Prevalence of HIV, Treponema pallidum and Their Coinfection in Men Who Have Sex with Men, Medellín-Colombia

Introduction

In Colombia, HIV and gestational syphilis are notifiable events; however, they are poorly investigated infections in men who have sex with men (MSM).

Objective

To determine the prevalence of HIV, Treponema pallidum, and their co-infection in MSM treated at a Health Services Provider Institution (HSPI) specialized in infectious diseases from Medellín.

Methods

Cross-sectional study with 3454 MSM. Prevalence was determined with its 95% confidence interval; associated factors were identified using Fisher's Exact test, Pearson's Chi-square, and trend Chi-square. Multivariate adjustment was performed using logistic regression. Analyses were performed using SPSS 29.0.

Results

The prevalence of HIV was 5.7%, T. pallidum 0.7%, and co-infection 0.6%. The prevalence of HIV was higher in MSM aged between 24-40 years (7.5%), with technical or university studies (10.0%), without health insurance affiliation (12.4%), and those who have had a sexual partner with HIV (36.2%). T. pallidum was higher in MSM without health insurance affiliation (3.4%), who had sexual relations with people diagnosed with an STI (5.9%), and a sexual partner with HIV (12.1%). Co-infection was higher in MSM without health insurance affiliation (2.7%), and those who had a partner with HIV (11.2%).

Conclusion

Compared with the general Colombian population, MSM have a higher risk of HIV, but are similar to T. pallidum. The identification of the main associated factors in each infection demonstrates the need to prioritize subgroups of MSM that show greater vulnerability to these events. This research demonstrates the urgency of implementing health education strategies in MSM who have a sexual partner with HIV or other STIs. Large gaps were also evident in the magnitude of the three events according to the health insurance affiliation regime, which demonstrates problems of social and health injustice, especially with MSM without health insurance affiliation.

Understanding antibiotic knowledge, attitudes, and practices: a cross-sectional study in physicians from a Colombian region, 2023

BACKGROUND

Antibiotic resistance has been identified as a global health threat. Knowledge, attitudes, and inappropriate prescription practices of antibiotics by physicians play a crucial role in this problem. In Colombia, research addressing this issue is scarce.

METHODS

A cross-sectional study involving 258 physicians was conducted. A scale with questions on sociodemographic aspects, level of education, satisfaction with antibiotic education received, and knowledge, attitudes, and practices was administered. The scale was designed for each item to be analyzed individually or as a total score ranging from 0 to 100 (0 being the lowest and 100 the highest).

RESULTS

31.5% of physicians rated the education received on antibiotics as fair to poor. The knowledge score was 80.1 (IQR 70.5-87.5); however, 25.2% agreed to some extent that amoxicillin is useful in treating most respiratory infections, and 15% agreed that antibiotics are effective in treating upper respiratory infections. Attitudes scored 80.2 (IQR 75.0-86.5), with 99% stating that bacterial resistance is a public health problem in Colombia, but only 56.9% considering it a problem affecting their daily practice. Practices scored 75.5 (IQR 68.8-81.2), and 71.7% affirmed that if they refuse to prescribe antibiotics to a patient who does not need them, the patient can easily obtain them from another physician. General practitioners were found to have lower scores in all three indices evaluated.

CONCLUSION

The study reveals enduring misconceptions and concerning practices in antibiotic prescription, particularly among general practitioners. Enhancing knowledge necessitates the implementation of continuous medical education programs that focus on updated antibiotic guidelines, and resistance patterns. Fostering positive attitudes requires a culture of trust and collaboration among healthcare professionals. Practical enhancements can be realized through the establishment of evidence-based prescribing guidelines and the integration of regular feedback mechanisms. Moreover, advocating for the inclusion of antimicrobial stewardship principles in medical curricula is crucial, emphasizing the significance of responsible antibiotic use early in medical education.

Metabolically Unhealthy Normal Weight: Prevalence and Associated Factors in an Adult Population from Northwest Colombia

Background and Aim

Individuals with a normal weight may have metabolic alterations at risk for chronic non-communicable diseases. The prevalence of this condition and associated factors have not been reported in Latin American populations. We aimed to estimate the presence and associated factors of Metabolically Unhealthy Normal Weight (MUNW) in adults from a public program for the control and prevention of chronic diseases in Medellín, Colombia.

Methods

Cross-sectional study. Overweight and normal weight were characterized according to the absence or presence of one or more components of the metabolic syndrome, obtaining four phenotypes: Metabolically Healthy Normal Weight (MHNW), MUNW (phenotype of interest), Metabolically Healthy Overweight (MHO), and Metabolically Unhealthy Overweight (MUO). The association of these phenotypes with sociodemographic variables of lifestyles and increased waist circumference was conducted by using logistic regression.

Results

In 37,558 individuals (72.7% women), the prevalence of MUNW was 23.3%. Among the additional phenotypes, MUO was found to be more prevalent (71.6%), while MHNW and MHO were very slightly common, 2% and 3.1%, respectively. In a multiple model, the factors associated with MUNW were age over 60 years (trend [OR 1.56 95% CI 0.97-2.52] p-value = 0.066), living in a rural area ([OR 1.58 95% CI 1.09-2.29] p-value = 0.015), and increased waist circumference ([OR 1.68 95% CI 1.45-1.95] p-value < 0.001). Male gender was inversely associated with all phenotypes (P < 0.05).

Conclusion

Almost a quarter of the analyzed population presented MUNW. People living in a rural area and over 60 years old were more likely to present MUNW. Men were less likely to present the weight phenotypes studied, although they could have been underrepresented.

Social representations of cancer in patients from Medellín, Colombia: a qualitative study

Background

Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia.

Methods

This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages.

Results

SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic.

Conclusion

In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.

Antibiotic Self-Medication Patterns and Associated Factors in the Context of COVID-19, Medellín, Colombia: A Survey Based Cross Sectional Study

Objective

To describe the frequency of self-medication with antibiotics and its associated factors in Medellín, Colombia.

