Universidad De Los Andes Research Articles

Impact of COVID-19 on Maternal Mental Health in a Fragile and Conflict-Affected Setting: A Longitudinal Case-Control Study in Tumaco, Colombia

Background: The effects of the COVID-19 pandemic on mental health have been understudied among vulnerable and marginalized populations, particularly in fragile and conflict-affected settings. We analyzed changes in mental health and parenting stress among caregivers, many of whom are Internally Displaced Persons (IDPs), in a conflict-affected setting in Colombia.Method: We used longitudinal data from a psychosocial support program in which 1,374 caregivers with children aged 2-5 were randomly assigned to treatment and control groups across four sequential cohorts. At end-line, two cohorts were assessed prior to the pandemic, while two cohorts were assessed two to five weeks into the national lockdown. We estimated the impact of COVID-19 by comparing end-line outcomes between pre and post-pandemic cohorts using lagged-dependent variable models.Findings: Results showed that the likelihood of reporting symptoms above the risk threshold increased by 14 percentage points for anxiety (95% CI 0·100 – 0·174), five percentage points for depression (0·005 – 0·091), and ten percentage points for parental stress (0·046 – 0·146). Impact was stronger for Internally Displaced Persons (IDPs), and participants with lower educationor with pre-existing mental health conditions. Impact was also higher for those reporting food insecurity, job loss, or illness of a relative.Interpretation: Mental health significantly worsened due to COVID-19. Considering the vulnerability and preexisting mental health conditions of this population, the estimated effects are substantial. Policies in fragile and conflict-affected settings targeting IDPs and other vulnerable people will be important to mitigate further mental health and socioeconomic problems.Trial Registration: The trial was registered at the Clinical Trials Registry #NCT03502252 and at the Social Science Registry #2868, while the amendment for the phone survey was registered in the latter registry on April 20, 2020.Funding Statement: Saving Brains – Grand Challenges Canada; Fundación Éxito; Fundación FEMSA; United Way Colombia.Declaration of Interests: Dr. Moya reports grants from Saving Brains - Grand Challenges Canada, Fundación Exito, Fundación Femsa, and United Way Colombia, which supported implementation and impact evaluation of the Semillas de Apego program in Tumaco, Colombia. All other authors have nothing to declare. Ethics Approval Statement: Study procedures were approved by the Universidad de los Andes’s Ethics Committee (Protocol 786, 2017).

Health-related quality of life in older people with functional independence or mild dependence

Background The concept of Health-Related Quality of Life (HRQOL) has grown in importance in the elderly population (PM), which is due to the increase in life expectancy of contemporary societies and the desire of people to live the most advanced years in good condition. Objective To know the effect of the epidemiological dimensions, functional capacity, social and psychological well-being on the HRQL of a group of senior people from the Borough of Puente Alto intervened by the multidimensional model of the Integral Center for Happy Aging, CIEF, Universidad de los Andes. Results Correlation was observed between the dimensions mentioned above, as well as the improvement in the predictive models of HRQL in the extent to which social and psychological variables are incorporated into the morbidity and functional capacity dimension, the latter strongly related to HRQL according to the scientific literature. Conclusion The study shows the relevance of incorporating measures of social and psychological well-being in the evaluation of HRQL, especially with a view to the design of multidimensional interventions that encompass individual content and the environment in which seniors develop.

Contentious memories: History and urban redevelopment in Bogotá, Colombia

ABSTRACT In 2004, the city of Bogotá designated the historic working-class neighborhood of Las Aguas an “Urban Renovation Zone.” Subsequently, in 2012 the Universidad de los Andes proposed a massive redevelopment plan called Progresa Fenicia, with city approval. Redevelopment is imminent and residents’ responses have been diverse. In an effort to contribute to the literature that seeks to enrich and nuance our understanding of urban renewal processes and gentrification, this article explores the subjective experiences of long-term residents and the role of history and memory in such processes. Our analysis is based on participant observation and 31 oral histories from long-term residents of the small urban area designated for intervention. Through them, we seek to illuminate how residents understand their personal experience of the transformation of the neighborhood, and their part in urban renewal processes that extend into the past but also the future. We emphasize the agency of long-term residents, arguing that the past and memory play a significant role in how people define place, position themselves vis-à-vis urban interventions, and shape their experiences of urban redevelopment beyond monetary issues, class displacement, physical landscape, and housing policy.

