Boletín Coomtacto V.8 #1 by PROSPERTECH SA

Newsletter

for health professionals of Coomeva Medicina Prepagada ISSN 2011-3579

Vol. 8

April 2015

OUR PREPAID MEDICINE IN THE CONTEXT OF THE NEW LAW THAT GUARANTEES THE FUNDAMENTAL RIGHT TO HEALTH CARE

CONTENT 4

INTERVIEW ALEJANDRO GAVIRIA: “IT IS URGENT TO RESTORE THE CONFIDENCE IN THE SYSTEM”

HEALT UP TO DATE CANCER SURVIVAL DEPENDS ON WHERE YOU LIVE

RESEARCH REPORT

THE SYSTEMIC APPROACH TO DIABETES

PROMOTION AND PREVENTION

HEALTHY HABITS PROTECT FROM DEMENTIA

EBM

SOME GENE VARIANTS PROTECT AGAINST HIV

ACKNOWLEDGEMENTS 18  COLOMBIAN INTERNATIONAL INNOVATION AWARD  RECOGNITION TO THE FIRST OTOLOGIST IN THE COLOMBIAN CARIBBEAN

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“... It gives access to health care services in a timely, and efficient manner, with high quality, for the preservation, improvement, and promotion of wellbeing...”. Defining clearly the new Statutory Health Care Act, with its new character, and essence, Colombians will now benefit from the status the health care system acquires as a value inherent to the human condition. And our new challenge leads us to establish a categorical difference from the POS, which should be clearly perceived and valued by our users, particularly in cities where health care infrastructure allows us to offer different services. Colombian health care needs confirm the importance of the coexistence of the voluntary, and the compulsory insurance policies. The apparent disadvantage of the first one versus the second one, in terms of the scope of their benefit plans, opens up an excellent opportunity for the development of an additional model that results in a product that offers huge benefits for our population, achieving a good blend of excellent accommodations, quality services, operational excellence, opportunity of choice, and access to technology. We are at a turning point. The new legislature offer a golden opportunity, while the law makers regulate the new Health Care Act, they can also satisfy the needs of the market, allowing us to generate products that complement, with sufficient funding, and benefit the two existing successful models of health care insurance: the prepaid medical system, and the mandatory. That is the challenge in this new era of progress, and development of our country. To the extent that every day we feel committed to the trust offered to us by the national government, to provide quality, and timely health care services to citizens. But also it is a challenge to our long term expertise in Coomeva Medicina Prepagada. From the birth of our company, we have always sought to achieve our mission of serving the member families, with all the possible tools to build an excellent quality of life. In order to achieve these goals, and to take our organization to an ideal level of strength, and leadership, we’ve implemented, and reinforced during the last 50 years several programs on health promotion, and prevention of diseases, designed for each of the members of the family we like to call Coomeva Medicina Prepagada. Through various programs and follow-up strategies, that also includes the promotion of new healthy habits, and lifestyles, so that we can effectively modify risks to the health of our users. This is the commitment with which we enter these new challenges, with an optimistic outlook about the future of Colombia. General Management Coomeva Medicina Prepagada

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INTERVIEW

Highlights of the new Health Statutory Act

LEJANDRO GAVIRIA: “IT IS URGENT TO RESTORE THE CONFIDENCE IN THE SYSTEM”

Following president Juan Manuel Santos’s signature of February 1751 Law, Colombia has new regulations for health care services, which raises them to the category of a fundamental right, modifying the system that existed since 1993, with law 100. Based on this principle, the law sanctioned by the Congress, with support of the national medical community, introduced major changes that, in the words of President Santos, will change the history of the Colombian health care system.

Bulletin COOMTACTO: With the reform of the statutes of the health care system how will they improve services for the Colombians? What is new in the Colombian health care system? Alejandro Gaviria: This is a momentous change. The fundamental right to health care is now regulated with clear rules. Before, jurisprudence on health went on one side, while the laws on the other. Now, this law ensures consistency between rules and jurisprudence. Plus, there is also a symbolic value, it is inclusive, offering a new vision of the system, and it’s goals. BC: What we used to call POS, had an exclusive tendency, and now the system became inclusive. Could you please explain how this new plan of services, and supplies will start operating, and what will it exclude?

Photography: Herminso Ruiz, Ministerio de Salud y Protección Social.

Meanwhile, the health care minister Alejandro Gaviria said that after this crucial legislative act, for the country’s future, next two years will be key to the implementation of the law, with regards to equality, improvement of the access to health care, sustainability, promotion, and prevention, legal, and medical autonomy, among other aspects, within what he called, “reasonable limits”. This is the next step after reaching a financial adjustment, and universal coverage goals.

In an exclusive interview with Bulletin COOMTACTO, the minister explained some of the most important aspects of the new law, and talked about other issues for the national health care system.