Methods

A descriptive study was conducted on 778 individuals surveyed regarding sociodemographic characteristics, self-medication with antibiotics, reasons for using these drugs, and types of antibiotics used. The analysis was performed in SPSS using absolute and relative frequencies with their corresponding confidence intervals, chi-square test, and logistic regression.

Results

The frequency of self-medication with antibiotics was 46% (95% CI 42.5-49.5), with 47.4% (95% CI 42.2-52.5) of the population using antibiotics without medical prescription for flu-like symptoms related to COVID-19. Amoxicillin (33.7%), azithromycin (10.9%), and cephalexin (4.7%) were the most used antibiotics. The main factors associated with self-medication were age group, zone of residence, and lack of information on the appropriate use of these medications.

Conclusion

The city exhibits a high frequency of self-medication with antibiotics, predominantly in conditions where they are ineffective, such as flu-like symptoms related to COVID-19. These findings highlight the contribution of the COVID-19 pandemic to bacterial resistance through self-medication and underscore the need to implement targeted actions to control the use of these medications.

HIV in Three Groups of Young People from Medellín: General Population, Organizations for People with Socioeconomic Vulnerability, and Men Who Have Sex with Other Men

Introduction

In Colombia, there are no studies that analyze the effect of socioeconomic vulnerability and belonging to the group of men who have sex with other men (MSM) on the prevalence of HIV in young people.

Objective

To compare the prevalence of HIV in three groups of young people from Medellín-Colombia: general population, socioeconomic vulnerability and MSM.

Methods

This cross-sectional analytical study included 2449 young people from the general population, 1736 from institutions that serve young people in situations of socioeconomic vulnerability, and 2269 MSM. The prevalence of infection in each group was determined, statistical differences were identified using Pearson's Chi-square and Trend's Chi-square, and crude and adjusted odds ratios were estimated using logistic regression with 95% confidence intervals. Analyses were performed in SPSS 29.0.

Results

HIV prevalence was 0.8% in the general population group, 1.3% in young people with socioeconomic vulnerability, and 5.6% in MSM. The groups with the highest HIV were as follows: (i) in MSM it was 4.1 compared to the general population, (ii) between 25-28 years of age it was 2.9 times compared to those under 20 years, (iii) in men it was 10 times that registered in women, (iv) in young people with primary, secondary, technical and university studies it was 7.1; 6.7; 11.0 and 14.5 times that found in those who did not register studies, (v) in affiliates of the subsidized health regime it was 2.2 times and in those without affiliation 2.4 times compared to the infection in affiliates of the contributory health regime.

Conclusion

HIV prevalence was high, and explained by socioeconomic vulnerability, having sex between men, gender, age, education, and health affiliation, demonstrating the intersectionality of determinants of the health system, socioeconomic status, and determinants individuals in the occurrence of HIV in young people in Medellín.

Influence of Positive Thinking Ideology on Physician Representations of Cancer

To understand the influence of positive thinking ideology on cancer representations among physicians in the city of Medellín.

METHODS

This qualitative study was conducted on the basis of the theoretical and methodological elements of Corbin and Strauss's grounded theory. Fourteen physicians were included and selected according to the criteria of maximum variation for education, years of study, and personal and family history of cancer. The information was collected through semi-structured interviews and analyzed with open, axial, and selective coding.

RESULTS

the ideology of positive thinking has managed to permeate the medical discourse and the representations that they form about the etiology and treatment of cancer. Physicians place the mind, emotions, attitude, and positive thinking as determinants of the origin of the disease and the response to therapy. To argue this link, they use two strategies: (i) a sophisticated and specialized discourse that involves relationships among thoughts, genetics, the neurological, immune and endocrine system and (ii) a mystical and less rational discourse that emphasizes the omnipotence of the mind and thoughts. In no case was the idea of positive thinking rejected or in disagreement with this style of thinking expressed.

CONCLUSION

The fact of linking the disease with mental factors refers to the mind-body dualism and generates a responsibility of the patients on the etiology and therapeutics of the disease, as well as an erasure of the social and political determinants of cancer. The technical discourse and the symbolic capital of physicians offer scientific legitimacy to these ideas and can become performative for patients.

Social determination of malaria in pregnancy in Colombia: a critical ethnographic study

BACKGROUND

The meanings and experiences related to malaria in pregnancy (MiP) and its processes of social determination of health (PSDH) have not been reported in the world scientific literature. The objective was to understand the meanings and experiences of MiP, and to explain their PSDH in an endemic area from Colombia, 2022.

METHODS

Critical ethnography with 46 pregnant women and 31 healthcare workers. In-depth and semi-structured interviews, focus group discussions, participant and non-participant observations, and field diaries were applied. A phenomenological-hermeneutic analysis, saturation and triangulation was carried out. The methodological rigor criteria were reflexivity, credibility, auditability, and transferability.

RESULTS

At the singular level, participants indicated different problems in antenatal care and malaria control programmes, pregnant women were lacking knowledge about MiP, and malaria care was restricted to cases with high obstetric risk. Three additional levels that explain the PSDH of MiP were identified: (i) limitations of malaria control policies, and health-system, geographic, cultural and economic barriers by MiP diagnosis and treatment; (ii) problems of public health programmes and antenatal care; (iii) structural problems such as monetary poverty, scarcity of resources for public health and inefficiency in their use, lacking community commitment to preventive actions, and breach of institutional responsibilities of health promoter entity, municipalities and health services provider institutions.

CONCLUSION

Initiatives for MiP control are concentrated at the singular level, PDSH identified in this research show the need to broaden the field of action, increase health resources, and improve public health programmes and antenatal care. It is also necessary to impact the reciprocal relationships of MiP with economic and cultural dimensions, although these aspects are increasingly diminished with the predominance and naturalization of neoliberal logic in health.

Knowledge, Attitudes, and Practices Regarding Antibiotic Sales in Pharmacies in Medellín, Colombia 2023

OBJECTIVE

Describe the knowledge, attitudes, and practices regarding the sale of antibiotics in pharmacies in Medellín, Colombia.

