Biomedica : revista del Instituto Nacional de Salud最新文献

Introduction: Dengue is an endemic disease in Colombia, with spatial variations influenced by climatic, socioeconomic, and basic service access factors. Territorial characterization based on these determinants supports a better understanding of disease distribution and enables the design of more effective control strategies.

Objectives: To identify groups of departments in Colombia based on the relationship between dengue incidence rates and climatic, socioeconomic, and basic service access factors in 2023.

Materials and methods: Data were collected from the Instituto Nacional de Salud of Colombia, the Encuesta Nacional de Calidad de Vida, and satellite sources, such as ERA5 and CHIRPS. Variables related to access to basic services (drinking water, sewage, and waste collection), housing deficit, temperature, precipitation, and the normalized difference vegetation index (NDVI) were analyzed. A multiple factor analysis was applied to reduce dimensionality, followed by hierarchical clustering and self-organizing maps to identify department groupings.

Results: Three groups of departments with distinct characteristics were identified. The most vulnerable group (group 3) showed an average incidence rate of 1,046.87 cases per 100,000 inhabitants, associated with extreme housing deficits, limited access to basic services, and climatic conditions favorable for vector proliferation.

Conclusions: The analysis identified key territorial patterns in dengue incidence and highlighted the influence of structural factors on disease transmission. These findings provide a foundation to strengthen public policies and design more targeted prevention and control strategies in the most vulnerable regions.

Introduction: The consequences of climate change for women in Latin American countries are more severe due to persistent gaps in education, land ownership and access to information services. These inequities heighten health, welfare and livelihood risks among rural women.

Objective: To describe the relationship between climate change and food security from a gender perspective in Latin America.

Materials and methods: An exploratory review was conducted in Redalyc, SciELO, Google Scholar, EBSCO, Web of Science and Scopus. We analyzed 36 documents published between 2010 and 2022 focusing on Latin American countries

Results: he most frequently described extreme events were droughts, floods, rising temperatures, and landslides, all of which contributed to food supply shortages. Evidence shows persistent gaps in health, access to resources and information, security and human rights, which perpetuate social vulnerability and hinder the effectiveness of public policies addressing the impacts of climate change and the social consequences of the pandemic. Climate-related risks are particularly severe for indigenous and Afro-descendant women and girls, older women, LGBTIQ+ people, women with disabilities, women in migration contexts, and those living in rural, remote or disaster- and conflict-prone areas.

Conclusions: Climate change is not gender-neutral, and there remains a gap in the implementation of gender-sensitive climate adaptation policies.

Introduction: Wildfire activity is intensifying in Latin America due to climate and land-use changes, but the health impacts of wildfire-derived PM2.5 in urban areas remain poorly quantified and recognized.

Objective: To assess the evidence on wildfire-related PM2.5 and its association with mortality and morbidity in Latin American cities.

Materials and methods: We conducted a rapid systematic review and meta-analysis following PRISMA guidelines, using data from PubMed, Scopus, and Bireme. One reviewer independently screened 163 articles and extracted data from 14 eligible studies. A risk of bias assessment was conducted using the Newcastle-Ottawa Scale.

Results: Most studies were conducted in Brazil (n = 12) and used time-series or modelling designs to estimate health risks. Wildfire-specific PM2.5 exposure was associated with allcause, cardiovascular, and respiratory mortality. Reported effect estimates ranged from 1.7 to 7.7% increases in risk per 10 μg/m³ of exposure. Other studies assessed preterm birth, COVID-19 outcomes, and site-specific cancers. While two studies provided harmonized RR estimates for all-cause mortality, high heterogeneity and methodological differences prevented formal meta-analysis.

Conclusion: Wildfire smoke contributes measurably to premature mortality in Latin America, but current evidence is unevenly distributed across regions, time periods, and population subgroups. Studies rarely capture the disproportionate risks faced by indigenous and rural communities or the intraurban disparities linked to poverty and geography. Future research should focus on the health burden of morbidity linked to wildfire PM2.5.

Introduction: Soil-transmitted helminthiases remain a significant public health burden in Colombia, especially in rural and tropical areas. Climate change is expected to alter environmental conditions that favor the survival and transmission of Ascaris lumbricoides, Trichuris trichiura, and hookworms.