“First, we must recognize that fundamental part of the problem is the lack of specialists. The Integrated Health Care Model as stated in PND will help reduce waiting time for appointments, with an efficient and timely primary care for patients. “

AG: The benefit plan will be different, it will be redefined. It will be a more implicit than explicit plan, based on inclusions rather than exclusions, in order to ensure the greatest collective benefit based on the public health care resources. To regulate this benefit plan the law grants the State two years, a reasonable time limit that can be extended. No health care system in the world can immediately incorporate all technologies at once. BC: According to this, we can expect a considerable reduction of lawsuits from users demanding access to services, and supplies to which they were already entitled, but EPSs denied them because they were not included in the POS? AG: First of all, some facts: less than 1% of the users of the health care system used lawsuits. They have already been reduced by almost half during the last six years. And they are no longer mainly related to procedures, and basic medicines. They are related to ancillary social services, and new technologies. We hope that with the new benefit plan there is an even greater reduction in lawsuits. Also of the reimbursements of the whole system. In any case, protection resources will continue to flow. The law is clear on this. BC: What changes in the organizational structure, or the functional flow of health care system? Will EPS still be the only

insurance managers? Will they remain as the entities that decide if the user has the right to services, and supplies? What is the new role of pre-paid medicine? AG: The statutory health law changes nothing in that regard, it addresses the ‘why’, not the ‘how’. BC: Will the ordeals end for the patients when they are trying to get access to a specialist? On average they have to wait three months for an appointment. AG: First, we must recognize that the lack of specialists is a fundamental part of the problem. This complicates access. And the Integrated Health Care Model within the National Development Plan (NDP), will reduce the demand of appointments with specialists with a more efficient, and timely primary care service. BC: Does the government guarantee the money for this new reform, is it sustainable, and how much will it cost yearly? AG: The law guarantees the resources of the health care system. UPCs will be like the pension funds. They will be budgeted. They do not depend on fiscal, nor political considerations. But until the expansion of benefits is defined, it is impossible to talk about costs. Anyway health care spending in Colombia will surely increase, as we have said, we will have to think about additional income sources.

INTERVIEW BC: Finally, another issue of importance to our country, how much is Chikunguña epidemic going to cost? Could have this mosquito infestation be avoided with a much more aggressive prevention campaign? Was the magnitude of the problem underestimated, and the implemented plan was not enough? AG: No, not at all. We handled adequately the Chikunguña situation from the beginning. The Ministry started acting in 2010, when a reference laboratory for the diagnosis of virus was installed at the National Institute of Health. We prepared ourselves for the arrival of Chikunguña identifying and studying people that arrived from the Caribbean with compatible symptoms of the disease, and developed the National Plan of Response. Moreover, since March 2014, we issued External Bulletin 014, addressing all IPSs in the country, with the guidelines for diagnosis, treatment, follow up of new cases of the viral infection. In September of that same year, when the four indigenous cases of the disease were recorded at Bolivar, we activated the Unified Command Center against Chikunguña. Since then we have been on guard. We have transferred $ 6.408 million specifically for the plan against Chikunguña, and an additional $ 11,000 million for the distribution of other resources, such as insecticides and mosquito nets. Likewise, we have trained, with the Colombian Medical Federation, more than 6,500 health care professionals in ETV and Chikunguña.

At the same time, it is important to regain legitimacy, and confidence in the system. It has been lost by its corruption scandals, quality problems, untimeliness, and financial difficulties. Sustainability is another challenge of the system. New technologies, rapidly aging population, and the rising expectations of the urban middle classes, will increase health care spending, as it happens in all countries of the world. The health care system has to be founded on a coherent social agreement. If there is not a minimum correspondence between benefits and resources, between social demands and what they are willing to pay, past financial problems will return.

BC: Minister, thank you very much. How do you envision in the near future the health care system in Colombia? AG: The challenges of the system can be summarized in three words: fairness, legitimacy and sustainability. In the coming years it is imperative to reduce the gaps between regions, socioeconomic, and ethnic groups, in both health care outcomes, and effective access in essential service groups.

“In the coming years it is imperative to reduce the gaps between regions, socioeconomic, and ethnic groups, both in health care outcomes and, effective access to essential services”.

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HEALTH UP TO DAY

ANCER SURVIVAL DEPENDS on where you live

A cancer patient is more likely to survive depending on where he lives, according to “Concord 2”, the new map of the overall survival rate for these diseases. It analyzed data from 325 patients, out of a universe of 25 million people in 67 countries, between 1995-2009, with 10 different types of cancer. This descriptive research was published in The Lancet in November 2014. Concord 2 involved 500 international researchers, whom used as a starting point data from 25 million patients. It included cases predominantly of liver, lung, breast, prostate, cervix, ovarian, gastric, colon, and rectal cancers.

progress is due to changes in government and institutional policies, also more investment in health care systems, as well as the improvement in their effectiveness and their ability to treat and cure patients.

Claudia Allemani, epidemiologist and the main author of this paper, said liver and lung cancers had the worst prognosis of all the tumors, “with a five years life expectancy below 20% in most countries, rich and poor”. But they also found large differences in death risk in different regions, probably due unequal access to health care services, as well as untimely diagnosis and treatment.

HOW DID THEY DO IT

Meanwhile, five year life expectancies for colon, rectal and breast cancers have steadily increased in most developed countries. This

Concord 2 was intended to initiate a global monitoring system for cancer survivor rates, using centralized data records of a population base. Indicative of the effectiveness of health care systems, it is useful in the analysis for official global policies for cancer control. Collected records were evaluated on 250,000 cases, ages 15 to 99 years, and 75,000 children, ages 0 to 14, out of a universe of twenty seven million patients during the period 19952009. Data was collected until last year’s December 31.

