The use of rapid dengue diagnostic tests in a routine clinical setting in a dengue-endemic area of Colombia

There is insufficient evidence of the usefulness of dengue diagnostic tests under routine conditions. We sought to analyse how physicians are using dengue diagnostics to inform research and development. Subjects attending 14 health institutions in an endemic area of Colombia with either a clinical diagnosis of dengue or for whom a dengue test was ordered were included in the study. Patterns of test-use are described herein. Factors associated with the ordering of dengue diagnostic tests were identified using contingency tables, nonparametric tests and logistic regression. A total of 778 subjects were diagnosed with dengue by the treating physician, of whom 386 (49.5%) were tested for dengue. Another 491 dengue tests were ordered in subjects whose primary diagnosis was not dengue. Severe dengue classification [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1-4.5], emergency consultation (OR 1.9; 95% CI 1.4-2.5) and month of the year (OR 3.1; 95% CI 1.7-5.5) were independently associated with ordering of dengue tests. Dengue tests were used both to rule in and rule out diagnosis. The latter use is not justified by the sensitivity of current rapid dengue diagnostic tests. Ordering of dengue tests appear to depend on a combination of factors, including physician and institutional preferences, as well as other patient and epidemiological factors.

Molecular identification of Saint Louis encephalitis virus genotype IV in Colombia

Saint Louis encephalitis virus (SLEV) is a member of the Japanese-encephalitis virus serocomplex of the genus Flavivirus. SLEV is broadly distributed in the Americas and the Caribbean Islands, where it is usually transmitted by mosquitoes of the genus Culex and primarily to birds and mammalian-hosts. Humans are occasionally infected by the virus and are dead-end hosts. SLEV causes encephalitis in temperate regions, while in tropical regions of the Americas, several human cases and a wide biological diversity of SLEV-strains have been reported. The phylogenetic analysis of the envelope (E) protein genes indicated eight-genotypes of SLEV with geographic overlap. The present paper describes the genotyping of two SLEV viruses detected in mosquito-pools collected in northern Colombia (department of Cordoba). We used reverse transcription-polymerase chain reaction to amplify a fragment of theE-gene to confirm the virus identity and completeE-gene sequencing for phylogenetic analysis and genotyping of the two-SLEV viruses found circulating in Córdoba. This is the first report of SLEV genotype IV in Colombia (Córdoba) in mosquitoes from a region of human inhabitation, implicating the risk of human disease due to SLEV infection. Physicians should consider SLEV as a possible aetiology for undiagnosed febrile and neurologic syndromes among their patients who report exposure to mosquito-bites.

Malaria in gold-mining areas in Colombia

Gold-mining may play an important role in the maintenance of malaria worldwide. Gold-mining, mostly illegal, has significantly expanded in Colombia during the last decade in areas with limited health care and disease prevention. We report a descriptive study that was carried out to determine the malaria prevalence in gold-mining areas of Colombia, using data from the public health surveillance system (National Health Institute) during the period 2010-2013. Gold-mining was more prevalent in the departments of Antioquia, Córdoba, Bolívar, Chocó, Nariño, Cauca, and Valle, which contributed 89.3% (270,753 cases) of the national malaria incidence from 2010-2013 and 31.6% of malaria cases were from mining areas. Mining regions, such as El Bagre, Zaragoza, and Segovia, in Antioquia, Puerto Libertador and Montelíbano, in Córdoba, and Buenaventura, in Valle del Cauca, were the most endemic areas. The annual parasite index (API) correlated with gold production (R2 0.82, p < 0.0001); for every 100 kg of gold produced, the API increased by 0.54 cases per 1,000 inhabitants. Lack of malaria control activities, together with high migration and proliferation of mosquito breeding sites, contribute to malaria in gold-mining regions. Specific control activities must be introduced to control this significant source of malaria in Colombia.

Participación social en salud: conceptos de usuarios, líderes comunitarios, gestores y formuladores de políticas en Colombia. Una mirada cualitativa.

