Coomtacto Magazine (English version) Vol. 10-2

ISSN 2011-3579

A MAGAZINE FOR COOMEVA MEDICINA PREPAGADA HEALTH CARE PROFESSIONAL VOL. 10 No. 2 • AUGUST 2017

HEALTH UPDATE A heart beat for cancer stricken children in Santander | PÁG. 8

P P

Coomeva Medicina Prepagada actively participates in Alianza AFLC With joint efforts in order to rid the world of dental cavities | PÁG. 18

EBM

Could celiac disease have an unexpected origin? | PÁG. 32

Adriana Zableh Solano

A heart beat

for cancer stricken children in Santander | PÁG. 14

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A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

TENEMOS LA FÓRMULA

QUE ASEGURA TU TRANQUILIDAD

RC MÉDICA COOMEVA En Coomeva conocemos y entendemos los riesgos a los que estás expuesto, por eso te protegemos con nuestra Póliza RC Médica.

Algunos beneficios: Asesoría y acompañamiento de abogados expertos en defensa de los médicos, desde la etapa pre procesal hasta el fin del proceso.

Cubre los perjuicios patrimoniales (lucro cesante) y extra patrimoniales (perjuicios morales, fisiológicos y de vida en relación), sin afectar el amparo básico por errores u omisiones involuntarios.

Cubre los eventos que se presenten durante la vigencia de la póliza o el periodo de retroactividad contratado.

Adquiérela en nuestras oficinas y asegúrate hasta por $1.500 millones.

Cooperando es posible Línea Nacional: 01 8000 950 123, Cali: 333 0000, Bogotá: 748 1515, Barranquilla: 361 9800, Pereira: 316 9300, Medellín: 415 7700, Palmira: 273 3302. Opción 4.

Contents

8

20 RESEARCH INTERVIEW Manizales leads a network that decreased the mortality rate related to cervical cancer Because of the oncogynecologist Germán Olarte’s dedication and creative developments, early detection of cervical cancer has improved, and therefore the mortality rate related to it has decreased.

24 MERITS

The international accreditation of the JCI Centro Médico Imbanaco is among the best in the world

5 EDITORIAL 6 MEDICAL ADVANCES Alzheimer’s disease: some memories are lost but not the feelings.

8 HEALTH UPDATE

The physician’s crucial role preventing, detecting and treating child abuse Sometimes pediatric appointments are the only chance for children in order to avoid trauma, suffering and the negative consequences on their physical and emotional development that could turn out to be irreversible and even deadly. This is an opportunity to reflect on the role and responsibility health care professionals have in preventing this terrible ailment of our society.

14 COVER PAGE

A heart beat for cancer stricken children in Santander

Doctor Adriana Zableh Solano and a group of concerned citizens have been helping children with cancer, promoting their health, entertainment and wellbeing. And these efforts have decreased the mortality rates, while increasing the humanity of their medical treatments.

18 PROMOTION & PREVENTION

August • 2017

Coomeva Medicina Prepagada actively participates in Alianza AFLC With joint efforts in order to rid the world of dental cavities Efforts are pulled together in order to work as a team with the academy, professionals, institutions and the community in order to educate and prevent, approaching the patient in an integral manner, the point is that by year 2026 this disease will be a distant memory.

Thanks to the culture of creative, innovative, safe and high quality and human services, the most influential hospital in southwestern Colombia, received this golden award. It shares it worldwide with only 588 other institutions of this type.

27 FROM COOMEVA Mipres, for the user’s wellbeing

Jorge Zapata Builes

General Manager Coomeva Medicina Prepagada

Editorial board Pascual Estrada Garcés, MD National Health Director Martha Liliana Cifuentes National Coordinator of Relationships with the Health Care Professionals Bertha Lucía Varela, MD National Head of Medical Audit Julián Adolfo Villegas National Head of Medical Audit Ana María Correa National Quality Auditor

The health care workers should adequately use this platform.

It is designed to give an easier access to non-POS services and, therefore, improve your health.

28 COOMEVA PROMOTES A new relationship model is on its way with the health service providers It is very satisfying for us to present you with the agreements we achieved with the health service providers throughout the country.

30 OUR PLUS Coomeva Medicina Prepagada offers pet assistance services

Marco Emilio Ocampo National Medical Auditor Juan Fernando Saavedra National Head of Publicity and Marketing David Montes National Communications Coordinator

Editorial production and printing Legis S.A.

www.comunicaciongraficalegis.com

Now pet assistance services for those other family members will be available. They will enjoy not only your love and happiness, also your unconditional protection.

These are some of the benefits that your pets will receive.

32 EBM Could celiac disease have an unexpected origin?

mercadeorelacional@legis.com.co Tels.: (1) 4255255, Exts.: 1314, 1393, 1552, 1516 Sales: María Cristina Arévalo Durán Cel.: 3112862724 maria.cristina.arevalo@gmail.com

Recently an unexpected, but significant, association was identified between some types of virus that used to be considered non-pathogenic and the possibility of developing celiac disease.

These findings could be the starting point of new vaccines that would suppress the autoimmune response in these cases.

35 MEDICAL WORLD Specialty meetings, academic and professional events, books, music and movies.

Front page picture: Jaime del Rio

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Editorial

‘To love is to care’

Self-care is the

FIRST THERAPEUTIC STEP

T

Jorge Alberto Zapata Builes General manager Coomeva Medicina Prepagada

So, today, we want to invite you, naturally taking into account your doctor’s instructions, to consider your fundamental role as a person in charge of his own care and preservation. And this attitude will also help us transmit to other people this massage about the importance of the individual responsibility in health care, making them more aware that “To Love is to Care”.

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August • 2017

he five pillars of a new conception on world public health were outlined in 1986, at the First International Conference on Health Promotion in Ottawa (Canada), where self-care became decisive for the search of collective wellbeing.

Personal responsibility became a central element for this search. And, as a matter of fact, personal interiorization of activities that diminish risk factors within the population, such as lack of physical activity, smoking, drug use and abuse, excessive alcohol and unhealthy food intake, are now considered dangerous. These conducts could have a negative impact on health, but, on the other hand, could also be prevented adapting new habits with commitment.

In this sense, Coomeva Medicina Prepagada, as an organization that acknowledges self-care as the basis for its healthy users, launched a new strategy called ‘To Love is to Care’. It is intended to promote healthy habits with the use of publicity and informative campaigns. In essence, it is designed to generate the conviction in people that adequate daily habits are the first step in health care.

Soon, in future COOMTACTO magazine editions, you will find new sections devoted to selfcare. The point is to improve your knowledge on medical progress and research on these fascinating topics.

As usual, we will approach these contents from technical and scientific perspectives that will, above all, give our readers new ideas on therapeutics that could improve health on the long run for the whole family.

DEVELOPMENTS Photos: ®2017 SHUTTERSTOCK PHOTOS

MEDICAL

A NEW MOBILE PHONE APPLICATION DETECTS ABNORMALITIES IN SEMEN A group of specialists at Brigham Women’s Hospital at Harvard University Massachusetts General Hospital, in the US, created a smart phone application capable of analyzing the sperm concentration and mobility with a 98% accuracy. It gives the results in about 5 seconds and it costs nearly 4,1 euros. A true bargain, if we consider its components are being built with a 3D printer. Its prototype uses the mobile’s processor and camera, and it was tested on 350 samples. This development will most certainly be available for all in the market place.

A KEY MEDICINE FOR CYSTIC FIBROSIS TREATMENT Cystic fibrosis is a disease that today affects 70.000 people worldwide, and even though there is no cure available for it, scientists at George Washington, Perugia and Rome universities announced the discovery of a promising new therapy. They researched on mice a synthetic peptide called alfa 1 timosyne. This molecule is an immune modulator that could stop the progression of the disease. It seems to reduce tissue inflammation.

Results have been promising, even though the molecule is jet to be tested on humans.

SOURCE: “THYMOSIN Α1 REPRESENTS A POTENTIAL POTENT SINGLE-MOLECULEBASED THERAPY FOR CYSTIC FIBROSIS”, PUBLISHED IN NATURE. UNITED KINGDOM. MAY 2017.

S O U R C E : ARTICLE “AN AUTOMATED SMARTPHONE-BASED DIAGNOSTIC ASSAY FOR POINT- OF- CARE SEMEN ANALYSIS”, PUBLISHED IN SCIENCE TRANSLATIONAL MEDICINE. UNITED STATES. MARCH 2017.

BARIATRIC SURGERY: AN ALLY AGAINST TYPE II DIABETES

August • 2017

Research at the Cleveland Clinic, in the United States, by Johnson & Johnson Medical Devices, suggests bariatric surgery improves the outcome and quality of life for obese patients with diabetes type II. The study, called Stampede, compiled five years of data on 150 patients of this sort. They were divided into 3 groups: the first one, only received intensive medical treatment; the second one, were those whom underwent a Roux Y gastric bypass surgery, as well as intensive medical treatment; and in the last one, patients were treated with the gastric sleeve together with intensive medical treatment. Findings suggest that operated patients had an enduring improvement, as far as the glycaemic level is concerned, and also a reduction in drug use in the 5 years follow up.

SOURCE: ARTICLE “BARIATRIC SURGERY VERSUS INTENSIVE MEDICAL THERAPY FOR DIABETES - 5-YEAR OUTCOMES”, PUBLISHE IN THE NEW ENGLAND JOURNAL OF MEDICINE. MASSACHUSETTS MEDICAL SOCIETY, USA. JUNE 2017.

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LONG-TERM ANTIBIOTIC TREATMENTS AND THEIR RELATIONSHIPS WITH COLORECTAL CANCERS Adults using antibiotics for long periods could be at risk of developing intestinal precancerous lesions. Experts at Massachusetts General Hospital and Harvard Medical School, in the States, analyzed data from the Nurses’ Health Study, a database that keeps information on 121.700 American nurses since 1976.

They selected a sample of 16.642 women, over 60 years of age, with an adenocarcinoma diagnosis. They found that long term antibiotic use during youth had a direct relationship with digestive malignancies. Women who used them form more than 2 months between the ages of 20 and 30 had a 36% increase in the rate of the probability of developing an adenocarcinoma. While women whom took the long-term antibiotics between 40 and 50 increased, their risk increased by 69%.

SOURCE: ARTICLE “LONG-TERM USE OF ANTIBIOTICS AND RISK OF COLORECTAL ADENOMA”, PUBLISHED IN GUT. UNITED KINGDOM. APRIL 2017.

A quick diagnosis of sepsis is crucial for its treatment, and, ultimately, for its outcome. It is now possible to detect it in only 15 minutes with a simple blood test. This test is patented to Kamon Shirakawa, a Japanese researcher who came to Colombia in past May. The test works with presepsine, an early and specific sepsis marker. This molecule can easily be measured in blood because its concentration increases within two hours of the infection, and it stays high for as long as the patient is infected. So, it is useful for doctors while monitoring the disease. It can also be used as a marker with patients that are candidates for cardiac surgery. The test can be carried out in the laboratory, the ICU and the emergency ward because it is done with a compact totally automatized analyzer called a PathFast.

S O U R C E : A R T I C L E “ N U E VA F O R M A E F I C I E N T E D E D I AG N O S T I C A R S E P S I S . L L EG A A CO LO M B I A INVESTIGADOR JAPONÉS QUE PATENTÓ MÉTODO AVANCE EN SALUD”, COLOMBIA. MAY 2017.

PEMBROLIZUMAB: A NEW TREATMENT ALTERNATIVE AGAINST CANCER Cancer treatment research is a continuous endeavor. Merck Sharp & Dohme (MSD) recently presented a new molecule called pembrolizumab (comercialized in Colombia with the Invima sanitary registry for Keytruda®). It is lung cancer treatment, particularly for the small cell cancer, as well as for some skin and head and neck cancers. This molecule works on the immune system. It interferes with the growth and propagation of certain malignant cells. Also, it can be employed as a first line drug in cancer treatment, when the lung malignancy has not disseminated, tests are positive for PD-L1 and there are either abnormalities on the gene RGFR or the ALK. Pembrolizumab is given intravenously, every 3 weeks, and the application takes around a half an hour.

SOURCE: WEBPAGE WWW.KEYTRUDA.COM. MAY 2017.

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August • 2017

A NEW WAY TO DIAGNOSE SEPSIS

HEALTH UPDATE

The physician’s crucial role preventing, detecting and

August • 2017

treating child abuse

8 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

Sometimes pediatric appointments are the only chance for children in order to avoid trauma, suffering and the negative consequences on their physical and emotional development that could turn out to be irreversible and even deadly. This is an opportunity to reflect on the role and responsibility health care professionals have in preventing this terrible ailment of our society.

Manizales and of Sociedad Colombiana de Pediatría.

Amazing data that “shows how a society does not acknowledge children nor adolescent’s rights as subjects, subjects of their own destiny.

And the first place where their rights are disregarded is within their families”, adds Darío Botero Cadavid, a pediatrician and a member of Comité de Puericultura, Crianza y Salud of Sociedad Colombiana de Pediatría.

Abuse includes battering with physical consequences, as well as sexual and psychological violence. “It is a purposeful harm against attitudes and abilities, affecting the child’s self-esteem, the way he relates to others, his communication and way living, affecting his personality, socialization and his mental development”, explains doctor Montoya.

Devastating consequences “Any form of child abuse causes suffering to everybody, and has long-term repercussions on the development of the personality”, points doctor Botero. But also other aspects, such as age, the child’s developmental phase at the time of the ill-treatment, as well as the form of abuse, are all variables that have very much to do with the whole thing.

Neglect, physical abuse, sexual and other forms of violence, together with the frequency, the duration and the severity, and also the type of relationship with the perpetrator matters, 9

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August • 2017

Photos: ®2017 SHUTTERSTOCK PHOTOS

A

ccording to Instituto Nacional de Medicina Legal y Ciencias Forenses, between January and March 2017 they have performed 4.315 examinations of youngster between 0 and 17 years due sexual abuse. On average, every hour two children arrive there with signs of rape and battering. In 2016, 7.648 cases of children between 10 and 14 years were reported, that is 75% of all these type of cases (9.659), and 10.65% (2.011) were on children under4.

This is dramatic, unexplainable, reproachable and reprehensible. As a matter of fact, these events frequently appear on the media, with tortures, murders and rapes. Anyway, World Health Organization considers them an urgent health care problem and a human right violation with terrible social consequences.

“The situation in Colombia is not far removed from the rest of the world, even though it has troubling particularities that make it severe and perpetual, such as violence within the family. Paradoxically, the family, the environment where the child should be protected, accounts for almost 70% of this sort of violence”, explains Carlos Alberto Montoya Marín, a pediatrician and an afectologist, also a researcher and the author of several books on this topic, as well as a member of Red Afecto contra el Maltrato Infantil de

HEALTH UPDATE are all aspects to be considered. They have bearing in these cases.

There is no such thing as a slight harm. “Early exposure to violence affects the brain. In cases of prolonged violence exposure, even as a witness, immunologic and neurological changes are linked to social, emotional and cognitive consequences.

And they are even related to behaviors that cause diseases, harm and social dysfunctions”, says expert Paulo Sérgio Pinheiro in his “World report on violence against boys and girls”.

Also chronic stress is related to anxiety and fear. It increases the risk of mental disorders, with long-term consequences that affect the personality as a whole, with psychiatric and social consequences.

“In adulthood, battered children are more prone to violence. They have an increased risk of aggression against their spouses, children and even other people. But, also against themselves, like in cases of suicide, repetitive sexual abuse and juvenile violence; and survivors of child abuse also tend to self-inflicted dangerous situations, such as alcohol intake, smoking and other forms of drug addiction”, says Montoya.

August • 2017

A watchful eye Child abuse can be prevented.

This requires everybody’s awareness, with public health campaigns directed at families, this is primary prevention; also with group strategies, known as secondary prevention; and working together with kindergartens and schools, tertiary prevention. The point is to speak out on every case and treat every affected child.

Parents should be the first protecting their children within a healthy environment. Primary attention services back families through home visits and parental forming programs.

All environments should promote affection and proper ways of relating with each other. And, naturally, the pediatrician’s participation is of the utmost importance.

Child abuse can be prevented. This requires everybody’s awareness, with public health campaigns directed at families, this is primary prevention; also with group strategies, known as secondary prevention.

“In order to diagnose child abuse, it is necessary to acknowledge it even exists, risk factors should be explored, detecting them in a timely manner. Medical appointments could be the child’s only hope for a change, and to achieve the adequate way of life he deserves. It might be the only

opportunity to stop the pain and suffering”, emphasizes doctor Montoya.

Elements to be taken into account A. At the appointments the pediatrician should be attentive to:  Belt or buckle marks, cigarette butt burns, shapes such as the iron, etc.

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A multidisciplinary treatment

E

 If the child’s lesions correspond with the motive to assist to the physician.  I f a l o n g t i m e m i g h t h a v e passed between the event and the medical appointment.  The child is afraid or too shy, or even, on the contrary, he could be too active or too attached to the physician.  W h e n t a l k i n g p r i v a t e l y t o t h e p a re n t s , o r t h o s e w h o care for the child, conflict i n g v e r s i o n s a p p e a r, w i t h vague explanations and trivializations.

 Parents could also have exaggerated their worries because of the supposed accident. Guilt is related to an extremely warm and accommodating behavior with the child at the doctor’s office.  Ask about the child’s school performance. Commonly this is a suggestive indicator, together with other psychological elements that point to child abuse, for instance: missing school, hyperactivity, aggressiveness, rebelliousness, disorganization.