“We watched high impact cancers, including leukemia in children. We used control procedures to standardize quality and estimated five year life expectancies, adjusting them to background mortalities in each country or region, age, sex, marital status, and race, or ethnicity in some countries, “ said doctor Allemani. COUNTRIES WITH THE HIGHEST SURVIVAL RATES

According to this study, the survival rate of colorectal cancers reached 60% in 22 countries, while breast cancer rose to 85% in 17 countries. And it should be noted that Brazil, Colombia, and Ecuador have high breast cancer survival rates, 87%, 76% and 83%, respectively. Meanwhile prostate cancer survival rates increased 10% to 20%, between 1995 and 1999, and between 2005 and 2009, in 22 countries in Latin America, Asia, and Europe, survival rates rose to 60% compared to Bulgaria, Brazil, Puerto

The research findings sugest that cancer is more lethal in countries where a quality health care system hasn’t been implemented and where a timely attention with equal treatment for the entire population isn’t provided.

Rico, the US and Thailand where it reached 95%. For cervical cancer survival rates ranged between 50% and 70%, it was close to 60% in countries like Brazil, Cuba, Ecuador and Puerto Rico, while in Chile it increased from 42% to 51%, and in Argentina from 46% to 51%. Ovarian cancer, had a survival rate of 40% or higher only in Ecuador, the United States and 17 other countries in Asia and Europe. Meanwhile acute lymphoblastic leukemia in children had survival rate below 60% in several countries, even though it reached 90% in Canada and four European countries. These findings suggest cancer is deadlier in countries where health care systems do not offer proper and timely attention to patients, and in those whom did not promote early detection of these diseases. Also high mortality was associated with a lack of resources, clear policies and guidelines that in favor of patients. Summin up, this paper suggests countries with better economic and social conditions tend to have better health care systems, offering better access to treatment, improving survival rates. After this international multicenter research compared trends in survival rates of various types of cancers, the major conclusion is that these differences are related largely to difficulties in early diagnosis and adequate treatment.

HEALTH UP TO DATE

COLOMBIAN SITUATION Analogizing with the Concord 2 study, Cancer in Colombia represents a growing public health problem: according to the mortality numbers of Glocoban 2012, 104 people die daily because of this disease. The Ministry of Health & Social Protection recognizes that these results are a combination of factors that include: population with bad habits, like tobacco consumption, overweight, low intake of fruits and vegetables, and fast food, sugared drinks, alcohol excess and last, but not least, deficiency of health services in prevention fields, early detection, palliative care measures and treatments, which the population with lower monetary income rarely agrees with in an opportune, informed way. In the case of breast and cervix cancer, where the National Institute of Cancerology reports the presence of 11000 women a year, 2000 of

Finally, one of the objectives of this paper is to use this analysis of the survival rates of different cancers as a universal indicator for researchers, patients, academics, politicians, and others interested in the subject, in order to help improve systems global health. This analysis seeks to use cancer survival rates as an indispensable source of information for patients and researchers, and an incentive for politicians to improve systems of health policy and health care. This research was funded by the Canadian Association of Fight Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), the Centers for Disease Control and Prevention (Atlanta, USA), Swiss Re (London, UK), Swiss Cancer Research Foundation (Bern, Switzerland), League of Cancer Switzerland (Bern, Switzerland) and University of Kentucky (Lexington, USA.

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which die because the didn’t receive a proper preventative diagnosis and treatment. And when these women agree to take the treatment, 50% of them agree 3 to 6 months after the pathology had gotten diagnosed, a lot of them in late stages of the disease. “This is concerning. In addition, it astonishes us that in Colombia, the judges are the ones who make the medical decisions, when it should be the health professionals”, states Alessandra Durstine, an adviser of the American Cancer Society for Latin America and the Latinamerican Union against Female Cancer (Ulaccam). In agreement with the specialist’s opinion, Colombia should adopt similar measures to Brazil and Chile’s: to reduce the time of the diagnostic and the initiation of the treatment to a maximum of 30 days.

SOURCES Global surveillance of cancer survival 1995-2009: Individual analysis of data for 25,676,887 patients from 279 population-based registries in 67 countries country (CONCORD-2) Claudia Allemani, PhD, Hannah K Weir, PhD, Helena Carreira, MPH, Rhea Harewood, MSc, Devon Spika, MSc, Xiao-Si Wang, PhD, Finian Bannon, PhD, Jane V Ahn, MSc, Christopher J Johnson, MPH, Audrey Bonaventure, D, Rafael Marcos-Gragera, PhD, Charles Stiller, MSc, Prof Gulnar Azevedo e Silva, MD, Wan-Qing Chen, PhD, Prof J Olufemi Ogunbiyi, FWACP, Bernard Rachet, FFPH, Matthew J Soeberg, PhD, You Hui, MAppStats, Tomohiro Matsuda, PhD, Prof Magdalena Bielska-Lasota, MD, Hans Storm, MD, Prof Thomas C. Tucker, PhD, Prof Michel P Coleman. http://dx.doi.org/10.1016/ S0140-6736(14)62038-9 • http://www.thelancet.com/journals/lancet/article/ PIIS0140-6736%2814%2962038-9/abstract • http://www.thelancet.com/journals/lancet/article/ PIIS0140-6736%2814%2962038-9/fulltext What countries are survives cancer? BBC Health, World. Consulted on February 18, 2015. Available from November 26, 2014 in http://www.bbc.co.uk/ mundo/noticias/2014/11/141126_salud_mapa_cancer_ paises_sobrevivir_il?ocid=socialflow_facebook • h t t p : / / w w w . b b c . c o . u k / m u n d o / n o t i cias/2014/11/141126_salud_mapa_cancer_paises_sobrevivir_il?ocid=socialflow_facebook

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RESEARCH Photography: Juan Manuel Rodríguez

REPORT

How to curb blindness?