Objective: To estimate the current spatial distribution of these infections and project prevalence changes by 2035 under climate change scenarios, with and without public health interventions.

Materials and methods: An ecological study with spatial modeling was conducted, integrating epidemiological, climatic, and biological data. Baseline prevalence data were obtained from the Encuesta Nacional de Parasitismo Intestinal (2012-2014). Climate projections from the ERA5-Land satellite product (2024-2035) were used alongside generalized additive models to estimate environmental suitability. A systematic review defined optimal temperature and humidity thresholds for the development of infective stages. Two scenarios were modeled: one without intervention and another with mass drug administration and improved sanitation.

Results: Baseline prevalence was 11.3% for A. lumbricoides, 18.4% for T. trichiura, and 6.4% for hookworms, with highest rates in Amazonia and the Sierra Nevada de Santa Marta. In a no-intervention scenario, projected prevalences increased to 13.6, 21.2, and 8.0%, respectively. The intervention scenario reduced these to 6.8%, 12.7%, and 5.6%. Temperature and humidity were strong positive predictors (p < 0.01), while altitude and forest cover showed negative associations.

Conclusions: Climate change may intensify soil-transmitted helminthiases transmission in Colombia by 2035. However, sustained control strategies could significantly mitigate this impact. Spatial modeling offers a valuable tool to guide targeted interventions and inform public health planning.

Introduction: Vector-borne diseases pose a public health challenge in Colombia, influenced by climatic and environmental factors. El Niño and deforestation can alter vector habitats, affecting the incidence of dengue, Zika, chikungunya, malaria, cutaneous leishmaniasis, and yellow fever.

Objective: This study analyzes the relationship between these variables and vector-borne diseases incidence in Colombia (2007-2024).

Materials and methods: An ecological study was conducted using incidence and outbreak data for six vector-borne diseases, linked to climate information, El Niño, and deforestation. Regression models and random forests were applied to assess associations.

Results: Between 2007 and 2024, 3,283,259 cases of vector-borne diseases were reported in Colombia. Of these, 49.9% (1,639,120) were dengue and 39.8% (1,307,351) malaria, accounting for 89.7% of total cases. El Niño was associated with increased incidence of dengue (β = 213.24; 95% CI: 86.05-338.43), chikungunya (β = 26.41; 95% CI: 17.54-70.36), and Zika (β = 14.12; 95% CI: 10.06-89.30). Maximum temperature showed a positive relationship with dengue (β = 5.74; 95% CI: 2.15-13.63) and malaria (β = 17.28; 95% CI: 3.81-30.75). Deforestation was associated with malaria (β = 12.35; 95% CI: 4.62-20.08) and cutaneous leishmaniasis (β = 8.67; 95% CI: 2.21-15.13). Mean precipitation had negative associations with chikungunya and leishmaniasis.

Conclusions: Climate change and deforestation impact the epidemiology of vector-borne diseases in Colombia. Integrated public health and environmental conservation strategies are needed to mitigate their effects.

The rise in global temperatures, accelerated by ongoing climate change, requires promotion of public health policies, such as the creation of early warning systems for high temperatures and heatwaves, to reduce the risk to the most vulnerable population groups, including children, pregnant women, and older people.Scientific evidence supports that pregnant women are at greater risk of preterm birth during exposure to high temperatures; adults and children may be at risk of dehydration, and adults over 65 years may be at higher risk of heart disease.This paper analyzes some of the early warning systems for high temperatures and heatwaves in various countries, with a focus on reducing risks to human health.In Colombia, current regulations allow the creation of early warning systems for high temperatures. The Plan decenal de salud pública 2022-2031, established by Resolution 2367 of 2023, through strategic axis 5: “climate change, emergencies, disasters, and pandemics”, calls for the development of intersectoral work for health management associated with these phenomena. This plan has as its strategic territorial goal that the different territories generate early warning systems by 2031 to reduce the impact of the threats exacerbated by climate change.Finally, we present a climate-risk-based framework and invite government institutions to lead this process.

Introduction: Hypertension is a serious medical condition associated with high morbidity and mortality. The prevalence of hypertension is increasing in lower-middle-income countries, but the lack of local data can hinder the planning and development of strategies to manage this condition.