Thomas Binkley’s continuing influence, 25 years on

The first time I heard a recording of Studio der Frühen Musik was one of those revelatory moments that change the course of one’s life. The recording of L’Agonie du Languedoc from 1975, recounting the horror of the Albigensian crusade, was played during my first-semester Music History class at the Universidad de los Andes in Bogotá, Colombia. This was medieval music as I had never heard it before, a sound that I did not know was possible in the interpretation of early music. Listening to it now, I can hear that their collaboration with a singer from Languedoc brought the troubadour poetry close to the intimate interpretations of mid-20th-century protest singer-songwriters such as Victor Jara and Violeta Parra, explaining why I was so surprised to hear medieval European music sung in such a manner. There was a freedom of emotive expression which countered the usual restraint I had known in early music recordings.

Communities of learning as support for one knowledge and innovation management system: A case study

AbstractThe problem was creating a Knowledge and Innovation Management System at Bogotá's Water Supply and Sewage Company (Empresa de Acueducto y Alcantarillado de Bogotá) as a public service business. This article proposes the creation of a community of learning as a space for innovation within the organization. Acknowledging the theoretical bases that have been established for the notions of community of learnings at the Universidad de los Andes, we test a practice methodology that, within the organization, fosters the creation and strengthening of a community of learning composed of mentors and apprentices. They have the capability of proposing new practices in their organization.

Integrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities

BackgroundIntegrated Management of Childhood Illnesses (IMCI) is a strategy developed by the World Health Organization (WHO) and UNICEF in 1992. It was deployed as an integrated approach to improve children’s health in the world. This strategy is divided into three components: organizational, clinical, and communitarian. If the Integrated Management of Childhood Illnesses implementation-related factors in low- and middle-income countries are known, the likelihood of decreasing infant morbidity and mortality rates could be increased. This work aimed to identify, from the clinical component of the strategy, the implementation-related factors to Integrated Management of Childhood Illnesses at 18 Colombian cities.MethodsA quantitative cross-sectional study was performed with a secondary analysis of databases of a study conducted in Colombia by the Public Health group of Universidad de Los Andes in 2016. An Integrated Care Index was calculated as a dependent variable and descriptive bivariate and multivariate analyses to find the relationship between this index and the relevant variables from literature.ResultsInformation was obtained from 165 medical appointments made by nurses, general practitioners, and pediatricians. Health access is given mainly in the urban area, in the first level care and outpatient context. Essential medicines availability, necessary supplies, second-level care, medical appointment periods longer than 30 min, and care to the child under 30 months are often related to higher rates of Integrated Care Index.ConclusionHealth care provided to children under five remains incomplete because it does not present the basic minimums for the adequate IMCI’s implementation in the country. It is necessary to provide integrated care that provides medicine availability and essential supplies that reduce access barriers and improve the system’s fragmentation.

SISCOVID: modelos de sistemas complejos para contribuir a disminuir la transmisión de SARS-COV-2 en contextos urbanos de Colombia

The development and implementation of strategies to reduce SARS-CoV2 transmission is a prevailing challenge for Colombia. These strategies ought to be dynamic and specific to each region, seeking to balance health and economic impacts. This task calls for an interdisciplinary approach to ensure a holistic view of the problem. This article presents findings and results obtained from the SISCOVID project, which used simulated systemic models to support decision making and efforts to mitigate the pandemic in Colombia. The project included researchers from Universidad de Los Andes, the Centro Nacional de Consultoría (CNC) and Universidad de Ibagué, in alliance with several international universities and companies. SISCOVID helped decision makers design strategies to reduce SARS-CoV-2 transmission in urban contexts for the cities of Barranquilla, Bogotá, Cali, Cartagena, and Medellín.

Recomendaciones para el uso de la hormona de crecimiento humana recombinante en pacientes pediátricos de talla baja en Colombia

In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociacion Colegio Colombiana de Endocrinologia Pediatrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatria, Secretaria Distrital de Salud de Bogota- Subred Integrada de Servicios de Salud Suroccidente, Fundacion Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clinica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.

