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Purpose: We aimed to compare cancer mortality among foreign- and Colombian populations in Colombia during the period of 2006-2020. Methods: This retrospective study utilized vital statistics from the Colombian National Department of Statistics (DANE). The dataset included variables such as age group, sex, country of permanent residency, insurance, education level, marital status, ethnicity, and cause of death. The population data to calculate rates was obtained from the Colombian census and the United Nations. Crude and adjusted rates as well as proportional mortality rates were calculated. Results: A total of 561,932 cancer deaths occurred in Colombia from 2006 to 2020. The foreign population (country of permanent residency different to Colombia) had a lower crude cancer mortality rate (31.1 per 100,000 inhabitants) than the Colombian population (81.9 per 100,000 inhabitants). However, the age-adjusted cancer mortality rate among the foreign population was 253.6 per 100,000, compared to 86.1 per 100,000 among the Colombian population. The proportional cancer mortality was 10.4 % among foreign population compared to 17.4 % among Colombian population. Conclusions: The proportional cancer mortality shows that the proportion of cancer-related deaths is greater among the Colombian population compared to the immigrant population. However, immigrants in Colombia have a higher age-adjusted cancer mortality rate than Colombians, indicating that immigrants have worse cancer outcomes than the Colombians even though the immigrant population is younger. This is likely due to the frequent barriers that immigrants encounter in accessing health care in Colombia. Future research needs to focus on access to care for the immigrant population by investigating cancer-related risk factors among immigrants and addressing their barriers to cancer prevention and treatment.
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BACKGROUND: Cervical cancer patients in Colombia have a lower likelihood of survival compared to breast cancer patients. In 1993, Colombia enrolled citizens in one of two health insurance regimes (contributory-private insurance and subsidized- public insurance) with fewer benefits in the subsidized regime. In 2008, the Constitutional Court required the Colombian government to unify services of both regimes by 2012. This study evaluated the impact of this insurance change on cervical cancer mortality before and after 2012. METHODS: We accessed 24,491 cervical cancer mortality records for 2006-2020 from the vital statistics of Colombia's National Administrative Department of Statistics (DANE). We calculated crude mortality rates by health insurance type and departments (geopolitical division). Changes by department were analyzed by rate differences between 2006 and 2012 and 2013-2020, for each health insurance type. We analyzed trends using join-point regressions by health insurance and the two time-periods. RESULTS: The contributory regime (private insurance) exhibited a significant decline in cervical cancer mortality from 2006 to 2012, characterized by a noteworthy average annual percentage change (AAPC) of -3.27% (P = 0.02; 95% CI [-5.81, -0.65]), followed by a marginal non-significant increase from 2013 to 2020 (AAPC 0.08%; P = 0.92; 95% CI [-1.63, 1.82]). In the subsidized regime (public insurance), there is a non-significant decrease in mortality between 2006 and 2012 (AAPC - 0.29%; P = 0.76; 95% CI [-2.17, 1.62]), followed by a significant increase from 2013 to 2020 (AAPC of 2.28%; P < 0.001; 95% CI [1.21, 3.36]). Examining departments from 2013 to 2020 versus 2006 to 2012, the subsidized regime showed fewer cervical cancer-related deaths in 5 out of 32 departments, while 6 departments had higher mortality. In 21 departments, mortality rates remained similar between both regimes. CONCLUSION: Improvement of health benefits of the subsidized regime did not show a positive impact on cervical cancer mortality in women enrolled in this health insurance scheme, possibly due to unresolved administrative and socioeconomic barriers that hinder access to quality cancer screening and treatment.