 Ask the child to tell a story and analyze it, taking into account it is difficult for them to talk openly about abuse and non-verbal language could be very eloquent.  Children tend to be unable to narrate abstract stories about experiences they haven’t lived, much more so if they are negative or traumatic. It is difficult for them to keep the coherence of details, such as emotional and physical aggressions of the genitals and anus.  Finally, it is important to believe in the child when he speaks of 11

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August • 2017

very hospital and clinic that offers health services to children should ideally have an interdisciplinary team, including social workers, psychologist, nurse, physiotherapy, nutrition, pediatrics, psychiatry and other professions.

If a pediatrician suspects child abuse, he should “first of all talk to the family or the person with the child”, says Doctor Darío Botero Cadavid.

All the workers at a health care institution are obliged to denounce the event at Instituto Colombiano de Bienestar Familiar (ICBF), the family courts or any other related authorities, such as the police, Personería, Procuraduría, Defensoría or the Attorney General Office.

We suggest having at hand at hospitals and emergency services a list of the institutions that protect children, such as: Attorney General Office, Police, CTI, Instituto Colombiano de Bienestar Familiar, Asociación Afecto de Bogotá (www.afecto.org).

“An adequate clinical history, with detailed descriptions of the findings and the treatments, will be very helpful to the proper authorities in courts.”

It is worth remembering that article 18 in 2006 law 1098, called Código de Infancia y Adolescencia (Childhood and Adolescence Code), defines “child abuse involves all types of harm, punishment, humiliation or abuse, be it physical or psychological, including neglect, omission, ill-treatment or exploitation, also sexual abuse or violence against a child or an adolescent by his parents, legal representatives or anybody else”.

Also in the July 10th 2007 law 1146 makes it clear that “sexual violence against a child or an adolescent is considered every sexual act or behavior against them, forcing them or coercing them in anyway, be it physical or emotional, taking advantage of their defenselessness, inequality and the power relationship between the victim and the perpetrator.

This task involves many people, as 2007 law 1146 establishes it in the 3rd article where it creates “linked to Ministerio de la Protección Social, Comité Interinstitucional Consultivo para la Prevención de la Violencia Sexual y la Atención Integral de los Niños, Niñas y Adolescentes Víctimas de Abuso Sexual”, were there are also representatives of the Colombian associations of psychiatry, psychology, pediatrics and sexology, among others.

August • 2017

HEALTH UPDATE

abuse or battering, and also defend him. The highest probability is he isn’t lying.

B. Some suspicious situations that could suggest child abuse: Neglect and poor hygiene, emotional deprivation.  Frequent hospitalizations and repeated accidents.  Long bone fractures with an awkward clinical history.  Any child less than a year old with a fracture.  A girl without the menarche with genital bleeding or discharges.  Suicide attempts.  Neglect: to take a long time to go looking for help.  Unexplained altered psychomotor development.  U n e x p l a i n e d s e v e r e dehydration.  Multiple skin lesions that suggest the use of an instrument.  Fetal abuse: to neglect the pregnancy, maternal alcohol and other psychoactive drug use, an abused mother.  Genital lesions.

C. Situations that demand immediate notification:

 Severe neurologic lesion explained as a small accident.  Evidence of a shaken baby.

According to the Mayo Clinic, this a syndrome related to when the parents or the person in charge of the baby shake him because of frustration or anger, frequently related to persistent crying. It could result in permanent brain damage, and even death. Symptoms include

irritability, difficulty to be awake, seizures, breathing abnormalities, appetite loss, hematomas and vomit.  Deliberate burns with cigarette butts, liquids or an iron on the back, buttocks, legs, diaper area or the back of the hands.  A bone fracture in a child that doesn’t walk yet.  A sexually transmitted disease or HIV.

REFERENCES 1. ASOCIACIÓN AFECTO CONTRA EL MALTRATO INFANTIL, WWW.AFECTO.ORG.CO 2. BUTCHART A, KAHANE T. PREVENCIÓN DEL MALTRATO INFANTIL: QUÉ HACER, Y CÓMO OBTENER EVIDENCIAS. ORGANIZACIÓN MUNDIAL DE LA SALUD (OMS); 2009.

3. COLOMBIA, CONGRESO DE LA REPÚBLICA. LEY 1098, CÓDIGO DE LA INFANCIA Y LA ADOLESCENCIA (2006 NOV 8).

4. COLOMBIA, CONGRESO DE LA REPÚBLICA. LEY 1146 DE 2007. DISPONIBLE EN: HTTPS://WWW.RAMAJUDICIAL. GOV.CO/DOCUMENTS/573203/887553/LEY+1146+DE+2007+%28PREVENCIO%CC%81N+VIOLENCIA+SEXUAL+DE+LOS+NIN%CC%83OS+Y+ADOLESCENTES%29.PDF/3A258443-D17E-4BC7-9D04-5A4D04980E18 O EN HTTP:// WWW.MINEDUCACION.GOV.CO/1621/ARTICLES-146167_ARCHIVO_PDF.UNKNOWN 5. COLOMBIA, MINISTERIO DE SALUD Y PROTECCIÓN SOCIAL. RESOLUCIÓN 412, GUÍA DE ATENCIÓN AL MENOR MALTRATADO (2000).

6. CUADROS I. MANUAL BÁSICO PARA EL DIAGNÓSTICO Y TRATAMIENTO DEL MALTRATO INFANTIL. BOGOTÁ: LA IMPRENTA EDITORES; 2002.

7. ESTUDIO DEL SECRETARIO GENERAL DE LAS NACIONES UNIDAS SOBRE LA VIOLENCIA CONTRA LOS NIÑOS. DISPONIBLE EN: HTTPS://WWW.UNICEF.ORG/LAC/INFORME_MUNDIAL_SOBRE_VIOLENCIA_1(1).PDF 8. MONTOYA C. EL MALTRATO INFANTIL EN LA UNIDAD DE CUIDADO INTENSIVO PEDIÁTRICO. EN: ÁLVAREZ C, MONTOYA C, OCAMPO M, RAMÍREZ R (COMPS.). CUIDADO CRÍTICO PEDIÁTRICO. MANIZALES: EDITORIAL UNIVERSIDAD DE CALDAS; 2007. P. 75-90.

9. MONTOYA C, OMAÑA O, GUARÍN L, ET AL. MALTRATO INFANTIL. DOCUMENTO GUÍA. SEGURO SOCIAL. BOGOTÁ: NUEVAS EDICIONES; 1998.

10. ORGANIZACIÓN SAVE THE CHILDREN, WWW.SAVETHECHILDREN.ORG 11. PINHIRO PS. INFORME MUNDIAL SOBRE LA VIOLENCIA CONTRA LOS NIÑOS Y LAS NIÑAS. (EXPERTO INDEPENDIENTE PARA EL ESTUDIO DEL SECRETARIO GENERAL DE LAS NACIONES UNIDAS SOBRE LA VIOLENCIA CONTRA LOS NIÑOS).

12. POLÍTICA DE INFANCIA Y ADOLESCENCIA DE BOGOTÁ 2011-2021. DISPONIBLE EN: HTTP://INTRANETSDIS.INTEGRACIONSOCIAL.GOV.CO/ANEXOS/DOCUMENTOS/2.1_PROC_MISI_CONSTRUCCION_IMPLEMENTACION_POLITICAS_SOCIALES/(06012016)_POLITICA_DE_INFANCIA_Y_ADOLESCENCIA.PDF 13. SOCIEDAD COLOMBIANA DE PEDIATRÍA. LA CRUDA RADIOGRAFÍA DEL MALTRATO INFANTIL EN BOGOTÁ. DISPONIBLE EN: HTTPS://SCP.COM.CO/ACTUALIDAD-PEDIATRIA-SOCIAL/LA-CRUDA-RADIOGRAFIA-DEL-MALTRATO-INFANTIL-EN-BOGOTA/

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COVER PAGE

A heart beat for

stricken children in San Doctor Adriana Zableh Solano and a group of concerned citizens have been helping children with cancer, promoting their health, entertainment and wellbeing. And these efforts have decreased the mortality rates, while increasing the humanity of their medical treatments.

August • 2017

M

any forms of cancer can remit, if they are detected on time and treated adequately. “ This is what we should think when a patient is diagnosed with a malignant tumor. And many things are yet to be done in order to return healt”.

With this belief, doctor Adriana Zableh Solano acts as the medical head at Unit of Oncology and Radiotherapy at Hospital Universitario de Santander. She is also one of the founders of Asociación Sanar, Bucaramanga Regional, that works in favor of the timely attention and wellbeing of children with cancer.

She has toiled in this manner for more than 20 years, and even though some cases are not as fortunate, she is still prudently optimistic. Enough to continue her fight against cancer in children. She is convinced that “those who have a strong family support and a stable religious belief, in any religion, do have a better chance”.

How do you see the situation in our country?

For Colombia, child cancer is a challenge. Yearly there are around 2.000 new cases. And the most frequent are leukemias, brain tumors, as well as some types of bone malignancies. Despite that, it can be treated successfully: around 60% of the children die because of a lack of adequate and timely medical care. It is the second death cause in the age group between 2 and 14 years.

In our department, and its influence area, the northeastern region of the country, we diagnose around 120 new cases yearly. And almost 50% of them are cared for at Hospital Universitario de Santander.

