For a health problem or condition to be considered a public health issue, four criteria must be met: 1) the health condition must place a large burden on society, a burden that is getting larger despite existing control efforts; 2) the burden must be distributed unfairly (i.e., certain segments of the population are unequally affected); 3) there must be evidence that upstream preventive strategies could substantially reduce the burden of the condition; and 4) such preventive strategies are not yet in place. Chronic kidney disease meets these criteria for a public health issue. Therefore, as a complement to clinical approaches to controlling it, a broad and coordinated public health approach will be necessary to meet the burgeoning health, economic, and societal challenges of chronic kidney disease.

PEER REVIEWED: Chronic Kidney Disease: A Public Health Problem That Needs a Public Health Action Plan

Road safety research in the context of low- and middle-income countries: Macro-scale literature analyses, trends, knowledge gaps and challenges

Chagas disease is the leading cause of nonischemic cardiomyopathy in Latin America. Timely access to diagnosis and trypanocidal treatment and preventive tools for millions of infected people continues to be a challenge. The purpose of this study was to identify potential barriers for the diagnosis of Chagas disease in Colombia from the perspective of healthcare providers. Using a simultaneous mixed-methods study design, we analyzed trends in access to screening and diagnosis for Chagas disease in Colombia and assessed the national barriers to access. The main barriers to access at the national level included a limited governmental public health infrastructure for the diagnosis of Chagas disease and limited physician awareness and knowledge of the disease. Data indicate that 1.5% of total expected cases based on national prevalence estimates were reported. Few public health laboratories have the capacity to perform complementary tests for the diagnosis of Chagas disease and almost 6 months elapse between the requests of the tests and the confirmation of the disease. This study shows that infected people must overcome a number of barriers to achieve diagnosis. Reducing barriers to early diagnosis of Chagas disease is an important goal in the fight against the disease.

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Barriers to Diagnosis Access for Chagas Disease in Colombia.

Objective: To analyze differences in survival of breast, cervical, lung, prostate and stomach cancer by health insurance regime (HIR) and socioeconomic position (SEP) in an intermediate city in a middle-income country. Methods: All patients with breast, cervix uteri, lung, prostate and stomach cancer  diagnosed between 2003 and 2007 and characterized by the Manizales population-based Cancer Registry (MCR) were included and followed up to a maximum of 5 years for identifying deaths. Survival probabilities estimated by HIR were defined according to the type of affiliation at the date of diagnosis, and by socioeconomic stratification of residence (SS) as indicator of SEP, stratifying for other prognostic factors using Kaplan-Meier methods. Cox proportional hazard models were fitted for multivariate analysis. Results: A total of 1,384 cases and 700 deaths were analyzed. Five-year observed survival  was 71.0% (95% IC: 66.1-75.3) for breast, 51.4% (95% IC: 44.6-57.9) for cervix, 15.4% (95% IC: 10.7-20.8) for lung, 71.1% (95% IC: 65.3-76.1) for prostate and 23.8% (95% IC: 19.3-28.6) for stomach. Statistically significant differences in survival by HIR were observed for breast, lung, prostate, and stomach - with poorer survival for the subsidized and uninsured patients. Differences by SS were observed for lung and prostate. Differences in survival by HIR were independent of SS, and viceversa. Conclusions: Important inequities in cancer survival exist related to HIR and SEP. Possible explanations include underlying comorbidities, late stage at diagnosis, or barriers to timely and effective treatment.

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Health inequities and cancer survival in Manizales, Colombia: a population-based study

The scope of this paper is to characterize the main barriers faced by the Colombian population when they attempt to gain access to health services. It is an observational, descriptive and exploratory study using both quantitative and qualitative techniques. It was based on the records of Petitions, Complaints, Claims and Suggestions sent to the National Department of Health of Colombia between January 2102 and June 2013. In-depth interviews were conducted with users of health services, as well as officials of the Health Promoting Companies and Outlets for Right to Health of the Health Department of Bogota. The study is based on domains proposed by Frenk et al for effective access to health services. Users of this study found limitations starting at admission and search for care due to communication failures in accessing health services. For ongoing care services, they encountered barriers resulting from the need for authorizations, lack of availability of specialist medical appointments, surgical procedures and drug delivery. Based on the findings, the conclusion reached is that the barriers perceived by users generate negative perceptions and harmful consequences both for them and for their families.

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Barreras de acceso administrativo a los servicios de salud en población Colombiana, 2013

Resumen El objetivo de este estudio fue identificar la prevalencia y algunas caracteristicas asociadas al uso de casco en dos ciudades en Colombia; se usaron tanto tecnicas cuantitativas como cualitativas. La prevalencia de uso de casco en conductores de motocicleta fue mayor en Ibague (98,1%) que en Valledupar (82,4%); en pasajeros de Valledupar no fue superior a 2%. Los hombres tuvieron 2.1 veces mas posibilidad de usar el casco que las mujeres (IC 95: 1,6-2,7). Con las tecnicas cualitativas se identificaron factores que explicaron los motivos de uso/no uso del casco (higienicas, climaticas, esteticas y de seguridad) en Valledupar. El casco es una medida que protege ante un siniestro vial; no obstante, la prevalencia de uso no es la ideal. Es importante que las autoridades de transito, salud y la sociedad civil se organicen para disenar y aplicar medidas orientadas para fortalecer el uso de este elemento de proteccion personal.