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Cobertura Universal do Seguro de Saúde , Neoplasias do Colo do Útero , Humanos , Colômbia/epidemiologia , Neoplasias do Colo do Útero/mortalidade , Feminino , Pessoa de Meia-Idade , Adulto , Seguro Saúde/estatística & dados numéricosRESUMO
Introducción: la información en cáncer en poblaciones indígenas colombianas es escasa; de ahí que el objetivo de este estudio sea conocer las perspectivas comunitarias y de los prestadores de servicios de salud acerca del cáncer de cuello uterino (CaCU) en mujeres indígenas del Amazonas colombiano. Materiales y métodos: estudio cualitativo, derivado de una investigación de métodos mixtos de triangula-ción convergente. Se realizaron 40 entrevistas semiestructuradas que incluían profesionales de la salud y actores clave comunitarios representados en curacas, médicos tradicionales o chamanes, parteras, pro-motores de salud, auxiliares de salud pública, líderes y lideresas, abuelos, abuelas y mujeres indígenas en general. Para el análisis se utilizó la técnica de análisis de contenido. Resultados: emergieron cuatro categorías:1) concepciones y factores de riesgo alrededor del cáncer en general y el CaCU, 2) prácticas de cuidado y de atención occidentales y ancestrales para el CaCU, 3) dificultades socioculturales y del sistema de salud para la prevención y atención del CaCU y 4) recomendaciones para el fortalecimiento de la de prevención del CaCU. Conclusión: los participantes reconocen la citología cervicouterina como una forma de prevenir el cáncer y aunque los participantes mencionaron algunos aspectos culturales y personales que podrían constituirse en una barrera para la prevención y control del CaCU, se hizo hinca-pié en los problemas estructurales del sistema de salud, la falta de integración cultural y las dificultades de acceso al tamizaje, diagnóstico y tratamiento.
Introduction: Information on cancer in Colombian indigenous populations is scarce, the objective of this study was to know the community and health care providers' perspectives on cervical cancer (CaCU) in indigenous women of the Colombian Amazon. Materials and methods: Qualitative study, derived from a mixed methods research of convergent triangulation, 40 semi-structured interviews were conducted, including health professionals and key community actors represented by curacas, traditional doctors or shamans, midwives, health promoters, public health assistants, leaders, grandfathers, grandmothers, and indigenous women in general. The content analysis technique was used for the analysis. Results:Four categories emerged: (a) conceptions and risk factors surrounding cancer in general and CaCU; (b) western and ancestral care and attention practices for CaCU; (c) sociocultural and health system diffi-culties for the prevention and attention of CaCU, and (d) recommendations for strengthening CaCU pre-vention. Conclusion: Participants recognize cervical cytology as a way to prevent cancer and although participants mentioned some cultural and personal aspects that could constitute a barrier to cervical cancer prevention and control, the greatest emphasis was given to structural problems of the health system, lack of cultural integration and difficulties of access to screening, diagnosis and treatment.
Introdução: a informação sobre o câncer nas populações indígenas colombianas são escassas, o objetivo deste estudo foi conhecer as perspectivas da comunidade e dos prestadores de serviços de saúde sobre o câncer do colo do útero (CaCU), em mulheres indígenas da Amazônia colombiana. Materiais e méto-dos: estudo qualitativo, derivado de uma investigação de métodos mistos de triangulação convergente. Foram realizadas 40 entrevistas semiestruturadas que incluíram profissionais de saúde e principais atores comunitários representados em curacas, médicos tradicionais ou xamãs, parteiras, promotores de saúde, assistentes de saúde pública, lideranças, avôs, avós e mulheres indígenas em geral. Para a análise foi uti-lizada a técnica de análise de conteúdo. Resultados: emergiram quatro categorias, a) concepções e fatores de risco em torno do câncer em geral e do CaCU; b) cuidados e práticas de cuidado ocidentais e ancestrais para CaCU; c) dificuldades socioculturais e do sistema de saúde para a prevenção e cuidado do CaCU, e d) recomendações para fortalecer a prevenção de CaCU. Conclusão: as participantes reconhecem a citolo-gia cervical como forma de prevenção do câncer e embora as participantes tenham mencionado alguns aspectos culturais e pessoais que poderiam constituir uma barreira para a prevenção e controle do câncer do colo do útero, a maior ênfase foi dada aos problemas estruturais do sistema de saúde, a falta de integra-ção cultural e as dificuldades de acesso ao rastreio, ao diagnóstico e ao tratamento
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Humanos , ColômbiaRESUMO
BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.
