Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021

ilustraciones, diagramas

Autores:: Camargo Bermúdez, Laura Cristina

Tipo de recurso:

Fecha de publicación:: 2023

Institución:: Universidad Nacional de Colombia

Repositorio:: Universidad Nacional de Colombia

Idioma:: spa

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dc.title.spa.fl_str_mv	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021
dc.title.translated.eng.fl_str_mv	Ecological analysis of vaccination coverage against Covid-19 in the 32 departments of Colombia during 2021
title	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021
spellingShingle	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021 610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva pública Vacunas contra la COVID-19/ provisión & distribución COVID-19/mortalidad Cobertura de Vacunación COVID-19 Vaccines/supply & distribution COVID-19/mortality Vaccination Coverage Covid-19 Estudio ecológico Vacunación Tasas de mortalidad Covid-19 Ecological study Vaccination Mortality rates
title_short	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021
title_full	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021
title_fullStr	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021
title_full_unstemmed	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021
title_sort	Análisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021
dc.creator.fl_str_mv	Camargo Bermúdez, Laura Cristina
dc.contributor.advisor.spa.fl_str_mv	Pio de la Hoz Restrepo, Fernando
dc.contributor.advisor.none.fl_str_mv	Moreno Montoya, José
dc.contributor.author.spa.fl_str_mv	Camargo Bermúdez, Laura Cristina
dc.contributor.researchgroup.spa.fl_str_mv	Epidemiologia y Evaluacion en Salud Publica
dc.contributor.subjectmatterexpert.spa.fl_str_mv	Moreno Montoya, José
dc.subject.ddc.spa.fl_str_mv	610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva pública
topic	610 - Medicina y salud::616 - Enfermedades 610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva pública Vacunas contra la COVID-19/ provisión & distribución COVID-19/mortalidad Cobertura de Vacunación COVID-19 Vaccines/supply & distribution COVID-19/mortality Vaccination Coverage Covid-19 Estudio ecológico Vacunación Tasas de mortalidad Covid-19 Ecological study Vaccination Mortality rates
dc.subject.decs.spa.fl_str_mv	Vacunas contra la COVID-19/ provisión & distribución COVID-19/mortalidad Cobertura de Vacunación
dc.subject.decs.eng.fl_str_mv	COVID-19 Vaccines/supply & distribution COVID-19/mortality Vaccination Coverage
dc.subject.proposal.spa.fl_str_mv	Covid-19 Estudio ecológico Vacunación Tasas de mortalidad
dc.subject.proposal.eng.fl_str_mv	Covid-19 Ecological study Vaccination Mortality rates
description	ilustraciones, diagramas
publishDate	2023
dc.date.issued.none.fl_str_mv	2023-12
dc.date.accessioned.none.fl_str_mv	2024-04-02T00:57:41Z
dc.date.available.none.fl_str_mv	2024-04-02T00:57:41Z
dc.type.spa.fl_str_mv	Trabajo de grado - Maestría
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/masterThesis
dc.type.version.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.content.spa.fl_str_mv	Text
dc.type.redcol.spa.fl_str_mv	http://purl.org/redcol/resource_type/TM
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dc.identifier.instname.spa.fl_str_mv	Universidad Nacional de Colombia
dc.identifier.reponame.spa.fl_str_mv	Repositorio Institucional Universidad Nacional de Colombia
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url	https://repositorio.unal.edu.co/handle/unal/85837 https://repositorio.unal.edu.co/
identifier_str_mv	Universidad Nacional de Colombia Repositorio Institucional Universidad Nacional de Colombia
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.indexed.spa.fl_str_mv	Bireme