“Memory Clinics”: A Series of Memory Challenges for the Improvement of Metacognitive Skills in a Pharmacology Course

Pharmacology training requires adequate skills for lasting learning of facts and medications that are unfamiliar to most medical students. Metacognition encompasses skills such as memorization, time management, deliberate practice, and self‐regulation, that are critical to the learning and application of pharmacology concepts. To improve students’ approach to learning pharmacology, we have created the “Memory Clinics” (MC). Memory clinics are metacognitive spaces focused on the training of working memory as a vehicle for students to actively assess their study methods, strengths and difficulties when learning pharmacology.Three MCs were offered to students enrolled in the medical pharmacology course during the second academic term of 2019. Each MC occurs in a one‐hour block and is divided in different stages, during which students are instructed to memorize biomedical material, solve a crossword on that material in a limited period of time, and reflect on their learning process and techniques through open questions. At three moments (T0 min, T10 min, T20 min) during the study time, students are also required to report their expected performance on a numerical scale before solving the crossword puzzle. After obtaining preliminary results, as reported in Table 1, we applied an unequal variance T‐test to evaluate possible differences for expected performance between genders at T0, T10 and T20, as well as actual performance on the crossword in each MC. We did not find a difference for expected performance between men and women (p>0,05). When combining genders and comparing expected and actual performances, we found a difference in scores as additional MCs were included in the analysis (p<0.0002 One‐Way correlated ANOVA).Our results suggest there are not significant differences between men and women when estimating their performance on a memory challenge. Students show differences in their expected performances before, during and after encountering the challenge with a tendency to overestimate their efficacy. Students appear to predict more accurately their performance after participating in several MCs throughout the semester. MCs allowed us to collect qualitative data on self‐confidence and the effects of self‐perceived expertise that we are currently analyzing. Preliminary results suggest changes on confidence and self‐efficacy after students are exposed to a metacognitive challenge.Support or Funding InformationFAPA‐ Universidad de Los Andes, College of Medicine, Vicepresidency for Research. Mean for expected and final scores * by gender during Memory Clinics Expected Performance Final Score Moment T 0 min T 10 min T 20 min Gender F M F M F M F M MC 1 65,5 ± 13,2 69,3 ± 11,6 60,1 ± 15 59,5 ± 18,2 72 ± 13,6 72,9 ±12,7 57 ± 17,3 56 ± 16,6 MC 2 63,6 ± 13,6 70,6 ± 11 59,4 ± 15,8 60,3 ± 18,2 71 ± 14,3 73 ± 13,6 55,6 ± 17,9 55,9 ± 17,5 MC 3 47,8 ± 16,2 48,2 ±21,9 39,8 ± 16,1 35,6 ± 16,2 50,4 ± 13,5 49,4 ± 22,4 44 ± 0,2 49 ± 0,2 F: Female, M: Male *Mean score, ± SD

Experience of the Globally Harmonized System’s Implementation at an Anatomy Laboratory

Anatomy laboratories and amphitheaters general practice requires constant chemical substances usage. Previous classification systems used in laboratories around the globe exposed wide margins of confusion, no symbology consensus and were open to interpretation, associated with occupational injuries, workplace related diseases and a lack of students and workers protection. For this reason, it was necessary to establish a universal, homogenized, technical and internationally recognized by scientific community system: the Globally Harmonized System of classification and labeling of chemical products (GHS).The GHS was proposed with the purpose of harmonizing the characteristics and data sheets of different substances, reagents and components. When projected by the UN, this system was standardized according to international protocols. Even the Intergovernmental Forum for Chemical Safety recommends that all countries implement the GHS as soon as possible, being one of the main reasons the fact that student’s misunderstanding of labeling of chemical substances can result in unsafe behavior that may cause accidents or disasters.Our aim is to describe and evaluate the main differences between the implementation of the GHS compared to previouslly used classification systems. A documentary analysis of United Nations purple book on the updated official report of the globally harmonized system was carried out, together with documents from previous organization systems.As a main finding, nine danger pictograms are set (previously eight), that harmonize criteria to avoid physical, health and/or environmental danger situations. For each sheet the use of specific danger pictograms, warning words, hazard instructions and precautionary statements is stablished. These sheets must be accompanied by a hazard communication paper that includes detailed information about identification, manufacturer, importer and/or supplier, classification, hazards, precautionary measures and emergency procedures, among others.The implementation of the GHS in an anatomy laboratory consists in four principles: checklist of hazardous materials in stock, labeling of hazardous materials, preparation of material safety datasheets with the format and the requirement of at least a 3‐h training course for eligible students and workers.The GHS implementation together with an easy divulgation of hazards and the Occupational Health and Safety requirement (BS OHSAS 18001) which is a framework that contains necessary policies, procedures and controls that helps workspaces achieve the best possible working conditions, aligned with internationally recognized best practices, leads to optimized human and environmental protection, besides constituting a guide system for those countries that lacked one, reducing the need to test chemical products and facilitating the trade of dangerous substances.Support or Funding InformationAnatomy Laboratory, Universidad de los Andes, School of Medicine.

