Meanings of the practices aimed at preventing cervical cancer

RESUMEN: El cáncer de cuello cérvico uterino ocupa el tercer lugar en las enfermedades oncológicas que afectan a las mujeres de todo el mundo; se calcula que globalmente esta enfermedad causa entre 230.000 y 275.000 muertes anuales [1, 2], y que su tasa de mortalidad es del 52% de los casos. Para el 2008 se calculó que el 88% de las muertes atribuibles a esta enfermedad ocurrió en África, Asia, Latinoamérica y el Caribe [1]

Proceso de adopción de la conducta saludable de toma de citología vaginal en mujeres jóvenes

Objetivos. Esta investigación evaluó la relación entre el modelo de Aproximación de Procesos a la Acción Saludable y la adopción de la conducta de toma de citología vaginal.Métodos. Se realizó un estudio correlacional, donde se incluyeron variables sociodemográficas, conocimientos, factores de riesgo y variables psicosociales.Se caracterizaron las etapas motivacional y volitiva implicadas en el proceso de adopción de la conducta saludable y se establecieron tres grupos de participantes según la fase del cambio. Las asociaciones entre las variables fueron evaluadas con análisis bivariados y multivariados.Resultados. Las mujeres se agruparon según la fase del cambio: No intencional (n=57), Intencional (n=270) y Acción (n=194). A medida que se pasó de la fase motivacional a la fase volitiva aumentaron las puntuaciones obtenidas en las escalas psicosociales, factores de riesgo y conocimiento. Los análisis de varianza mostraron diferencias significativas entre los grupos, excepto en los factores de riesgo.Conclusiones. El patrón de variación de los factores psicosociales a lo largo de las tres etapas evidenció la discontinuidad del proceso de adopción de la conducta saludable. Los conocimientos, la cantidad de hijos y los factores de riesgo tuvieron un efecto importante. La edad fue un factor importante en el proceso. Esta información es útil para la planeación de acciones de prevención del cáncer mediante la toma de citología vaginal

Factors associated with cervical cancer screening in women from middle and low socioeconomic status in Bogotá, Colombia

ABSTRACT: In Colombia, cervical cancer (cc) is the second most common type of cancer among women. It has an agestandardized incidence of 21.5/100,000. The purpose of this study was to examine the knowledge and perceived factors associated with CC screening among women from low medium income status in Bogotá, Colombia. Methodology: the study was conducted with 10 focus groups segmented by age groups (18-33, 34-49, and 50-66). Two researchers conducted content analysis and identified the emerging categories. Results: the sample consisted of 81 women whose ages ranged from 18 to 66. Early onset of sexual activity, promiscuity, vaginal infections, hpv, genetics, abortions, and lack of hygiene were identified as the most important risk factors for cc. Participants recognized that this disease does not always have symptoms, and that pap smears detect it early. However, they mentioned fear of undergoing a pap test, discomfort or pain, embarrassment, poor services, procrastination, and fear of a cancer diagnosis as the main barriers preventing regular screening. Women recommended educational campaigns and improved customer service as strategies to motivate them. Conclusion: participants reported basic knowledge about CC and screening. Actions to facilitate screening must be multifaceted and based on the barriers and facilitators mentioned by each age group.RESUMEN: En Colombia el cáncer de cuello uterino (CaCu) es el segundo más común en las mujeres con una incidencia estandarizada de 21,5/100.000. En este estudio se examinaron el conocimiento y los factores percibidos asociados con el tamizaje de CaCu en mujeres de nivel socioeconómico bajo/ medio en Bogotá, Colombia. Metodología: 10 grupos focales segmentados por grupos de edad (18-33, 34-49 y 50-66). Dos investigadores realizaron análisis de contenido, identificando categorías emergentes. Resultados: participaron 81 mujeres entre 18 y 66 años. Aunque se encontraron diferencias por grupos de edad, el inicio temprano de la actividad sexual, promiscuidad, infecciones vaginales, vph, genética, abortos y falta de higiene, fueron identificados como los principales factores de riesgo para CaCu. Ellas reconocieron que esta enfermedad no siempre tiene síntomas, y que las citologías la detectan tempranamente. Sin embargo, mencionaron miedo a practicarse la citología, incomodidad/dolor, pena, mala atención, procrastinación y miedo al diagnóstico de cáncer como las principales barreras para el tamizaje rutinario. Las mujeres recomendaron campañas educativas y mejorar el servicio como estrategias para motivarlas. Conclusión: las participantes reportaron conocimientos básicos acerca del CaCu y el tamizaje. Las acciones para facilitar el tamizaje deben ser multifacéticas y acordes con las barreras y facilitadores reportados en cada grupo etario