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INTRODUCTION: Every year 1.5 million new cancer cases are diagnosed in Latin America and the Caribbean (LAC). Of these, about 40 % could be prevented. Health illiteracy has been identified as a main barrier for cancer prevention. Primary healthcare professionals (HCP) are key in cancer prevention as they are the first entry point of the population into the healthcare system. The LAC Code Against Cancer 1st edition aims to improve health literacy and awareness of cancer prevention in the LAC population, through building capacity of primary HCP. METHODS: The definition and development of the learning objectives, curriculum, structure, and evaluation of an online learning program for primary HCP was led by a dedicated group of experts from the LAC Code Against Cancer project. A pedagogical guideline and a template to ensure harmonization across topics were produced to guide the program development. Two rounds of internal revisions and an editorial process were performed. RESULTS: An online competency-based microlearning program for primary HCP was produced, taking the LAC Code Against Cancer as a basis. The competences addressed in the curriculum are core knowledge, communication skills, decision-making and applying knowledge to real-world situations. A comprehensive evaluation to assess acquisition of these competences, based on the Miller's Pyramid, was designed with three data collection points: a) immediately before, to assess baseline knowledge and skills; b) immediately after, to determine acquired competences; and c) at 3-6 months follow-up, to assess performance in daily practice. The e-learning will be freely available in the Virtual Campus for Public Health of the Pan American Health Organization in Spanish, English, and Portuguese. CONCLUSION: Primary HCP, perceived as trustworthy sources of information, are key actors to increase the population's awareness and literacy on cancer prevention. Building capacity of these professionals has the potential to increase dissemination and impact of the LAC Code Against Cancer by prompting communication with the public and offering personalized actionable preventive messages through counselling.
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Fortalecimento Institucional , Neoplasias , Humanos , América Latina/epidemiologia , Região do Caribe/epidemiologia , Neoplasias/prevenção & controle , Atenção à Saúde , Atenção Primária à SaúdeRESUMO
El objetivo de este artículo es describir las experiencias en salud sexual y reproductiva de exguerrilleras de las Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo (fARC-EP) durante el conflicto armado y después de la firma del Acuerdo de Paz. A lo largo de 2018 se realizó un estudio de caso interpretativo a través de observación participante, once entrevistas y dos grupos focales. En las fARC-EP no hubo un enfoque de salud sexual y reproductiva integral ni con perspectiva de género; se privilegió la prevención del embarazo con métodos y sanciones para las mujeres. Debido a su carácter de ejército clandestino, las decisiones no eran tomadas de manera individual, y la autoridad del superior implicaba las relaciones erótico-afectivas, aunque se garantizaba una atención expedita para casos de urgencias. Posterior a la firma del acuerdo, con su consiguiente inserción en el sistema de salud colombiano, se amplían las posibilidades de atención para casos no urgentes, pero persisten las barreras de atención del sistema de salud.
This study examined the sexual and reproductive health statuses of former female guerrillas of the Revolutionary Armed Forces of Colombia-People's Army (fARC-EP) during the armed conflict and after the signing of the peace agreement. During 2018, an interpretive case study was conducted through the participant observation, 11 interviews, and 2 focus groups. In the fARC-EP group, no comprehensive approach to sexual and reproductive health was noted from a gender perspective, but pregnancy prevention using methods and sanctions for women was found to be privileged. Owing to its characteristic as a clandestine army, decisions were not made individually, and the authority of the superior involved erotic-affective relationships, although expedited attention was guaranteed for emergency cases. After the signing of the agreement, with its consequent insertion into the Colombian health system, the possibilities of care for non-urgent cases have been expanded, with the barriers to healthcare being emphasized
O objetivo deste artigo é descrever as experiências em saúde sexual e reprodutiva de ex-guerrilheiras das Forças Armadas Revolucionárias da Colômbia - Exército Popular (fARC-EP) durante o conflito armado e após a assinatura do acordo de paz. Durante o ano de 2018, foi realizado um estudo de caso interpretativo através da observação participante, 11 entrevistas e dois grupos focais. Nas fARC-EP não havia abordagem integral da saúde sexual e reprodutiva ou perspectiva de gênero; privilegiou-se a prevenção da gravidez com métodos e sanções para as mulheres. Por ser um exército clandestino, as decisões não eram tomadas individualmente, e a autoridade do superior implicava relações erótico-afetivas, embora garantisse atendimento ágil em casos de emergência. Após a assinatura do convênio, com sua consequente inserção no sistema de saúde colombiano, ampliam-se as possibilidades de atendimento aos casos não urgentes, mas enfatizam-se as barreiras para o atendimento no sistema de saúde.