MATLAB Tool for Color Comparative Analysis in Fixed Specimens. A Five Solution Single Blind Controlled Trial

Formaldehyde fixation avoids decomposition process of cadaveric specimens 1, making them useful for anatomy teaching and research 2. However, formaldehyde leads to fresh appearance loss in the tissue, which reduces its academical value. Although some color recovery solutions have been presented 3, 4, no standardized method for quantitative color assessment in fixed tissues has been proposed.Our aim of is to present a MATLAB tool for color recovery analysis in formaldehyde fixed tissues.Four different animal tissues (cardiac and skeletal muscle, kidney and liver), previously fixed with 10% formaldehyde (v/v) were treated in five different solutions (mineral staining, sodium bisulfite, sodium bicarbonate, GERDEX and modified Chilean solution 3). Tissues were photographed at different stages of preservation. Analysis was carried out in two different spaces of chromatic representation (RGB and HSV).A computerized color comparison tool was developed allowing visualization of the chromatic presence in RGB color space through a three‐dimensional distribution (color cloud). Besides color cloud intersection percentage, frequency histograms of RGB distributions and the color saturation (S) distribution were used to generate performance metrics based on the Bhattacharyya distance. Each metric addressed one specific desired characteristic of a color recuperated specimen.Mineral staining proved to be the solution with the best overall performance across most of the proposed metrics, significantly recovering the color compared to fresh tissue. Although significant results were obtained, future works implementing more robust methods of comparison, that involve metrics based on multiple desirable characteristics of a specimen are necessary.The MATLAB tool developed showed to be useful for the quantitative color analysis and comparison in formaldehyde fixed tissues. Further studies should be done to standardize quality metrics of existing and upcoming preservation techniques.Support or Funding InformationAnatomy Laboratory, School of Medicine, Universidad de los Andes.

Formolized Cadaveric Specimens Immersion‐Recovery Protocol

Cadaveric dissection, promoted by multiple anatomists and institutions as a fundamental area of medical education and training , requires embalming of the bodies to disinfect and preserve them. Therefore, despite being a known toxic and carcinogenic agent, formaldehyde is still widely used for its characteristics and results. Our objective is to introduce a Formolized Cadaveric Specimens Immersion‐Recovery Protocol developed at our laboratory, the chemical reagents used, performed processes and results. The protocol consists on specimen’s immersion in an aqueous solution of potassium hydroxide (KOH) for its maceration, this process causes chemical reactions like lipids saponification and proteins breakdown. The immersion time varies from one specimen to another; however, KOH concentration should never exceed 10% (w/v), otherwise tissue hydrolysis may occur. After a profuse wash, oxidative degradation is carried out: oxidizing formaldehyde into H2O and CO2 through the degradation of hydrogen peroxide (H2O2). It is extremely important to avoid the contact of this agent with the previously used KOH, which would cause the decomposition of H2O2 into H2O, O2 and hydroxyls, without obtaining a proper formaldehyde oxidation. For this purpose, sodium hypochlorite can also be used, with variable results. To ignore this chemical basis limits the achievement of ideal results. This processes allow to obtain 60% more joint movement on goniometry measures compared with formolized specimens, with a change from grey color generated by formaldehyde to ocher. Likewise, the degradation of formaldehyde allows obtaining minimum levels of it in treated specimens, thus reducing health impact on those who handle the specimens. After the recovery process, our specimens were preserved with a low formaldehyde solution. Anatomy students were invited to a peer‐guided extracurricular activity, they interacted with both formolized and recovered specimens, and a likert questionnaire was used to evaluate their experiences with both techniques. Students referred that recovered specimens looked more realistic and considered them better to work with. They also mentioned recovered corpses had less sensory hassles, like eye watering, airway irritation and coughing. Previous studies have compared Thiel solution and formaldehyde fixation. Thiel‐preserved bodies are considered to be a better choice on dissection and surgical training, since tissues offer a more realistic experience. Nonetheless, this technique has disadvantages such as higher costs, vacuum conservation, and the need of trained personal to handle the specimens. Moreover, some chemicals and infrastructure are not available worldwide. An example of the former scenario is present with Ammonium Nitrate, key component in Thiel’s, which is strictly regulated in several countriesSupport or Funding InformationAnatomy Laboratory, Universidad de Los Andes, School of Medicine