BACKGROUND Health sector reforms taking place in Colombia during the Nineties included policies to promote social participation in the health system, which is considered essential to its functioning. The aim of this article is to analyse the meaning and the significance of participation in health for the different social actors involved in implementing policies in Colombia. METHODS A qualitative, descriptive, exploratory study was carried out using focal groups (FG) and semi-structured individual interviews (I) of the different social actors: 210 users (FG), 40 community leaders (FG), 3 policy makers (E) and 36 healthcare professionals (E). A carried out analysis was content up of the contents. The study area corresponded to the municipalities of Tulua and Palmira in Colombia. RESULTS The concept of participation was interpreted differently depending on the actor studied: for users and leaders the concept referred to contributing ideas, presence in social spaces, solidarity and frequently, and use of the health services. Healthcare professionals considered the activities carried out by institutions together with the community as social participation, the use of services and affiliation to the health system. Policy markers considered participation to concern evaluation and control of the health services by the community, to improve its quality. CONCLUSIONS The different concepts of participation reveal dif ferences between the content of the policy and how it is understood and interpreted by the different social actors in their interaction with the health services. These different perspectives must be taken into account to develop a link between society and the health services.

Detection of all four dengue serotypes in Aedes aegypti female mosquitoes collected in a rural area in Colombia

The Aedes aegypti vector for dengue virus (DENV) has been reported in urban and periurban areas. The information about DENV circulation in mosquitoes in Colombian rural areas is limited, so we aimed to evaluate the presence of DENV in Ae. aegypti females caught in rural locations of two Colombian municipalities, Anapoima and La Mesa. Mosquitoes from 497 rural households in 44 different rural settlements were collected. Pools of about 20 Ae. aegypti females were processed for DENV serotype detection. DENV in mosquitoes was detected in 74% of the analysed settlements with a pool positivity rate of 62%. The estimated individual mosquito infection rate was 4.12% and the minimum infection rate was 33.3/1,000 mosquitoes. All four serotypes were detected; the most frequent being DENV-2 (50%) and DENV-1 (35%). Two-three serotypes were detected simultaneously in separate pools. This is the first report on the co-occurrence of natural DENV infection of mosquitoes in Colombian rural areas. The findings are important for understanding dengue transmission and planning control strategies. A potential latent virus reservoir in rural areas could spill over to urban areas during population movements. Detecting DENV in wild-caught adult mosquitoes should be included in the development of dengue epidemic forecasting models.

Contratos psicológicos: uma revisão da literatura

No presente trabalho tem-se por objetivo discutir, por meio de uma revisão da literatura, o conceito de contratos psicológicos e sua importância para o entendimento das relações de trabalho, apresentando seu conteúdo, categorização, principais correntes e resultados encontrados nas pesquisas nacionais e internacionais, para, em seguida, apresentar os desafios a serem explorados por futuros pesquisadores sobre o tema.

Contratos flexíveis de trabalho: diferentes perfis de trabalhadores qualificados brasileiros

RESUMOO objetivo neste artigo é discutir como profissionais que já passaram por vínculos tradicionais de trabalho se organizam na nova realidade laboral da experimentação de contratos flexíveis, considerados, na pesquisa aqui relatada, como contratos não CLT. Por meio de entrevistas realizadas com 43 trabalhadores bem qualificados, foi construída uma tipologia composta por nove perfis com caracterís ticas próprias, a saber: PJ, Paraquedista, Indiferente, Pragmático, Independente, Autônomo, Empresário, Ressentido e CLT. Mostra -se que a construção dos perfis ajudou a compor uma imagem de como essa realidade de trabalho é vivenciada por trabalhadores qualificados e conclui-se, nesse caso, que o trabalho flexível não é sinônimo de trabalho precário, pois não acarreta, necessariamente, prejuízos do ponto de vista profissional ou pessoal para o indivíduo que opta por realizá-lo.

Social Determinants of Child Health in Colombia: Can Community Education Moderate the Effect of Family Characteristics?

Contextual effects on child health have been investigated extensively in previous research. However, few studies have considered the interplay between community characteristics and individual-level variables. This study examines the influence of community education and family socioeconomic characteristics on child health (as measured by height and weight-for-age Z-scores), as well as their interactions. We adapted the Commission on Social Determinants of Health (CSDH) framework to the context of child health. Using data from the 2010 Colombian Demographic and Health Survey (DHS), weighted multilevel models are fitted since the data are not self-weighting. The results show a positive impact of the level of education of other women in the community on child health, even after controlling for individual and family socioeconomic characteristics. Different pathways through which community education can substitute for the effect of family characteristics on child nutrition are found. The interaction terms highlight the importance of community education as a moderator of the impact of the mother’s own education and autonomy, on child health. In addition, the results reveal differences between height and weight-for-age indicators in their responsiveness to individual and contextual factors. Our findings suggest that community intervention programmes may have differential effects on child health. Therefore, their identification can contribute to a better targeting of child care policies.