While, in more developed countries, 90% of the children improve, in Colombia survival rates depend on the insurance company that covers them. For those within the prepaid system the survival rate is near 80%, while for those in the contributive regime it is around 70%, and only 20% of the children do make it

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PROFILE

cancer tander

First of all, her love of children he was born at Bucaramanga (Santander), and graduated from the medical school at Universidad Industrial de Santander and as a radioncologist at Pontificia Universidad Javeriana de Bogotá. For the last 12 years she has been the medical head at Unit of Oncology and Radiotherapy at Hospital Universitario de Santander. Where she arrived in 1994, it was then called Hospital Universitario Ramón González Valencia, right after working at Hospital Universitario Erasmo Meoz at Cúcuta. She married Doctor Hermann Rodríguez Díaz, whom she thinks is a fine person, an excellent friend and an inseparable companion for her activities.

She has developed several projects and activities in order to improve the quality and integrity of the poorest cancer patient services in the region. She is a founding member of Asociación Sanar at Bucaramanga.

She has received several awards. Among them the first Premio Mujer Cajasan in Santander and also the second runner up for the Mujer Cafam award in Colombia.

Two of the most prestigious awards given in our country to women dedicated to social activities worthy of recognition.

She’s also the president and founder of Fundación Vivir, a growing NGO that intends to build a new oncology unit, Centro Oncológico de Santander, at Hospital Universitario de Santander, with the purpose of helping the poorest and most vulnerable oncological patients in the department and its area of influence. Also, it will most certainly improve the undergraduate and postgraduate training programs.

And she also teaches at the medical and paramedical schools and is a lecturer on oncology related topics. Also she is a founding member of Asociación Colombiana de Radioterapia Oncológica (ACRO) and of Asociación Latinoamericana de Terapia Radiante Oncológica (Alatro).

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August • 2017

Photos: JAIME DEL RÍO

S

COVER PAGE without social security, also called linked system.

For years you have been particularly sensitive to children cancer, you are committed to help these patients, how did this interest of yours begin?

Ley 100 appeared almost at the same time as I graduated as an oncologist. Its conception is good; it intends to give universal health coverage. The problem then was that intermediaries appeared, shifting the destiny of health funds to purposes different than healthcare.

Patients that come to us from the subsidized regime with the suspicion of a malignancy or even with the diagnosis have usually faced all sorts of difficulties in order to be diagnosed and treated in a timely and adequate manner, improving their outcomes.

So, we founded Asociación Sanar to overcome these difficulties of the Colombian health care system, and improve the pediatric patient’s care.

August • 2017

How does Asociación Sanar work?

Sanar Bogotá was born 31 years ago. Its goal was to help children with cancer that was being treated at Hospital de la Misericordia. Today it also operates at Barranquilla and Pereira. And we, at Bucaramanga, are the newest site (16 years). In those days, together with our pediatric oncologist, doctor Ernesto Rueda Arenas, as well as a group of sensible people to these issues, decided, with guidance of Sanar Bogotá, to start our own Sanar sectional. A new opportunity for us to direct our efforts to offer a service that cares for the integral wellbeing of the children with humanity and sensibility to the pediatric population and their families.

The foundation includes physicians and other good people, together with the parents and other family members of the patients, even of children that have already died because of the disease.

The funds to cover all of our activities come from donations, recreational activities, such as a yearly bingo, and from the collection and sale of lids and other plastic residues. Achieving our goal, we also decrease contamination. A plastic lid, for instance, left unattended in the environment will take around 100 years to degrade.

You care for the children integrally, how do you do it?

The foundation embraces all the children with a cancer diagnosis that arrive at Hospital Universitario de Santander. Sanar pays for the person that assists to the consultation in pediatric oncology. And that person keeps all the data on the patient and his family, including phone numbers, addresses, the insurance company, clothing and shoe sizes, just in case someone wants to donate something useful to the patient.

Sanar gives the patient personal hygiene elements, as well as mattresses to make comfortable the mother that accompanies him when he is admitted to the hospital. And also at casa Sanar, located nearby the hospital, we have washers and dryers for their own clothing and their children’s. Also, the psychologists are valuable assets that help the children and their families to accept and fight the disease.

We also support their nutrition, education and recreation, together with other organizations that work with us. This way we offer them a truly integral service.

You give them services that other ways would not be considered, such as recreation and tourism.

How do these elements help them?

The psychological wellbeing of a child diagnosed with cancer improves the treatment success. So, our foundation promotes activities that

The head office for Fundación Sanar Bucaramanga opened their doors to the public 16 years ago to aid children suffering from cancer, but over all, to bring the, love, hope and kind treatment.

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Finally, we help our survivors to adapt and give a new meaning to their lives. We believe this improves our country. Among them we already have several graduated doctors, nurses, engineers and other professionals.

We are far from perfection, but we are still working on it sensibly and with commitment.

How has Sanar affected the children with cancer and their families?

In 2015 I payed a medical epidemiologist to study and measure the survival rates of children with cancer treated at Hospital Universitario de Santander. And I’m proud to say that since Sanar Bucaramanga started operating, no child with cancer has died because of a lack of medicines.

The survival rates have increased from 40% to 70%, in the typical

disease: acute lymphoid leukemia.

This is why we work so hard.

How can anyone help Sanar?

We ask our politicians and representatives to help us generating and enforcing laws in favor of the oncological patient. As for the rest of the community, everyone can back at least one of our campaigns. Patients and their mothers are short of hygiene elements, clothing and shoes. Any support helps them improve their life quality. We require donations because we are a non-governmental and non-lucrative organization.

And finally, I would like to reflect, many cancers in adults can be prevented.

That’s why there are so many campaigns promoting these ideas. But this is not true for children’s cancer. So it must be handled through early detection programs.

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A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

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alleviate the difficulties of facing their daily realities.

There are other foundations that help the children not to miss school.

Another one, together with SENA students, makes wigs for the patients. While yet another one, on Sundays, gives lunches to the mothers and entertains the admitted patients to the hospital.

And also a very important contrib u t i n g fo u n d at i o n , a d v i ce s a n d supports them on legal issues related to the cancer treatment and their follow up appointments.

And another one, once a year, takes the children and their mothers to the sea side, many of them have never been there before. All these foundations make lives easier for these patients. They even celebrate special dates with them, such as Children’s day, their birthdays and the most awaited for, Christmas!

PROMOTION

PREVENTION

Coomeva Medicina Prepagada actively participates in Alianza AFLC

With joint efforts in order to rid the world of

dental cavities Efforts are pulled together in order to work as a team with the academy, professionals, institutions and the community in order to educate and prevent, approaching the patient in an integral manner, the point is that by year 2026 this disease will be a distant memory.

August • 2017

Photo: ®2017 SHUTTERSTOCK PHOTOS

D

ental cavity prevalence in patients under 12 years in Colombia has gone from 57% in 1998 to 37% in 2014. In adults between 20 and 34, it decreased from 74% to 53% during the same period.

This data was published in the IV estudio nacional de salud bucal (IV National Oral Health Report, Ensab 2014)

by Ministerio de Salud y Protección Social. So there has been an important advance in this field, we can assume prevention campaigns have been successful and odontopediatrics and other related specialties have led this initiative.

So, today, the approach to this sort of patient is integral. All his vital functions and his normal development should tend to the adequate balance we call ‘health’. So a newborn with complications during his first stages of his development; having required, for instance, nasogastric tube feeding, later on requires monitoring and periodic checkups of the progression of the orofacial structures; so different specialists should intervene in such a case.

On the other hand, statistics show the oral cavity is the access route to many diseases, so it

is important to keep it in the best shape possible. And dental cavities are the most prevalent mouth diseases. So on September 2010 at Bahía, Brazil, Alliance for a Cavity-Free Future was launched. The purpose was to be more effective educating in order to prevent dental cavities, reducing its incidence and cost. After all, it is a disease that can be prevented, controlled and treated

early on in its initial stages, improving life quality for the patients.

And by October 2010 the Colombian chapter of the alliance was formed during the 50 year congress of Asociación Colombiana de Facultades de Odontología (Colombian Association of Dentistry Schools).

Probably this was the first Latin American initiative of this type, facing this public health issue.

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Achieving the goals Statistics presented at the beginning of this article suggest education, prevention and professional integral intervention are benefitting the population.

These are specific goals the alliance has achieved, and has been validating since 2015: *First goal: all children born after 2026 should be cavity-free throughout their lives. *Second goal: within the first three years of Alliance for a Cavity-Free Future chapter’s launch, 90% of the faculties and dental associations in the region should be onboard with the project. “Dental cavities are a process”, the

With the support of members of the alliance, numerous prevention campaigns have been carried out in the schools and neighborhoods of Cali. idea is to improve the treatment and prevention of the disease.

Third goal: Alliance for a Cavity-Free Future chapters will work jointly with a wide range of organizations in order to reduce inequality in dental cavity treatment, control and prevention, both nationally and internationally.