Experience‐based Modified Sheet Plastination Protocol

Specimen preservation has been perfected over time through the application of multiple preservation techniques such as sheet plastination. Already described advantages of this technique are: reduction of risks associated with manipulation, longer shelf life and visualization of both internal and external anatomical structures through the sheets.This method represents an alternative to create models that can be used to teach Gross Anatomy especially because the final cuts obtained from this technique are similar to those seen in diagnostic images such as Magnetic Resonance Imaging or Computed Tomography.Our objective is to present a modified standardized sheet plastination protocol based on experience gained through the technique development in our laboratory and other previously released protocols.As a basis, published protocols such as: BIODUR; University of Murcia, Spain; Dalian University, China; National University, Colombia; among others were used.Since dehydration was the step with the greatest variation, three alternatives were tested: isopropyl alcohol, acetone and ethanol. Forced impregnation is done using BIODUR P‐40 resin until −15mmHg are acquired in the impregnation chamber and cayalysis is then pursued through vertical positioning of the sheets in a Near UV spectrum (NUV) light chamber.Using acetone or ethanol in addition to a longer dehydration time, requires augmented costs and reactant usage, algo, tissue sheets do not set in the center of the vertical chamber, which resulted in broken or bent sheets. Due to this, isopropyl alcohol was chosen as the best intermediate medium. Dehydration changes were made every three days with the solvent at −20°C, starting with a concentration of 95% and making the last refill at 99.8%. The, specimens were placed in a vacuum chamber with BIODUR P‐40 resin. Constant bubbling was monitored while the pressure decreased until bubbling stopped and pressure was further reduced to a minimum of 15 mmHg.Specimens were then assembled on double‐glass sheets with the help of hooks and silicone hoses in vertical shape allowing proper catalysis on both sides simultaneously. This method provided more uniform results and reduced time spent at this stage. Finally, these were placed in a NUV chamber for 72 hours. Near UV‐light was used instead of UV‐light because of the health risk of using UV light chamber in a student access‐free laboratory.In our experience, better results were obtained by making thin cuts of specimens (<6mm) since it facilitates the visualization of structures and allows the resin to remain fully translucent after being catalyzed.Likewise, results improved when using isopropyl alcohol as a dehydration method because it is less volatile allowing a gradual dehydration to limit dimensional change and shrinkage of the tissue.Support or Funding InformationAnatomy Laboratory, School of Medicine, Universidad de los Andes.

Peer Assisted Learning Experience as an Extracurricular Activity during a Gross Anatomy course.

Multiple medical schools have modified classical teaching methods introducing new tools to improve learning processes 1. Amongst these, extra academic activities defined as out of the curriculum, of voluntary participation 2, and without grading, have been described as activities requiring auto discipline, teamwork, commitment and knowledge 3 as these are mostly carried out by an academic peer. These and other group activities in and out of campus should not be overlooked, as they also influence student performance in medical school. Additionally, peer assisted learning has many benefits, which include preparing students as future educators, improving their communication skills and reducing staff workload.The aim of this study is to describe the effect of a peer assisted learning based extracurricular activity on student performance during a Gross Anatomy course in an integrated curriculum medical school and the students’ perception on their own learning process.Quantitative and qualitative data acquisition tools were used to determine the existence or not of an association between the activity and students summative performance. Grades from two groups without the activities n=162 and two with these n=127 were considered with a total of 22 interventions. Additionally, quantitative data was triangulated with qualitative data obtained from a focal group with the student’s perception on their own learning process.No positive association (p > 0.05) between the grades of each group were found. However, as each exam is composed by a theoretical and a practical component, a decrease in the difference between theoretical and practical grades when peer assisted extracurricular activities were applied was evident. When qualitative data was analyzed, there was a general perception by students that they had less stress levels during the practical component after the activity.Peer‐assisted extracurricular activities show to be beneficial for both: those who attend and peers. Students consider this activity as helpful in reducing other factors such as stress and anxiety that may also be influencing their performance on the exam. However, not finding an association may occur because the students who are more academically able tend to seek out teaching and/or research opportunities and participated at these activities 2. This and other factors need to be addressed and evaluated in order to restructure this tool, so it can be improved in a way it can be implemented and fully analyzed in the future.Support or Funding InformationAnatomy Laboratory, Universidad de los Andes School of Medicine

Epidemiological research as a driver of prevention: the Sibaté study. Commentary.