HE SYSTEMIC APPROACH TO DIABETES

Diabetes mellitus affects multiple organs, for instance, the kidneys, the nervous system and the retina, causing nephropathy, neuropathy and retinopathy. About 40% of diabetic patients might have some degree of retinopathy. Also diabetes is the leading cause of blindness in adults between 20 and 72 years, especially with macular edema. In 2012 a study estimated that 7% of all diabetics are suffering from these complications, roughly 21 million patients worldwide. There are several treatments today: laser, surgery and injections of antiangiogenics, but they all have limited effects if diabetes is not adequately controlled. A study published in 2013 revealed the difference between the costs of treating diabetic patients, comparing the well handled with the poorly handled. They found difference in costs that were staggering: poorly handled cases increases treatment costs up to 70 times, with poorer functional outcomes. “This implies a diabetic patient’s retina is very expensive: they usually require two or three surgeries, laser therapy and drug injections to treat macular edema. We are talking, for example, in the case of injections, of at least three millions per injection. And we must also consider the effect of injections, which in theory can be indefinitely long, while controlling the retinopathy with a diabetes unresolved background. An absurd from the economic and therapeutic point of view, “says Dr. Hugo Hernán Ocampo, a retinologist at Clínica Oftalmológica de Cali, for whom diabetic retinopathy is a way to measure the severity of the underlying condition. “When a patient comes to the ophthalmologist with retinal damage from diabetes, we know there has been mishandling during the course of the disease. To develop a diabetic retinopathy a lot has to happen before. The problem is not only the retina, it is also high cholesterol, hypertension and other risk factors that worsen the conditions of the patient. This is the systemic approach to the treatment of diabetes based on our new understanding of the disease.”

TOWARDS A NEW APPROACH This new approach to diabetes mellitus is demanding. It requires a treatment that integrates professionals from various specialties, including nephrologists, nutritionists, retinologists. Team work offers the patient the possibility of a systemic approach to the disease. However, the conventional way the health system works may conflict this approach. In Dr. Ocampo’s opinion, it would be necessary to create a specialized and fluid system in which the diabetic can be examined and treated without hindrances because of the complexities of the health system. Such a program designed

PROFESSIONAL PROFILE OF

HUGO OCAMPO, MD (Assigned to Coomeva Medicina Prepagada)

Dr. Ocampo is an ophthalmologist with a subspecialty in retina and vitreous from the Universidad del Valle. In 2007 he received the Outstanding Youth Award by the International Junior Chamber - Chapter Cali. In the same year he published the textbook, Basic Manual Ophthalmology, one of the first interactive learning documents in the country. In 2009 he published his article on the guidelines for the handling of macular degeneration in the elderly in the magazine of the Colombian Society of Ophthalmology (Vol. 42 No. 2). Since 2009 he has been a guest speaker at various academic events of his specialty in California (USA), Mexico, Bogota, and Cali, where he practices with great commitment in Clínica Oftalmológica de Cali, that works with Coomeva Medicina Prepagada, Southwestern regional (Cali). Likewise he published several investigations of vital importance to the community. Also Dr. Ocampo provides his professional services to Coomeva Medicina Prepagada.

for the global handling of the diabetic patient has already been implemented successfully, with conclusive results, at institutions like Clínica Oftalmológica de Cali. On the other hand, education is also very important. For the patients to understand diabetes mellitus as a systemic disease is part of the adequate handling the disease. This way they can change behaviors and risk factors, such as improving eating habits and physical activity routines. Also health professionals can interact with patients, striving to convey pertinent information. A more humane and empathetic approach is established through a dialogue with patients and families. “To pay attention, educate, and encourage the patient are valuable aspects of the treatment, they will make him feel heard and empowered; the patient is in control of his life, he questions and suggests”, said the specialist. Additionally, the need to educate about diabetes mellitus involves creating an environment of open knowledge, sharing and updating information. “Conferences and forums on the topic, with as much information as possible, and with new developments reaching more and more people, doctors and other health professionals, create an environment in which both physicians and patients can express openly their doubts and concerns”, says Ocampo. All of these elements can improve the treatment possibilities, while being cheaper for the system, and with a positive impact on the diabetic patient and his family.

We encourage our suppliers to share with us their experiences research topics, academic activity or community programs.

In this way we can enrich this section providing its achievements and developments in their professional work. Write to prestadores_coomeva@coomeva.com.co

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PROMOTION AND PREVENTION

EALTHY HABITS

Protect from Dementia

Studies suggest that cognitive impairment affects women more frequently, and the more common subtype of dementia is Alzheimer’s disease. Data are consistent with the report from the World Health Organization (WHO), suggesting that every seven minutes a new case is diagnosed.