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HumanosRESUMO
Resumen Objetivo: Describir la experiencia en la atención en salud de mujeres con anormalidades citológicas con biopsia negativa para malignidad o cáncer de cuello uterino invasor no mayor a 2 meses, en los departamentos de La Guajira y Nariño, en Colombia, entre 2016 y 2017. Metodología: Se presenta el componente cualitativo de un estudio de métodos mixtos de triangulación convergente, a través de 10 entrevistas y 3 grupos focales. Participaron 9 mujeres con cáncer y 6 con anormalidades citológicas entre los 43 y 65 años de edad, 6 de ellas indígenas y 14 pertenecientes al régimen subsidiado. Resultados: Las participantes mencionaron experiencias negativas frente a la atención en salud, pues enfrentan múltiples barreras para acceder al diagnóstico y al tratamiento, como demora en la asignación y la autorización de citas, exámenes y procedimientos; el gasto de bolsillo para traslados a ciudades capitales donde se brinda el servicio; dificultades para encontrar acompañamiento familiar fuera de sus comunidades de origen y barreras idiomáticas en mujeres de comunidades indígenas. También se presentaron dificultades de comunicación efectiva con el personal de salud, lo que llevó a algunas participantes a no entender su diagnóstico tratamiento, y a no sentirse escuchadas. La vivencia del cáncer generó sufrimiento, rechazo de personas de su entorno social y despersonalización. Conclusiones: Las barreras de diversa índole para el acceso oportuno al tratamiento se agudizan por características de base como la pobreza y la pertenencia a grupos étnicos, convirtiéndose la supervivencia en una lucha diaria, que va más allá de las características propias de la enfermedad.
Abstract Objective: To describe the health care experience of women with cytological abnormalities with negative biopsy for malignancy or invasive cervix cancer within two months after diagnosis, in La Guajira and Nariño departments, Colombia, between 2016 and 2017. Methodology: The qualitative component of a mixed methods study of convergent triangulation is presented, through ten interviews and three focus groups. Nine women with cancer and six women with cytological abnormalities between 43 and 65 years of age participated; six of them were indigenous, and fourteen are enrolled to the subsidized health regime. Results: Participants referred negative experiences in the health care system as they face numerous barriers for the diagnosis and access to treatment. Such as, delay in the assignment and authorization of medical appointments, tests, and procedures; the out-of-pocket expenses for transportation to capital cities where the health service is provided; difficulties to find family support outside their communities of origin, and language barriers among women from indigenous communities. Besides, effective communication problems with health personnel were also presented, which lead some participants to misunderstanding their diagnosis or treatment and feeling that they were not being heard. The experience of having cancer led to suffering, rejection from people in their social environment, and depersonalization. Conclusions: Barriers of various kinds for the timely access to treatment are exacerbated by baseline characteristics such as poverty and belonging to ethnic groups, turning survival into a daily struggle, which goes beyond the specific characteristics of the disease itself.
Resumo Objetivo: Descrever a experiência na atenção em saúde de mulheres com anormalidades citológicas com biopsia negativa para malignidade ou câncer de colo de útero invasivo não maior a 2 meses nos estados de La Guajira e Nariño, na Colômbia, entre 2016 e 2017. Metodologia: Foi apresentado o componente qualitativo de um estudo de métodos mistos de triangulação convergente, através de 10 entrevistas e 3 grupos de foco. Participaram 9 mulheres com câncer e 6 com anormalidades citológicas entre 43 e 65 anos da idade, 6 delas indígenas e 14 pertencentes ao sistema subsidiado. Resultados: As participantes mencionaram experiências negativas na atenção em saúde, pois enfrentaram múltiplos obstáculos para ter acesso ao diagnóstico e ao tratamento, como demora na marcação e autorização de consultas, exames e procedimentos; despesas com transporte para cidades capitais onde se oferece o serviço; dificuldades para ter acompanhamento familiar fora das suas comunidades de origem e barreiras idiomáticas para mulheres de comunidades indígenas. Apresentaram-se também, dificuldades de comunicação efetiva com o pessoal de saúde, o que levou a algumas participantes a não entender seu diagnóstico ou tratamento e a não se sentirem escutadas. A experiência do câncer gerou sofrimento, rejeição de pessoas do entorno social e despersonalização. Conclusões: As barreiras de diversas índoles para o acesso oportuno ao tratamento foram agudizadas por características de base como a pobreza e ao fato de pertencer a grupos étnicos, transformando a sobrevivência numa luta diária, que vai além das características próprias da enfermidade.
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Armed conflict disproportionately affects the morbidity, mortality, and wellbeing of women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition interventions in ten conflict-affected settings in Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen. We found that despite large variations in contexts and decision making processes, antenatal care, basic emergency obstetric and newborn care, comprehensive emergency obstetric and newborn care, immunisation, treatment of common childhood illnesses, infant and young child feeding, and malnutrition treatment and screening were prioritised in these ten conflict settings. Many lifesaving women's and children's health (WCH) services, including the majority of reproductive, newborn, and adolescent health services, are not reported as being delivered in the ten conflict settings, and interventions to address stillbirths are absent. International donors remain the primary drivers of influencing the what, where, and how of implementing WCH interventions. Interpretation of WCH outcomes in conflict settings are particularly context-dependent given the myriad of complex factors that constitute conflict and their interactions. Moreover, the comprehensiveness and quality of data remain limited in conflict settings. The dynamic nature of modern conflict and the expanding role of non-state armed groups in large geographic areas pose new challenges to delivering WCH services. However, the humanitarian system is creative and pluralistic and has developed some novel solutions to bring lifesaving WCH services closer to populations using new modes of delivery. These solutions, when rigorously evaluated, can represent concrete response to current implementation challenges to modern armed conflicts.
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Conflitos Armados , Atenção à Saúde/organização & administração , Socorro em Desastres/organização & administração , Adolescente , Saúde do Adolescente , Adulto , Criança , Saúde da Criança , Feminino , Humanos , Masculino , Refugiados/estatística & dados numéricos , Socorro em Desastres/estatística & dados numéricos , Saúde da MulherRESUMO
Although most tobacco users initiate this behavior before the age of 18, little is known about engaging in tobacco use prompting behaviors (TPBs) during childhood/adolescence and tobacco use in adulthood, particularly among women in low- and middle-income countries (LMICs). The purpose of this study was to examine engagement in TPBs during childhood or adolescence and tobacco use in adulthood among Colombian women and whether or not current/past tobacco users who were engaged in TPBs during their childhood or adolescence had more odds of engaging other children or adolescents in these behaviors as adults. There were 4262 adult women who were recruited and completed an interviewer-administered survey through a door-to-door approach across the 9 regions of Antioquia, Colombia using a multi-stage probabilistic sampling. TPBs were defined as someone being asked to: (1) empty an ashtray, (2) buy cigarettes, (3) put the cigarette in their mouth and light it, (4) light a cigarette without putting it in their mouth, or (5) smoke with the adult during childhood or adolescence. We conducted bivariate regression logistic models where variables with a P < .25 were included in a parsimonious model. Approximately 40% of participants (41%) reported engaging in TPBs in childhood or adolescence. Buying cigarettes, lighting cigarettes with their mouth, and smoking with an adult were significantly associated with tobacco use in adulthood. Current/past tobacco users who reported being engaged in TPBs during childhood or adolescence (except for smoking with an adult) had higher odds of prompting these behaviors as adults. TPBs during childhood or adolescence are relevant contributors to tobacco use in adulthood among Colombian women.