Although asbestos exposure and risks can be prevented, only five countries in Latin America have banned asbestos, including Colombia. Beginning in 2011, a collaboration between the Istituto Superiore di Sanità in Italy and Universidad de los Andes in Colombia was established, bringing together relevant expertise aiming to improve our understanding of the asbestos problem. An important result of this collaboration was a recently published study conducted in Sibaté, Colombia, a municipality where an asbestos-cement facility has operated since 1942. The evidence collected suggests the presence of a mesothelioma cluster in Sibaté. Landfilled zones with an underground layer of friable asbestos were also discovered in the urban area of the municipality. The importance of this type of collaboration can go beyond understanding the impact of asbestos at the local level, which is crucial, and may also contribute in solving unanswered questions of the problem in countries that banned asbestos decades ago.

Spatial Dynamic Effects in the Colombian Health System

We seek to understand if spatial dynamics affect the population in social, economic and health terms. To carry out this study, we propose the following two stages. In the first stage we try to understand the causes of high infant mortality in rural areas in comparison to the urban areas based on literature and the changes made to the Colombian health model. The second stage is a spatial econometric analysis of the variables of interest, where the CEDE database of the Universidad de los Andes is utilized. The findings of this study confirm the importance of the inclusion of spatial effects, which is a sign that the health dynamics of populations are interrelated. This spatial interdependence corroborates the suggestion from literature where proposing policies coordinate the system and consider local and neighboring populations. Also, municipal administrations require the need to consider mechanisms of interlocution whilst working with their peers and allow these factors to be included in the planning of political measures taken that affect health conditions. Finally, we confirm differences between the rural and urban performance.

Spatial Dynamic Effects in the Colombian Health System

We seek to understand if spatial dynamics affect the population in social, economic and health terms. To carry out this study, we propose the following two stages. In the first stage we try to understand the causes of high infant mortality in rural areas in comparison to the urban areas based on literature and the changes made to the Colombian health model. The second stage is a spatial econometric analysis of the variables of interest, where the CEDE database of the Universidad de los Andes is utilized. The findings of this study confirm the importance of the inclusion of spatial effects, which is a sign that the health dynamics of populations are interrelated. This spatial interdependence corroborates the suggestion from literature where proposing policies coordinate the system and consider local and neighboring populations. Also, municipal administrations require the need to consider mechanisms of interlocution whilst working with their peers and allow these factors to be included in the planning of political measures taken that affect health conditions. Finally, we confirm differences between the rural and urban performance.

Spatial Dynamic Effects in the Colombian Health System

We seek to understand if spatial dynamics affect the population in social, economic and health terms. To carry out this study, we propose the following two stages. In the first stage we try to understand the causes of high infant mortality in rural areas in comparison to the urban areas based on literature and the changes made to the Colombian health model. The second stage is a spatial econometric analysis of the variables of interest, where the CEDE database of the Universidad de los Andes is utilized. The findings of this study confirm the importance of the inclusion of spatial effects, which is a sign that the health dynamics of populations are interrelated. This spatial interdependence corroborates the suggestion from literature where proposing policies coordinate the system and consider local and neighboring populations. Also, municipal administrations require the need to consider mechanisms of interlocution whilst working with their peers and allow these factors to be included in the planning of political measures taken that affect health conditions. Finally, we confirm differences between the rural and urban performance.

Aqui estão as minhas contas: antologia poética by Adília LopesSofia de Sousa Silva