dc.relation.references.spa.fl_str_mv	Abrams, E. M., Greenhawt, M., Shaker, M., Pinto, A. D., Sinha, I., & Singer, A. (2022). The COVID-19 pandemic: Adverse effects on the social determinants of health in children and families. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 128(1), 19–25. https://doi-org.ezproxy.javeriana.edu.co/10.1016/j.anai.2021.10.022 Ali, H. A., Hartner, A. M., Echeverria-Londono, S., Roth, J., Li, X., Abbas, K., Portnoy, A., Vynnycky, E., Woodruff, K., Ferguson, N. M., Toor, J., & Gaythorpe, K. A. (2022). Vaccine equity in low and middle income countries: a systematic review and meta-analysis. International journal for equity in health, 21(1), 82. https://doi-org.ezproxy.javeriana.edu.co/10.1186/s12939-022-01678-5 Anakpo, G., & Mishi, S. (2022). Hesitancy of COVID-19 vaccines: Rapid systematic review of the measurement, predictors, and preventive strategies. 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Estudios Post censales [https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/censo-nacional-de-poblacion-y-vivenda-2018/informacion-tecnica ] Echoru, I., Ajambo, P. D., Keirania, E., & Bukenya, E. E. M. (2021). Sociodemographic factors associated with acceptance of COVID-19 vaccine and clinical trials in Uganda: a cross-sectional study in western Uganda. BMC public health, 21(1), 1106. https://doi-org.ezproxy.javeriana.edu.co/10.1186/s12889-021-11197-7 Fatima, M., Ikram, N., Majeed, A., Parveen, F., Tariq, M., Barkat, M. Q., Zeng, L. H., … Wu, X. (2022). COVID-19 vaccine trials and sex-disaggregated data. Expert review of vaccines, 21(3), 285–288. https://doi.org/10.1080/14760584.2022.2015331 Fierabracci, A., Arena, A., & Rossi, P. (2020). COVID-19: A Review on Diagnosis, Treatment, and Prophylaxis. International journal of molecular sciences, 21(14), 5145. https://doi-org.ezproxy.javeriana.edu.co/10.3390/ijms21145145 Fiolet, T., Kherabi, Y., MacDonald, C. 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S., Singh, R., Pala, S., Bali, S., Rustagi, N., Goel, K., Sankhe, L., Modi, B., Gupta, M., Aggarwal, A. K., Rajagopal, V., & Padhi, B. K. (2022). Sociodemographic Determinants of Willingness and Extent to Pay for COVID-19 Vaccine in India. Frontiers in public health, 10, 870880. https://doi.org/10.3389/fpubh.2022.870880 Kirtipal, N., Bharadwaj, S., & Kang, S. G. (2020). From SARS to SARS-CoV-2, insights on structure, pathogenicity and immunity aspects of pandemic human coronaviruses. Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases, 85, 104502. https://doi.org/10.1016/j.meegid.2020.104502 López-Gay, A., Spijker, J., Cole, H. V. S., Marques, A. G., Triguero-Mas, M., Anguelovski, I., Marí-Dell'Olmo, M., Módenes, J. A., Álamo-Junquera, D., López-Gallego, F., & Borrell, C. (2022). Sociodemographic determinants of intraurban variations in COVID-19 incidence: the case of Barcelona. 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G., Lahmar, I., Dubuisson, A., Zumla, A., Raoult, D., Merad, M., Gachot, B., Hénon, C., Solary, E., Fontenay, M., André, F., Maeurer, M., Ippolito, G., Piacentini, M., Wang, F. S., Ginhoux, F., Marabelle, A., Kroemer, G., … Zitvogel, L. (2020). Immune responses during COVID-19 infection. Oncoimmunology, 9(1), 1807836. https://doi-org.ezproxy.javeriana.edu.co/10.1080/2162402X.2020.1807836 Mesa-Vieira, C., Botero-Rodríguez, F., Padilla-Muñoz, A., Franco, O. H., & Gómez-Restrepo, C. (2021). The Dark Side of the Moon: Global challenges in the distribution of vaccines and implementation of vaccination plans against COVID-19. Maturitas, 149, 37–39. https://doi.org/10.1016/j.maturitas.2021.05.003 MINSALUD – DATOS COVID-19. (2023). Ministerio de Tecnologías de la Información y las Comunicaciones. [https://www.datos.gov.co/Salud-y-Protecci-n-Social/Asignaci-n-de-dosis-de-vacuna-contra-COVID-19/sdvb-4x4j/explore/query/SELECT%0A%20%20%60num_resolucion%60%2C%0A%20%20%60fecha_resolucion%60%2C%0A%20%20%60a_o%60%2C%0A%20%20%60cod_territorio%60%2C%0A%20%20%60nom_territorio%60%2C%0A%20%20%60laboratorio_vacuna%60%2C%0A%20%20%60cantidad%60%2C%0A%20%20%60uso_vacuna%60%2C%0A%20%20%60modificacion_res%60%2C%0A%20%20%60fecha_corte%60/page/filter] Mirahmadizadeh, A., Rezaei, F., Jokari, K., Moftakhar, L., Hemmati, A., Dehghani, S. S., Hassani, A. H., Lotfi, M., Jafari, A., & Ghelichi-Ghojogh, M. (2022). Correlation