The study entitled “Potential for primary prevention of Alzheimer’s disease: an analysis of data from population-based”, was published in The Lancet Neurology in August 2014*. It identified seven modifiable risk factors: diabetes mellitus, arterial hypertension, obesity, inactivity, depression, smoking, and low education levels. The analysis projected a 10% to 20% relative reduction of the disease per decade by year 2050 for each of the seven risk factors. It concluded that the incidence of the disease could decline, improving education, treating depression, and lowering the prevalence of cardiovascular risk factors, exercising, quitting cigarettes, treating hypertension, obesity and diabetes mellitus. Carol Brayne, a researcher at the Institute of Public Health, at University of Cambridge, said “although there is no single way to treat dementia, steps can be taken to reduce risk factors. By exercising, avoiding obesity, hypertension and diabetes, a person can prevent it “. Meanwhile, Simon Ridley, head at the British Alzheimer’s Research group, said “although we know that age is the greatest risk factor for Alzheimer’s disease, there are a number of lifestyle and health risk factors that can be modified, reducing the risk that later on the person will develop this clinical manifestation”. Among these risk factors, physical inactivity is probably the most prevalent in Alzheimer’s patients in the States, Britain and the rest of Europe.

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CARE IN THE CONSULTING ROOM Pay attention to changes in recent memory, such as forgetting the meanings of objects and words. These are warning signs that could suggest cognitive impairment in the patient. In addition remember, recommend exercise, a balanced diet, good life habits, regular medical checkups, and keep mentally active. These are the most important preventive strategies.

PREVENT FROM AN EARLY AGE In the Memory Clinic at the Institute of Cognitive Neurology (Ineco), director Dr. Paul Richly conducted a study in 2013 in Brazil. It showed that prevention is crucial, healthy life still is important: avoid smoking, exercise, sleep properly, have a balanced diet, are indispensable. These habits contribute to a healthy aging, as well as a formal education, that has been associated with a better cognitive reserve. “A third of the people over 85 years will have Alzheimer’s at some time, but we also

Healthy habits from an early age prevent Alzheimer’s. Recent studies suggest that more than half of the worldwide burden of disease is related to modifiable risk factors. This is good news. Less than half of these problems depend on uncontrollable factors such as genes and aging.

know that this percentage may be reduced if physical inactivity is reduced and higher levels of education are achieved”, Richly said. A healthy lifestyle can diminish by 33% new Alzheimer’s cases, according to this study. “To avoid this disease and other degenerative conditions of the brain, risk factors must be reduced between 30 and 40 years of age, obtaining the best results”, said Dr. Richly, Also a greater cognitive reserve reduces mental deterioration, it is linked to intellectual development, years of education, a healthy diet, regular exercise, and controlled cardiovascular risk factors.** TOBACCO IS ALSO RELATED TO DEMENTIA Smoking is one of the biggest risk factors for degenerative and metabolic diseases, it is costly, and deadly. Moreover, in recent years it has also been included among the heaviest predisposing factors to dementia. These are the conclusions of a cohort study that followed 21,000 patients for 23 years, within the Kaiser Permanente Health Care System, one of the leading insurance systems in the US. The study was published in 2010 in Iladiba, an online magazine***. It also showed that more than two packs of cigarettes a day, in consumers ages 50 and 60, have a 157% increase in risk of developing it two decades later, and have a 172% risk of developing vascular dementia during the same period. “Participants were in midlife when the research started. They used to be heavy smokers. Two decades later, one-fourth of the group (5,367 patients) had

some form of dementia, including Alzheimer, 1,136, and 416 vascular dementia”, the authors said. They also found that smoking a pack a day increased by 37% these risks, compared to nonsmokers, and the risk increased significantly as the individual smoked more, reaching more than twice the risk in smokers of two packs or more a day. These results leave no doubt that smoking affects the brain and memory functions, probably the same way it alters many other organs. SOURCES: * Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Sam Norton, PhD, Fiona E Matthews, PhD, Deborah E Barnes, PhD, Prof Kristine Yaffe, MD, Prof Carol Brayne, http://dx.doi.org/10.1016/S1474-4422(14)70136-X http://www.thelancet.com/journals/laneur/article/ PIIS1474-4422(14)70136-X/abstract ** Quick guide for families of people with Alzheimer’s disease. Paul Richly Head of Clinical INECO memory. 2014. http://www.fundacionineco.org/upload/155/192 /a_1378740856_296242894.pdf *** Smoking heavily in middle age life strong risk factor for dementia. Iladiba. Health Education. Date: 29/12/2010. Completion Date Effective: 05/05/2061. http://www.iladiba.com/

PAGE VIEWS: • http://www.telam.com.ar/notas/201408/73268-alzheimer-prevencion-habitos-saludables.html • https://southerncalifornia.kaiserpermanente.org/ sandiego-es/manage-your-health/ • http://www.ineco.org.ar/clinica-de-memoria/

EBM

OME GENE VARIANTS protect against HIV

An international team of researchers at the Immunogenetics Unit at Universidad de Jaén detected two alleles, or variants of genes, that protect against HIV. Experts discovered innate resistance to the virus. The study published in Genes and Immunity identified these alleles, C4BPA and CR2. Researchers analyzed the genome of individuals exposed to unsafe practices during several years. Mainly they were heroin addicts who had not been infected despite having high-risk behaviors. The study answered how could these people be immune to the infection even though they had fairly frequently exposures to the virus. Efforts were directed initially on a group of genes that were thought to be responsible of the protective effect.