METHOD

A cross-sectional descriptive study was conducted in 277 selected pharmacies using a stratified sampling method with proportional allocation to represent all areas of the city. Knowledge, attitudes, and practices (KAPs) were assessed using a scale, analyzed with absolute and relative frequencies for each item, and represented in a global score ranging from 0 to 100, with a higher score indicating better KAPs. Data were analyzed using relative frequencies with 95% confidence intervals, the Mann-Whitney U test, the Kruskal-Wallis test, and linear regression.

RESULTS

Of the included pharmacies, 52.6% were chain pharmacies, 48.4% were attended by pharmacy assistants, and 59% of pharmacists had more than 5 years of experience. The median knowledge score was 70.8 (IQR 58.3-87.5), with 35.3% of pharmacists believing that antibiotics are effective in treating the common cold, 35.2% for treating COVID-19, and 29.4% considering them available for sale without a medical prescription. The attitude score was 53.3 (40.0-66.7), with 60.9% agreeing that prohibiting the sale of antibiotics without a prescription would decrease their sales. The practice score was 62.5 (40.0-79.2), with 65.4% of pharmacists stating that they sometimes sell antibiotics without a prescription due to patients struggling to obtain a medical consultation, 61.3% admitting to selling antibiotics without a prescription for urinary tract infections, and 41.3% for upper respiratory tract infections. Practices were predominantly influenced by pharmacy type (chain or independent) and, to a lesser extent, by knowledge and attitudes.

CONCLUSION

Pharmacists in Medellín exhibit inadequate knowledge, attitudes, and practices regarding the use and sale of antibiotics without a medical prescription. These findings align with international evidence highlighting the need for educational and regulatory strategies promoting rational antibiotic use in pharmacies.

Knowledge, Attitude and Practice Regarding Antibacterial and Their Resistance in Medellín-Colombia: A Cross-Sectional Study

OBJECTIVE

To describe the knowledge, attitudes, and practices (KAPs) profile on bacterial resistance and antibiotic in the general population of Medellín.

MATERIAL AND METHODS

A cross-sectional study was conducted from September to December 2022, with 902 participants selected through stratified sampling with proportional allocation of different sectors of the city. The KAP scale was developed through a literature review, elimination of duplicate items, validity assessment, and reliability evaluation using Cronbach's alpha. Each item was presented with absolute and relative frequencies on a Likert scale, with a total score ranging from 0 to 100, where a higher score indicates better knowledge, attitudes, and practices. Comparisons were made using Mann-Whitney U, Kruskal-Wallis H, and linear regression.

RESULTS

The knowledge score median was 73.3 (IQR 63.3-93.3), with 36.9% reporting that antibiotics can be stopped once symptoms improve and 26.1% considering them as analgesics or antipyretics. The attitudes score was 83.3 (IQR 73.3-93.3), with 95.3% expressing concern about the impact on their health or that of their family and over 90% agreeing that more information is needed on antibiotic resistance. The practice score was the lowest at 63.9 (IQR 50-75), with 48% having been prescribed antibiotics at the pharmacy and 42.6% taking them to treat flu symptoms. Economic status (β 2.645), education in health-related areas (β 6.224), gender (β 2.892), and education level (β 3.257) determined knowledge. Knowledge (β 0.387), gender (β 2.807), and education level (β 0.686) influenced attitudes, but practices were only determined by Knowledge (β 0.084) attitudes (β 0.552) and age group (β 2.858).

CONCLUSIONS

Knowledge about antibiotics and bacterial resistance does not significantly influence the practices of the population. Therefore, interventions aimed at improving knowledge need to be reconsidered as they may not contribute to the appropriate use of antibiotics and prevention of resistance to these drugs.

Clinical and Parasitological Profiles of Gestational, Placental and Congenital Malaria in Northwestern Colombia

This study compared the clinical-parasitological profiles of gestational (GM), placental (PM), and congenital (CM) malaria in northwestern Colombia. A cross-sectional study with 829 pregnant women, 549 placentas, and 547 newborns was conducted. The frequency of GM was 35.8%, PM 20.9%, and CM 8.5%. P. vivax predominated in GM; in PM, the proportion of P. vivax and P. falciparum was similar; in CM, P. falciparum predominated. The main clinical findings were headache (49%), anemia (32%), fever (24%), and musculoskeletal pain (13%). The clinical manifestations were statistically higher in P. vivax infections. In submicroscopic GM (positive with qPCR and negative with thick blood smear), the frequency of anemia, sore throat, and a headache was statistically higher compared with pregnant women without malaria. GM, PM, and CM reduce birth weight and head circumference. In Colombia, this is the first research on the clinical characteristics of GM, PM, and CM; contrary to evidence from other countries, P. vivax and submicroscopic infections are associated with clinical outcomes.

Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia

Background: Understanding the causal attributions for cancer, the elements affecting therapeutic adherence, and behaviors that may compromise people’s health or even put them at risk of dying from this disease has garnered a considerable degree of attention. Methods: This study was designed in the city of Medellín with the aim to develop and validate a model for the study of (i) the categories that can be attributable to cancer etiology, (ii) the categories that can be attributed to the efficacy of treatment, and (iii) the relationship between the categories that can be attributed to the etiology and to the efficacy of the treatment. Structural equations were performed on 611 participants. Results: The analysis revealed that attributing the disease to psychogenic factors distances people from biomedical treatments (β coefficient, −0.12), and brings them closer to psychogenic (β coefficient, 0.22) and alternative treatments (β coefficient, 0.24). Attributing cancer to behavioral factors brings people closer to psychogenic treatments (β coefficient, 0.40) over biomedical treatments (β coefficient, 0.24). Conclusions: Symbolic, cultural, and social factors were evidenced, thereby leading to the underestimation of biomedical treatments and imparting a greater degree of importance to psychogenic or alternative therapies. These therapies will subsequently affect the achievement of therapeutic objectives such as increased survival.

A systematic review and meta-analysis of the hemodynamic effects of etomidate versus other sedatives in patients undergoing rapid sequence intubation

INTRODUCTION

Rapid sequence intubation is an airway rescue and protection technique in which different sedatives are used to perform orotracheal intubation. Etomidate, due to its pharmacokinetic and pharmacodynamic qualities, particularly hemodynamic stability, is the most widely used sedative in this scenario. However, its superiority over other sedatives is controversial.

MATERIALS AND METHODS

We performed a meta-analysis using a pre-designed protocol and PRISMA guidelines to evaluate the mean difference between systolic blood pressure before and after administration of the sedative. We also analyzed the relative risks of hypotension.

RESULTS

Ten studies were included. The incidence of hypotension in patients receiving etomidate ranged from 6.4% to 75.2%, and between 24.0% and 65.9% in patients receiving other sedatives. No significant differences were found in the mean difference in systolic blood pressure during pre-intubation 0.01 mm Hg (95% CI: -0.90; 0.92) or in post-intubation 0.98 mmHg (95% CI: -0.24; 2.20). The relative risk analysis showed that the risk of hypotension is equal to an RR of 1.19 (95% CI: 0.92-1.54) between those who received etomidate and those who received the other sedatives.

CONCLUSIONS

The risk of hypotension after rapid intubation sequence with etomidate does not differ significantly compared to other sedatives. However, the studies included in this review were heterogeneous.

Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs

Introduction

Snakebite envenomation is a public health event of mandatory reporting in Colombia. It is considered a medical emergency in which the government must guarantee antivenom availability. We describe snakebite epidemiological figures in Colombia between 2008 and 2020 and correlate them with antivenom manufacturing figures to determine rate coverage and the need for antivenom.

Methods

We performed an ecological study based on secondary official figures from the National Health Institute, the National Institute for Surveillance of Medicines and Foods, the National Administrative Department of Statistics and the Ministry of Health and Social Protection. Absolute and relative frequencies were calculated with 95% confidence intervals, position measurements, dispersion and central tendency.

Results

Through our research, we revealed that in the last 13 years (2008–2020), there were an average of 4467 annual snakebite envenomation cases affecting all the departments in Colombia. Antioquia reported the highest number of snakebites with 647 (95% CI 588–706) cases per year. The population incidence per 100,000 inhabitants was 9.5; the highest rates were found in Vaupés at 116.1 and Guaviare at 79.24. During the last seven years (2014–2020) Colombia produced an average of 21,104 antivenom vials per year, while the annual demand for antivenom is estimated at 54,440 units needed to guarantee access.

Discussion

Colombia does not produce sufficient vials to cover their needs, and this is why only 74.4% of accidents (out of the 92% not classified as dry bites) were treated, and even 9.7% of the severe accidents did not receive the specific treatment (8% of the victims were classified as dry bites). Figures support the regular antivenom shortages declared by the Ministry of Health and Social Protection in the last 13 years (11 health emergency declarations). New efforts are needed to: 1) boost the production of GMP-based high-quality antivenom, that covers the national needs and is made availability, 2) a better estimation method to calculate the need for antivenom in Colombia, and 3) implementation of production-distribution chains guaranteeing access in remote communities.

Prevalencia de infección por Treponema pallidum en individuos atendidos en un centro especializado de Medellín, Colombia

Objetivo: Describir la prevalencia de infección por Treponema pallidum en individuos atendidos en un centro especializado de Medellín, Colombia, 2019. Metodología: Estudio de corte, con 776 sujetos de población general (aparentemente sanos-asintomáticos y sin factores de riesgo para sífilis), 126 hombres que tienen sexo con hombres (hsh) y 190 jóvenes vulnerables (estrato socioeconómico bajo, desempleados y sin finalizar educación básica), captados intramural y extramuralmente en espacios de concentración de hsh y organizaciones no gubernamentales. Se empleó fuente de información primaria basada en un encuesta y prueba de detección de anticuerpos IgG, IgM e IgA específicos para T. pallidum. Resultados: La prevalencia de infección por T. pallidum fue 0,53 % en jóvenes vulnerables, 2,19 % en población general y 16,67 % en hsh. La razón de odds de infección en los sujetos con edad entre 51-60 años fue 13,8 (IC 95 % = 3,5-51,5) respecto a la hallada en los jóvenes entre 21-30 años; 12,0 (IC 95 % = 1,8-79,2) en quienes no tienen escolaridad frente a los universitarios; 3,3 (IC 95 % = 1,1-9,9) en las personas sin afiliación en salud, comparadas con las del régimen contributivo, y 8,1 (IC 95 % = 2,8-23,0) en quienes tiene relaciones sexuales con grupos clave versus quienes no refieren estas prácticas. Conclusión: Se halló una menor prevalencia de infección por T. pallidum en los jóvenes, seguida de los sujetos de población general y fue mayor en hsh. Se identificaron los grupos de mayor riesgo (entre los tres subgrupos estudiados), que incluyen sujetos excluidos de los programas de prevención, con confluencia de factores de riesgo sexual y privación socioeconómica.

Healthcare Inequities Experienced by Patients with Cancer: A Qualitative Study in Medellín, Colombia

PURPOSE

This study aimed to understand the lived experiences of patients with cancer that facing inequities in oncological care in the city of Medellín.

PATIENTS AND METHODS

A qualitative study was conducted based on the theoretical and methodological elements of the grounded theory, specifically the description and conceptual ordering of Corbin and Strauss. Sixteen patients with cancer, who belonged to low (n=5), middle (n=4) and high (n=7) social classes, were included by theoretical sampling with category saturation. Data were collected using semi-structured interviews and analyzed in a category system based on the three social classes.

RESULTS

The patients were aged between 23 and 71 years old, and they were diagnosed with different types of cancer such as breast, cervical, prostate, stomach, leukemia and lymphoma. Patients' experiences showed that diagnosis, specialized care, treatment and hospital discharge were different based on their social class.

CONCLUSION

Patients' lived experiences associated with cancer reflect complex social situations, in which social determinants affect the level of citizens' empowerment and self-management against the risks of get disease and die. Being part of low and middle social classes meant being subjected to a dehumanized, cold, impersonal and discontinuous treatment, in which healthcare was focused on the disease instead of individuals' preferences and values. In contrast, patients belonging to the high class had the resources necessary to face risks, which ensured access to more humanized and individualized healthcare.

Preferences in a Group of Patients with Cancer: A Grounded Theory

PURPOSE

This study was conducted to understand the preferences of patients with cancer in Medellin, Colombia.

METHODS

A qualitative approach based on the theoretical and methodological resources of the grounded theory was conducted. Between June 2020 and March 2021, patients over 18 years old with a confirmed diagnosis of cancer within the past 2 years treated in Medellin, Colombia, were selected. Theoretical saturation sampling was performed. Each participant was interviewed between 2 and 3 times in accordance with the open, axial, and selective coding of the grounded theory.

RESULTS

A common preference set emerged in all patients related to the attributes of healthcare professionals and is a category that unites their scientific and humanistic aspects. On the other hand, very heterogeneous preferences were presented that were associated with the doctor-patient relationship and the therapeutic objectives. In the doctor-patient relationship, there are those who adhere to a paternalistic model and those who opt for an informative model. In therapeutic objectives, two subcategories emerged: those who are inclined to preserve life and those who accord more value to the quality of life.

CONCLUSION

The categories that emerged illustrate the complexity and challenges of the preferences of patients with cancer in theoretical and experiential terms for social studies of medicine, philosophy, and bioethics. From medical social studies, it's emphasized that the experiences of dehumanization are constant, which generates shared preferences in the patients related to the ideal of the medical professional. From the philosophical perspective, the care received by patients coincides with what was called medicine for slaves in ancient Greece, insofar as patients are not assumed to be free subjects. With respect to bioethics, some ideas are raised contrary to the support of individual autonomy; relational autonomy and the respect for the person above the autonomy itself are advocated.

Impact of chronic kidney disease on health-related quality of life in the pediatric population: meta-analysis

OBJECTIVE

To meta-analyze health-related quality of life in pediatric patients with chronic kidney disease in comparison to healthy patients according to the dimensions of the PedsQL instrument.

SOURCES OF DATA

A systematic review was performed with meta-analysis for the mean difference in each of the health-related quality of life dimensions. The authors searched for ten scientific databases including PubMed, Scopus, SciELO, Science Direct, ProQuest, Google Scholar. Reproducibility by the Kappa index was evaluated, and Dersimonian and Laird's tests, RI coefficient, Begg statistic, Forest Plot, and sensitivity analysis were carried out.

SUMMARY OF THE FINDINGS

17 investigations were included in the qualitative synthesis and 7 in the quantitative synthesis with a population of 1214 of both healthy and sick pediatric patients with 3-5 chronic kidney disease stages. The health-related quality of life in pediatric chronic kidney disease patients presented lower scores in all the evaluated dimensions: in the physical dimension the difference is of 13.6 points, in the emotional dimension 7.8, in the social dimension 8.2, in the school dimension 20.8, with the total difference being 17.7 points.

CONCLUSION

The findings of this study show that pediatric patients have lower health-related quality of life in all the evaluated dimensions, with the "school" dimension being the most affected and the "emotional" one the least. In this sense, we suggest monitoring the health-related quality of life of pediatric patients with chronic kidney disease so that interventions can be oriented to strengthen the affected dimensions, including adjustments to daily life and prevention of complications related to the disease.

Knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Colombia: a cross-sectional descriptive study

BACKGROUND

This study was designed to describe the knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Medellín, Colombia.

METHODS

A cross-sectional study was conducted among medical students from three universities from September to December 2018. The sample size was calculated, the classrooms were visited, and those students who were willing to participate were invited to do so. The data collection instrument was constructed in three stages: i) the literature was systematically reviewed, ii) the items from the studies identified were extracted, and iii) item reduction was performed with exploratory factor analysis. Data were analyzed by calculating absolute and relative frequencies and means for quantitative variables. The indexes of knowledge, attitude, and practice were transformed to a scale from 0 (worst possible score) to 100. Comparisons were performed using the Mann-Whitney U test, Kruskall-Wallis H test, and linear regressions.

RESULTS

Five hundred and thirty-two medical students were included with a response rate of 96%. Of the total participants, 49.1% reported having used antibiotics within the past year. Regarding knowledge, only 18.2% had heard of the term "antimicrobial stewardship" and 69.3% were aware that empiric antibiotic therapy contributes to antibiotic resistance. Regarding attitude, 11.6% considered that antibiotics should be discontinued as soon as symptoms disappear and 24.6% stated that it is better to prescribe broad-spectrum antibiotics to ensure that the patient is cured. Regarding practice, 28.5% recognized that resistance is a multifactorial problem, but they do not act on it because they consider that individual actions would have little impact. The adjusted linear regression showed that the variables associated with knowledge, attitude, and practice were socioeconomic status, training cycle, university, previous experience of research or education, the general perception of the training received, and antibiotic consumption.

CONCLUSION

Knowledge, attitude, and practice differ widely depending on the university, training cycle, and socioeconomic status, and a significant proportion of students consider that the standard of training received at the university on antibiotics and bacterial resistance is poor or mediocre. These findings show that there is a need to strengthen the medical students' curriculum on antibiotics, mechanisms of antibiotic resistance, and the prudent use of antibiotics as an important strategy to combat problem-resistant public health, primarily in endemic countries.