between environmental factors and COVID-19 indices: a global level ecological study. Environmental science and pollution research international, 29(11), 16667–16677. https://doi.org/10.1007/s11356-021-16876-x Mobarak, A. M., Miguel, E., Abaluck, J., Ahuja, A., Alsan, M., Banerjee, A., Breza, E., Chandrasekhar, A. G., Duflo, E., Dzansi, J., Garrett, D., Goldsmith-Pinkham, P., Gonsalves, G. S., Hossain, M. M., Jakubowski, A., Kang, G., Kharel, A., Kremer, M., Meriggi, N., Nekesa, C., … Więcek, W. (2022). End COVID-19 in low- and middle-income countries. Science (New York, N.Y.), 375(6585), 1105–1110. https://doi.org/10.1126/science.abo4089 Mohamadian, M., Chiti, H., Shoghli, A., Biglari, S., Parsamanesh, N., & Esmaeilzadeh, A. (2021). COVID-19: Virology, biology and novel laboratory diagnosis. The journal of gene medicine, 23(2), e3303. https://doi.org/10.1002/jgm.3303 Morales, D. X., Beltran, T. F., & Morales, S. A. (2022). Gender, socioeconomic status, and COVID-19 vaccine hesitancy in the US: An intersectionality approach. Sociology of health & illness, 44(6), 953–971. https://doi-org.ezproxy.javeriana.edu.co/10.1111/1467-9566.13474 Mousavizadeh, L., & Ghasemi, S. (2021). Genotype and phenotype of COVID-19: Their roles in pathogenesis. 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Influence of socio-ecological factors on COVID-19 risk: a cross-sectional study based on 178 countries/regions worldwide. medRxiv : the preprint server for health sciences, 2020.04.23.20077545. https://doi-org.ezproxy.javeriana.edu.co/10.1101/2020.04.23.20077545 Sy, K. T. L., White, L. F., & Nichols, B. E. (2021). Population density and basic reproductive number of COVID-19 across United States counties. PloS one, 16(4), e0249271. https://doi-org.ezproxy.javeriana.edu.co/10.1371/journal.pone.0249271 The World Data Bank (2023). World Development Indicators [ https://databank.worldbank.org/reports.aspx?source=2&series=SP.POP.TOTL&country=COL ] Tregoning, J. S., Flight, K. E., Higham, S. L., Wang, Z., & Pierce, B. F. (2021). Progress of the COVID-19 vaccine effort: viruses, vaccines and variants versus efficacy, effectiveness and escape. Nature reviews. Immunology, 21(10), 626–636. https://doi.org/10.1038/s41577-021-00592-1 Vitiello, A., Ferrara, F., Troiano, V., & La Porta, R. (2021). COVID-19 vaccines and decreased transmission of SARS-CoV-2. Inflammopharmacology, 29(5), 1357–1360. https://doi.org/10.1007/s10787-021-00847-2 Wouters, O. J., Shadlen, K. C., Salcher-Konrad, M., Pollard, A. J., Larson, H. J., Teerawattananon, Y., & Jit, M. (2021). Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Lancet (London, England), 397(10278), 1023–1034. https://doi-org.ezproxy.javeriana.edu.co/10.1016/S0140-6736(21)00306-8 World Health Organization, WHO (2023). Number of COVID-19 cases reported to WHO [ https://data.who.int/dashboards/covid19/cases?n=c ] Vilà, R., Torrado, M., & Reguant, M. (2019). Análisis de regresión lineal múltiple con SPSS: un ejemplo práctico. REIRE Revista d Innovacio i Recerca En Educacio, 12 (2). https://doi.org/10.1344/reire2019.12.222704
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dc.format.extent.spa.fl_str_mv	99 páginas
dc.format.mimetype.spa.fl_str_mv	application/pdf
dc.coverage.temporal.none.fl_str_mv	2021
dc.coverage.country.spa.fl_str_mv	Colombia
dc.coverage.tgn.none.fl_str_mv	http://vocab.getty.edu/page/tgn/1000050
dc.publisher.spa.fl_str_mv	Universidad Nacional de Colombia
dc.publisher.program.spa.fl_str_mv	Bogotá - Medicina - Maestría en Infecciones y Salud en el Trópico
dc.publisher.faculty.spa.fl_str_mv	Facultad de Medicina