Prácticas de atención del parto en una institución prestadora de servicios de salud en la ciudad de Bogotá

Objectives: To analyze the practices of healthcare personnel during deliveries at a healthcare provider institution in the city of Bogota from two perspectives: gender and humanization of the delivery. Taking into account that in Colombia there has been an integral implementation, since 2016, of a comprehensive route to provide maternal perinatal Health Care as a part of a new healthcare model proposed by the Ministry of Health and Social Protection. Methodology: Qualitative, descriptive and interpretive study conducted between June and August 2017; it included non-participative observation in delivery rooms and semi-structured interviews of women whose delivery had been observed, and the healthcare Personnel that attended them. Field journals and interviews were coded. Content analysis was conducted and the information was triangulated. Results: Delivery care is based on medicalized care, which subordinates women and coincides with a routine job, including a lack of communication between women and the healthcare personnel. The research showed aspects that violate women's rights during labor and delivery, which are legitimized by healthcare personnel and justified by women themselves. Conclusions: This study is a contribution to Public Health, for it evidences a phenomenon normalized in medical practice, which deserves an intervention from the perspective of humanizing Health Care Services

Barriers and facilitators of the health system related to the follow-up of cytological abnormalities, Medellin-Colombia

ABSTRACT: Identifying barriers and facilitators of the diagnostic monitoring and treatment of cytological abnormalities in low-income women users of the public health service network in Medellin, Colombia. Methods: We created eight focal groups (62 women) according to age groups (ages 25-45 and 46-69), and performed a content analysis. Results: The reported barriers of the health system were: a) structural barriers: fragmentation in the provision of the service, problems with the affiliations and characteristics of the affiliation regime; b) management barriers: problems and delays in the assignment of appointments, long queues, problems with authorizations and mistreatment; and c) economic barriers derived from the aforementioned and related with expenses. Management and structural facilitators were also mentioned. Conclusion: Some structural characteristics of the health system and the management of insurance companies limit access for women to the monitoring of pre-cancerous lesions.RESUMEN: identificar barreras y facilitadores del seguimiento: diagnóstico y tratamiento de anormalidades citológicas en mujeres de bajos ingresos usuarias de la red pública de servicios de salud de la ciudad de Medellín, Colombia. Métodos: se realizaron ocho grupos focales (62 mujeres) según grupos de edad (25-45 y 46-69 años) y se hizo un análisis de contenido. Resultados: las barreras del sistema de salud reportadas fueron: a) barreras estructurales: fragmentación en la prestación del servicio, problemas con afiliaciones y características del régimen de afiliación; b) barreras administrativas: problemas y demoras en la asignación de citas, largas filas, problemas con autorizaciones y maltrato; y c) barreras económicas derivadas de las dos anteriores y relacionadas con el gasto de bolsillo. También se mencionaron facilitadores estructurales y administrativos. Conclusión: algunas características estructurales del sistema de salud y de la administración de las aseguradoras limitan el acceso de las mujeres al seguimiento de lesiones precancerosas

Humanização dos serviços reprodutivos a partir das experiências das mulheres: contribuições para a reflexão

