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To determine the incidence of pulmonary tuberculosis (TB) in inmates, factors associated with TB, and the time to sputum smear and culture conversion during TB treatment. Prospective cohort study. All prisoners with respiratory symptoms (RS) of any duration were evaluated. After participants signed consent forms, we collected three spontaneous sputum samples on consecutive days. We performed auramine-rhodamine staining, culturing with the thin-layer agar method, Löwestein-Jensen medium and MGIT, susceptibility testing for first-line drugs; and HIV testing. TB cases were followed, and the times to smear and culture conversion to negative were evaluated. Of 9,507 prisoners held in four prisons between April/30/2010 and April/30/2012, among them 4,463 were screened, 1,305 were evaluated for TB because of the lower RS of any duration, and 72 were diagnosed with TB. The annual incidence was 505 cases/100,000 prisoners. Among TB cases, the median age was 30 years, 25% had <15 days of cough, 12.5% had a history of prior TB, and 40.3% had prior contact with a TB case. TB-HIV coinfection was diagnosed in three cases. History of prior TB, contact with a TB case, and being underweight were risk factors associated with TB. Overweight was a protective factor. Almost a quarter of TB cases were detected only by culture; three cases were isoniazid resistant, and two resistant to streptomycin. The median times to culture conversion was 59 days, and smear conversion was 33. The TB incidence in prisons is 20 times higher than in the general Colombian population. TB should be considered in inmates with lower RS of any duration. Our data demonstrate that patients receiving adequate anti-TB treatment remain infectious for prolonged periods. These findings suggest that current recommendations regarding isolation of prisoners with TB should be reconsidered, and suggest the need for mycobacterial cultures during follow-up.

(1) Background: Evidence on the association between air pollution and the risk of exacerbations of chronic obstructive pulmonary disease (COPD) is scarce and inconsistent. We aimed to analyze the association between long-term exposure to particulate matter with a diameter of less than 2.5 µm (PM2.5) and nitrogen dioxide (NO2) and exacerbation of COPD (COPD-E) in Bogotá, Colombia. (2) Methods: We conducted a retrospective cohort study of 722 COPD patients in the AIREPOC program of the Fundación Neumológica Colombiana between 2018 and 2021. Exposure to PM2.5 and NO2 was estimated for residential locations using the inverse squared-distance weighted regression (IDWR) method. Hazard ratios (HRs) were calculated for the first COPD-E during follow-up using Cox models, adjusted for meteorological, demographic, and clinical variables. (3) Results: COPD-E was associated with long-term exposure to PM2.5 (HR: 1.03, 95%CI: 1.02–1.05) and NO2 (HR: 1.05, 95%CI: 1.03–1.07), controlling for the effect of quality of life, history of COPD-E, forced expiratory volume in one second (FEV1) pre-bronchodilator, and exposure to solar radiation. An association was found between COPD-E and concentrations ≥ 25 µg/m3 of NO2 (HR: 1.49, 95%CI: 1.12–1.98) but not with concentrations ≥ 15 µg/m3 of PM2.5. (4) Conclusions: This study suggests that people with COPD exposed to higher concentrations of PM2.5 and NO2 had an increased risk of COPD-E. Solar radiation was also associated with an increased risk of COPD-E. The results highlight the importance of continuing efforts to reduce air pollution. COPD patients should be aware of air quality indices and follow the recommendations, as well as participate in air governance spaces.

Background The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. Methods Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01–2015 and May-31–2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. Results From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1–2 was 90.0% (Kappa = 0.59) and 1–3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1–2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1–3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). Conclusions Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation.

On June 2, 2021, the Colombian Ministry of Health and Social Protection, through Resolution No. 777, laid down the requirements to resume all restricted economic and social activities. Similarly, said Resolution established the Municipal Epidemiological Resilience Index (IREM by its acronym in Spanish) as a tool to support decision-making regarding this economic reactivation amid the third epidemic peak of COVID-19 in the country. The purpose of this article is to perform a critical analysis of the technical aspects of the IREM and to explore the feasibility of its implementation as a support for the resumption of economic and social activities as proposed in the Resolution. The present critical analysis emphasizes on the lack of a clear definition of epidemiological resilience that is consistent with the scientific literature. Furthermore, the face and content validity of the index, as well as the construct validity of the index and of its dimensions, are called into question and, therefore, the feasibility of using it to determine said resumption.