WHAT PROTECTS THESE PEOPLE FROM HIV? Data collected by scientists -headed by Antonio Caruz member of the Immunogenetics Unit at Universidad de Jaén (UJA), in Spain-, suggest that patients had a specific genetic pathway of innate immunity for complement regulators and HIV complement receptors that could inactivate the infection. One of the most significant advances in this research is that several types of proteins are encoded by these genes, and some people have different variants that protect them against HIV. This characteristic is called genetic polymorphism.

Initial data suggested a genetic pathway of innate immunity through regulatory and complement

receptors that inactivated human immunodeficiency virus (HIV). These alleles, variants of the same gene, determine immunity, much like other genes determine the blood group or the eye color.

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ALARMING FIGURES ABOUT HIV Too many lives have been lost worldwide over the past 40 years since the first case of HIV was reported. This is an epidemic that has killed 39 million people according to the World Health Organization (WHO), and it is estimated that another 35 million patients are currently infected. Research, such as this one from Universidad de Jaén in collaboration with the universities of Milan and Lleiva, represent significant hope.

“Because of this research there is a possibility that other experts may explore the therapeutic possibilities of these particular areas of the genes associated with protective effects against HIV. These alleles are involved with antibodies that coat the virus, suggesting they could have a role in potential vaccines against the HIV infections”, says the article. Dr. Caruz also pointed that after testing 450 patients exposed to the virus, the blood samples were taken to University of Milan, Italy, in partnership with Universidad de Jaen, where they found allele CR2, one of the protective sequences that was also present in a group of healthy women, whom were at high risk of being infected because their sexual partners were HIV positive. “In this case, although they were exposed to the virus through sexual contact, the patients were not infected, and we suspect that these gene mutations also protects them”, added Caruz. HIV is a very important research topic. Even though its transmission rate is relatively low -about 1-3% of the exposures, while hepatitis B, for instance, is much higher, about 30%-, there are many other variables that intervene, like the type of sexual act, the immune situation of the patient, the viral load, and the presence of other concomitant sexually transmitted diseases.

SOURCES Association of complement receptor 2 polymorphisms With innate resistance to HIV-1 infection R Herrero1, LM Real2, A-Juárez3 Rivero, JA Pineda2, Á Camacho3, Macías2 J, M Laplana4, P Konieczny1, FJ Márquez1, JC Souto5, JM Soria5, I Saulle6, Caputo7 The S, M Biasin6, Rivero3 A, J and A Caruz1 Fibla4 1Immunogenetics Unit, Department of Experimental Biology, University of Jaen, Jaen, Spain2Infectious Diseases and Clinical Microbiology Unit. Valme Hospital, Seville, Spain 3Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) / Reina Sofia University Hospital, Cordoba, Spain 4Human Genetics Unit , Department of Basic Medical Sciences, University of Lleida IRBLleida, Lleida, Catalonia, Spain 5Institut Sant Pau Biomedical Research (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 6Department of Biomedical and Clinical Sciences , University of Milan, Milan, Italy 7Maria Annunziata Hospital, Florence, Italy Correspondence: Dr A Caruz, Immunogenetics Unit, University of Jaen, Campus Las Lagunillas SN, Building 344 B3, Jaén, 23071, Spain. E-mail: caruz@ujaen.es. Received 5 June 2014; Revised 10 November 2014; Accepted 12 November 2014 Advance online publication 8 January 2015 http://0-www. nature.com.es.library.du.ac.bd/gene/journal/vaop/ncurrent/full/ gene201471a.html HIV infection and its treatment, “The HIV / AIDS” Basics. Consulted on February 18, 2015. Available from August 2012 athttp: //aidsinfo.nih.gov/contentfiles/ elvihysutratamientoquedebesaberusted_fs_sp.pdf. Biomedicine and health: other medical specialties. “They discover two variants of genes that protect some people against HIV.” Consulted on February 20, 2015. Available from January 29, 2015 in http://www.agenciasinc.es/noticias/descubren-dos-variantesde-genes-que-protegen-a-ciertas-personas-contra-el-vih • http://www.agenciasinc.es/Noticias/Descubren-dos-variantesde-genes-que-protegen-a-ciertas-personas-contra-el-VIH • http://www.telesurtv.net/news/Descubren-dos-variantes-degenes-que-protegen-contra-el-VIH-20150131-0024.html • http://diariodigital.ujaen.es/node/45660 • h t t p : / / w w w . d i a r i o m e d i c o . c o m / 2 0 1 5 / 0 2 / 0 4 / area-cientifica/especialidades/genetica/ mutaciones-cr2-protegen-vih-por-via-parenteral-sexual • http://www.elpaisonline.com/index.php/2013-01-15-1416--26/internacional/item/157914-dos-variantes-degenes-protegen-contra-vih-sida

ACKNOWLEDGEMENTS

olombian international innovation award

On October 16th, Siemens, a multinational organization that every year awards the best audiology companies in the world, granted Audiocom IPS with the Siemens Business Excellence Award 2014, in the Innovation category. This well deserved recognition was given to that outstanding enterprise because it is one in its kind, worldwide, they developed a computer program that allows tracking patients otology data with maximum precision, helping both administrators and health care professionals to achieve a precise in the diagnosis, and therefore the need to order a hearing devices, depending on the case. This new application is available in the cloud so that the entire structure involved in the patient’s care can access it, saving costs, and optimizing the distribution of the therapeutic supplies, also avoiding difficult, expensive, and exhausting administrative procedures, such as the delivery of treatments through lawsuits. “We’re using this new tool that benefits both the health care insurers, and patients, because it optimizes curative and preventive procedures. We are very proud of this award, a tribute to Colombian innovation”, said Nohora Ortiz, general manager of Audiocom IPS. Coomeva joins this celebration, and expresses its pride to have Audiocom within its select group of health care providers. In recent days we gave to Dr. Ortiz, head of Audiocom, a symbolic present expressing our joy, and gratefulness.