dc.publisher.place.spa.fl_str_mv	Bogotá, Colombia
dc.publisher.branch.spa.fl_str_mv	Universidad Nacional de Colombia - Sede Bogotá
institution	Universidad Nacional de Colombia
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spelling	Atribución-SinDerivadas 4.0 Internacionalhttp://creativecommons.org/licenses/by-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Pio de la Hoz Restrepo, Fernando28854bbe4b124fbe4f441507d984a848Moreno Montoya, Joséd10a67ef1c696b089ad8ca810a395d68300Camargo Bermúdez, Laura Cristina559d9a743f0c39d96a4677f5ce740429Epidemiologia y Evaluacion en Salud PublicaMoreno Montoya, José2021Colombiahttp://vocab.getty.edu/page/tgn/10000502024-04-02T00:57:41Z2024-04-02T00:57:41Z2023-12https://repositorio.unal.edu.co/handle/unal/85837Universidad Nacional de ColombiaRepositorio Institucional Universidad Nacional de Colombiahttps://repositorio.unal.edu.co/ilustraciones, diagramasLa enfermedad del nuevo coronavirus SARS-CoV2 (Covid-19) fue detectada por primera vez en una aldea en China a finales del 2019, ocasionada por un Beta-coronavirus SARS-CoV2, desde entonces el aumento de casos reportados fue de manera exponencial hasta llegar a ser declarada Pandemia (Fierabracci, A, et al, 2020). A inicios del 2020 la comunidad científica inició una carrera para desarrollar opciones terapéuticas eficaces para disminuir el número de casos y muertes ocasionadas por la Covid-19 (Vitiello, A. et al, 2021). Durante ese año se desarrollaron múltiples vacunas que incluyeron RNAm, vectores virales y virus inactivados, las cuales demostraron disminuir el contagio y los síntomas en personas infectadas con Covid-19 (Vitiello, A. et al, 2021). Sin embargo, la vacunación mundial presenta múltiples amenazas, especialmente en los países de medianos y bajos ingresos (PMBI), los cuales tienen menos recursos para acceder a las vacunas necesarias para inmunizar a toda la población (Choi, E. 2021). En este trabajo se realizó un estudio ecológico descriptivo utilizando un análisis geográfico de las coberturas de vacunación contra Covid-19 (variable dependiente), las tasas de mortalidad por Covid-19 en Colombia (Variable dependiente) y su relación con los factores sociodemográficos (variables independientes) en los 32 departamentos durante el año 2021. Adicionalmente, se realizó un análisis de las medidas de tendencia central, un análisis de regresión lineal simple y múltiple, además de un modelo de Poisson para determinar si existe una relación estadística entre las coberturas de vacunación, las tasas de mortalidad y los factores sociodemográficos. Para lograrlo, se realizó una revisión sistemática de las bases de datos de libre acceso en las páginas del ministerio de salud, el DANE y el instituto nacional de salud (INS). Se encontró que la mayoría de los departamentos presentaron coberturas de vacunación superiores al 100% siendo San Andrés y Bogotá los departamentos con mayor cobertura de vacunación (207%, 194% respectivamente). En contraste, los departamentos con menor cobertura de vacunación fueron Vichada (52%), Chocó (65%) y Vaupés (78%). Se analizaron también las tasas de mortalidad departamentales por Covid-19 para el año 2021 y se analizó su relación con las tasas de mortalidad del 2020. Se encontró que en todos los departamentos hubo un aumento significativo de la mortalidad en 2021, comparado con 2020, el cual estaba influenciado por el porcentaje de población rural y población femenina y población mayor o igual a 60 años. También se evidenció que hay una relación directamente proporcional entre la cobertura de vacunación versus las variables de porcentaje de población total, población mayor o igual a 60 años y población femenina. En contraste, se observó una relación inversamente proporcional entre la cobertura de vacunación y el porcentaje de ruralidad. Adicionalmente, el modelo de regresión lineal múltiple y el modelo Poisson, presentaron coeficientes muy bajos para la vacunación respecto a las tasas de mortalidad, los cuales pueden no ser estadísticamente significativos y no permiten evidenciar la magnitud de la relación entre las variables. Este efecto pudo ser debido a que los departamentos con mayores coberturas contaban con una mejor infraestructura del sistema de salud, los cuales posiblemente recibieron los casos más graves de Covid-19 remitidos para tratamiento especializado y allí fallecían. Los resultados aquí presentados muestran que no hay un efecto protector ecológico de la vacunación contra Covid-19 y las tasas de mortalidad por Covid-19 para el año 2021. Sin embargo, los factores sociodemográficos poblacionales como el porcentaje de ruralidad, el género y la edad afectan directamente estas variables para cada departamento de Colombia. (Texto tomado de la fuente).The new coronavirus disease SARS-CoV2 (Covid-19) was detected for the first time in a village in China at the end of 2019, caused by a Beta-coronavirus SARS-CoV2. Since then, the increase in reported cases has been exponential until becoming declared a Pandemic (Fierabracci, A, et al, 2020). At the beginning of 2020, the scientific community began a race to develop effective therapeutic options to reduce the number of cases and deaths caused by Covid-19 (Vitiello, A. et al, 2021). During that year, multiple vaccines were developed that included mRNA, viral vectors and inactivated viruses, which were shown to reduce contagion and symptoms in people infected with Covid-19 (Vitiello, A. et al, 2021). However, global vaccination presents multiple threats, especially in low- and middle-income countries (LMIC), which have fewer resources to access the vaccines necessary to immunize the entire population (Choi, E. 2021). In this work, a descriptive ecological study was carried out using a geographical analysis of vaccination coverage against Covid-19 (dependent variable), mortality rates from Covid-19 in Colombia (dependent variable) and their relationship with sociodemographic factors (independent variables) in the 32 departments during the year 2021. In addition, an analysis of the measures of central tendency, a simple and multiple linear regression analysis, in addition to a Poisson model was carried out to determine if there is a statistical relationship between the coverage of vaccination, mortality rates and sociodemographic factors. To achieve this, a systematic review of the freely accessible databases on the pages of the Ministry of Health, DANE and the National Institute of Health (INS) was carried out. It was found that the majority of the departments presented vaccination coverage greater than 100%, with San Andrés and Bogotá being the departments with the highest vaccination coverage (207%, 194% respectively). In contrast, the departments with the lowest vaccination coverage were Vichada (52%), Chocó (65%) and Vaupés (78%). The departmental mortality rates due to Covid-19 for the year 2021 were also analyzed and their relationship with the mortality rates of 2020 was analyzed. It was found that in all departments there was a significant increase in mortality in 2021, compared to 2020. which was influenced by the percentage of rural population and female population and population greater than or equal to 60 years of age. It is also evident that there is a directly proportional relationship between vaccination coverage versus the variables of percentage of total population, population greater than or equal to 60 years of age, and female population. In contrast, an inversely proportional relationship will be observed between vaccination coverage and the percentage of rurality. Furthermore, the multiple linear regression model and the Poisson model presented very low coefficients for vaccination with respect to mortality rates, which may not be statistically significant