Prevalence of hepatitis B/C viruses and associated factors in key groups attending a health services institution in Colombia, 2019

Both hepatitis B virus (HBV) and hepatitis C virus (HCV) are major sources of morbidity and mortality worldwide; however, their prevalence in key groups in Colombia is not yet known. We aimed to analyse the prevalence of HBV and HCV and its associated factors in key groups who were treated at an institution providing health services in Colombia during 2019. This was a multiple-group ecological study that included 2,624 subjects from the general population, 1,100 men who have had sex with men (MSM), 1,061 homeless individuals, 380 sex workers, 260 vulnerable young people, 202 drug users, 41 inmates and 103 people from the lesbian, gay, bisexual and transgender community. Prevalence of infection with a 95% confidence interval and its associated factors was calculated for each group. Confounding variables were assessed using logistical regression and SPSS 25.0 software. Prevalence of HBV and HCV in the general population was 0.15% and 0.27%, respectively; 0.27% and 2.09% in MSM; 0.37% and 2.17% amongst homeless individuals; 0.26% and 0.0% amongst sex workers; 0.39% and 0.0% amongst vulnerable youth; and 5.94% and 45.54 amongst injecting drug users. In the multivariate HBV model, the explanatory variables included the study group, city of origin and the type of health affiliation; for HCV they were group, origin, sex, age group, health affiliation, use of drugs and hallucinogen use during sexual intercourse. A high prevalence of HBV and HCV were evidenced for both viral infections, which was, consequently, much higher within the key groups. The main associated factors that were identified related to origin and type of health affiliation and demonstrated a double vulnerability, that is, belonging to groups that are discriminated and excluded from many health policies and living under unfavourable socioeconomic conditions that prevent proper affiliation and health care.

HIV Prevalence and Associated Factors in Key Groups and General Population Treated at a Health Care Institution in Colombia in 2019: A Cross-Sectional Study

BACKGROUND

Research conducted on the prevalence of HIV/AIDS and its associated factors among key groups in Colombia is scarce. The few available studies show heterogeneity in their results and increasing trends of infection. This study analyses the prevalence of HIV and associated factors in key groups served at a health care institution in Colombia in 2019.

METHODS

We performed a cross-sectional study with the sample comprised of 5771 subjects from the general population, the LGBTI community, sex workers, people who inject drugs and prisoners. The diagnosis was based on a fourth-generation ELISA. Variables related to sociodemographics, healthcare, sexual risk factors and biological measures of infected subjects were analysed. Prevalence and odds ratios were calculated with 95% confidence intervals, and logistic regression models were performed to identify confounding variables and interactions between independent variables using SPSS 25.0.

RESULTS

The prevalence of HIV was 0.27% among the general population, 0.53% among sex workers, 0.66% among the homeless, 2.44% among transgender persons, 2.44% among prisoners, 5.36% among men who have sex with men and 7.92% among injection drug users. The explanatory model showed higher prevalence among men, those with higher education levels, those with no health coverage, those who have sex with people from key groups and those with sexually transmitted infections, with some interactions between the latter variables.

CONCLUSION

A high prevalence of infection was found in the key groups, while the main explanatory factors for high infection rates were identified. The data show that national and global goals related to controlling HIV have not been achieved mainly in groups that are at a higher risk of obtaining and transmitting it and, paradoxically, also that are excluded from the national health coverage.

Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study

BACKGROUND

The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia.

METHODS

The study population comprised medical students who were enrolled in three universities. The instrument contained questions regarding their current academic term, the university, the perceived quality of the education received on antibiotic therapy and bacterial resistance, and specific questions on upper respiratory tract infections, pneumonia, urinary tract infections, and skin and soft tissue infections. The information was analyzed by calculating frequencies and measures of dispersion and central tendency. Knowledge regarding the treatment for each type of infection was compared using the Mann-Whitney U test and the Kruskal-Wallis H test.

RESULTS

We included 536 medical students, of which 43.5% students consider that the university has not sufficiently trained them to interpret antibiograms and 29.6% students consider that the quality of information received on the subject at their university ranges from regular to poor. The mean score for knowledge regarding antibiotic therapy for upper respiratory tract infections was 44.2 (9.9) on a scale from 0 to 100. The median score with regard to the treatment of pneumonia was 52.9 (14.7), that of urinary tract infection was 58.7 (14.8), and that of skin and soft tissue infections was 63.1 (19.4). The knowledge regarding antibiotic therapy for upper respiratory tract infections, pneumonia, and urinary tract infection does not improve with the academic term, the university, or perceived quality of the education received.

CONCLUSION

A large proportion of medical students perceive that the training received from the university is insufficient with regard to antibiotic use and bacterial resistance, which is consistent with the limited knowledge reflected in the selection of antibiotic treatment for respiratory, urinary tract, and skin and soft tissue infections. Overall, the situation was identical among all universities, and it did not significantly increase with the completion of an academic term.

Prevalence of Metabolic Syndrome and Its Association with Sociodemographic Characteristics in Participants of a Public Chronic Disease Control Program in Medellin, Colombia, in 2018

BACKGROUND

Metabolic syndrome has increased to epidemic levels in low- and middle-income countries. The knowledge on metabolic syndrome and its related diseases constitutes a clinical, epidemiological, and economic challenge of great relevance. The frequency of metabolic syndrome may vary between populations depending on age, sex, lifestyle, and culture; however, in Colombia, there is only little research, and the available studies focus on small populations that do not allow estimating their prevalence and distribution in different sociodemographic groups. We aimed to estimate the prevalence of metabolic syndrome and its association with sociodemographic characteristics in participants attending public chronic disease control programs in Medellin, Colombia, in the year 2018.

METHODS

We conducted a cross-sectional study in all patients who participated in a public chronic disease control program. Involved in this study were 68,288 individuals who attended at 10 hospital units and were strategically distributed in the city. The diagnostic criteria of the metabolic syndrome and its components were based on the consensus of the Latin American Diabetes Association. The data on age, sex, blood pressure, weight, height, physical activity, medications, lipid profile, and glycemic and glycosylated hemoglobin levels were obtained for clinical records. The prevalence, Pearson's chi-square test, prevalence ratios (Kato-Katz method), and odds ratios (Woolf method) were estimated with 95% confidence intervals. A multivariate adjustment model was used with a logistic regression model to identify potential confounders using Epidat 4.2 and SPSS^® 25.0.

RESULTS

The prevalence of the syndrome was 35.4%, with abdominal obesity in 82.3% individuals, hypertension in 48.6%, glucose intolerance in 25.5%, and hypertriglyceridemia in 22%. The prevalence of the syndrome exhibited statistical differences according to the area of residence. It was 15% higher in women; 31% and 59% higher in young and older adults, respectively, than in individuals aged <25 years; 11% and 13% higher in the illiterate population and population with primary studies than in individuals with higher education; and approximately 200 times higher than those who are sedentary.

CONCLUSION

A high prevalence of the syndrome and its constitutive factors in the study population demonstrated the importance of controlling it and increasing community-based prevention strategies, prioritizing the identified groups that are at the highest risk.

Direct medical costs of urinary tract infections by Gram-negative bacilli resistant to beta-lactams in a tertiary care hospital in Medellín, Colombia

Introduction: Urinary tract infections are very frequent in the hospital environment and given the emergence of antimicrobial resistance, they have made care processes more complex and have placed additional pressure on available healthcare resources. Objective: To describe and compare excess direct medical costs of urinary tract infections due to Klebsiella pneumoniae, Enterobacter cloacae and Pseudomonas aeruginosa resistant to beta-lactams. Materials and methods: A cohort study was conducted in a third level hospital in Medellín, Colombia, from October, 2014, to September, 2015. It included patients with urinary tract infections caused by beta-lactam-susceptible bacteria, third and fourth generation cephalosporin-resistant, as well as carbapenem-resistant. Costs were analyzed from the perspective of the health system. Clinical-epidemiological information was obtained from medical records and the costs were calculated using standard tariff manuals. Excess costs were estimated with multivariate analyses. Results: We included 141 patients: 55 (39%) were sensitive to beta-lactams, 54 (38.3%) were resistant to cephalosporins and 32 (22.7%) to carbapenems. The excess total adjusted costs of patients with urinary tract infections due to cephalosporin- and carbapenem-resistant bacteria were US$ 193 (95% confidence interval (CI): US$ -347-734) and US$ 633 (95% CI: US$ -50-1316), respectively, compared to the group of patients with beta-lactam sensitive urinary tract infections. The differences were mainly found in the use of broad-spectrum antibiotics such as meropenem, colistin, and fosfomycin. Conclusion: Our results show a substantial increase in the direct medical costs of patients with urinary tract infections caused by beta-lactam-resistant Gram-negative bacilli (cephalosporins and carbapenems). This situation is of particular concern in endemic countries such as Colombia, where the high frequencies of urinary tract infections and the resistance to beta-lactam antibiotics can generate a greater economic impact on the health sector.

Incidencia de tuberculosis, VIH e Índice de Desarrollo Humano en Colombia: un análisis por departamentos 2005-2014

Objetivo: Correlacionar la incidencia de tuberculosis pulmonar, tuberculosis extrapulmonar y VIH con el índice de desarrollo humano por departamentos en Colombia entre los años 2005 y 2014.Métodos: Estudio ecológico en 29 departamentos de Colombia, con datos de las secretarias de salud, SIVIGILA y del Programa de las Naciones Unidas para el Desarrollo. Los análisis se realizaron con medidas de resumen, intervalos de confianza, Kruskal Wallis y correlación de Spearman en SPSS.Resultados: Se encuentra incremento en la incidencia de tuberculosis pulmonar y VIH en el lapso estudiado. Por otra parte, no se halló correlación entre el IDH con la tasa de tuberculosis pulmonar; sin embargo, con la tuberculosis extrapulmonar y el VIH se identificaron correlaciones positivas y significativas con Rho Spearman de 0,320 y 0,324 respectivamente.Conclusión: Este estudio puso de manifiesto una correlación positiva y significativa entre la infección por VIH, tuberculosis extrapulmonar e índice de desarrollo humano que indica que las regiones del país con mayor nivel de desarrollo presentan las mayores tasas de infección. Esta información es importante para que las autoridades sanitarias realicen acciones que ayuden a comprender las causas que explican este fenómeno.

Metanálisis de pruebas inmunológicas para el diagnóstico de la infección por Paracoccidioides, 1972-2017

Objetivo: Evaluar la validez diagnóstica de las pruebas inmunológicas en la infección por Paracoccidioides, a partir de un metaanálisis de la literatura publicada entre 1972-2017.Métodos: Se realizó un metanálisis según las fases de identificación, tamización, elección e inclusión descritas en la guía PRISMA. Se evaluó la calidad metodológica con la guía QUADAS y se garantizó la reproducibilidad en la selección de estudios y extracción de la información. Se estimó la sensibilidad, especificidad, razones de verosimilitud, OR diagnóstica y área bajo la curva ROC usando Meta-DiSc.Resultados: Se identificaron 21 estudios que evaluaron 32 pruebas diagnósticas con una población de 1.404 individuos sanos, 2.415 con otras infecciones y 2.337 con Paracoccidioides. La mayoría de pacientes son de Brasil y Colombia. Las pruebas analizadas incluyen inmunodifusión, western blot, ELISA, aglutinación en látex. Las pruebas presentaron una sensibilidad y especificidad superior al 90%, razón de verosimilitud positiva y negativa de 24,7 y 0,08 respectivamente. La OR diagnóstica fue 495,9 y el área bajo la curva de 0,99. En la meta-regresión por tipo de antígeno se encontró que las mezclas de antígenos y el gp43 presentaron resultados satisfactorios en todos los parámetros; por su parte, los que utilizaron el antígeno p27 no presentaron resultados aceptables en ninguno de los parámetros.Conclusión: La elevada validez diagnóstica hallada en las pruebas serológicas que utilizan mezclas de antígenos o gp43 purificada evidencia la pertinencia de su uso en clínica y en programas de tamización.

Health-Related Quality of Life in Patients with Chronic Kidney Disease in Hemodialysis in Medellín (Colombia)

PURPOSE

Hemodialysis is a treatment that is essential for the survival of patients with terminal chronic kidney disease. However, it is highly invasive, non-curative, and physically, psychologically, socially, and financially demanding, which has an impact on the patient's health-related quality of life (HRQL). In Colombia, research from the point of view of patients undergoing hemodialysis is scarce.

