions that are difficult to find in other legal agrarian economies. For this reason, policies pursuing a transition from war to peace, such as the ones that emerged from the 2016 Peace Agreement between the Colombian government and the FARC guerrilla, must incorporate a gender perspective in order to acknowledge the social progress that women can achieve in war scenarios. MethodsThe empirical evidence comes from thirty-one in-depth and semi-structured interviews with cocalero peasants, social leaders and public officials; ethnographic fieldwork in two municipalities with the highest levels of illicit crop production (Puerto Asís and Tumaco); official documents of anti-drug and Alternative Development policies in Colombia, and other official information from the agencies in charge of implementing these policies; and data from the survey of participants of the National Comprehensive Program for the Substitution of Illicit Crops (PNIS) (National University of Colombia, 2019), and one dataset from the Colombian National Administrative Department of Statistics (the Quality of Life Survey of 2018). For the analysis of the data we used an open-codification method and conducted hypothesis tests with Welch's correction. ResultsIn Colombia, women involved in the coca economy experience a degree of empowerment that leads to increased income, time control and decision-making power. When we compared the lived experience of cocalero women with what the National Crop Substitution Programme -PNIS- offers, we found that the programme falls short from offering viable gender-sensitive alternatives, producing a setback in women's empowerment. ConclusionIllicit crop economies in war contexts can be a source of social advancement for marginalized populations, particularly women. Thus, peace policies that do not recognise these advances, i.e. that do not incorporate a gender perspective in their design, deepen gender-based inequalities.

Breast cancer in Colombia: a growing challenge for the healthcare system.

To provide a comprehensive overview of breast cancer in Colombia. Data on breast cancer in Colombia are scarce. We present incidence data from population-based cancer registries that represent 4 distinct regions of the country. Other data originate from non-governmental institutions and healthcare providers within Colombia, official sources, expert opinion, Colombian legislation, and the Cancer Mortality Atlas publishes by Colombian National Cancer Institute. In Colombia, the age-standardized incidence rate remained relatively stable between 2012 and 2020 (43.1 to 47.8 cases per 100,000 women-years); Additionally, survival since 1995 has presented a substantial improvement from 65.7 to 72.1. In 33% of cases, the diagnosis of breast cancer was made in advanced stages, stage III or higher. The health demography survey conducted in 2015 showed that the participation in mammography screening in women aged 40 to 69 remains low 48.1%. Some limitations regarding access to early detection and diagnosis include economic strata, health insurance coverage, origin, and accessibility. On average, a 90-day period was reported from onset of symptoms to diagnosis of breast cancer. The first action towards improving outcomes in breast cancer should be to improve stage at diagnosis and timely access to care.

Conceptual design of coastal patrol vessel (CPV) with flight deck for the reception and deployment of helicopter

This paper presents the development of the conceptual design of a coastal Patrol vessel with the capacity to receive and deploy a helicopter, in order to increase the efficiency of coastguard operations developed by the Colombian National Navy. As a starting point, the design of the coastal patrol vessel built by Cotecmar and named CPV46 was taken, on which modifications were implemented in its main dimensions and distribution of spaces, which allowed to include a flight deck to receive a BELL 412 EP helicopter, complying with the regulations for this type of operations.This design was developed based on the design spiral method, where each turn of the spiral includes estimates and performance calculations influenced by each other and corresponding to the different stages of the design. For this work, the conceptual design was divided into eight booklets containing the state of the art, mission profile, capacity sizing, naval architecture, propeller selection, generator selection, stability study and cost estimation, concluding in the feasibility of the design based on its cost at a conceptual level.

Trends in diabetes mortality identified from death certificates in Colombia, 1979-2017.

ABSTRACTObjective.To describe the mortality trends of diabetes mellitus (DM) in Colombia, by sex and age group, from 1979 to 2017.Methods.We carried out an ecological study using mortality data from the Colombian National Administrative Department of Statistics. Crude and age-standardized annual mortality rates per 100 000 people were estimated. Trends of standardized rates were described by sex and age groups. Joinpoint regression models were performed to study mortality trends.Results.Throughout the whole period, the total number of DM recorded deaths in Colombia was 200 650, 58% (116 316) in women (p<0.05). The age-standardized mortality rates (ASMR) by sex increased from 13.2 to 26.6 deaths per 100 000 in women and from 10.1 to 22.7 in men from 1979 to 1999. We observed a decrease from 26.6 to 15.4 per 100 000 in women, and from 22.7 to 15.9 in men for the period 1999-2017. The joinpoint regression analysis showed that the average annual percentage change of the period did not vary in both sexes (men: -0.2%, 95% CI –1.0 to 1.4%; women: 0.7%, 95% CI –0.1 to 1.6%).Conclusions.The DM mortality showed a decreasing trend after 2000 in women and 2004 in men. Primary and secondary prevention programs must continue to be strengthened for an earlier diagnosis of diabetes.