https://www.scielosp.org/pdf/csc/2016.v21n12/3793-3801/es

Factors associated with the use of motorcycle helmets in two Colombian cities.

espanolintroduccion: La hipertension arterial sistemica (HAS) es un factor de riesgo para las enfermedades cronicas. En el mundo, un 20-25% de los adultos presentan HAS, de los que el 70% vive en paises en desarrollo. La enfermedad renal cronica hipertensiva (ERCH) es una complicacion de la hipertension arterial mal controlada. El presente estudio pretende analizar el comportamiento de la mortalidad por ERCH en Mexico entre 1998-2009. Material y metodos: Estudio longitudinal, con analisis de registros secundarios a ERCH procedentes de las bases de datos suministradas por el Instituto Nacional de Estadistica, Geografia e Informatica (INEGI), donde se analizan las tasas especificas por edad y sexo, y razones estandarizadas de mortalidad (REM) por estados y regiones. Se emplean metodos de georreferenciacion estatal. Resultados: En Mexico, entre 1998 y 2009 hubo 48,823 muertes por ERCH. La tasa de mortalidad estandarizada ascendio desde 3.35/100,000 habitantes a 6.74 (p Englishintroduction: High blood pressure (HBP) is a risk factor for chronic diseases. Worldwide, 20-25% of adults have hypertension, with 70% of them living in developing countries. Hypertensive renal disease (HRD) is a complication of insufficiently controlled hypertension. This study aims to analyze the behavior of HRD mortality in Mexico between 1998 and 2009. Methods: Longitudinal study with secondary analysis of HRD records from the databases provided by INEGI, which analyzes the specific rates by age and sex and standardized mortality ratio (SMR) by states and regions. Georeferencing methods are used statewide. Results: In Mexico from 1998 to 2009 there were 48,823 deaths from HRD. The standardized mortality rate rose from 3.35/100,000 inhabitants to 6.74 (p

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Comportamiento de la mortalidad por enfermedad renal crónica hipertensiva en la República Mexicana entre 1998-2009. Un problema creciente

Los accidentes del transito representan una de las principales causas de mortalidad, lesiones y discapacidad en personas a nivel mundial. Este fenomeno no es ajeno al contexto colombiano, con la particularidad del aumento del parque automotor durante las ultimas dos decadas con mayor numero de motocicletas, que representan mas del 50 % de las lesiones y muertes en los accidentes de transito. El trabajo fue autorizado por el comite de etica e investigacion, su proposito es identificar las estrategias mas efectivas que contribuyan a la prevencion y control de las lesiones causadas por el transito de motocicletas. Se realizo una revision sistematica de la literatura que incluyo estudios observacionales, investigacion cualitativa y estudios econometricos. Se recopilaron 30 articulos publicados entre el 2002 y el 2013. Estos estudios muestran la implementacion del uso del casco, de medidas de visibilidad, control de comportamientos de riesgo y la aplicacion de leyes donde se restringe la ingesta de alcohol, como las principales practicas orientadas a la prevencion de accidentes en los motociclistas. El presente estudio resalta la robustez del uso del casco como la principal medida para la prevencion y control de estos accidentes, reconoce la complejidad del fenomeno y la necesidad en consecuencia de la sinergia entre metodos cualitativos y cuantitativos para darleuna mayor explicacion; supone una base conceptual solida para la generacion de politicas publicas pertinentes que busquen la disminucion de la morbilidad, mortalidad y discapacidad asociada a este tipo de siniestros viales.

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Evidencias para la prevención y control de lesiones en motociclistas

El objetivo de este trabajo es caracterizar el patron de uso del cinturon de seguridad en dos ciudades de Colombia. Se realizo un estudio observacional mixto: Cuantitativo y cualitativo. Se estimaron prevalencias de uso y se llevaron a cabo analisis bivariados y multiples con tecnicas de modelos lineales generalizados. Tambien se realizaron grupos focales y entrevistas a profundidad para ahondar en las razones de uso de este elemento de proteccion. Se identifico un patron de uso mayor en Ibague (64,9%) que en Valledupar (10,2%); fue menor en hombres (35,4%) que en mujeres (44,8%); mayor en conductores de taxis (54,4%) que en conductores de camionetas y autos (24,9%). La posibilidad de uso fue 16 veces mayor en Ibague respecto a Valledupar (IC 95%: 12,8–20,4). Se identifico que el cinturon de seguridad no se reconoce como dispositivo de proteccion, se percibe incomodo y que resta movilidad al conductor dentro del vehiculo; su principal uso es para evitar una multa de transito. Se concluye que en el pais deben promoverse medidas de control, supervision y educacion para el uso efectivo de este dispositivo de seguridad.

https://dialnet.unirioja.es/descarga/articulo/6061518.pdf

Jorge Martín Rodríguez Hernández

Papers

Barreras de acceso administrativo a los servicios de salud en población Colombiana, 2013

Factors associated with the use of motorcycle helmets in two Colombian cities.

Comportamiento de la mortalidad por enfermedad renal crónica hipertensiva en la República Mexicana entre 1998-2009. Un problema creciente

Evidencias para la prevención y control de lesiones en motociclistas

Patrones de Uso de Cinturón de Seguridad Vial en Dos Ciudades de Colombia