Health In Colombia Research Articles

Las invisibles: una lectura desde la salud pública sobre la violencia sexual contra niñas y mujeres Colombianas en la actualidad*

Objetivo: este artículo pretende exponer la situación actual de la violencia sexual en Colombia, desde la perspectiva de una salud pública con enfoque de género.Metodología: identificación, recopilación y análisis documental de un conjunto de estudios y otras fuentes sobre violencia sexual y salud pública en Colombia correspondientes al período 1993 -2006, seleccionadas mediante revisión de bases de datos electrónicas y catálogos de bibliotecas.Resultados: se presentan algunos conceptos sobre la violencia sexual y los derechos humanos de las mujeres; se caracteriza la magnitud del problema entre las niñas y mujeres de nuestro país; se discuten algunas políticas públicas desplegadas en Colombia ante el tema; y se señalan áreas críticas para la acción futura.Conclusiones: lo encontrado conduce a considerar que es necesario estimular la reflexión, la investigación, el análisis y las acciones interdisciplinarias efectivas y sensibles a los asuntos de género en torno a este tema, que no obstante su importancia ha permanecido relegado en medio del complejo panorama de la salud pública nacional.

Uso de antibióticos en infección de vías urinarias en una unidad de primer nivel de atención en salud, Bogotá, Colombia

Describing using antibiotics for urinary tract infection in a first level of attention health care unit. This was an observational and descriptive study of a cohort of register-based patients attending the Universidad Nacional de Colombia's Health Service Unit (UNISALUD) diagnosed as suffering urinary tract infection between July 2002 and June 2003. 6,3 % urinary tract infection incidence was found, especially affecting women (84,4 %). The signs and symptoms were the same as those usually found in this disease. 58% corresponded to lower tract infection, 36 % to non-specific infection, 4 % to infection during pregnancy and 2 % to upper tract infection. The following uropathogens were isolated: E. coli (88.9%), Proteus spp. (5,1%), Klebsiella spp. (3,7 %), Enterobacter spp. (1%), Citrobacter spp. (1 %) and Staphylococcus saprophyticus (0,3 %). There was great variability in the antibiotic schemes being prescribed. Nitrofurantoin, Trimethoprim-sulfamethoxizole and Fluoroquinolones were the most prescribed, per defined daily dose; these antibiotics presented low susceptibility for the uropathogens so isolated. There was a 4:1 ratio of empirical treatment respecting confirmed ones. 98 % of the cases corresponded to patients suffering from a single event or having just 1 to 2 recurrences. DISCUSSION The urinary tract infection studied here presented a similar epidemiological profile to that usually found in the general population. The isolated microorganism's low susceptibility to the prescribed antibiotics could reflect inappropriate use of antibiotics by the health service, inducing selective pressure on bacterial resistance.

The effects of the armed conflict on the life and health in Colombia

This article is an approach to the consequences of the internal armed conflict that Colombia has lived during the last four decades. It starts with the identification of the conflict's context and its current characteristics. It then focuses on the different manifestations and consequences of the conflict and on their deep impact on the life, quality of life, health, disease, and health services of the population. In special we refer to the high homicide rates, forced internal displacement, kidnapping and the use of antipersonnel mines. Among the most affected groups are young men, women, children, and ethnic minorities such as indigenous and afro-american people. This analysis also refers to the frequent violations of International Humanitarian Law and to the negative impact of violence on the provision of health services. Finally, general conclusions are drawn, and alternatives for studies on the problem and for possible solutions from the standpoint of the health sector are proposed.

Renal Disease in Colombia

Chronic renal disease represents a problem of public health in Colombia. Its prevalence has increased in last decade, with a prevalence of 44.7 patients per million (ppm) in 1993 to 294.6 ppm in 2004, considering that only 56.2% of the population has access to the health. This increase complies with the implementation of Law 100 of 1993, offering greater coverage of health services to the Colombian population. The cost of these pathologies is equivalent to the 2.49% of the budget for health of the nation. The three most common causes of renal failure are diabetes mellitus (DM; 30%), arterial hypertension (30%), and glomerulonephritis (7.85%). In incident patients, the DM accounts for 32.9%. The rate of global mortality is 15.8%, 17.4% in hemodialysis and 15.1% in peritoneal dialysis. In 2004, 467 renal transplants were made, 381 of decease donor with an incidence of 10.3 ppm.The excessive cost of these pathologies can cause the nation's health care system to collapse if preventative steps are not taken. In December of 2004, the Colombian Association of Nephrology with the participation of the Latin American Society of Nephrology and Arterial Hypertension wrote the “Declaration of Bogotá,” committing the state's scientific societies and promotional health companies to develop a model of attention for renal health that, in addition to implementing national registries, continues to manage renal disease.

Health reform, equity and the right to health in Colombia

The author develops a long-term perspective to assess advances in equity and the right to health in the Colombian health system reform. In a restricted political system, actors in the field of health in Colombia have chosen individualistic alternatives to legalize inequities in individual purchasing power for services. Despite the complex regulations established in the General System for Social Security in Health, there is a trend towards consolidating traditional inequities and to further restrict opportunities for achieving the right to health with full, equitable, universal guarantees.