Fourth goal: by 2020 regional member of Alliance for a Cavity-Free Future must’ve formed integral systems, locally appropriate, and capable of controlling and handling dental cavities, as well as monitoring the existing treatments and their developments.

Action fronts In order to achieve these goals, Alliance for a Cavity-Free Future Colombian chapter developed two

related work fronts. The first one has been evolving within the academy. It is trying to build a consensus among universities about teaching the assignments related to dental cavities. It emphasizes dental health is a right, while it also improves the overall formation and actualization of dental health care human resources. And the second one, within the community, is intended to improve children’s general health conditions, designing and operating local plans and attention models according to the primary health care principles.

We are achieving all these goals.

There are notable improvements. We are getting closer to the goal that by 2026 dental cavities will only be a historic detail.

For those interested in participating in this very important project, you may contact Lina María García, head of Frente Comunitario lina. garcia.z@correounivalle.edu.co or Andrea Díaz, dental health auditor and head of the Alliance for a Cavity-Free Future at Coomeva Medicina Prepagada (andreax_diaz@coomeva.com.co).

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According to doctor Lina María García Zapata, a master’s degree graduate on epidemiology and the director of the Colombian chapter of Alliance for a Cavity-Free Future, “it is a strategy that joins forces between academy, private and public sectors, as well as the community, so as to orient efforts and resources towards reducing dental cavity incidence within the youngest population in order to improve life quality and eventually eradicate the disease by 2026”.

Salud Oral Coomeva Medicina Prepagada, through its Dental Élite program, participates in this Project in the Valle Section together with Secretaría de Salud Municipal de Cali, Colgate-Palmolive, Universidad del Valle, ESE Ladera, Academia de Odontopediatría and Academia de Pediatría. Also, at a national level the strategies and programs this alliance has developed are backed by Asociación Colombiana de Facultades de Odontología, together with Universidad del Bosque, Universidad de Antioquia and several local governments, mainly Cundinamarca and Antioquia, as well as Ministerio de Salud y Protección Social.

RESEARCH

INTERVIEW

Manizales leads a network that decreased

the mortality rate related to cervical cancer Because of the oncogynecologist Germán Olarte’s dedication and creative developments, early detection of cervical cancer has improved, and therefore the mortality rate related to it has decreased.

August • 2017

M

ore than two decades ago the standardized mortality rate related to cervical cancer was over 11 cases in 100 thousand inhabitants, according to Instituto Nacional de Cancerología-Ministerio de Salud y Protección Social. And looking at these data, by departments, Caldas had the highest mortality rate. While its capital, Manizales, had the highest incidence nationwide, 38.6% of the cases, according to a research done at that time in 10 cities.

However, by 2013, the national rates had decreased to 6.4 cases per 100 thousand inhabitants, and by 2021 the rate is expected to be fewer than 5.5 cases. And Caldas was also able to change this terrible trend. With the help of several institutions, they implemented a community cervical cancer control intervention model that could be extended to the whole country.

“Basically it decentered all those activities Hospital Universitario de Caldas used to take care of, and turned them into primary level responsibilities throughout the towns. This way, we built Red de Patología Cervical y Colposcopia (Cervical Pathology and Colposcopy Network), that provides health care services all over the region. So patients don’t have to travel in order to find a trained doctor and have easy

access to prevention”, explains the leader of the project: doctor Germán Olarte Echeverry, a gynecologist and an obstetrician formed at Universidad de Caldas and a gyneconcologist form Pontificia Universidad Javeriana.

For the Colombian researcher, an indispensable aspect has been to commit and form general practitioners with a specific training program that takes at least a year, turning them into new health agents capable of “detecting cervical malignancies early on, and eradicating them, curing patients with low costs, within their own environments, and without interfering with their work. And by the way, it turned out to be a successful strategy that could be useful for the rest of the country”. The best part of it all? “We reduced the mortality rates!”, says doctor Olarte.

Technology is a fundamental ally Besides traveling to all the towns in Caldas since 1986, in order to take care of the job the university hospital used to do and also to train general practitioners in colposcopy and become physician that could inform people on risk factors and the prevention of cervical cancer, doctor Olarte overcame a technical barrier. There weren’t enough colposcopes and they were unable to move this big and heavy

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Photos: FELIPE ALVAREZ

August • 2017

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RESEARCH

INTERVIEW

August • 2017

equipment in order to take care of the patients.

So he invented and developed the Colpolarte colposcope. A portable device that allows a 360 degree stereoscopic view of the cervix, that is to be used after the gynecological physical exam, an unavoidable part of the medical appointment in order to establish the presence of pelvic masses, and stage them if they are found. The whole point is to diagnose early on intraepithelial malignancies, when they are more likely to be cured.

As a gyneconcologist and a researcher at Grupo de Cáncer de Cuello Uterino y Mama at Universidad de Caldas, he formed a joint venture in order to patent the device. So it “transfers technology and knowledge, and the regions become autonomous handling such an overwhelming problem as cervical cancer”, adds the doctor.

X-ray

I

n Colombia, cervical malignancies are considered the first cancer related death causes among women between 30 and 59 years, according to a survey by Instituto Nacional de Cancerología that was presented by Ministerio de Salud y Protección Social on World Cancer Day. “It is sort of a parasitic disease in Colombia”, argues doctor Germán Olarte.

“Women starting their sexual lives anywhere in the country, that are undernourished, overweighed or obese, and with economical restrictions, should be tested, they are the vulnerable group”, advices the specialist.

When intraepithelial malignancies are found early on there is a 98% to a 100% cure rate. “The problem lies when the tumor is left alone. 10 years later on it tends to become an invasive cancer. Then it turns into a grave problem: the treatment becomes expensive and mutilating; surgery, chemotherapy and radiotherapy are usually required. With early diagnosis, cervical cancer can be cured almost always with a very slight incapacity, it usually is an ambulatory procedure and organs are preserved”.

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PROFILE

Decentered towns Germán Olarte Echeverry

Social welfare is at his heart

H

e is a gynecologist, an oncologist and a researcher at Grupo de Cáncer de Cuello Uterino y Mama at Universidad de Caldas, where he taught gynecology and obstetrics. After that he started working on oncology and developing the program that would take him around Caldas installing cervical pathology and colposcopy units, and forming general practitioners for this purpose.

“We are an interdisciplinary team that includes gynecologist Paola Gallego, as well as William Aristizábal and Carlos Ruiz, biomedical engineers”, says the doctor. He defines himself as someone who is devoted to social causes and welfare. “My single goal is population growth with a high life quality”.

He is a simple man. He is a committed doctor and a husband with four children, and also four grandchildren, whom he loves deeply and shares his time with.

But also, his medical work and his invention of the Colpolarte colposcope have given him several acknowledgements, locally, nationally and internationally. One of them by Universidad de Caldas at Encuentro Innova: Conocimiento Útil a la Sociedad (Innova Fair, useful knowledge to Society) acknowledging his historical research for his own medical school: he received the first three invention patents, one of them for the Colpolarte colposcope.

Also the township of Manizales acknowledged him publicly for his achievements as a teacher, a researcher and the social impact of his work. The council at Facultad de Ciencias para la Salud at Universidad de Caldas also awarded him for his “scientific, ethical and humanist spirit”.

While, Sociedad Caldense de Obstetricia y Ginecología (Socalog) honored him for “his trajectory and his achievements as a true example for obstetrics and gynecology for Caldas and Colombia”. They gave him a honorary mention within the II Coffee Regional Congress on Gynecology and Obstetrics Central Zone.

WE INVITE OUR HEALTH CARE PROFESIONALS to share with us your research, academic or community experiences.

This way we can enrich this section, while publishing your professional achievements and developments. Write to us at prestadores_coomeva@coomeva.com.co 23 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

August • 2017

This community intervention model decenters knowledge and technology towards the first attention levels. It not only involves trained personnel, but also requires the Colparte colposcope. It is an easy to use and inexpensive portable device. As a matter of fact, as we speak, they already have 16 colposcopes of this sort that are going to be delivered in towns where trained general practitioners are awaiting for them.

And another benefit: patients tend to be more consistent with their medical follow ups. This issue used to be an obstacle. They had to travel, for instance to Manizales, and when they arrived there they also had to move 6 or 7 more times in order to receive the diagnosis, attention and treatment. Today it can all be done at their own towns, in one place. If patients aren’t persistent, it is unavoidable that the tumor will go on and the risks increase.

Today, there are 2 outstanding towns: Salamina and Aguadas. “At Salamina, that used to be a high risk town, the yearly mortality rate was 15 women, now, after training the general practitioners and giving them the necessary technology, after 2006, the mortality rate decreased to 1 yearly case. And in the last 5 years, there have been no deaths because of this disease”. This is an outstanding achievement!

On the other hand, according to several surveys the general practitioners and the community have had positive responses to the program.

“Those heroic physicians have been able to help the people. While the community sees it as something extraordinary: they are being taken care of without having to travel, and this involves less costs, not having to leave the children on their own and being able to work freely”.