Introduction: Humanized care at childbirth observes attributes in the care of pregnant women aimed at making the reproductive experience satisfactory. Objectives: This study is aimed to hear the experiences related to pregnancy and childbirth care as well as the suggestions to strengthen humanized childbirth in an integrated healthcare subnetwork in Bogotá from the voice of women and to analyze them from a humanization perspective. Materials and Methods: A qualitative phenomenological study was conducted based on semi-structured interviews and focus groups in 16 participants to explore the experiences of pregnancy and childbirth. A thematic analysis was implemented. Results: Lack of opportunities and deficiencies in the coordination, information and treatment of patients affect pregnancy care. In labor and delivery, experiences related to the lack of knowledge of patient privacy, feeling like "guinea pigs", uninformed interventions, and authoritarian exercise of healthcare professional-patient power relations are reported. Discussion: The need to ensure priority attention to pregnant women, eliminating barriers and improving information and treatment of patients is evident. In childbirth, the existence of dehumanizing practices, which have been naturalized in reproductive healthcare, is recognized and must be eradicated. Conclusions: It is necessary to break cultural and gender paradigms that affect the humanization of pregnancy and childbirth care by providing staff training, recognizing the needs of patients and qualifying the institutional organization for childbirth care. Respect for the rights of pregnant women should be a priority in student training. Permanent support to patients is crucial. How to cite this article: Ospina Vanegas Diana Paola; Cristancho Gómez Sandra Milena; Lafaurie Villamil María Mercedes; Rubio León Diana Carolina. Humanización de los servicios reproductivos desde las experiencias de las mujeres: aportes para la reflexión. Revista Cuidarte. 2020; 11(2): e1005. http://dx.doi.org/10.15649/cuidarte.1005Introducción: La atención humanizada del parto observa atributos en el cuidado a la gestante, orientados a hacer satisfactoria la experiencia reproductiva. Objetivos:  Recoger, a partir de la voz de las mujeres, y analizar, desde una perspectiva de humanización, experiencias con la atención del embarazo y parto y sugerencias para fortalecer el parto humanizado en una subred integrada de servicios de salud de Bogotá. Materiales y Métodos: Estudio cualitativo fenomenológico, basado en entrevistas semiestructuradas y grupos focales, que exploraron experiencias de embarazo y parto con 16 participantes. Se implementó un análisis temático. Resultados: La falta de oportunidad y falencias en la coordinación, información y trato a las usuarias afectan la atención del embarazo. En el trabajo de parto y parto, se relatan experiencias de desconocimiento de la privacidad, sentirse “conejillos de indias”, intervenciones no informadas y ejercicio autoritario de las relaciones de poder profesionales-usuarias. Discusión: Se evidencia la necesidad de garantizar la atención prioritaria a las gestantes, eliminando barreras y mejorando la información y trato a las usuarias. En el parto, se reconoce la existencia de prácticas de deshumanización, naturalizadas en la atención reproductiva, que deben ser erradicadas. Conclusiones: Se requiere romper paradigmas culturales y de género que afectan la humanización en la atención al embarazo y parto mediante formación al personal, reconociendo las necesidades de las usuarias y cualificando la organización institucional para la atención del parto. El respeto a los derechos de las gestantes debe primar en procesos formativos con estudiantes. El acompañamiento permanente a las usuarias es crucial. Como citar este artículo: Ospina Vanegas Diana Paola; Cristancho Gómez Sandra Milena; Lafaurie Villamil María Mercedes; Rubio León Diana Carolina. Humanización de los servicios reproductivos desde las experiencias de las mujeres: aportes para la reflexión. Revista Cuidarte. 2020; 11(2): e1005. http://dx.doi.org/10.15649/cuidarte.1005Introdução: O cuidado humanizado ao parto observa atributos no cuidado à gestante, orientados a tornar satisfatória a experiência reprodutiva. Objetivos:  Reunir, a partir da voz das mulheres, e analisar, do ponto de vista da humanização, experiências com os cuidados com a gravidez e o parto e sugestões para fortalecer o parto humanizado em uma sub-rede integrada de serviços de saúde em Bogotá. Materiais e Métodos: Estudo fenomenológico qualitativo, baseado em entrevistas semiestruturadas e grupos focais, que explorou experiências de gravidez e parto com 16 participantes. Uma análise temática foi implementada. Resultados: A falta de oportunidade e falhas na coordenação, informação e tratamento das usuárias afetam o cuidado da gravidez. No trabalho de parto e parto, são relatadas experiências de ignorância da privacidade, sentimento de "cobaias", intervenções desinformadas e exercício autoritário de relações de poder entre usuários profissionais. Discussão: É evidente a necessidade de garantir atendimento prioritário às gestantes, removendo barreiras e melhorando as informações e o tratamento para as usuárias. No parto, é reconhecida a existência de práticas de desumanização, naturalizadas no cuidado reprodutivo, que devem ser erradicadas. Conclusões: É necessário romper os paradigmas culturais e de gênero que afetam a humanização no cuidado com a gravidez e o parto, por meio da capacitação da equipe, reconhecendo as necessidades das usuárias e qualificando a organização institucional para o cuidado ao parto. O respeito pelos direitos das mulheres grávidas deve ter precedência nos processos de treinamento com as estudantes. O acompanhamento permanente dos usuários é crucial. Como citar este artigo: Ospina Vanegas Diana Paola; Cristancho Gómez Sandra Milena; Lafaurie Villamil María Mercedes; Rubio León Diana Carolina. Humanización de los servicios reproductivos desde las experiencias de las mujeres: aportes para la reflexión. Revista Cuidarte. 2020; 11(2): e1005. http://dx.doi.org/10.15649/cuidarte.100

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Diseño para el consumo cultural, la innovación y la inclusión social

Esta obra presenta diversos trabajos de investigación que tienen en común propuestas de diseño desde la cultura, la inclusión y la innovación social, desarrolladas por investigadores nacionales e internacionales adscritos a diversas universidades, así como a programas de posgrado

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe