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URI permanente para esta colecciónhttp://hdl.handle.net/10906/81313

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Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants
(Elsevier, 2016-04-09) Guerrero Carvajal, Ramiro
Background One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. Methods We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.
Trends in adult body-mass index in 200 countries from 1975 to 2014 : A pooled analysis of 1698 population-based measurement studies with 19.2 million participants
(Elsevier, 2016-04-02) Bennett, James E.; Taddei, Cristina; Fortunato, Léa; Hajifathalian, Kaveh; Riley, Leanne Margaret; Danaei, Goodarz; Bentham, James; Guerrero Carvajal rguerrero@proesa.org.co, Ramiro; Ikeda, Nayu; Di Cesare, Mariachiara; Stevens, Gretchen Anna; Zhou, Bin; Lu, Yuan; Bixby, Honor; Cowan, Melanie J.
Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18.5 kg/m2[underweight], 18.5 kg/m2to <20 kg/m2, 20 kg/m2to <25 kg/m2, 25 kg/m2to <30 kg/m2, 30 kg/m2to <35 kg/m2, 35 kg/m2to <40 kg/m2, ≥40 kg/m2[morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19.2 million adult participants (9.9 million men and 9.3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21.7 kg/m2(95% credible interval 21.3-22.1) in 1975 to 24.2 kg/m2(24.0-24.4) in 2014 in men, and from 22.1 kg/m2(21.7-22.5) in 1975 to 24.4 kg/m2(24.2-24.6) in 2014 in women.
Traslados entre eps en Colombia: ¿Qué dicen las historias laborales de cotizantes en cinco ciudades del país?
(Universidad Javeriana, 2016-01-01) Prada Ríos, Sergio Iván
Insurers (hmos) argue that there is no incentive to invest in prevention activities because members can easily move to another insurance company. At the same time freedom to choose hmos is a key accountability mechanism of the Colombian Health System because citizens can leave low-quality insurers and enroll in high-quality insurers. This paper quantifies the size of the rate of transfers between hmos in the country to shed light on this debate. This study used publicly available information on affiliation histories to the health system for the last 14 years (2001-2014) for a random sample of adults between 40 and 50 in five different capital cities. The rate of enrollee transfers within a continuous enrollment period between hmo was estimated. Results showed that 56 % of enrollees had four or more enrollment periods; within the same enrollment period at least 54 % of enrollees did not transfer between hmo; in a year less than 6 % decided to transfer; there was a weak correlation between transfers and hmo service quality indicators.
Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: A pooled analysis of population-based surveys
(Elsevier, 2015-09-01) Guerrero, Ramiro
Background Vitamin A defi ciency is a risk factor for blindness and for mortality from measles and diarrhoea in children aged 6–59 months. We aimed to estimate trends in the prevalence of vitamin A defi ciency between 1991 and 2013 and its mortality burden in low-income and middle-income countries.
Cámaras de fotodetección y accidentalidad vial. Evidencia para la ciudad de Cali
(Universidad de los Andes, Facultad de Economia, 2016-01-01) González, Juan F.
This paper aims to evaluate the impact of photo detection cameras installed in the city of Cali (Colombia) in 2012 on road accidents. Using 10.146 intersections with accident records for the period 2010-2013, a matching algorithm is used to identify a control group. Using different estimators, an evaluation of total accidents, damages and injuries is carried for treated intersections, compared to the control group, after the cameras were installed. Findings show an increase in all types of accident records on the four intersections treated in January 2012, this effect is reduced for those intersections treated in May, and it disappears in those treated in August. The main conclusions are that accidents were not reduced by the camera program and that accident history was not the criterion for treatment assignment. © 2016 Universidad de los Andes, Facultad de Economia. All rights reserved.