MERITS

The international accreditation of the JCI

Centro Médico Imbanaco is

Photo: CENTRO MÉDICO IMBANACO IMAGES FILE

F August • 2017

or the last 41 years, Centro Médico Imbanaco has been devoted to high quality, safe and human attention, always trying to provide wellbeing, care and life to the patients. It is not surprising. That’s why it has been honored with the international accreditation given by the Joint Commission International (JCI), the most experienced accreditation organization in the world.

Centro Médico Imbanaco is the first of its sort in southwestern Colombia to receive such recognition. Even though it is the fifth in the country -other

Thanks to the culture of creative, innovative, safe and high quality and human services, the most influential hospital in southwestern Colombia, received this golden award. It shares it worldwide with only 588 other institutions of this type. awarded institutions are Fundación Cardioinfantil, Fundación Cardiovascular de Colombia, Hospital Pablo Tobón Uribe and Fundación Santa Fe de Bogotá-.

After a thorough process carried out by the expert auditors from the Joint Commission International, they arrived at the conclusions that the clinical processes, the service lines and the

professionalism of all the workgroups are integrated, committed and achieve adequate standards offering high quality health care services.

They considered 1.076 items, worldwide requirements, of which 99.6% (1.072) were a 100% fulfilled.

And, as a matter of fact, technological resources and patient’s safety were the 2 aspects with the best scores.

WE INVITE OUR HEALTH CARE PROFESIONALS to share with us your research, academic or community experiences.

This way we can enrich this section, while publishing your professional achievements and developments. Write to us at prestadores_coomeva@coomeva.com.co 24 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

among the best in the world Also auditors underscored innovation and careful implementation of safe building management systems within the organization for its personnel and their belongings, as well as for its technology, the handling of dangerous material, and also for emergencies and threats due to disasters and fires.

In the tribute Coomeva Medicina Prepagada offered Centro Médico Imbanaco, from left to right, Doctors Jorge Alberto Zapata Builes, Coomeva Medicina Prepagada CEO; Armando González Materón, Centro Médico Imbanaco’s CEO; Edgar Iván Ortiz Lizcano (gynecology and osbstetrics), President of the Board of Centro Médico Imbanaco; nurse Carolina González, Patient Quality and Safety Coordinator Centro Médico Imbanaco; and doctor Astolfo Franco, Centro Médico Imbanaco Quality Director.

In order to achieve these grand advances in the service and safety culture that made the institution eligible for this priceless recognition, they started by excluding from their language words like ‘competitiveness’; instead, they replaced it with the creative mind concept that emphasizes the dreams of those who work at the organization and share the interest in the common wellbeing. This way they created a new attitude, and everyone tried to do their best. So, with joy and pride we can say this recognition by JCI is well deserved.

However, this accreditation isn’t the only one received by the hospital. In the year 2000 Patient Safety Program, a pioneer strategy in Colombia, was implemented. They also received ISO 9001, ISO 14001 e ISO 18001 quality certificates by Icontec. Besides, the clinical laboratory was offered

its international accreditation by the American Pathology College, after fulfilling more than 3.500 requirements.

And it is also worth mentioning, this was the first laboratory to receive such recognition in the region. Proud of their achievements in favor of the community, members of the community of Centro Médico Imbanaco have built a culture around ethics, quality, comfort and safety for the patients.

Coomeva MP congratulates the organization Moved by the quality award given to Centro Médico Imbanaco by Joint Commission International, on last june 27th at Club Colombia de Cali, Coomeva Medicina Prepagada payed tribute to the whole team at the clinic, the best in southwestern Colombia, and one of the most distinguished in the nation and the world.

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Ever since 1976, when Centro Médico Imbanaco started operating in Cali with only 28 consultation rooms occupied by doctors that used to teach at Universidad del Valle, its main goal has been to offer the best and most advanced possible health care services from the human perspective, as well as from the technological and the technical points of view. A goal they already achieved, evolving and developing continuously, until they got to be one of the best in the world. As a matter of fact, before its main building was finished, it was already among the best 12 clinics and hospitals in Latin America, according to a list published in América Economía, a magazine from Chile.

With this new award, Centro Médico Imbanaco is now among the select 588 credited worldwide institutions by the Joint Commission International’s Hospital Program. And its golden award is also considered the golden standard in world health care.

Two people working at Centro Médico Imbanaco led this huge effort.

They planned it carefully and rigorously, and then they also controlled it until they finally got the accreditation: Nurse Carolina González, Quality and Patient Safety Coordinator, and Doctor Astolfo Franco, Quality Director. It took them 3 years of hard and committed work with all the areas and process’s heads in the institution.

Photo: JORGE MEJIA

A huge step in evolution

MERITS

August • 2017

Photo: CENTRO MÉDICO IMBANACO IMAGES FILE

Some of the health care professionals at Centro Médico Imbanaco, together with the board members and Coomeva Medicina Prepagada representatives, celebrated the clinic’s achievement in a friendly environment. Also a commemorative plak was given to the team that led the accreditation process, as well as to Doctor Armando González Materón, the head of the institution. It turned out to be an emotional get together, acknowledging the brave and outstanding work Centro Médico Imbanaco has done for the southwestern region, and, for that matter, the whole country.

“In the name of the board of directors of Centro Médico Imbanaco, as well as my own, we want to thank Coomeva Medicina Prepagada, and the whole Grupo Coomeva, for its support of our institution, through your hospital and clinic network and, in the beginning of our organization, giving loans to the 26 original founding partners, in order to build our first two story building. Coomeva has been with us from the start, and has accompanied us while we grow and develop. It has been a first order strategic ally. Thanks Coomeva, thanks Doctor Zapata”. These were the grateful words Doctor González Materón spoke, he was an asset for the accreditation process, as well as for the whole community.

Coomeva is proud of having such an ally, a high quality medical organization. It is a job well done. Congratulations and thank you whole heartedly to all the people that made these events possible. And we wish you all the best, with a bright future for the benefit of Colombia’s health care system.

Centro Médico Imbanaco (Cali)

Photos: JORGE MEJIA

The JCI considered 1.076 items, worldwide requirements, of wich 99.6% (1.072) were a 100% fulfilled by the CMI.

Aspects from the tribute held by Coomeva Medicina Prepagada at the Centro Médico Imbanaco.

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FROM

COOMEVA

MEDICINA PREPAGADA

Mipres, for the

user’s wellbeing The health care workers should adequately use this platform. It is designed to give an easier access to non-POS services and, therefore, improve your health.

Photo: ®2017 SHUTTERSTOCK PHOTOS

M

Differences between the old CTC model and the new Mipres model Old CTC non-POS prescription (Resolution 5395)

New Mipres non-POS prescription (Resolution 3951)

Health care professionals used to ask for the non-POS service on a hand filled CTC form.

The health care professional asks for the non-POS service with the Mipres web application.

The user used to take the CTC form to the EPS, together with a copy of the clinical history and the prescription.

Paper work is suppressed. The EPS downloads the prescriptions from the Mipres application.

CTC is eliminated, EPS no longer CTC and EPS established the pertinence of the form, and could approve have the authority to approve or deny or deny the non-POS service. non-POS services.

by Invima, and can only be used for diagnosis established by the Ministry.

• EPS check Mipres prescriptions, and if inconsistencies are found (POS

Coomeva Medicina Prepagada’s call Trying to ease the access to our health care services for our affiliates, Coomeva Medicina Prepagada calls on all ascribed professionals to use the Mipres platform to prescribe non-POS services.

service, a prescription error, an unjustified service, among others) they can return it to the doctor, in order to correct it.

• IPS offering non-POS services must form professional groups that will evaluate Unirs prescriptions, complementary services and ambulatory nutritional products. They will approve, or not, the services.

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inisterio de Salud y Protección Social’s 2016 resolution number 3951 designed and implemented the Mipres platform. It standardized prescriptions of technologies and services that are not included in the benefit plan for the whole country, also known as ‘non-POS’. And it replaces the old authorization procedure, where the EPS’s Comité Técnico-Científico (CTC) used to oversee users who could receive the non-POS services.

Mipress started operating since April 1st, 2017, within the contributive regime, and applies, for now, to health care professionals, IPS and EPS that offer non-POS services to the affiliates.

What you should know about Mipres: • Through the platform physicians, dentists, optometrists and nutritionists can prescribe.

• It must only be used for non-POS services, medicines with Invima health registration and procedures included in CUPS. • What used to be called exclusions (such as diapers, sun blocks, humectants, etc.), are now called ‘complementary services’.

• Unirs medicines (no indicated uses in Sanitary Registration Number) are those with unauthorized indications

COOMEVA

PROMOTES

A NEW RELATIONSHIP

August • 2017

model is on its way with the health service providers

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Photos: ®2017 SHUTTERSTOCK PHOTOS

A

fter thoroughly evaluating the relationship policies with health service providers and developing a new model, It’s our pleasure to inform you that within very well attended forums and meetings, in several regions of the country, the ideas and proposals that emerged there were duly noted, and action plans were designed in order to execute them between 2017 and 2019.

These are the activities to be performed during this year’s second semester and the first half of 2018: 1. Tariff policy revision, modification and actualization:  Different payment for subspecialities, accounting for offer and demand basic variables within the market place.  Tariff unification for professio. nal procedures within the same specialty and region.

2. I m p ro v e m e n t o f a d m i n i s t r a tive efficacy and problem solving capabilities:  Modification and improvement of the common and shared user operative routes.  To define new common and shared user operative routes, making them more agile and with a shorter response time for the services.

3. Benefits only for health service providers and their family groups:  Exclusive tariffs for ascribed professionals and their families

whom want to become affiliates of Coomeva Medicina Prepagada’s services.

4. Stimulus for the health service providers’ development  Acknowledgement of excellence of professionals and institutions ascribed to Coomeva Medicina Prepagada.

While, at the same time, we are executing these tasks, we are also strengthening the communications and their mechanisms with the whole family of health service providers. And, from time to time, we will keep you informed through different channels about the progresses and achievements of these goals. We will all be able to participate in the agreement´s information and benefits.

Coomeva Medicina Prepagada is committed to strengthening even more the links it has with the health care professionals. We are interested in your needs, preferences and aspirations. All this, in order to implement the necessary strategies required to build even more confidence, security and fidelity among our much appreciated health service provider community.

Grupo Coomeva, one of the most solid cooperatives in Colombia, is unconditional, turning it into a power house that will propel the new model.

This is the way we believe we can continue to lead the voluntary insurers sector in Colombia.

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It is very satisfying for us to present you with the agreements we achieved with the health service providers throughout the country.

OUR PLUS

Coomeva Medicina Prepagada offers pet assistance services

Now pet assistance services for those other family members will be available. They will enjoy not only your love and happiness, also your unconditional protection. These are some of the benefits that your pets will receive.

Phone veterinary guidance GEA Colombia offers the entitled affiliates veterinary service phone guidance, 24 hours a day, the whole year round. When the person calls the assistance line, the veterinarian evaluates the pet’s symptoms, and will suggest provisional or preventive actions or procedures while a consultation is possible.

This service is available for unlimited yearly events.

August • 2017

Vaccine:

1 pet, 1 event Vaccination services will be available to only one of the affiliate’s pets, be it a dog or a cat, over six months old, with a prior checkup by a Providers Services Network of GEA Colombia’s professionals. He or she will verify the vaccine card and the pet’s identity. It only applies to vaccine reinforcements.

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Veterinarian stay, 3 days, COP $150.000, 1 event

Veterinary transport, COP $150.000, 2 events

In case of a hospitalization of the ensured’s pet, GEA C o l o m b i a of fe r s veterinary hospitalization, 24 hours a day, 365 days a year. With this service, the insured’s pet will be able to stay and be cared for at an GEA Colombia authorized veterinary center for up to 3 continuous days. This service is offered up to 30 km from the city limits and should be coordinated at least 3 hours before hand.

Also, it will take place at the veterinary network offered by the GEA providers.

If the ensured requires emergency veterinary transport to a service center for the pet because of a disease or an accident, or it requires transport to a hotel or a day care, the company coordinates and follows up the transport. This service is only available in the main cities, within 30 km from the city limits.

This service has a 2 events limit and a $150.000 maximum price per service.

Searching and finding

the pet In case the affiliate’s pet is lost, GEA Colombia, prior requirement of the owner and his authorization, will circulate images in a blog and in social networks in order to find it.

These services will be available for 2 events per year.

Legal assistance GEA Colombia offers phone legal assistance on civil rights issues, telling the insured owner of the pet what to do in case it bites, attacks and injures someone in a public venue, and there is a sue because of it.

Exclusions:

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Photos: ®2017 SHUTTERSTOCK PHOTOS

 When the victim provokes the pet.  When the event happens within private property.  When the pet defends itself from a violent attack.

This service is limitless during the year.

Photo and illustrations: ®2017 SHUTTERSTOCK PHOTOS

EBM

Could celiac disease have an unexpected origin?

August • 2017

By: Santiago Barrios Vásquez, MD*

Recently an unexpected, but significant, association was identified between some types of virus that used to be considered non-pathogenic and the possibility of developing celiac disease. These findings could be the starting point of new vaccines that would suppress the autoimmune response in these cases.

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This study shows virus belonging to the human intestinal reovirus family, usually found within the normal intestinal flora, might be involved in the processes that trigger abnormal immunological reactions to gluten. chronic inflammatory autoimmune disease. And one of the most promising aspect of these findings is the possibility of developing a vaccine that could in the future prevent this chronic and grave autoimmune disease, reducing the risks of severe and long term complications derived from it.

Deep into celiac disease Celiac disease has been explained as an abdnormal immune response against gluten, a common protein among grains such as wheet, rye and barley. When the patient ingests the protein an abnormal immunological response is initiated against the small bowel, eventually decreasing its normal capacity to absorb nutrients. And this theory of the physiopathology also explains why this abnormality can have systemic manifestations, and why, for now, the only available and effective

treatment against it is to absolutely avoid gluten in the diet.

On the other hand, celiac disease can be diagnosed at any age. The diagnosis is usually established when the person starts eating gluten containing foodstuffs. But also it is known, since the last century, that the later the disease is diagnosed the risk of developing another autoimmune disease is higher for these patients. And if celiac disease goes on untreated, it frequently presents other autoimmune associated diseases.

It is important to bare in mind that among these other autoimmune diseases, diabetes mellitus type I, multiple sclerosis and herpetiform dermatomyositis, can be diagnosed. Celiac disease has even been linked to anemia, osteoporosis and osteopenia, as well as with infertility and spontaneous

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A

new study1 suggests that a group of virus that used to be considered non-pathogenic could be related to celiac disease. This recent research on lab rats arrives at conclutions that suggest the possibility that members of the reovirus family, usually found in the human intestine as part of the normal digestive tract flora, and therefore usually considered harmeless, could be related to the processes that initiate the physiopathologic events that preced the abnormal immune response against gluten. A common protein in grains in the usual diet.

This disease is considered one of the severe autoimmune alterations, because it is associated with lessions on the small intestine lining, that later tend to have grave consequences.

Also, celiac disease occurs in people with a particular genetic predisposition. As a matter of fact, the illness has a hereditary pattern, specially among first degree relatives, such as parents, children and brothers, the risk of developing it among them is around 1 in 10. It is also a common disease in the world, affecting 1 in 10 people, with severe and enduring complications. “Research suggests a usually benign virus could alter the immune system in such a way it prepairs the terrain for an autoimmune alteration, in predisposed people, that could manifest itself as a celiac disease�, said doctor Bana Jabri, the main researcher and the head of research at the Celiac Disease Center at Chicago University.

These results are noteworthy because they suggest that members of the reovirus family of the human intestine, a common community virus, could be linked to the origins and the natural history of this disease in patients with a specific hereditary predisposition. After all, as it usually occurs in nature, events tend to have several causes, not just one. So, besides a genetic predisposition, these types of infections could also involved in the causality and progression of this

August • 2017

MBE abortions; and also with certain neurological abnormalities, such as epilepsy, migrane, athaxia, seizures, dementia, neuropathy, myopathy and multifocal leukoencephalopthy, as well as with short stature and several types and localizations of digestive cancers, especially digestive lymphomas, together with other digestive abnormalities, for instance pancreatic insufficiency and gall bladder function alterations.

So more than half of the patients with celiac disease are diagnosed during adolescence and adulthood.

Usually because they have other autoinmune conditions, such as idiopathic junevenile arthritis, Sjögren’s disease, several types of anemia, autoimmune hepatitis and thyroiditis, chronic fatigue syndrome and herpetiform dermatitis. And the disease has also been linked to Down’s syndrome, gluten athaxia and idiopathic dilated cardiomyopathy, as well as with other digestive diseases, such as liver abnormalities like primary biliar chirrrosis and lymphocitary and mycroscopic colitis.

Also, because it is an autommune disease, the response tends to be stable over the years, therefore treatment for celiac diseas requires a perennial gluten free diet. Patients should always avoid foodstuffs derived from wheet, rye and barley, such as bread and bear, for example.

“Eventhough the interaction of the specific virus in the context, in other words, the general health state of the host or phenotype, offered by host’s genome, do matter”, added doctor Jabri in a press release published by the universiy.

Other noteworthy aspect of this research is that lab rats that developed gluten intolerance, also had a statistically significant increase in the concentrations of antibodies against reovirus, when compared to those that didn’t have the autoimmune disease.

“So that’s why we believe, after more research yet to come, we should

consider in the future if children at risk of developing celiac disease should receive the vaccine”, added the spokesperson for the research.

For these researchers the results open up the way to finding more knowledge on the relationship between certain viral infections and the origins and development of autoimmune diseases, in a way never expected, much the same as it happened with type I diabetes mellitus. And these findings must come before the possibility of, eventually, developing a vaccine that could prevent and modify the course of these abnormalities.