Earnings Effects of Household Investment in Health in Colombia

This study considers the links between primary indicators of health and individual labor productivity in Colombia and explores how additional public expenditures on health may improve individuals' health. Sample statistics how that illness occurs more frequently for women than for men, for less educated than for more educated, for rural than urban residents, and for older individuals. The well educated are considerably taller than those without schooling (6 cm. for males and 4 cm. for females). The empirical evidence confirms that health indicators are related to individual earnings in Colombia. A Mincerain log-earnings equation that includes health indicators as a form of human capital in addition to schooling is specified. When the morbidity variable is treated as endogenous and measured with error and the model is estimated by instrumental variables [IV], it becomes significant and has the expected negative sign. Controlling for age, education, sector of employment, gender and geographic location, an increase by 50% on the average number of days an individual was ill and unable to do his ordinary activities in the last month would imply reductions in labor earnings of 11% for urban males, 8% for urban females, 13% for rural males and 7% for rural females. The estimations with height show a positive sign and high significance even without the IV correction, but the coefficients increased with IV methods by an order of magnitude. Having one more centimeter of stature would increase urban female earns by 4.7% and urban male earnings by 12%. Individual's wealth and living in a community with better health provision indicators are linked with better health outcomes. An analysis of the returns to schooling shows that schooling captures part of the effect of health on productivity when the health indicator is not included in the Mincer equation.

Transformation of ministries of health in the era of health reform: the case of Colombia.

Ministries of health are being called upon to lead major health reforms; at the same time they must reform themselves to become more modern institutions and assume new and different functions and roles in the more dynamic reformed system. The literature on public administration and on health reform has recommended many processes of institutional reform and development, building on private sector management techniques, popularized by 'reinventing government' and 'total quality management'. More recently, thoughtful insights have emphasized improving public management through a focus on creating 'public value'; on political, as well as administrative, leadership; improving institutional performance through strengthening the 'task networks' of organizations needed to achieve strategic objectives; and creating a learning culture within the organization. This article applies these recent approaches to the specific needs of ministries of health in order to improve their capacity to lead major health reforms. This combined approach is then used to analyze and make recommendations to the Ministry of Health in Colombia where the authors were providing technical support for a major new health reform.

Violence and health in Colombia

In Colombia, violence seems uncontrollable. Along with massacres and group killings of astonishing cruelty, there are also kidnappings and disappearances, abuse of children and the elderly, and rape of young adolescents. Every day, without respite, Columbians are witnesses or victims of street crimes as well as racial, sexual, and socioeconomic discrimination. Unwillingly, they become agents of aggression in public transport, at home, at school, and at work. Colombia has the highest rates of mortality from homicide in the world. Apart from the enormous institutional burden that violence imposes on the health services and forensic medicine, it now constitutes the principal public health problem in the country. To confront it, the health sector must develop policies and finance actions, develop innovative ways to train personnel, implement public education processes, and devote more effort and greater creativity to research, which up to now has provided some, but not enough, important answers. Violence, which is the substitution of force for any type of dialogue, must be considered within the context of life and health. This it not merely an attempt to rationalize violence, much less to substitute words or reflection for action, but rather an attempt to understand it in depth in order to search for alternatives. With that goal, this article analyzes the subject of violence in Colombia, principally from the perspective of its effect on the health of the citizens and its implications for the health sector. The author fully recognizes the subjectivity and limitations of the views he expresses herein.

A policy is not enough: Women's health policy in Colombia

In 1992, thanks to the involvement of women's groups and a favourable political context the Ministry of Public Health in Colombia put forward a national women's health policy that calls for interventions in five areas: self-care, abuse and violence, mental health, occupational health, and reproductive health and sexuality. Three years and several international conferences later, there have been few sustained efforts to implement the policy and it is difficult to assess the impact of those that have taken place. Serious and well planned efforts among women, and on the part of governmental and non-governmental sectors, will be needed to put it into practice.

Training in epidemiology in the National School of Public Health of Colombia.

Training in epidemiology in the National School of Public Health of Colombia.

Public Health in Colombia

THE April issue of the Boletin de la Oficina Sanitaria Panamericana contains an interesting paper on this subject by Dr. Eduardo Santos, a former president of the Republic of Colombia. He states that in spite of adverse conditions 140 aqueducts, thirty sewers and twenty new hospitals have been constructed in the Republic in the past fifteen or twenty years. More than eight hundred institutions are now devoted to maternity and child welfare, and the prenatal services number at present 126 as compared with 62 in 1937. During this period hospital beds have been increased from 11,422 to 16,322, and forty-five hospitals with a total of 1,500 beds are now under construction. There are at present twenty-five tuberculosis dispensaries as compared with only four in 1937. The yellow-fever campaign,is being carried on by the Government in collaboration with the Rockefeller Institute, which has an excellent laboratory at Bogotá devoted to the production of yellow fever vaccine. The campaign against typhus and bartonellosis is continuing. There is practical cooperation between the State and private agencies, such as the Red Cross, the Colombia Anti-Tuberculosis League, the Association for the Care of Lepers and other groups.