El efecto del empleo, el paro y los contratos temporales en la baja fecundidad española de los años 1990

España destaca en el contexto europeo tanto por sus bajos niveles de fecundidad como por sus altos niveles de paro e inestabilidad en el empleo. En este texto se investigan empíricamente los efectos de la participación laboral de las mujeres y de sus parejas sobre la fecundidad, y más específicamente el impacto de los contratos temporales y el desempleo. La perspectiva teórica utilizada se basa en el análisis de los cursos de vida individuales y subraya las influencias del contexto institucional y social. Se utiliza una muestra longitudinal del Panel de Hogares de las Comunidades Europeas, relativa a los años 1994-2001, y métodos de análisis de biografias. Los resultados indican un acusado impacto negativo de la inestabilidad en el empleo, que supone una posposición en el calendario de la fecundidad y una reducción de las tasas de fecundidad. Este efecto depresivo sobre la fecundidad es aún más intenso cuando los dos miembros de la pareja están en situación laboral precaria.

Health risk behavior pattern among students from Cartagena, Colombia: prevalence and associated variables

The aim of the study was to determine the prevalence and variables associated with the pattern of risky health behavior (PRHB) among adolescent students in Cartagena, Colombia. A cross-sectional study was designed to investigate PRHB in a random cluster sample of students from middle and high schools. The associations were adjusted by logistic regression. A total of 2,625 students participated in this research, with ages from 10 to 20 years, mean=13.8 years (SD=2.0), and 54.3% were women. A total of 332 students reported PRHB (12.7%, 95%CI 11.4–14.0). Age over 15 years (OR=2.19, 95%CI 1.72–2.79), not being heterosexual (OR=1.98, 95%CI 1.36-2.87), poor/mediocre academic performance (OR=1.87, 95%CI 1.47–2.38), family dysfunction (OR=1.78, 95%CI 1.40–2.28) and male gender (OR=1.58, 95%CI 1.24–2.01) were associated with PRHB. One in every eight students presented a PRHB. It is important to pay greater attention to students who are over 15 years of age, male, not heterosexual, with a poor/mediocre academic performance and a dysfunctional family.

La Alfabetización digital mediática y el reto de las TIC en Colombia : diagnóstico y análisis de las principales iniciativas educomunicativas en el escenario 2.0

Històricament la inserció de Colombia a les TIC i al desenvolupament que aquestes comporten va ser lenta. Tot i això, als últims anys s'han desenvolupat projectes de infraestructura i apropiació tecnològica a grans velocitats. En aquest escenari la educomunicació ha avançat de manera formidable i la web colombiana comença a nodrir-se de continguts abundants i de qualitat per a l'educació. Aquest treball examina les principals iniciatives 2.0 per a l'educomunicació i dóna un diagnòstic sobre la seva funcionalitat (progressos i carències). Finalment, dóna una serie de recomanacions per al correcte ús de les eines que ofereix la web 2.0

From severance pay to self-insurance: Effects of severance payments savings accounts in Colombia

In 1990 Colombia replaced its traditional system of severance paymentswith a new system of severance payments savings accounts (SPSAs). Althoughseverance payments often are justified on the grounds that they provideinsurance against earnings loss, they also increase costs for employersand distort employment decisions. The impact of severance payments dependslargely on how much of the costs to employers can be shifted to workers.The theoretical analysis in this paper shows that, in contrast to atraditional system of severance payments, the system of SPSAs facilitatesthe shifting of severance payments costs to workers in the form of lowerwages. Empirical results using the Colombian National Household Surveysindicate that the introduction of SPSAs shifted around 80% of the totalseverance payments contributions to wages and had a positive effect onweekly hours. Results using the 1997 Colombian Living Standards MeasurementSurvey suggest that, although SPSAs in part replaced employer insurancewith self-insurance, SPSAs continue to play a consumption smoothing rolefor the non-employed.

