Universidad El Bosque

Despite an increase in mental health problems, there is low implementation of mental health services, high catastrophic health spending, and a high incidence of coercive mental health practices. This could hinder recovery after a suicide attempt. To analyze catastrophic spending and coercive practices, and their relationship with variables associated with recovery (depression and well-being) and with the functioning of health services (continuity of care), in people who attempted suicide during 2024 and 2025 in Caldas, Colombia. A cross-sectional and population-based was conducted with stratified random sampling in Colombia. Validated instruments were applied to determine subjective well-being, depressive symptoms and continuity of care in health services. To determine the perception of coercive practices in the care of suicidal behaviors in health services, an instrument was used that divided coercive practices into formal (physical abuse, isolation, forced hospitalization) and informal (involuntary medication, lack of participation in treatment planning). A multiple linear regression was calculated for formal and informal coercion. The model for formal coercion explained 21% of the variance, and the model for informal coercion explained 63.2%, both with high coefficients for catastrophic health expenditures. Compared to those who did not report coercion, those who did reported it presented with more depressive symptoms, worse continuity of care, catastrophic health expenditures, and a lower socioeconomic status. There is a relationship between the coercive practices perceived and catastrophic spending on mental health services for psychosocial recovery. Those subjected to any coercive practice may have worse outcomes in terms of catastrophic mental health spending and depressive symptoms. Catastrophic spending is proposed as a form of structural coercion that could hinder psychosocial recovery.

Abstract The Aotus lemurinus complex comprises three-night monkey species: Aotus griseimembra , A. lemurinus , and Aotus zonalis , whose distributions have historically been described as allopatric. In this study we applied ecological niche modeling (ENM) to evaluate this long-held hypothesis by comparing their climatic niches and estimate their potential geographic distributions. We assessed regions of potential distribution overlap to determine whether species distributions agree with allopatric, sympatric or parapatric patterns. Further, we quantified pairwise climatic niche similarity test to analyze niche conservatism patterns in this complex. Our results revealed potential regions of sympatry and parapatric contact identified in the inter-Andean valleys of Colombia and along the Colombia -Panama border, spanning elevations above and below 1,000 m. We found a phylogenetic niche conservatism within the complex. Thus A. griseimembra and A. lemurinus , most related species, showed the moderate higher climatic niche similarity, than the other pairwise comparissons. Overall, these findings challenge the allopatric distribution model and underscore a more dynamic ecological and biogeographic structure within the A. lemurinus complex, highlighting the importance of considering transitional zones and historical processes when interpreting their distributional patterns.

Introducción: los síntomas de los trastornos de la interacción cerebro-intestino (TICI) tienen alta comorbilidad psiquiátrica. La personalidad, entendida como un patrón relativamente estable de cognición, emoción y conducta, podría modular la expresión y gravedad de los síntomas gastrointestinales. Objetivo: determinar la relación entre los dominios de personalidad y la presencia y gravedad de los síntomas relacionados con TICI en una muestra clínica de pacientes con trastornos mentales en Bogotá. Métodos: estudio observacional, analítico y transversal realizado en 131 pacientes mayores de 18 años atendidos en una clínica de salud mental. Para medir síntomas gastrointestinales se utilizó la escala Irritable Bowel Syndrome Severity Score (IBS-SSS) y el Personality Inventory for DSM-5 (PID-5) para medir rasgos de personalidad. Se realizaron análisis descriptivos, pruebas de correlación y comparaciones mediante Kruskal-Wallis. Resultados: el 91,2% de los participantes presentó algún síntoma de los TICI, según el puntaje obtenido en la escala IBS-SSS, con predominio de rangos moderados (42,6%) y leves (31,6%). Los dominios de afecto negativo (r = 0,176; p = 0,041), desapego (r = 0,250; p = 0,003) y psicoticismo (r = 0,177; p = 0,039) se correlacionaron significativamente con mayor gravedad de los síntomas. El dominio de desapego mostró una diferencia de mayor gravedad sintomática en IBS-SSS (χ² = 11,5; grados de libertad [gl] = 3; p = 0,009) con respecto a otros dominios de personalidad. Conclusiones: los rasgos de personalidad de desapego, afecto negativo y psicoticismo se relacionan con mayor presencia de síntomas de trastornos intestinales, lo que confirma la hipótesis de la interacción intestino-cerebro. Esto resalta la importancia de evaluar tanto los rasgos de personalidad en gastroenterología como los síntomas digestivos en salud mental.