Exacerbations of chronic obstructive pulmonary disease (COPD-E) have been associated with levels of air pollution. The occurrence of COPD-E is associated with increased mortality in this population. To determine the association between long-term exposure to PM and NO , and the frequency of COPD-E in patients belonging to AIREPOC, an institutional integrated care program for COPD in Bogota, Colombia. Retrospective cohort study included patients with COPD living in Bogotá, between 2018 and 2021, who received health care in the AIREPOC program. Each patient´s home address was geolocated. Information from local air quality network stations was used to estimate daily and annual mean PM and NO exposure level for each patient using the inverse distance squared weighted regression (IDWR) method. The effect of PM and NO concentrations categorized at 15 µg/m and 25 µg/m respectively on the frequency of COPD-E was estimated using a zero-truncated negative binomial model adjusted for potential confounders. Goodness-of-fit was assessed by residuals. During the observation period, 580 COPD-E occurred in 722 patients. Significant associations were found between COPD-E and NO concentrations ≥25 µg/m (incidence density ratio, RDI: 1.29, 95% CI: 1.02-1.67) after adjustment for sun exposure, COPD severity, depression, and ambient humidity. No association was found between the frequency of COPD-E and PM concentrations ≥15µg/m . Prolonged exposure to high levels of NO increases the frequency of COPD exacerbations in patients residing in Bogotá. These results highlight the importance of strengthening air quality control measures and educating people with COPD to know and interpret the local air quality indices and to follow the recommendations derived from its alterations.

IntroductionAir pollution poses a risk for people with Chronic Obstructive Pulmonary Disease (COPD). This study estimated the short-term effect of variations in air pollutant concentrations on exacerbations of COPD (COPD-E) in Bogotá, Colombia.MethodsWe performed an ecological time series study from 2014 to 2021 to evaluate the short-term effect of fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) levels on COPD-E treated in the emergency and hospitalization services. Daily counts of patients with COPD-E discharge diagnoses were obtained from the National Health Information System, and daily measurements of PM2.5, NO2, and O3 concentrations and meteorological data were obtained from air monitoring stations. A Generalized Additive Model was used with Distributed Lag Non-Linear Models to control for confounders.ResultsAn increase of 10 μg/m3 in PM2.5 and O3 was associated with increased COPD-E admissions (lagged 0-3 days) with Relative Risk (RR) of 1.04 (95%CI: 1.02 -1.07) and RR:1.03 (95%CI:1.01 – 1.04), respectively. During the rainy season and minimum temperature of the series, for every 10 μg/m3 increase in PM2.5 concentration, COPD-E admissions (lagged 0-3 days) increased with RR 1.03 (95%CI: 1.01-1.06). A higher magnitude of association was observed in men (PM2.5, 1.04 95%CI:1.01 – 1.06 and O3, 1.04 95%CI:1.02 – 1.05, lag 0-7 days) than in women.ConclusionsA higher air pollution was associated with more COPD-E. These results highlight the importance of actions aimed at improving air quality.

Background/Aims: Recent studies have implicated a region on chromosome 1q21-23, including the NOS1AP gene, in susceptibility to schizophrenia. However, replication studies have been inconsistent, a fact that could partly relate to the marked psychopathological heterogeneity of schizophrenia. The aim of this study is to evaluate association of polymorphisms in the NOS1AP gene region to schizophrenia, in patients from a South American population isolate, and to assess if these variants are associated with specific clinical dimensions of the disorder. Methods: We genotyped 24 densely spaced SNPs in the NOS1AP gene region in a schizophrenia trio sample. The transmission disequilibrium test (TDT) was applied to single marker and haplotype data. Association to clinical dimensions (identified by factor analysis) was evaluated using a quantitative transmission disequilibrium test (QTDT). Results: We found significant association between eight SNPs in the NOS1AP gene region to schizophrenia (minimum p value = 0.004). The QTDT analysis of clinical dimensions revealed an association to a dimension consisting mainly of negative symptoms (minimum p value 0.001). Conclusions: Our findings are consistent with a role for NOS1AP in susceptibility to schizophrenia, especially for the ‘negative syndrome’ of the disorder.

We greatly appreciate the comments made by Rojas-Botero et al.1 on our paper entitled “Critical reflections on the Municipal Epidemiological Resilience Index used for public policy decision-making regarding the control of the COVID-19 pandemic in Colombia”.2 We acknowledge that public health, understood as the well-being of the community, should be the focus of all our efforts as health professionals. In this sense, decision-making amid a major emergency, such as the one we are currently experiencing due to the COVID-19 pandemic, requires a balanced and calm judgment that considers both the general context and local specificities, as well as the best available scientific evidence, that is, evidence that not only supports decisions, but also prioritizes benefits over risks.

Objective. This study sought to determine gender differences in theinterpretation of tuberculosis (TB) in a group of patients from thecity of Medellín. Methodology. This was a qualitative study, withthe grounded theory method. Twelve semistructured interviewswere applied to patients from both genders who were cured of TB.The sample was selected through convenience and for analysisthe information was categorized through the Atlas Ti tool. Results.Regarding the symptoms, the most reported is cough, but menmanifest expectoration more frequently. Men overstated thesymptoms, while women tend to minimize them. Women reportmental impairment and emotional-type manifestations producedby the disease. Men and women expressed ignorance about thedisease upon diagnosis. Both manifested fear of infection, workincapacity, loss of employment, rejection by others, and death.Also highlighted is the importance of family support and of thehealthcare personnel. Women expressed shame in that othersknew of their disease and mentioned greater intolerance withtaking the medications. Conclusion. The gender role constructedculturally constitutes the central axis that explains how men andwomen interpret TB and can be modified by educational andaccompaniment processes. Family support plays an important rolein the healing process. Although common aspects exist, delvinginto the gender differences against the interpretation of TB maypermit a different approach of the disease and better control of it.Key words: tuberculosis; gender identity; fear; social support. Objetivo. Determinar las distintas interpretaciones con respecto a la tuberculosis (TB) a partir de las diferencias de género en un grupo de pacientes de la ciudad de Medellín. Metodología. Estudio cualitativo, con el método de la teoría fundamentada. Se aplicaron 12 entrevistas semiestructuradas a pacientes de ambos géneros curados de TB. La muestra se seleccionó por conveniencia y para el análisis se categorizó la información mediante la herramienta Atlas Ti. Resultados. Con relación a los síntomas el más expresado es la tos, pero los hombres manifiestan con más frecuencia la expectoración. Ellos sobredimensionan los síntomas, mientras las mujeres tienden a minimizarlos. Estas, a su vez, refieren deterioro mental y manifestaciones de tipo emocional producidas por la enfermedad. Tanto hombres como mujeres expresaron desconocimiento sobre la enfermedad en el momento del diagnóstico. Ambos manifestaron miedo al contagio, incapacidad laboral, pérdida del empleo, rechazo de los otros y a la muerte. También resaltaron la importancia del apoyo familiar y del personal de salud. Las mujeres expresaron vergüenza de que otros supieran de su enfermedad y mencionaron mayores intolerancias con la ingesta de los medicamentos. Conclusión. El rol de género, construido culturalmente, constituye el eje central que explica la manera como hombres y mujeres interpretan la TB, lo que puede ser modificado por procesos educativos y de acompañamiento. El apoyo familiar juega un papel importante en el proceso de curación. Aunque hay aspectos comunes, la profundización en las diferencias de género frente a la interpretación de la TB, puede permitir un abordaje diferente de la enfermedad y un mejor control de la misma

Many countries in the world are facing challenges to reach the WHO proposed target of HPV vaccination of 90 % of girls by the age of 15. A population-based cross-sectional survey was conducted in Manizales, Colombia to identify sociodemographic factors and components of the health belief model related to HPV vaccination in the 2003, 2004, and 2005 birth cohorts of girls and their parents targeted by the national HPV vaccination program in 2012, 2013, and 2014. Complementary log-log generalized linear models were used to obtain adjusted Prevalence Ratios (aPR) and 95 % confidence intervals (CI). A lower prevalence of HPV vaccination was observed in girls of the 2004 (aPR 0.82; 95 % CI 0.71–0.92) and 2005 (aPR 0.61; 95 % CI 0.52–0.71) cohorts compared to the 2003 cohort. The higher scores of perceived benefits by girls (aPR 1.06; 95 % CI 1.05–1.08) or their parents (aPR 1.05; 95 % CI 1.03–1.06) were associated to a higher prevalence of HPV vaccination of the girls. Conversely, this prevalence decreased with perceived barriers by girls (aPR 0.94; 95 % CI 0.91–0.96) and parents (aPR 0.91; 95 % CI 0.88–0.94). Parent's education lower attainment, lower socioeconomic stratum, and subsidized (public) health insurance were related to decreased likelihood of HPV vaccination. The results suggest that campaigns for HPV vaccination require effective education strategies to improve public perception of the vaccine's safety and benefits. Decision-makers and implementers must address also other social determinants such as disparities in access to education by parents, the SES, and the type of health insurance to improve HPV vaccination coverage. •HPV vaccine uptake in Colombia is below the WHO target.•Sociodemographic factors and health beliefs influencing HPV vaccine uptake were assessed in girls and their parents.•Parental education, socioeconomic status, and health insurance correlated with lower vaccination rates.•Lower perceived benefits and higher perceived barriers in Girls and parents were also related to vaccine uptake.•Improved HPV vaccination in Colombia requires targeted education and addressing social determinants.