PATIENTS AND METHODS

We conducted a cross-sectional study involving 142 patients undergoing hemodialysis. We used an instrument that included the demographic and clinical information as well as the Charlson Comorbidity Index and Karnofsky Performance Status Scale. HRQL was assessed using EQ-5D-5L and KDQOL-36. The analysis was done using measures of central tendency for quantitative variables and relative frequencies for qualitative variables, in addition bivariate and multivariate regression analyses were conducted.

RESULTS

Based on the scores of the EQ-5D-5L scale, it was found that 14.5% subjects showed severe mobility problems, 5.8% were unable to bathe or dress by themselves, 12.9% were unable to perform usual activities, 13.5% were experiencing pain or discomfort (between strong and extreme), and 58.6% showed a certain degree of anxiety or depression. The KDQOL-36 scores were 67.4 ± 19.4 for the symptoms domain and 35.0 ± 27.5 for the disease burden domain. Results of the linear regression analysis showed that the main factors associated with HRQL were the Karnofsky Index and serum albumin levels (p < 0.05).

CONCLUSION

The result of this study revealed the impact on the quality of life of Colombian patients undergoing hemodialysis with chronic kidney disease who were highly affected by the disease burden. KDQOL-36 has excellent properties of reliability, internal consistency, and discriminant power; thus, its use is recommended in subsequent studies to monitor HRQL in this population.

[Causal association of antibiotic use and resistant tuberculosis infection: Casecontrol meta-analysis]

BACKGROUND

In the world scientific literature, analytical research on tuberculosis has not been meta-analyzed. The objective of this study was to identify risk factors for tuberculosis infection with drug resistance and meta-analyze the causal relationship of prior antibiotic use.

METHODS

Systematic review with meta-analysis of case-control studies, in five databases. An ex ante, exhaustive and reproducible protocol of search and selection was applied; with criteria of inclusion, exclusion and evaluation of methodological quality. Were performed a qualitative and quantitative synthesis of the articles that evaluated the previous consumption of antibiotics. The PRISMA guide applied and a meta-analysis of random effects was performed for the odds ratios, with analysis of Galbraith, Funelt Plot, Forest plot and sensitivity analysis.

RESULTS

We included 36 articles for the qualitative synthesis and 16 in the meta-analysis. We found a wide heterogeneity in the risk factors that include sociodemographic characteristics such as age, sex, schooling, occupation and prison; Clinics as contact with infected, absence of BCG vaccine, hospitalization, chronic comorbidities, malnutrition, HIV coinfection; And microbiological variables such as infection by Beijing genotype and therapeutic adherence. In the studies that evaluated previous consumption of antibiotic, 1880 cases and 5291 controls were studied, most with moderate or low methodological quality, with a combined measure that shows that the odds of developing resistance in patients with previous antibiotic use are 12 (95% = 6.0-23.7) times found for the non-exposed, in the meta-regression the odds were 16.6 (95% CI = 4.1-67.8) for the moderate quality studies and 5.0 (95% CI = 2.9, 8.7) for those with high methodological quality.

CONCLUSIONS

This meta-analysis revealed a strong causal association between the prior use of anti-tuberculosis antibiotics and drug-resistant Micobacterium tuberculosis infection.

High excess costs of infections caused by carbapenem-resistant Gram-negative bacilli in an endemic region

The financial burden of antibiotic resistance is a serious concern worldwide. The aim of this study was to describe the excess costs associated with pneumonia, bacteraemia, surgical site infections and intra-abdominal infections (IAIs) caused by carbapenem-resistant Gram-negative bacilli in Medellín, Colombia, an endemic region for carbapenem resistance. A cohort study was conducted in a third-level hospital from 2014-2015. All patients with carbapenem-resistant and carbapenem-susceptible Gram-negative bacterial infections were included. Pharmaceutical, medical and surgical direct costs were described from the health system perspective. Excess costs were estimated from generalised linear models with gamma distribution and adjusted for variables that could affect the cost difference. A total of 218 patients were enrolled, 48 (22.0%) of whom were infected with carbapenem-resistant bacteria. IAIs were the most frequent. The adjusted total excess cost was US$3966 [95% confidence interval (CI) US$1684-6249], with a significantly higher cost for antibiotics, followed by hospital stay, laboratory tests and interconsultation. The highest excess cost was attributed mainly to the use of broad-spectrum antibiotics (US$1827, 95% CI US$1005-2648), followed by length of hospital stay (US$1015, 95% CI US$163-1867). The results of this study highlight the importance of designing antimicrobial stewardship programmes and infection control strategies in endemic regions to reduce the financial threat of antimicrobial resistance to health systems.

Brotes hospitalarios de bacterias resistentes a colistina: revisión sistemática de la literatura

Objetivo: la colistina se ha constituido en un medicamento de uso común en países endémicos en resistencia a carbapenémicos; sin embargo, con su uso ha emergido el reporte de resistencia. El objetivo de este estudio es describir los brotes hospitalarios por bacterias resistentes a colistinaMaterial y método: revisión sistemática de la literatura en cinco bases de datos siguiendo los criterios de la guía PRISMA de identificación, tamización, elección e inclusión.Resultados: Se identificaron 13 brotes en 7 países diferentes, 77% (n = 10) en Italia y Grecia, y 61,5% (n=8) en cepas de K. pneumoniae. Los pacientes presentaron condiciones de base, con múltiples comorbilidades y exposición afrecuente a los servicios de salud. Las pruebas y los criterios de susceptibilidad fueron variables, los mecanismos de resistencia que se encuentran simultáneamente con resistencia a colistina incluyen carbapenemasas y betalactamasas de espectro extendido. El genotipo predominante de acuerdo a MLST fue el ST-258.Conclusión: la emergencia de resistencia a colistina no se circunscribe a un grupo etario ni a una comorbilidad específica; sin embargo, se concentra en países  donde la resistencia a carbapenémicos es endémica. Esto permite alertar a las autoridades sanitarias y a los centros hospitalarios para establecer programas de vigilancia, prevención y control que permiten la detección y contención oportuna de esta problemática