Carlos Alberto Agudelo Calderón

Sistema de salud en Colombia: 20 años de logros y problemas

An overview of some of the key processes and results of Colombias National Health System is presented. A systematic review of the literature evaluating the quality of the evidence published in indexed journals and literature not published in journals was made. Health system financial resources have seen a sustained increase while spending on health has remained at around 8% of GNP. Coverage, measured by affiliation to contributory and subsidized regimes, is in the order of 92% of the total population. The Mandatory Health Plan, defining the benefits to which one has access, has been broadly maintained but has been hampered by mechanisms for making legal complaints, thereby leading to financial deficits. The health system has contributed towards improving the poorest sectors income, but inequalities persist due to the lack of universal coverage, differences in health plans and the systems expenditure according to the populations income. Advances made in the National Health System have been positive but universality has not been achieved and this has stagnated in matters regarding access to services and equality.

La enseñanza-aprendizaje de la investigación cualitativa en el medio sanitario

La IC constituye una perspectiva de conocimiento necesaria en el medio sanitario. El trabajo asistencial se lleva a cabo siempre en contextos complejos y su mejora requiere de metodologias de investigacion que asuman dicha complejidad. Sin embargo, el conocimiento y la puesta en practica de la investigacion cualitativa (IC) en los servicios de salud continuan siendo muy limitados. Entre los diversos factores que condicionan su desarrollo, la ensenanza-aprendizaje (E-A) de la IC resulta fundamental, y no solo a nivel de pre-grado. Los profesionales y el medio sanitario presentan determinadas particularidades que han de ser tenidas en cuenta en el diseno y desarrollo de la E-A orientada a dicho campo. A partir de una experiencia formativa on-line durante ocho anos para profesionales de Atencion Primaria, se discuten los principales retos identificados al respecto.

Dissemination of public health information: key tools utilised by the NECOBELAC network in Europe and Latin America.

Background Open Access (OA) to scientific information is an important step forward in communication patterns, yet we still need to reinforce OA principles to promote a cultural change of traditional publishing practices. The advantages of free access to scientific information are even more evident in public health where knowledge is directly associated with human wellbeing. Objectives An OA ‘consolidation’ initiative in public health is presented to show how the involvement of people and institutions is fundamental to create awareness on OA and promote a cultural change. This initiative is developed within the project NEtwork of COllaboration Between Europe and Latin American Caribbean countries (NECOBELAC), financed by the European Commission. Methods Three actions are envisaged: Capacity building through a flexible and sustainable training programme on scientific writing and OA publishing; creation of training tools based on semantic web technologies; development of a network of supporting institutions. Results In 2010–2011, 23 training initiatives were performed involving 856 participants from 15 countries; topic maps on scientific publication and OA were produced; 195 institutions are included in the network. Conclusions Cultural change in scientific dissemination practices is a long process requiring a flexible approach and strong commitment by all stakeholders.

Priorización para el análisis de información en salud pública, preferencias de la red de conocimiento del Observatorio Nacional de Salud

OBJECTIVE To prioritize diseases, population and methods of analysis in public health according to the preferences of the stakeholders of the knowledge network of the National Health Observatory. METHOD The conjoint analysis methodology (AC) was used; it consists on the construction of a complete factorial model taking a random sample of subjects that must identify the preferences of the attributes of a given construct according to a pre-established order of importance. The stakeholders of the knowledge network who participated were professionals from public universities, members of health promotion entities, health provision services, health departments, non-profit health organizations, specialized research centers, mayors offices, and corporations. RESULTS The groups of priority diseases were mental and behavioral disorders (13.8%), cardiovascular and circulatory diseases (13%), neoplasms (10%), diarrhea, respiratory infections, meningitis and other common infectious diseases (6.7%), and nutritional deficiencies (6.3 %). The preferred prioritization criteria were the burden of disease and high-impact epidemiological dynamics. The analysis of priority information was the analysis of social determinants. The most preferred population was the general population. CONCLUSIONS Participants perceive both chronic and infectious diseases as a priority, which is consistent with the epidemiological transition of the country. The priority for the Colombian health system is to strengthen the capacity of human resources and the surveillance system in different areas to have a better decision-making process in relation to public health.