The effects of structural reforms on productivity and profitability enhancing reallocation: Evidence from Colombia

Estimates for the U.S. suggest that at least in some sectors productivity enhancing reallocationis the dominant factor in accounting for producitivity growth. An open question, particularlyrelevant for developing countries, is whether reallocation is always productivity enhancing. Itmay be that imperfect competition or other barriers to competitive environments imply that thereallocation process is not fully e?cient in these countries. Using a unique plant-levellongitudinal dataset for Colombia for the period 1982-1998, we explore these issues byexamining the interaction between market allocation, and productivity and profitability.Moreover, given the important trade, labor and financial market reforms in Colombia during theearly 1990's, we explore whether and how the contribution of reallocation changed over theperiod of study. Our data permit measurement of plant-level quantities and prices. Takingadvantage of the rich structure of our price data, we propose a sequential mehodology to estimateproductivity and demand shocks at the plant level. First, we estimate total factor productivity(TFP) with plant-level physical output data, where we use downstream demand to instrumentinputs. We then turn to estimating demand shocks and mark-ups with plant-level price data, usingTFP to instrument for output in the inversedemand equation. We examine the evolution of thedistributions of TFP and demand shocks in response to the market reforms in the 1990's. We findthat market reforms are associated with rising overall productivity that is largely driven byreallocation away from low- and towards highproductivity businesses. In addition, we find thatthe allocation of activity across businesses is less driven by demand factors after reforms. Wefind that the increase in aggregate productivity post-reform is entirely accounted for by theimproved allocation of activity.

Avaliação da Qualidade dos contratos de Seguros – Seguro Obrigatório Responsabilidade Civil Automóvel

Atualmente as empresas de serviços despendem grande parte do tempo na satisfação dos seus clientes, um dos requisitos, aliás de qualquer empresa que pretende garantir o mercado, apostando, cada vez mais, na qualidade. Oferecer um serviço de qualidade, garantindo assim a satisfação e fidelização dos clientes, fazem parte das estratégias prioritárias de todas as organizações preocupadas com a sobrevivência num mercado cada vez mais exigente e competitivo. A crescente procura por produtos/serviços de qualidade, faz com que as empresas se preocupem cada vez mais com a melhoria dos processos que compõem toda cadeia produtiva, procurando eliminar distúrbios que possam comprometer a excelência dos serviços. Assim sendo, a procura crescente pela certificação da ISO, demonstra grande interesse por parte dos gestores de topo pela gestão de Qualidade no mundo todo, como também em Cabo Verde. A boa qualidade do serviço apresentado ao cliente constitui a coluna vertebral estratégico para satisfação dos clientes na atividade seguradora, tanto a nível internacional com também a nível do nosso mercado cabo-verdiano. Apresentar um contrato, onde o cliente possa sentir confiança no serviço que lhe é oferecido é um fator diferenciador neste tipo de atividade. O trabalho que se apresenta visa demostrar ao utente como funciona o mercado segurador cabo-verdiano, bem como uma breve análise da performance financeira das duas seguradoras do nosso mercado e o funcionamento do Fundo Garantia Automóvel. Para além da retrospetiva teórica da Qualidade e sua gestão, procura-se com este trabalho ajudar na compreensão dos processos que compõem a atividade seguradora. A parte prática recai sobre a análise do contrato de Seguro de Responsabilidade Civil Automóvel da Impar. Muita das vezes quem compra um seguro automóvel, não se preocupa em saber como funciona o produto que lhe é oferecido, o que traz alguns constrangimentos, principalmente a quando da ocorrência de algum sinistro. Por isso a qualidade do contrato passa, indispensavelmente, pela qualidade das informações prestadas. Por outro lado, relacionada com a prática também se estuda o desenvolvimento dos últimos anos da carteira de prémios arrecadados, a quota do 5 mercado e os custos com sinistros (materiais, corporais e pensões) da Impar Seguros. A descrição de como funciona os processos tanto da venda do produto e, principalmente, a regulação de sinistro, bem como um pequeno exemplo de como se calcula um prémio e uma pensão são questões também abordadas. Foi utilizado na pesquisa de campo, entrevista tanto no organismo de regulação da atividade seguradora (BCV), como também na Impar e foi aplicado um inquérito por questionário para medir o nível de satisfação dos clientes. O presente trabalho serve para o enriquecimento dos conhecimentos na área de gestão da Qualidade e de que forma este contribui pelo desenvolvimento das organizações. Auditoria realizado no Instituto de Superior de Ciências Económicas e Empresarias (ISCEE).

A new species of Sycorax (Diptera, Psychodidae, Sycoracinae) from the Pacific coast of Colombia

Sycorax utriensis n. sp. is described and illustrated from a male specimen collected with a CDC light trap in the Parque Nacional Natural Ensenada de Utría, on the Pacific Coast of Colombia. Five species of Sycorax are now known from Colombia, S. andicola Young, 1979, S. colombiensis Young, 1979, S. fairchildi Young, 1979, S. trispinosa Young, 1979 and S. utriensis n. sp.