<h2>ABSTRACT</h2><h3>Objectives</h3> Global rheumatology training faces immense challenges, with over 1.7 billion people affected by musculoskeletal diseases and pronounced regional disparities in specialist access. Diverse curricula, resource limitations, and variable career pathways underscore the urgency for targeted harmonisation efforts. This study aims to present a vision for harmonising rheumatology training worldwide, highlighting the contributions of continental societies and innovative young networks, based on insights from the EMerging European Alliance of Associations for Rheumatology (EULAR) NETwork (EMEUNET) Presents session at EULAR Congress 2025 ‘Rheumatology Training Around the Globe'. <h3>Methods</h3> A narrative review of current training models across Africa, Asia-Pacific, Pan-America, and Europe using data from EULAR 2025 Congress supplemented with session slides and speaker insights. <h3>Results</h3> Programmes in Africa remain limited and fragmented, with severe workforce shortages and few structured training opportunities; regional responses include Young African Rheumatologists Network and select international partnerships. Asia-Pacific features multicountry, exam-based curricula governed centrally, but faces shortfalls in infrastructure and fellowship access, addressed in part by Asia Pacific League of Associations for Rheumatology-Young Rheumatology's educational initiatives. Pan-America is marked by significant programme heterogeneity and access barriers, with the United States standing out for its highly structured American College of Rheumatology-accredited programmes, robust educational events, and comprehensive resources. Pan-American League of Associations for Rheumatology Joven and digital education initiatives are reducing training gaps and advancing collaboration. Europe combines robust, competency-focused national programmes, with EULAR and European Union of Medical Specialties actively supporting harmonisation despite persistent local variation, and EMEUNET enhancing mentorship and career support. <h3>Conclusions</h3> Future harmonisation in rheumatology training requires flexible, competency-driven frameworks, expanded digital platforms, multilevel mentorship, and sustainable investment, integrating national programmes into global networks.

ABSTRACT.Dengue is a viral disease with a broad spectrum of clinical manifestations. Its severity is associated with risk factors such as periods of endemicity, although the extent of this contribution is unclear. In the present study, the characteristics of the clinical course and differences in the occurrence of severe and lethal outcomes were assessed by the degree of endemicity in patients with dengue treated in health institutions in Cali, Colombia, between 2019 and 2022. A longitudinal, observational-historical, single-cohort study was conducted. Analysis involved evaluating clinical complications during epidemic and endemic periods. Mortality, cumulative incidence of hospital or intensive care unit (ICU) admission, and survival time were estimated using the competing risks method. A total of 1,038 dengue cases were included. Patients with severe dengue and those with warning signs (WS) were consulted up to 6 or 5 days after symptom onset, respectively. A hospital stay of 2.0 days (Quartile [Q]1–Q3: 2–4 days) and an ICU stay of 4.5 days (SD ± 3.9 days) were estimated. A mortality rate of 5.5% was obtained for severe dengue, and a mortality rate of 0.4% was identified for patients with WS. In 2020 and 2021, the probability of hospitalization was 20% from initial contact. The likelihood of dying within 10 days after initial contact was 0% in 2019 and 11.2% (95% CI: 4.0–22.5%) in 2020. The incidence of hospitalization, number of hospital days, and ICU stays due to dengue varied by epidemiological year in a high-endemicity area. The probability of severe and lethal clinical outcomes was higher during 2020 and 2021.

To describe 5-year clinical outcomes after thymectomy in patients with myasthenia gravis (MG). We retrospectively analyzed patients who underwent thymectomy for MG between 2010 and 2023. Preoperative and annual postoperative assessments (up to 5 years) used the Myasthenia Gravis Foundation of America classification. Outcomes were stratified as complete stable remission (CSR), pharmacologic remission, or minimal manifestations, with additional evaluation by patient-reported changes in symptoms. Kaplan-Meier analyses were conducted for time-to-event data. Eighty-six patients were included (median age, 42 years; 60.5% female). The median duration of symptoms was 480 days (interquartile range, 28-56 days). Most patients (n = 70; 81.4%) had a low comorbidity burden. Preoperatively, 34% were Myasthenia Gravis Foundation of America class I. Acetylcholinesterase inhibitors were used in 95% of patients. Right video-assisted thoracoscopic thymectomy was the most common approach (76%), with a 2.3% intraoperative complication rate. Thymic hyperplasia was present in 87%; thymoma, in 13%. Postoperative intensive care was required in 96.5%, with myasthenic crisis the most frequent complication (8%). The median hospital length of stay was 4 days, and there was no 30-day mortality. At 1 year, 81.7% were Myasthenia Gravis Foundation of America class I. Kaplan-Meier analysis showed 50% reported symptom improvement by 360 days (95% confidence interval, 350-375 days). By 5 years, 8% achieved CSR. Although a decline in acetylcholinesterase inhibitor dosage was observed, this was not significant (P = .225). Thymectomy is associated with favorable long-term symptom control in MG, with low perioperative morbidity. However, rates of complete stable remission remain low, underscoring the need for further investigation into post-thymectomy outcomes and predictors of remission.