Análisis multidimensional de las capacidades en salud ambiental del Ministerio de Ambiente y Desarrollo Sostenible en Colombia

OBJECTIVES To approach the multidimensional analysis of functional capacities in environmental health in the Ministry of Environment and Sustainable Development, based on the UNDP model of interactions between central problems and functional capabilities. METHOD Individual institutional results obtained through surveys and information from secondary sources, CAR (Autonomous Regional Corporations) and environmental authorities on policies, strategies, action plans, regional environmental management plans, regulations, activities, and accountabilities related to environmental health during the period 2012-2015 were used as sources of information. RESULTS The consolidation of results per corporation about core issues and functional capabilities, in terms of the level of response, shows a significant heterogeneity. CONCLUSIONS Public leadership and social empowerment constitute a virtuous circle that allows strengthening capacities in projects of high social interest. Moreover, other capacities such as achieving commitments and institutional and technical capacities (policy design, implementation, evaluation, etc.) can be strengthened as well. Three alternatives for environmental health capabilities implementation have been proposed.

Inactividad física y factores de riesgo: aproximación a un modelo interpretativo para Bogotá

Objetivo Determinar los factores asociados con la inactividad fisica en adultos de 25 a 50 anos de Bogota y aproximarse a la definicion de un modelo explicativo. Materiales y Metodos Se utilizo una muestra de 1 600 adultos caracterizados en 2004 con el IPAQ largo y se midio la prevalencia de actividad fisica global y por dominios. Se determinaron los factores asociados utilizando regresion logistica. Resultados Se encontro 43,8 % de adultos inactivos, 55,6 % en el dominio de transporte, 53,6 % en el hogar, 48,8 % en tiempo libre y 32,2 % en el trabajo. El modelo incluyo como factores asociados ocuparse los ultimos 7 dias en trabajar, trabajar y estudiar, edad entre 25 y 40 anos y percepcion del estado de salud muy bueno. En el dominio del transporte, estado de salud muy bueno. En el dominio del hogar, ser mujer, ningun nivel educativo preescolar y secundaria, ocuparse en labores del hogar; estado de salud muy bueno, bueno o regular. En el dominio de tiempo libre, no tener una pareja estable, no fumar y observar la presencia de personas fisicamente activas en el barrio. Y en el dominio del trabajo ocuparse en trabajar, y trabajar y estudiar. Conclusion Los factores asociados a la actividad fisica global y por dominios, permiten comprender de manera mas apropiada los determinantes especificos del nivel de actividad fisica.Objetivo Determinar los factores asociados con la inactividad fisica en adultos de 25 a 50 anos de Bogota y aproximarse a la definicion de un modelo explicativo. Materiales y Metodos Se utilizo una muestra de 1 600 adultos caracterizados en 2004 con el IPAQ largo y se midio la prevalencia de actividad fisica global y por dominios. Se determinaron los factores asociados utilizando regresion logistica. Resultados Se encontro 43,8 % de adultos inactivos, 55,6 % en el dominio de transporte, 53,6 % en el hogar, 48,8 % en tiempo libre y 32,2 % en el trabajo. El modelo incluyo como factores asociados ocuparse los ultimos 7 dias en trabajar, trabajar y estudiar, edad entre 25 y 40 anos y percepcion del estado de salud muy bueno. En el dominio del transporte, estado de salud muy bueno. En el dominio del hogar, ser mujer, ningun nivel educativo preescolar y secundaria, ocuparse en labores del hogar; estado de salud muy bueno, bueno o regular. En el dominio de tiempo libre, no tener una pareja estable, no fumar y observar la presencia de personas fisicamente activas en el barrio. Y en el dominio del trabajo ocuparse en trabajar, y trabajar y estudiar. Conclusion Los factores asociados a la actividad fisica global y por dominios, permiten comprender de manera mas apropiada los determinantes especificos del nivel de actividad fisica.