Reviews 290 (pp. 22–24) and POSLAPSO [POSTLAPSE] (pp. 90–92). A pathway with entrance doors but with no foreseeable exit so far. ‘PORTA 2’ [DOOR 2] (pp. 13–16) describes the pathway to a time with no drama or urgent desire to escape; ‘PORTA GIRATÓRIA’ [REVOLVING DOOR] (pp. 17–21) describes a western eschatology that collects the interests accrued from our faith in money. The book’s end resumes the dialogue found at the beginning — ‘Periandro de Corinto, filho de Cypsélos, disse: “O descanso é uma coisa boa!” | Alberto do Porto, dito Mínimo, observou: “Estou de acordo contigo!”’ [Periander of Corinth, son of Cypselus, said, ‘Resting is a good thing!’ | Alberto of Porto, also known as Mininum, observed, ‘I agree with you!’]. But it is still not the end. After this, instead of an index, we can read ‘DISSE’ [I SAID]. We are again attracted by sounds. Even more: the book that announced itself through a verb in the first person, present tense — zombo [I mock] — now meets a first person from the past — I said. And this is still not the end. In the book’s colophon the fly persists; and on the back cover, lonely and wise, lies the large and venerable ear. The quest for the unexpected continues. ZOMBO is a book that succeeds in accomplishing what poetry does best: sewing together a singular time with a collective time; sewing together a time that was with a time that is — read, apropos, the ‘SONETO ERRÁTICO com duas caudas (ou codas para pessoas distintas)’ [ERRATIC SONNET with a double tail (or codas for distinguished people)] (p. 115).6 And, along the way, who knows, one may blow away or squash a few flies. Adília Lopes, Aqui estão as minhas contas: antologia poética, ed. with preface by Sofia de Sousa Silva (Rio de Janeiro: Bazar do tempo, 2019). 199 pages. Print. Reviewed by Jerónimo Pizarro (Universidad de los Andes, Colombia) In 2019, in the Atlântica collection, which ‘seeks to present a panorama of the best Portuguese poetry in Brazil’, an anthology of poems by Adília Lopes was published. Adília Lopes is a poet who in Brazil has had a very positive reception and has been read by authors of several generations. The anthology, selected and prefaced by Sofia de Sousa Silva, appeared a year after another one made in Colombia and published by a publisher in Medellín: Tragaluz. Adília Lopes’s work is being increasingly read and studied outside Portugal, though it remains to be seen whether it will be also within her own country, where it collides with the poetics of other writers, although many defend her — and her ‘rather dangerous game’, to recall her first book of verses — and she has many devoted readers. In Brazil, where the 2019 anthology was published, ‘Adília Lopes was first published in May 2001, in the 10th issue of the poetry magazine Inimigo Rumor’, as Silva mentions in her preface. The anthologist adds that in 2002 the São Paulo 6 Translator’s note: once more, the author puns on the similarity between the word cauda meaning ‘tail’ and coda, ‘coda’. Reviews 291 publisher Cosac Naify, now defunct, published, in the collection Ás de Colete, a selection of her poetry, and that in 2018, the independent publishing house Moinhos published Um jogo bastante perigoso — and did so with remarkable enthusiasm: ‘Owner of a unique imagination, [her] poetry is able to trip up the reader spectacularly, mixing the language of quantum mechanics and encrypted quotes to/from classic authors, with the mental logic of neighbours, old aunts, porcelain dolls, mundane life in Lisbon, and geckos [lizards from Portugal], leaving us helpless — and in love’ (see foreword). The recently published carioca anthology contributes to getting to know Adília Lopes beyond 2002 and it is now the best book, for those who live in Brazil, or for those who do not want to begin with Dobra, to discover an anti-poet that only those who do not only write conventional poetry can read laughing and with passion. In Brazil, where ‘the strong colloquialism of Adília Lopes, as well...

Carlos Zuleta and Lean

This case tells the story of Carlos Zuleta's philosophies toward Lean transformations in the country of Colombia. First, he describes the transformation at Porvenir, a Colombian private pension fund administrator that applied Lean to reduce the lead time from when a customer became eligible for pension payments to the moment they received their first payment. Then he describes his transition to his own boutique consulting firm, Rewire Colombia, focusing on operational excellence based on Lean principles and tools. A number of Lean success stories and Lean methodologies are described. People development is described in particular detail. The case can be used as an example of applying Lean in service settings in a non-US location. Excerpt UVA-OM-1690 Rev. Feb. 11, 2021 Carlos Zuleta and Lean Carlos Zuleta, a Colombian native, earned his undergraduate degree in business administration from the Universidad de los Andes in 1995. In 2000, he earned an MBA from the Darden School of Business at the University of Virginia. After two years in banking and another two in management consulting at top-tier US firms, Zuleta transitioned to working for a Colombian private pension fund administrator, Porvenirone of the largest companies in the countryfirst as a corporate strategic planner and later as chief operating officer. In September 2018, he left to form Rewire, his own Lean-transformation-focused consulting firm. What follows is Zuleta's story in his own words. Origins . . .