Explore the vast range of titles available.

Since the introduction of the pneumococcal conjugate vaccine PCV-10 in 2011 its impact on acute otitis media (AOM) in children under five years of age in Colombia was unknown. We aimed to describe the clinical and sociodemographic characteristics of a prospective cohort of patients between 3 and 59 months old attending a children's hospital in Cartagena, Colombia. A prospective cohort study was conducted over a 12-month period from August 5th, 2022 to August 5th, 2023. Diagnosis of AOM was confirmed by an otorhinolaryngologist. Middle ear fluid samples were obtained by swab or tympanocentesis, depending on the presence of spontaneous drainage. Samples with a positive culture for S. pneumoniae were sent to the Colombian National Health Institute for serotyping. We also estimated the prevalence of AOM caused by S. pneumoniae, the serotype distribution and antimicrobial resistance patterns. A total of 61 patients were enrolled, 58% were male, the median age was 12 months (IQR: 8-24). The most common isolated microorganisms were Pseudomonas aeruginosa (14.8%), methicillin-resistant Staphylococcus aureus (13.1%), and Streptococcus pneumoniae (9,8%). Six cases of S. pneumoniae were identified, median age was 26.5 months (IQR: 8-45), none had any comorbidities, and only one had a history of previous AOM episodes. Five of them were vaccinated. The serotype distribution was 19A (67%), 10F and 35A (17%) each. Within the antimicrobial resistance patterns, serotype 19A was multidrug resistant (resistance to: beta-lactams, macrolides, lincosamides and TMP/SMX). S. pneumoniae continues to be a leading cause of AOM in our country. Serotype 19A accounts for 67% of these infections and exhibits a multidrug-resistant pattern similar to that observed in invasive pneumococcal disease. These findings are consistent with international data and provide a baseline for tracking future AOM trends related to S. pneumoniae after the introduction of the PCV-13 vaccine.

Background Asthma is one of the most common chronic respiratory conditions worldwide. Asthma-related economic burden has been reported in Latin America, but knowledge about its economic impact to the Colombian health care system and the influence of disease severity is lacking. This study estimated direct medical costs and health care resource utilization (HCRU) in patients with asthma according to severity in Colombia. Methods This study identified all-age patients who had at least one medical event linked to an asthma diagnosis (CIE-10: J45-J46) between 2004 and 2014. Patients were selected if they had a continuous enrollment and uninterrupted insurance coverage between January 1–2015 and December 31–2015 and were categorized into 4 different severity levels using a modified algorithm based on Leidy criteria. Healthcare utilization and costs were estimated in a 1-year period after the identification period. A Generalized Linear Model (GLM) with gamma distribution and log link was used to analyze costs adjusting for patient demographics. Results A total of 20,410 patients were included: 69.5% had mild intermittent, 18.0% mild persistent, 6.9% moderate persistent and 5.5% severe persistent asthma; with mean costs (SD) of $67 (134), $482 (1506), $1061 (1983), $2235 (3426) respectively (p < 0.001). The mean total direct cost was estimated at $331 (1278) per patient. Medication and hospitalization had the higher proportion in total costs (46% and 31% respectively). General physician visits was the most used service (57.2%) and short-acting β-2 agonists the most used medication (24%). Conclusions Health services utilization and direct costs of asthma were highly related to disease severity. Nationwide health policies aimed at the effective control of asthma are necessary and would play an important role in reducing the associated economic impact.

The aim of this study was to estimate the association between rotavirus vaccine (RV) introduction and reduction of all-cause diarrhea death rates among children in five Latin American countries that introduced RV in 2006. Diarrhea mortality data was gathered from 2002 until 2009 from the Pan American Health Organization Mortality Database for five “vaccine adopter” countries (Brazil, El Salvador, Mexico, Nicaragua, and Panama) that introduced RV in 2006 and four “control” countries (Argentina, Chile, Costa Rica, and Paraguay) that did not introduce RV by 2009. Time trend analyses were carried out, and effects and 95% confidence intervals (CI) were estimated. Each of the five vaccine adopter countries, except Panama, showed a significant trend in declining mortality rates during the post-vaccine period from 2006 to 2009, whereas no decline was seen in control countries during these years. Furthermore, trends of reduction of all-cause diarrhea mortality in both children <1 year of age and <5 years of age were greater in the post-vaccination period compared with the pre-vaccine period in all vaccine adopter countries (except for Nicaragua), whereas in control countries, a reverse pattern was seen with greater reduction in the early years from 2002 to 2005 versus 2006–2009. An estimatedtotal of 1777 of annual under-5 deaths were avoided in Brazil, El Salvador, Mexico, and Nicaragua during the post-vaccination period. All vaccine adopter countries, except Panama, showed a significant decrease in all-cause diarrhea-related deaths after RV implementation, even after adjusting for declining trends over time in diarrhea mortality. These data strongly support continuous efforts to increase vaccination coverage of RV vaccines, particularly in countries with high levels of child mortality from diarrhea.