Objectives: To determine the prevalence, awareness, treatment, and control of hypertension in Quibdó, a predominantly afrocolombian middle-sized city. Additionally, we aimed to describe the distribution of risk factors and analyze the associations among clinical outcomes, demographic characteristics, behaviors, and prior conditions.

Materials and methods: This cross-sectional study used secondary data from a community-based screening conducted by local government institutions between May and September 2019.

Results: Among the participants screened, 892 (21%) had hypertension and 46.52% were aware of their diagnosis. Of the participants that were aware, 65.3% were receiving pharmacological treatment. However, only 54.61% of participants receiving treatment had controlled hypertension, meaning that only 16.5% of the population with hypertension had adequate awareness, treatment, and control. Additionally, 50.43% of the participants without hypertension had prehypertension and 62.53% of the population had excess body weight. While 91.81% had their blood pressure checked within the past year, there remains a persistent issue within the health care system.

Conclusion: The prevalence of hypertension in communities in lower-middle-income countries such as Quibdó is concerning, as is the low awareness, treatment, and control of this condition. Community-based screenings are useful; however, a gap remains in translating these efforts into effective public health prevention strategies and clinical practice. This highlights the need for future research to support the adoption of more comprehensive approaches to hypertension prevention and treatment in underserved communities.

Introduction: The Amazon foothills are a territory of contrasts between natural abundance and various socio-environmental problems. Ethnic and peasant communities –and particularly women– have been the primary victims of these conflicts, which have exacerbated inequality gaps that prevent these communities from achieving adequate levels of well-being, including food security.

Objectives: To determine the prevalence of food insecurity and identify the socioeconomic factors associated with its occurrence in two municipalities of the Andean-Amazon piedmont: San José del Fragua y Curillo.

Materials and methods: We conducted a cross-sectional study to estimate the prevalence of food insecurity in communities of two municipalities in the southwest of Caquetá, using the Escala Latinoamericana y Caribeña de Seguridad Alimentaria. One hundred eightynine surveys were applied to households in the municipalities of Curillo and San José del Fragua.

Results: Only 23.3% of the households declared food security, while 30.2% experienced moderate and severe food insecurity. Statistically significant associations were found between food insecurity and affiliation to the healthcare system, level of education, and selfrecognition as a victim of the armed conflict.

Conclusions: In these peasant populations, the high prevalence of food insecurity was associated with vulnerable socioeconomic conditions. The studied municipalities showed prevalence rates higher than the national average, reflecting marginalization and inequality related to the armed conflict, limited access to markets, and displacement of the agricultural vocation. These factors align with the country’s sustained increase in food insecurity, even after the signing of the Peace Agreement.

Background: IPEX syndrome is a rare hemizygous X-linked disorder with complex autoimmune reactions, characterized by immune dysregulation, polyendocrinopathy, and enteropathy. It has a poor prognosis and a high mortality risk without prompt therapy. Treatment options include pharmacological immunosuppression, nutritional and supportive care, and hematopoietic stem cell transplantation, the latter as the only curative option.

Case report: We present the case of a male infant, the second child of a nonconsanguineous couple, with negative prenatal screening and intrauterine growth restriction detected at 27 weeks' gestation. He was diagnosed with neonatal diabetes mellitus and treated with insulin. He was re-hospitalized for secretory diarrhea and rotavirus infection. At that moment, he was diagnosed with failure to thrive and hypothyroidism. He acquired multiple severe infections, including Candida parapsilosis fungemia, an urinary infection caused by extended-spectrum β-lactamase-producing Escherichia coli, and Klebsiella pneumoniae bacteremia. Endoscopy biopsy revealed chronic duodenitis with the absence of goblet and Paneth cells, findings suggestive of autoimmune enteropathy. Genetic testing identified a mutation in the FOXP3 gene, confirming the diagnosis of IPEX syndrome. We performed a hematopoietic stem cell transplantation from an alternative haploidentical donor and administered a cyclophosphamide post-transplant regime. At 320 days posttransplant, the patient fully recovered his nutritional status and immunity.

Conclusion: Haploidentical transplantation with a post-transplant cyclophosphamide regime can be a viable therapeutic option for patients with IPEX syndrome, lacking an HLA-identical donor, with promising outcomes based on the follow-up data.