“During the first year of life, the immune system is still maturing, so the child with a particular genome could acquire the virus, leaving an immunological scar, you might say, with long term consequences”, summed up Doctor Jabri.

REFERENCE 1. JABRI B., PREIDT R. LA ENFERMEDAD CELÍACA TIENE UN CULPABLE SORPRENDENTE. HEALTHDAY [INTERNET]. 2017 APR . AVAIL ABLE IN: HTTPS:// CONSUMER.HEALTHDAY.COM/DISEASES-AND-CONDITIONS-INFORMATION-37/CELIAC-DISEASE-962/ IQUEST-LA-ENFERMEDAD-CEL-IACUTE-ACA-TIENE-UN-CULPABLE-SORPRENDENTE-721445.HTML FURTHER READINGS: HTTPS://CELIAC.ORG/CELIAC-DISEASE/UNDERSTANDING-CELIAC-DISEASE-2/WHAT-IS-CELIAC-DISEASE/#Z0RY21KLQEUCGWGT.99

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MEDICAL

WORLD

EVENTS ‘2ND E-HEALTH CONGRESS Date and place: august 29th and 30th, Bogotá Information: Rozo & Asociados Phone number: (571) 703 4830 314 420 9545 E-mail: congresoesalud@rozoasociados.com Web page: www.esalud.com.co

‘VIII NATIONAL MEETING OF DERMATOLOGY RESIDENTS 2017

‘XVII COLOMBIAN CONGRESS ON PNEUMOLOGY AND THORAX SURGERY Date and place: august 3rd through the 6th, Barranquilla Information: Asociación Colombiana de Neumología y Cirugía de Tórax Phone number: (571) 322 2335 Web page: www.asoneumocito.org

Date and place: 18th through the 20th, Villavicencio Information: Asociación Colombiana de Dermatología y Cirugía Dermatológica Phone number: (571) 618 1455 - 634 6601 Web page: www. asocolderma.org.co

Date and place: august 8th through the 12th, Cartagena Information: Sociedad Latinoamericana de Patología Phone number: (57) 315 716 2884 E-mail: congreso@slap-patologia.org Web page: www.slap-patologia.org 35 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

August • 2017

‘XXXI LATINAMERICAN CONGRESS ON PATHOLOGY

MEDICAL

WORLD

EVENTS ‘43RD NATIONAL CONGRESS ON SURGERY

Date and place: august 22nd through the 25th, Medellín Information: Asociación Colombiana de Cirugía Phone number: (571) 257 4560 257 4501 E-mail: info@asocolcirugia.org Web page: www.asocolcirugia.org

‘XVII COLOMBIAN CONGRESS ON NUTRITION AND DIETETICS, I INTERNATIONAL AND INTERDISCIPLINARY CONGRESS ON ALIMENTATION AND NUTRITION Date and place: august 10th through the 12th, Bogotá Information: Asociación Colombiana de Dietistas y Nutricionistas Phone number: (571) 256 5586 E-mail: sedecundinamarca@acodin.org Web page: www.acodin.org

‘XXVI INTERAMERICAN CONGRESS ON CARDIOLOGY Date and place: September 20th through the 23rd, Panamá (Panamá) Information: Sociedad Panameña de Cardiología Phone number: (507) 221 8317 - 221 4921 E-mail: mfabregaimpakt@ cableonda.net Web page: www. cardiologiadepanama.org

‘V LATINAMERICAN CONGRES ON STEM CELLS Date and place: September 7th through the 10th, Punta Cana (Domican Republic) Information: Sociedad Latinoamericana de Células Madre Phone number: (809) 331 1900 E-mail: info@solcema.com Web page: www.congresosolcema.com

August • 2017

‘XIII INTERNATIONAL SIMPOSIUM ON MAGNETIC RESONANCE Date and place: September 29th and 30th, Lima (Perú) Information: Instituto de Alta Tecnología Médica (IATM) Phone number: (4) 520 3130 E-mail: simposio@iatm.com.co Web page: www.iatm.com.co 36 A MAGAZINE FOR THE HEALTH CARE PROFESSIONALS WORKING WITH COOMEVA MEDICINA PREPAGADA

BOOKS BEFORE FORGETTING Author: Tomás González

HYPERSENSIBILITY TO MEDICINES: FUNDAMENTALS AND CLINICAL MANAGEMENT Author: Edgardo José Jares

T

his book was born because of an initiative from Comité de Alergia por Medicamentos de la Sociedad Latinoamericana de Alergia, Asma e Inmunología. It is easy to use, and to consult, so that the reader can quickly recognize, diagnose and treat hypersensibility reactions to commonly used medicines, such as gastrointestinals, anesthetics and chemotherapics. It is a helpful publication for all sorts of specialist, as well as for general practitioners.

INTEGRAL APPROACH FOR PATHOLOGIES RELATED TO HUMAN PAPILOMA VIRUS Authors: Silvio Tatti, Laura Fleider, María de los Ángeles Tinnirello and Ricardo Caruso

T

his textbook gives doctors an overview of the lower genitourinary tract and extragenital human papiloma virus involvement. It also includes diagnosis and treatment issues, as well as the state of the art on vaccines, and their future.

UTRASONOGRAPHY FOR DERMATOLOGY AND DERMOAESTHETICS Authors: Fernando Alfageme Roldán and Gastón Roustan Gullón

T

he structure of this textbook makes it a rapid use handbook, the reader can even use it right by the ultrasonograph.

This publication, written in collaboration by more than 40 specialists, includes the details of cutaneous ultrasonography, as well as its indications and the way it should be used. Several aspects of clinical dermatology and dermoaesthetics are considered, together with more than 200 clinical and ultrasonographic images.

J

osefina and Alfonso shared a one kiss love and a rapid rejoining, but their tail is so legendary that more than 60 years later León decides to narrate it. He tells a story based on Alfonso’s trip diary. A young journalist aspiring to be a poet, left from Envigado in order to go to Bogotá at the beginning of the 20th century. And together with Josefina’s poor memory, who, in spite of her forgetfulness, managed to recapture her memories, repairing her melancholia and her life.

A LIQUID LOVE Author: Carolina Vega

iving birth is an extraordinary event. However, what happens when things are different? This is the moving testimony of a mother who narrates those things nobody speaks of. Step by step,it shows us how everything started right from the moment of her pregnancy diagnosis, up to the birth and how she started living with the baby. With humor, irony and realism she constructs the mother’s role, as well as the father’s, the grandparent’s and all those who accompany her in this momentous occasion.

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MEDICAL

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MUSIC

MOVIES

MUSES Natalia Lafourcade he Mexican singer, in cooperation with T Los Mocorinos duet, pays tribute with this production to the Latin-American folk song tradition. In Muses the continent is united by music. That’s why Lafourcade touches so many fans with marvelous songs like “Loneliness and the sea”, “What have I gotten from loving you”, “All the field’s dew”, “These are loves” and “You got me used to you”.

n the O 28th century,

VALERIAN AND THE THOUSAND PLANETS CITY Director: Luc Besson Cast: Dane Dehann, Cara Delevingne y Clive Owen

Valerian and Laureline are part of a special agent team in charge of keeping all the human territories in order.

Under the guidelines of the Defense Minister they embark in a mission at the amazing Alpha City.

A metropolis in constant expansion, where species coming from all over the universe have converged for centuries now, in order to share knowledge, intelligence and culture. However, there is a minister in Alpha downtown: a dark force that threatens the peaceful existence of the City of the Thousand Planets. And the lead characters must compete in order to identify the danger and safeguard Alpha, as well as the future of the whole universe.

THE DARK TOWER Director: Nikolaj Arcel Cast: Matthew McConaughey y Katheryn Winnick

‘JEI BEIBI’ Café Tacuba is the eighth album Tthehisrecorded in a studio by mexican group, also with the Argentinean Gustavo Santaolalla’s production.

On this occasion the band decided not to record with a traditional discographic label, but instead the musicians recorded independently the 13 tunes. You will find in the record track like “1-2-3”, “Killing”, “Automatic”, “I like your way”, “Lion tooth”, “Celebration”.

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he last knight, Roland Deschain, a warrior, has T dedicated himself to an eternal battle against Walter O’Dim, also known as The Man in Black. He has committed not to let him destroy the Dark Tower, a tower that keeps intact the unity of the universe. With the destiny of the worlds at risk, good and evil will clash in a final battle. But Roland must defend the Tower from The Man in Black.

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Tu mascota siempre ha disfrutado tu cariño y alegría.

Ahora podrá tener tu protección incondicional

Coomeva Medicina Prepagada presenta su nueva Asistencia para Mascotas.

Porque ellos también son parte de tu familia, protegemos a tus amigos peluditos.

• Orientación veterinaria telefónica.

• Estancia veterinaria.

• Asistencia legal mascotas entre otras.

Afíliate al Programa Oro o al Programa Oro Plus y podrás disfrutar de esta y otras asistencias.

Más información en medicinaprepagada.coomeva.com.co

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