Médico cirujano de la Universidad Javeriana de Bogotá, Magister en Salud Pública de la Universidad de Granada (España), Magister en Epidemiología de la Universidad de Copenhague (Dinamarca), Candidato a Doctor en Epidemiología y Salud Pública de la Universidad Autónoma de Madrid. Cuenta con experiencia de trabajo en ayuda humanitaria en poblaciones vulnerables afectadas por conflictos armados, epidemias y desastres naturales. Ha sido consultor para la implementación de modelos de atención en salud con enfoque familiar y comunitario y para el desarrollo de sistemas de vigilancia epidemiológica ambiental. Sus líneas de investigación en el área de la salud pública son, el impacto de las exposiciones ambientales (aire, ruido, cambio climático) sobre la salud colectiva y los efectos de la violencia sobre la salud de las poblaciones. Es miembro asociado de «Médicos sin Fronteras» y Miembro del Consejo Ejecutivo del Capítulo Latinoamericano de la ISEE (Sociedad Internacional de Epidemiología Ambiental). Ha sido coordinador del Área de Salud y Sociedad del programa de Medicina de la Universidad de Ciencias Aplicadas y Ambientales y actualmente esta a cargo de los cursos de Salud Pública y Salud Ambiental.
LÍNEAS DE INVESTIGACIÓN: Epidemiología Ambiental; Salud Ambiental; Impacto violencia en la salud pública
FACULTAD: Ciencias de la Salud
CATEGORÍA COLCIENCIAS: Asociado
NIVEL DE FORMACIÓN: Maestría/Magister
Trastorno de Estrés Postraumático, Ansiedad y Depresión en Adolescentes y Adultos expuestos al conflicto armado en Colombia 2005-2008
Fecha de publicación: 30/04/2016
El conflicto armado de larga evolución ha contribuido a que la violencia se haya convertido la principal causa de muerte y discapacidad temprana en Colombia. Menos conocido es su impacto sobre la salud mental y son escasos los estudios que evalúan estos efectos en el país. Este trabajo tuvo como objetivo, conocer los predictores de ansiedad, depresión y trastorno de estrés post traumático (TEPT) en cuatro diferentes poblaciones de Colombia, expuestas a distintas formas del conflicto armado durante los años 2005 a 2008.Materiales y métodos: Diseño transversal con una muestra de 4.420 personas entre los 13 y 89 años en cuatro regiones donde Médicos sin Fronteras realizó atención en salud mental (Bogotá-Soacha, Caquetá, Barbacoas-Nariño y Cauca-Putumayo) entre 2005-2008. El diagnóstico se realizó de acuerdo con los criterios del DSM IV. Se evaluaron factores de riesgos socioeconómicos y relacionados con la violencia. A partir de una muestra aleatoria de 40 historias clínicas se realizó extracción de datos cualitativos. La exposición al conflicto armado (OR=2,0, IC 95% 1,5-2,7) y la exposición a otros tipos de violencia (OR=1,5, IC 95% 1,1-2,2) fueron predictores positivos de ansiedad, mientras la violencia doméstica (OR=0,29, IC 95% 0,1-0,49) y la disfunción familiar (OR=0,61, IC 95% 0,4-0,8) mostraron una relación inversa.Conclusiones: El impacto del conflicto armado y de la violencia sobre la salud mental es significativo. Hay una alta heterogeneidad en los predictores, de acuerdo con el tipo de trastorno, la región examinada y el tipo de exposi ción al conflicto, lo cual fue confirmado por la información recogida en las historias clínicas.Las desigualdades sociales agravan estos impactos, por lo que es necesaria la inclusión de intervenciones de salud mental en la atención primaria en salud para reducir los efectos del conflicto armado sobre la salud mental.
Más información ⇨
Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017
Fecha de publicación: 01/01/2020
Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths.
Más información ⇨
Mortalidad global, regional y nacional específica por edad y sexo para 282 causas de muerte en 195 países y territorios, 1980-2017: un análisis sistemático para el Estudio Global de la Carga de Enfermedades 2017
Fecha de publicación: 10/11/2018
Global development goals increasingly rely on country-specific estimates for benchmarking a nation’s progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade.
Más información ⇨
Mapeo de 123 millones de muertes neonatales, de lactantes y niños entre 2000 y 2017
Fecha de publicación: 16/10/2019
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical
survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
Más información ⇨
Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015
Fecha de publicación: 15/07/2017
National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system Lancet 2017; 390: 231–66Published Online May 18, 2017 http://dx.doi.org/10.1016/S0140-6736(17)30818-8See Comment page 205*Collaborators listed at the end of the ArticleCorrespondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA [email protected]
Christopher J L Murray
Más información ⇨