Background Leukemia is the most common cancer in childhood. The estimated incidence rate of childhood leukemia in Colombia is one of the highest in America and little is known about its spatial distribution. Purpose To explore the presence of space-time clustering of childhood leukemia in Colombia. Methods We included children less than 15 years of age with confirmed diagnosis of acute leukemia reported to the national surveillance system for cancer between 2009 and 2017. Kulldorff’s spatio-temporal scan statistics were used with municipality and year of diagnosis as units for spatial and temporal analysis. Results There were 3846 cases of childhood leukemia between 2009 and 2017 with a specific mean incidence rate of 33 cases per million person-years in children aged 0–14 years. We identified five spatial clusters of childhood leukemia in different regions of the country and specific time clustering during the study period. Conclusion Childhood leukemia seems to cluster in space and time in some regions of Colombia suggesting a common etiologic factor or conditions to be studied.

Background Air pollutants are considered carcinogenic to humans. In some European countries, an association between industrial air pollution and childhood cancer has been established. This relationship has not been addressed in Latin America, despite the spatial variability of air pollutants that may limit the extrapolation of the results to other geographical areas. Objective To conduct a spatial analysis of the relationship between childhood cancer and proximity to industrial sources of air pollution in a metropolitan area of Colombia. Methods Incident cases of childhood cancers were obtained from the Population‐based Cancer Registry of the Metropolitan Area of Bucaramanga during 2000‐2015. Local and focused cluster tests were used for the detection of spatial clusters, and the Poisson multivariable model was used to evaluate the combined effects of spatial variables. Results The Kulldorff's focused test found a significant spatial cluster (P < 0.001) around one industrial agglomerate and the multivariable model results suggests that the distance effect is modified by the directional effect of the wind. Conclusion A spatial cluster of incident cases of childhood cancer occurred in the municipality of Bucaramanga, Colombia. Our finding supports the hypothesis that childhood cancer might be related with industrial air pollution exposure in a Latin American city.

Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000–2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf’s circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.

A surgery patient is a unique medical patient due to its requirements, not in the treatment itself but its prevention of post-operative complications affecting the user's close circle experience. Indeed, the patient journey is a crucial cross-functional business process because of the action and information flow between stakeholders and medical systems. Poor patient flow can reduce productivity, increase the risk of harming patients, and reduce the level of quality perceived by patients. Thus, hospitals can enhance the quality of the processes by understanding this roadmap. Consequently, this work focuses on establishing a framework that details the medical patient roadmap considering three approaches: Design Thinking (DT),  Lean Manufacturing Techniques, and Operations Research Applications (OR). This work implements the Lean manufacturing Techniques in healthcare (a.k.a., Lean Healthcare) to describe the roadmap's processes, bottlenecks, and mapping value. In parallel, the Design Thinking tools help to draw solutions through co-creation processes, including various stakeholders such as doctors, nurses, engineers, patients, and support staff. Finally, the Simulation tools help enhance the rapid prototyping regarding the roadmap's process modification. This work implements the three approaches in a healthcare institution in Colombia to improve surgery roadmap efficiency and compiled them into a theoretical framework.

A surgery patient is a unique medical patient due to its requirements, not in the treatment itself but its prevention of post-operative complications affecting the user's close circle experience. Indeed, the patient journey is a crucial cross-functional business process because of the action and information flow between stakeholders and medical systems. Poor patient flow can reduce productivity, increase the risk of harming patients, and reduce the level of quality perceived by patients. Thus, hospitals can enhance the quality of the processes by understanding this roadmap. Consequently, this work focuses on establishing a framework that details the medical patient roadmap considering three approaches: Design Thinking (DT),  Lean Manufacturing Techniques, and Operations Research Applications (OR). This work implements the Lean manufacturing Techniques in healthcare (a.k.a., Lean Healthcare) to describe the roadmap's processes, bottlenecks, and mapping value. In parallel, the Design Thinking tools help to draw solutions through co-creation processes, including various stakeholders such as doctors, nurses, engineers, patients, and support staff. Finally, the Simulation tools help enhance the rapid prototyping regarding the roadmap's process modification. This work implements the three approaches in a healthcare institution in Colombia to improve surgery roadmap efficiency and compiled them into a theoretical framework.