ecognition

to the first otologist in the Colombian Caribbean

Since Alfonso Yepes Rubiano found out what he was going to devote his life to, he has had no other mission but to provide health care services in the Colombian Caribbean region, particularly in his specialty. Dr. Yepes graduated as a doctor at Universidad del Norte, and as an otolaryngologist at Pontificia Universidad Católica Do Sul (Porto Alegre, Brazil), with a subspecialty in otology. He was trained, and acquired great experience, in ear surgery, on endoscopic dissection of the nose, nasal sinuses, and skull base. His eagerness to bring high technology, and advanced services, procedures, and treatments to the region led him to become the scientific director at Clínica Yepes Porto, where in 2004 the first ever cochlear implant was placed in the north coast. Since then, many achievements have taken place there. Therefore, he became the first otologist to provide services in our Caribbean, and through his work hundreds of patients, especially children, now enjoy a better quality of life. “I was always concerned because the inhabitants of this region had to travel far away to cities such as Medellin, and Bogota, to have an otological evaluation because they didn´t have the chance to do it here. So I decided to study this subspecialty in Bogota, during two years, and then returned to Barranquilla, to accomplish my mission”, says Dr. Yepes. For Coomeva Medicina Prepagada it is a privilege and honor to work with this dedicated specialist, part of our excellent group of health care providers in that region of the country, and we wanted to express our gratitude to him with a special recognition. Thank you, Dr. Yepes, for allowing us to share your professionalism!

We encourage our suppliers to share with us their experiences research topics, academic activity or community programs.

In this way we can enrich this section providing its achievements and developments in their professional work. Write to prestadores_coomeva@coomeva.com.co

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Soluciones de Salud LÍNEA LISA

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01 8000 961 338

FROM COOMEVA In Coomeva Medicina Prepagada, we go further to protect your health

NJOY MORE ADDITIONAL BENEFITS IN GOLD AND GOLD PLUS PROGRAMS

• Users of Gold and Gold Plus programs include coverage for medical travel assistance, as an added benefit. • Also enjoy other benefits, including coverage for post-hospital medications, psychiatric hospitalization, medical care for convalescence and accidental death policy. With Gold and Gold Plus Coomeva Medicina Prepagada programs, affiliates, besides having a wide network of specialists and clinics across the country for health care, examinations and diagnostic tests, hospitalization and surgery, among others, have ensured their care and welfare under different conditions, and even outside the country. Those traveling abroad and are users of these programs have health care coverage on their trips through the Assist-Card service. • Gold Plus Program: $ 50,000 coverage for up to 90 days.

• Gold Program: coverage or $ 35,000 euros and $ 5,000 for pre-existing, up to 90 days.

This service has no additional cost to our users and need not be activated in Colombia. If you are out of the country, call the contact lines of the central Assist-Card: free number for local calls in the United States 186 631 31531 or request a call by the system collect (call collect) to the number 571 218 7755 .

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MANY MORE BENEFITS Meet other additional benefits you can enjoy being user Gold and Gold Plus: • Coverage of post-hospital medications: if you are hospitalized for more than 24 hours because of an illness or ordinary accident, by service of ACE Insurance can be reimbursed for drugs up to $ 300,000 (per user year contract). • Accidental Death Policy: users of these programs can receive up to $ 5.5 million this event through ACE Insurance (hotline ACE Insurance: 01 8000 526 006). • Psychiatric Hospitalization coverage 90 days for Gold Plus users and 60 days for users of Gold program. • Medical care for convalescence: in case of major medical leave to five days, you can enjoy amenities like: - Transportation to medical appointments: twice a year. - Emergency Messaging: four times a year. - Accompanying clinical laboratory tests: twice a year. - Telephone legal assistance: unlimited 24 hours, 365 days, for guidance in business, labor, civil and family matters. - For more information and to schedule these services, please call 651 7033 from Bogota to and throughout the country (toll free) 01 8000 112 472. These lines will be willing to assist you Monday through Friday between 8:00 a. m. and 5:00 p. m., Saturday from 8:00 a. m. 12:00 m. Know the terms of service www.medicinaprepagada.coomeva.com.co

MEDICAL WORLD EVENTS

BOOKS

 ‘Principles of Pediatric Anesthesia and Critical Care’

 ‘Emergencies in hospitalized patients. Action Guide ‘

Date and place: 8 to 10 May Boston (United States) Reports: Harvard Medical School and Children’s Hospital Boston Phone: (+1) 617 384 8600 Email: amanda.buckley@childrens.harvard.edu Website: www.pediatricanesthesiaconference.com

 Congress ‘60 SCOOT ‘ Date and place: 20 to 24 May Cartagena Reports: Colombian Society of Orthopaedic Surgery and Traumatology Phone: (1) 625 7445 Email: secretaria@sccot.org.co Website: www.sccot.org