Alcohol use disorders and psychiatric diseases in Colombia
(Facultad de Salud de la Universidad del Valle, 2016-01-01) Castillo, Alejandro
Background: An accurate understanding of co-occurrence and comorbidity of alcohol use disorders (AUD) in Colombia is crucial for public health. Objective: A secondary analysis was conducted, using a 2003/2004 governments population database to determine the lifetime associations between AUD and other mental and addictive disorders in people of Colombia aged 18-65 years. Methods: Several statistical analysis were performed: testing prevalence difference in mental disorders by whether the individual had an AUD; a stratified analysis by gender and logistic regression analyses accounting for differences in demographic, socio-economic, behavioral and self-reported health status variables. Results: People with AUD comprised 9% of the population, of which 88% were males and on average 37 years old. They were more likely to be males, be working, and be current smokers; and less likely to be at home or retired. The population with AUD had greater chance to comply with criteria for all disorders but minor depressive disorder, post-traumatic stress disorder, nicotine dependence, and oppositional defiant disorder. Conclusion: This study demonstrates a high prevalence of mental disorders in the adult population with AUD in Colombia. The findings highlight the importance of comorbidity as a sign of disease severity and impact on public health and supports the need for training of more professionals and developing appropriate interventions and services. © 2016. Universidad del Valle.
A social network analysis of substance use among immigrant adolescents in six European cities
(Elsevier Ltd, 2016-11-01) Alves, Joana E.
Background Social integration and the health of adolescents with a migration background is a major concern in multicultural societies. The literature, however, has paid little attention to the wider determinants of their health behaviours, including the composition of their social networks. The aim of this study was to describe the composition of adolescents’ social networks according to migration background, and to examine how social networks are associated with substance use. Method In 2013, the SILNE study surveyed 11,015 secondary-school adolescents in 50 schools in six European cities in Belgium, Finland, Germany, Italy, the Netherlands, and Portugal, using a social network design. Each adolescent nominated up to five of their best and closest friends. Migration status was defined as first-generation migrants, second-generation migrants, and speaking another language at home
A century of trends in adult human height
(eLife Sciences Publications Ltd, 2016-07-26) Guerrero Carvajal, Ramiro
Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3- 19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8- 144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries. © NCD Risk Factor Collaboration.
Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: A pooled analysis of 96 population-based studies with 331 288 participants
(Lancet Publishing Group, 2015-08-01) Danaei, Goodarz
Background: Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA1c. We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods: We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA1c (HbA1c ≥6·5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG ≥7·0 mmol/L or 2hOGTT ≥11·1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings: Population prevalence of diabetes based on FPG-or-2hOGTT was correlated with prevalence based on FPG alone (r=0·98), but was higher by 2-6 percentage points at different prevalence levels
Overcoming social segregation in health care in Latin America
(The Lancet Publishing Group, 2015-03-28) Guerrero Carvajal, Ramiro
Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries.
Control of hypertension with medication: a comparative analysis of national surveys in 20 countries
(World Health Organization, 2014-01-01) Guerrero Carvajal, Ramiro
High blood pressure, also known as hypertension, is a major contributor to the global disease burden and was responsible for 7% of all disability-adjusted life years in 2010.1 Moreover, the number of people with uncontrolled hypertension has increased to around 1 billion worldwide in the past three decades.2 As a result, the effective control of hypertension has become a priority for global health policy and, with growing interest in the prevention and control of noncommunicable diseases (NCDs),3 it is vital that health-care systems deliver appropriate interventions for tackling high blood pressure.
Inequalities in non-communicable diseases and effective responses
(The Lancet Publishing Group, 2013-02-16) Guerrero Carvajal, Ramiro
In most countries, people who have a low socioeconomic status and those who live in poor or marginalised communities have a higher risk of dying from non-communicable diseases (NCDs) than do more advantaged groups and communities. Smoking rates, blood pressure, and several other NCD risk factors are often higher in groups with low socioeconomic status than in those with high socioeconomic status; the social gradient also depends on the country's stage of economic development, cultural factors, and social and health policies. Social inequalities in risk factors account for more than half of inequalities in major NCDs, especially for cardiovascular diseases and lung cancer. People in low-income countries and those with low socioeconomic status also have worse access to health care for timely diagnosis and treatment of NCDs than do those in high-income countries or those with higher socioeconomic status.

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