Background Cardiovascular diseases (CVDs) and diabetes mellitus (DM) are among the leading cause of morbidity and mortality in low-and-middle-income countries (LMICs) but evidence in these contexts regarding the effectiveness of primary prevention interventions taking into account patient adherence is scarce. We aimed to evaluate the effectiveness of a cardiovascular risk management program (De Todo Corazón - DTC program) in the incidence of the first cardiovascular outcome (CVO) in a low-income population from the Caribbean region of Colombia using adherence as the main variable of exposure. Methods A retrospective propensity score-matched cohort study was conducted. Adult patients with a diagnosis of hypertension (HTA), diabetes mellitus (DM), chronic kidney disease (CKD), or dyslipidemia affiliated to the DTC program between 2013 and 2018 were considered as the study population. Patients with 30 to 76 years, without a history of CVOs, and with more than 6 months of exposure to the program were included. The main outcome of interest was the reduction in the risk of CVOs (stroke, myocardial infarction, or congestive heart failure) based on the adherence to the intervention (attendance to medical appointments with health care professionals and the control of cardiovascular risk factors). Kaplan Meier curves and propensity score-matched Cox regression models were used to evaluate the association between adherence and the incidence of CVOs. Results A total of 52,507 patients were included. After propensity score matching, a sample of 35,574 patients was analyzed. Mean (SD) exposure time was 1.97 (0.92) years. Being adherent to the program was associated to a 85.4, 71.9, 32.4 and 78.9% risk reduction of in the low (HR 0.14; 95% CI 0.05–0.37; p  < 0.001), medium (HR 0.28; 95% CI 0.21–0.36; p  < 0.001), high-risk with DM (HR 0.67; 95% CI 0.43–1.04; p  = 0.075) and hig-risk without DM (HR 0.21; 95% CI 0.09–0.48; p < 0.001) categories, respectively. Conclusions The DTC program is effective in the reduction of the risk of CVOs. Population-based interventions may be an important strategy for the prevention of CVOs in underserved populations in the context of LMICs. A more exhaustive emphasis on the control of diabetes mellitus should be considered in these strategies.

Background According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous cardiovascular events reported. Methods We retrospectively reviewed the individual records from the hospitalizations database of 64,668 patients of cardiovascular risk management program from July 2014 to December 2015. We used a propensity score matching cohort analysis for this study. The Kaplan–Meier curves were constructed for the cardiovascular events related endpoints and matched Cox-regression analysis to estimate associations of a history of Type 2 DM with cardiovascular outcomes during 1.5 years of follow-up. A formal sensitivity analysis using The Breslow-Day and Tarone Homogeneity tests was conducted. Results Out of 56,351 patients with no previous cardiovascular events records, 19,368 (34.4%) patients were found to suffer Type 2 DM. Using propensity scores for Type 2 DM, we gathered a cohort of 18,449 pairs of patients with and without Type 2 DM who were balanced on 22 baseline characteristics. A first cardiovascular event occurred in 650 (3.5%) and 403 (2.1%) matched patients with and without Type 2 DM, respectively, during 1.5 years of follow-up. Type 2 DM was associated with first cardiovascular event (HR 1.69; 95% CI 1.43–2.00; p  = 0.000), AMI (HR 1.79; 95% CI 1.45–2.20; p = 0.000) and stroke (HR 1.54; 95% CI 1.18–2.02; p  = 0.001). Hazard ratios (95% CIs) for the association of Type 2 DM with all-cause mortality, cardiovascular mortality and all-cause hospitalization were 1.36 (1.21–1.53; p  < 0.001), 1.52 (1.12–2.08; p 0.004), and 1.20 (1.21–1.53; p < 0.001), respectively. Conclusion Type 2 DM resulted to be a significant independent risk factor for first cardiovascular event in Colombian Caribbean poor population with no previous records of cardiovascular events.

•ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S COVID-19 booster vaccinations are effective to prevent Mu and Delta variants.•For Omicron, booster doses of mRNA vaccines were the most effective to prevent symptomatic COVID-19. We carried out a study to estimate the vaccine effectiveness (VE) of homologous vaccination schedules against COVID-19, using data from mandatory information systems from Bogota, Colombia. A test-negative case-control study in adults from Bogota (Colombia), between March 1st of 2021 and February 25th of 2022. We assess VE among symptomatic COVID-19 cases during the Mul, Delta, and Omicron predominance periods in Bogota, with controls matched by sex, age (±5 years), and date of testing (±7 days), using a case:control ratio of 1:1. We selected homologous vaccination schedules with ChAdOx1, CoronaVac, BNT162b2, mRNA-1273, and Ad26.COV2.S. VE was reported as one minus the odds ratio in adjusted conditional logistic regressions, with their 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant. 52,913 cases were matched to controls, 16,722 for Mu, 14,094 for Delta, and 22,097 for Omicron. VE was high against COVID-19 during Mu weeks with full vaccination using the monovalent BNT162b2 (VE: 69; 95% CI, 65 to 72) vaccine and ChAdOx1 (VE: 64; 95% CI, 31 to 81) and significantly lower with CoronaVac (P < 0.001) and Ad26.COV2.S (P = 0.005). During Delta, VE against COVID-19 was higher with BNT162b2 (VE: 55; 95% CI, 51 to 58). The VE for COVID-19 cases during Omicron was higher with a booster dose of monovalent BNT162b2 (VE: 45; 95% CI, 34 to 54). The VE of primary series and booster for ChAdOx1, Ad26.COV2.S, and CoronaVac did not show protection for Omicron. Our study provides further evidence on the protective effect of mRNA vaccines for Omicron, and warrant that the duration of protection against symptomatic infection may last for only a few months.

Montes de María, a post-conflict zone in Colombia, is a subregion with widespread health-related problems in children and adolescents. We reviewed official documents (development plans) at national (Colombia) and local level (San Juan Nepomuceno, El Carmen de Bolívar and San Jacinto, Department of Bolívar) dedicated to aspects of childhood and adolescent policies, with a focus on health, from 2012 onwards. Eight semi-structured interviews with actors and members of municipal governments between June 2019 and May 2020 were carried out and analyzed. The formulation and implementation of public policies for children and adolescents that impact development indicators is not yet a reality in the three municipalities of Montes de María analyzed. The lack of a regulatory and indicative framework for the management and development of children and adolescents does not provide tools that contribute to work on problems such as low vaccination coverage, low coverage of higher education, and a high rate of teenage pregnancy. Montes de María, zona de postconflicto en Colombia, es una subregión con problemas generalizados en población infante y adolescente. Se llevó a cabo un estudio descriptivo con enfoque cualitativo que revisó documentos oficiales a nivel nacional (Colombia) y local (municipios de San Juan Nepomuceno, El Carmen de Bolívar y San Jacinto en el Departamento de Bolívar) dedicados a aspectos de las políticas de infancia y adolescencia de 2012 en adelante. También se analizaron los resultados de ocho entrevistas semiestructuradas a actores y miembros de los gobiernos municipales entre junio de 2019 y mayo de 2020. La formulación e implementación de políticas públicas para niños y adolescentes que inciden en los indicadores de desarrollo aún no es una realidad en los tres municipios de los Montes de María analizados. La falta de un marco normativo e indicativo para la gestión y desarrollo de niños y adolescentes no brinda herramientas que contribuyan a trabajar en problemas como la baja cobertura de vacunación, baja cobertura de educación superior y a una alta tasa de embarazo adolescente.