and do not allow us to show the magnitude of the relationship between the variables. This effect could be due to the fact that the departments with greater coverage had better health system infrastructure, which possibly received the most serious cases of Covid-19 referred for specialized treatment and died there. The results presented here show that there is no ecological protective effect of vaccination against Covid-19 and mortality rates from Covid-19 for the year 2021. However, population sociodemographic factors such as the percentage of rurality, gender and Age directly affects these variables for each department of Colombia. This work demonstrated that mass vaccination against COVID-19 is a fundamental tool to control the spread of the virus and protect the health of the population, especially in the population over 60 years of age and that the progress of the vaccination campaign in Colombia has been an important step in the fight against the pandemic. However, it is necessary to propose future studies that evaluate the coverage of the health system and take into account some individual sociodemographic factors that were not analyzed in this work, such as access to health centers, occupation, level of education and income, which, according to the literature, are related to vaccination and mortality from Covid-19.MaestríaMagíster en Infecciones y Salud en el TrópicoSe realizó un análisis ecológico descriptivo de comparación de grupos analizando como variables dependientes las coberturas de vacunación contra Covid-19 y las Tasas de Mortalidad por Covid-19 y como variables Independientes los factores sociodemográficos seleccionados (Edad, Género y Densidad Poblacional). Se realizaron análisis descriptivos y bivariados. Se aplicaron regresiones lineales simples, múltiples y de Poisson para el análisis estadístico.Epidemiología de Enfermedades transmisibles99 páginasapplication/pdfspaUniversidad Nacional de ColombiaBogotá - Medicina - Maestría en Infecciones y Salud en el TrópicoFacultad de MedicinaBogotá, ColombiaUniversidad Nacional de Colombia - Sede Bogotá610 - Medicina y salud::616 - Enfermedades610 - Medicina y salud::614 - Medicina Forense; incidencia de lesiones, heridas, enfermedades; medicina preventiva públicaVacunas contra la COVID-19/ provisión & distribuciónCOVID-19/mortalidadCobertura de VacunaciónCOVID-19 Vaccines/supply & distributionCOVID-19/mortalityVaccination CoverageCovid-19Estudio ecológicoVacunaciónTasas de mortalidadCovid-19Ecological studyVaccinationMortality ratesAnálisis ecológico de las coberturas de vacunación contra la Covid-19 en los 32 departamentos de Colombia durante el 2021Ecological analysis of vaccination coverage against Covid-19 in the 32 departments of Colombia during 2021Trabajo de grado - Maestríainfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/acceptedVersionTexthttp://purl.org/redcol/resource_type/TMBiremeAbrams, E. 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REIRE Revista d Innovacio i Recerca En Educacio, 12 (2). https://doi.org/10.1344/reire2019.12.222704InvestigadoresMaestrosPúblico generalResponsables políticosLICENSElicense.txtlicense.txttext/plain; charset=utf-85879https://repositorio.unal.edu.co/bitstream/unal/85837/1/license.txteb34b1cf90b7e1103fc9dfd26be24b4aMD51ORIGINAL1018473409.2024.pdf1018473409.2024.pdfTesis de Maestría en Infecciones y Salud en el Trópicoapplication/pdf1880304https://repositorio.unal.edu.co/bitstream/unal/85837/3/1018473409.2024.pdf4293da5ff37581f6458b4d1fb7a99037MD53THUMBNAIL1018473409.2024.pdf.jpg1018473409.2024.pdf.jpgGenerated Thumbnailimage/jpeg4603https://repositorio.unal.edu.co/bitstream/unal/85837/4/1018473409.2024.pdf.jpgbc23dec2f135f4620dd5596ac2a2dfe7MD54unal/85837oai:repositorio.unal.edu.co:unal/858372024-09-12 09:10:10.703Repositorio Institucional Universidad Nacional de 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