 ‘V Congress of Gynecology and Obstetrics for General Practitioners’ Date and place: 3 to 5 July Bogotá Reports: Colombian Federation of Obstetrics and Gynecology Phones: (1) 601 6622 - 601 8801 - 6018833 Email: congresosyeventos@ fecolsog.org Website: www.fecolsog.org

 ‘5th World Congress of the International Academy of Oral Oncology’

Phone: (+30) 210 327 4570 Email: info@iaoo2015.com Website: www.iaoo.pro

Date and place: 8 to 10 July Sao Paulo (Brazil) Reports: International Academy of Oral Oncology

 ‘XIII International Congress of Ophthalmology. Direct flight to modern medicine ‘ Date and place: 21 to 23 May Valley Event Center Pacific Information and registration: www.13congresointernacionaldeoftalmologiacali.com Email: XIIIcongresointernacional@clinicaofta.com Phone: (572) 511 0237 Organizers: Cali Eye Clinic

S. Manuel Moya Mir / Pedro Laguna del Estal This is a guide that helps the doctor on call to solve urgent problems that can occur in patients who are hospitalized, so the authors explain all the peremptory cases that may occur in adult patients and, likewise, actions complementary to the professional can perform the initial medication and treatment to follow. By studying this manual, the attending physician may also know when to consult a specialist on call and what are the indications for consultation with intensivists to assess admission to the intensive care unit.

 ‘Clinical cases of assisted reproduction and infertility’ Roberto Matorras Weinig / José Remohí This book is useful for specialists in obstetrics and gynecology and those doctors who are in training, addressing different problems of infertility and infertility from a multidisciplinary perspective. Throughout its 493 pages, the book raises in each chapter a specific situation with a problem of human reproduction, in which the female and male pathology is studied, the procedures are performed in the laboratory of assisted reproduction and the chances of success of specified treatments depending on the case.

 ‘Success is a choice’ David Fischman Based on scientific research, the author reveals the principles and strategies for success, a goal which can only come with a strong will and hard work. To Fischman, is our decision to take the plunge and plunge into the water, although it easier to stay in our comfort zone and not jump. The publication includes reflections, theories, exercises and humor for those who want to succeed despite adversity and failures they encounter along the way.

 ‘The five minds of the future’ Howard Gardner We live in a time of huge changes characterized by the acceleration of globalization, the accumulation of information and the growing hegemony of science and technology, and, according to the author, these changes require new ways of learning and thinking, both in the academic and professional field and in the world economy. In this book, Gardner defines the five cognitive abilities that in the coming years will be the most sought: the disciplined mind, the synthesizing mind, the creative mind, the respectful mind and the ethical mind.

MEDICAL WORLD MUSIC  ‘500 nights for a crisis’ Joaquín Sabina

With this release, which is composed of double CD + DVD, the Spanish singer collects the best moments of her September 2014 concert at the legendary Luna Park in Buenos Aires (Argentina). In this paper, fans will find a complete interpretation of which has been their most successful album: 19 days and 500 nights, he plays in the same order as the original, with songs like “A Song for cupcake”, “Closed for demolition “and” Wedding Night “. Also, viewers will see on the DVD the excellent scenery who set the show and is composed of a central screen that showed paintings and drawings by the author of Sabina.

 ‘Rebel heart’ Madonna

Crazy Heart, as the album name translates becomes the thirteenth studio album by American singersongwriter best known as the ‘Queen of Pop’. This album caused controversy because some of the songs previously met its launch due to leaked online; however, the artist solved the problem after it put the album on iTunes presale platform. With this new work, the artist fans can enjoy songs like “Living for love”, “Devil pray”, “Illuminati” and “Joan of Arc”.

MOVIE  ‘THE UNEXPECTED LOVE’ Director: Christian Ditter Starring: Lily Collins, Sam Claflin, Tamsin Egerton, Jaime Winstone, Christian Cooke, Suki Waterhouse This film tells the story of two best friends, Rosie and Alex, who from childhood had trusted each other and were told their secrets and dreams. In his time in high school, the two protagonists make plans to go to college together, but before that day came, Rosie, on a night of madness and debauchery, with one of the most popular kids at school, is pregnant; which changes the plans. Yet these young people maintain their friendship over time, even above difficulties.

 ‘BEE MAYA’ Director: Alexs Stadermann Starring: Anime Based on the cartoon series of the 70s, this film tells the story of a naughty bee not follow the rules of the hive, such as not trusting the wasps that live beyond the meadow. Everything seems complicated when royal jelly disappears and wasps are the main suspects, so that bees drawn to Maya as an accomplice to the robbery. None of his colleagues believed in his innocence, but Willy, his best friend is his only support for the truth and the real culprit. EVENTS

General

manager

Coomeva Medicina Prepagada

Jorge Alberto Zapata Builes

Editorial Meeting

Pascual Estrada Garcés, MD National Medical Director Coomeva Medicina Prepagada Martha Liliana Cifuentes Castaño National Coordinator Relationship with providers Bertha L. Varela, MD National Chief of Medical Audit Mauricio Castillo National Director of International Business Paula Lilián Henao National Communications Analyst Publishing production

mercadeorelacional@legis.com.co Avda. Calle 26 No. 82-70, Bogotá D.C. Phone: (571) 4255255, Exts.: 1314, 1552, 1142, 1486, 1516

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