Management of rheumatoid arthritis (RA) in many Latin-American countries is impaired by fragmentation and scarce healthcare provision, resulting in obstacles to access, diagnosis, and treatment, and consequently in poor health outcomes. The aim of this study is to propose a comprehensive care program as a model to provide healthcare to RA patients receiving synthetic DMARDs in a Colombian setting by describing the model and its results. Health outcomes were prospectively collected in all patients entering the program. By protocol, patients are followed up during 24 months using a treat-to-target strategy with a patient-centered care (PCC) model, meaning that a patient should be seen by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times a year according to disease activity by DAS28. Otherwise, patients receive standard therapy. The incidence of remission and low disease activity (LDA) was calculated by periods of follow-up. A total of 968 patients entered the program from January 2015 to December 2016; 80.2% were women. At baseline, 41% of patients were in remission, 17% in LDA and 42% in MDS/SDA. At 24 months of follow-up, 66% were in remission, 18% in LDA and only 16% in MDS/SDA. Regarding DAS28, the mean at the beginning of the time analysis was 3.1 (SD 1.0) and after 24 months it was 2.4 (SD 0.7), showing a statistically significant improvement (p < 0.001). In all patients, the reduction of disease activity was 65% (95% CI, 58–71). Patients entering the PCC program benefited from a global improvement in disease activity in terms of DAS28.

Objective: To measure out-of-pocket expenditures of patients with type 2 diabetes who attended an outpatient disease management program.Methodology: A descriptive study was conducted among outpatients with type 2 diabetes who attended a disease management program between June 18 and July 18, 2019. We used a self-admi-nistered questionnaire on out-of-pocket expenses in the last three months, including calculating ex-penses dedicated to food for diabetics, laboratory tests, supplies, radiology, medical appointments, and transportation. Out-of-pocket expenses are measured as the sum of the money spent in each category. Data were analyzed using absolute and relative frequencies, means, and standard devia-tions. The values are shown in US dollars for 2019.Results: The average expenditure was$60.76 (SD: 154.1, minimum: $ 2.93; maximum:$1.500.26). Medication accounted for 38.29% of total expenses (mean: $ 23.11, SD: $47.95), followed by trans-portation at 21.27% (mean = 12.83, SD = 21.75).Conclusion: Despite the broad coverage of Colombian healthcare for chronic diseases, this expen-diture could indicate problems with adequate access to the healthcare system, causing personal spending to improve the patient’s health conditions.Keywords: Diabetes mellitus type 2, delivery of health care, health expenditure, out-of-pocket pay-ments, Colombia.

•Monovalent rotavirus vaccine is effective in children between 6 and 12 months old in Colombia.•Lower effectiveness in children >12 months requires further assessment.•The results could confirm previous assessments on rotavirus vaccine effectiveness. To assess the effectiveness of the monovalent rotavirus vaccine (RV1) to prevent rotavirus diarrhea admissions to emergency departments (ED) in Colombia. A multicenter case-control study was carried out in six Colombian cities from 2011 to January, 2013. Cases were laboratory confirmed rotavirus diarrhea patients admitted to ED of selected health centers. Controls were patients with non-rotavirus diarrhea. Vaccination status was card-confirmed. Vaccine effectiveness and 95% confidence intervals (CI) were calculated from the conditional logistic regression models using the formula 1−adjusted odds ratio×100. 1051 fecal samples were collected from 193 cases and 858 controls. Vaccination history was confirmed on 173 cases (90%) and 801 controls (93%). Among the rotavirus-positive samples with vaccination history, 57% were G2P[4], 9.8% G9P[8], 6% G9P[6]. Median age of cases (17 months) was greater than controls (15 months) (P<0.001), and mothers of cases had lower level of education (P=0.025). The adjusted effectiveness was 79.19% (95% CI, 23.7 to 94.32) among children 6–11 months of age and −39.75% (95% CI, −270.67 to 47.24) among those >12 months of age. Against overnight rotavirus hospitalizations, RV1 provided protection of 84.42% (95% CI, 22.68 to 96.86) among children 6–11 months of age, and −79.49% (95% CI, −555.8 to 51.08) among those >12 months. RV1 provided significant protection against rotavirus hospitalization among children under 1 year of age in the Colombian setting. The observation of lower effectiveness in children >12 months requires further assessment.