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BACKGROUND: Information obtained in studies on the impact of human papilloma virus (HPV) testing on health-related quality of life is contradictory. OBJECTIVE: To assess the impact on health-related quality of life of the HPV test, colposcopy, and cytology as triage strategies after a cytology with atypical squamous cells of undetermined significance (ASCUS) in Medellín, Colombia. METHODS: We carried out a nested analysis on the randomized pragmatic trial (ASCUS-COL). Women with ASCUS were assigned randomly to one of the 3 arms (Pap smear, colposcopy, HPV). Participants completed a questionnaire at baseline, two weeks after receiving the results of the triage tests and one year after the second questionnaire. We used the SF-36 to assess health-related quality of life. RESULTS: The sum score of the physical health component (PHC) and mental health component (MHC) increased significantly over time for the whole sample and there were no statistically significant differences between arms of PHC = survey 1: mean 52.4 (SD 8.21) vs. survey 3: mean 54.4 (SD 8.16) p < 0.0001 and of MHC = survey 1: mean 44.9 (SD 11.72) vs. survey 3: mean 48.1 (SD 11.20) p < 0.0001. A lower MHC occurred in women with lesser schooling, belonging to the public health care regimen, higher number of live births, and separated. A lower PHC was associated with the cytology arm, higher age, lesser schooling, and belonging to the subsidized regime. The risk of having depression went from 42% in the first survey to 26% in the third. CONCLUSION: The triage strategies affected health-related quality of life in the same manner. ClinicalTrials.gov Identifier: NCT02067468.
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Teste de Papanicolaou/métodos , Papillomaviridae/patogenicidade , Infecções por Papillomavirus/diagnóstico , Qualidade de Vida/psicologia , Triagem/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae/genética , Adulto JovemRESUMO
BACKGROUND: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. OBJECTIVE: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. METHODS: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. RESULTS: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the post-conflict context. CONCLUSIONS: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.
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Objective: To examine the construct validity and reliability of the Spanish version of the HPV Impact Profile scale (HIP) among women in Medellin, Colombia.Methods: We conducted a nested analysis of data from the pragmatic randomized controlled trial "Evaluation of Strategies for Optimal Clinical Management of Women with Atypical Squamous Cells of Undetermined Significance" (ASCUS-COL; NCT02067468). Women with Atypical Squamous Cells of Undetermined Significance (ASCUS) were randomly assigned to one of three triage strategies (Pap smear, colposcopy, HPV). Participants completed a questionnaire with sociodemographic information and the HIP scale translated into Spanish at baseline, two weeks after receiving triage test results, and one year after the second questionnaire. We conducted exploratory and confirmatory factorial analysis, and then assessed test reliability using Cronbach's alpha. Subsequently, we conducted multigroup confirmatory factor analysis to assess differences according to women´s age, and configurational invariance of the factor structure over the three time measures.Results: The sample consisted of 675 women, with a mean age of 40 years. The exploratory and confirmatory factor analysis for the HIP showed a seven-factor structure with appropriate adjustment indicators ([Formula: see text]= 1466.783, p < .0001). Only two items (1 and 10) had low factor loads and were removed from the confirmatory analysis. Multigroup analysis according to women's age showed acceptable goodness of fit (RMSEA = 0.037, CFI/TLI:0.998/0.998). The factor structure was similar among the tree measures and the model preserved acceptable goodness of fit (RMSEA = 0.079, CFI:0.86). The Cronbach's alpha for the total score was 0.91, with the lowest score for sexual impact (0.49) and the highest score for worries and concerns (0.90).Conclusions: The Spanish version of the HIP had adequate reliability and construct validity, and its use could be considered in clinic and research settings.
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Células Escamosas Atípicas do Colo do Útero , Infecções por Papillomavirus/psicologia , Triagem/métodos , Adulto , Colposcopia , Condiloma Acuminado/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Psicometria , Reprodutibilidade dos Testes , Displasia do Colo do Útero/psicologiaRESUMO
Objective: To assess the psychosocial impact of human papillomavirus (HPV) testing, colposcopy, and Pap-smear, as triage strategies after a Pap-smear with atypical squamous cells of undetermined significance (ASCUS). We also sought to evaluate the psychosocial impact based on the results of the strategies. Methods: Nested within a randomised pragmatic trial, which compared an immediate colposcopy, repeat Pap-smear, and high risk HPV test, we enrolled 675 women between 2012 and 2014. Participants completed surveys at enrollment, two weeks after triage test results, and 1 year thereafter to assess cervical cancer and HPV knowledge, self-esteem, anxiety and HPV impact (HIP). Results: Knowledge, self-esteem, anxiety and HIP improved with no differences among arms. At the baseline, 31.4% and 32.7% of the participants had state anxiety and trait anxiety, respectively, which decreased to 10.7% and 13.3% in the last survey. Compared to HPV-negative women, HPV-positive women in the second survey had worse HIP scores (HPV-: M 22.9 [SD: 15.20]; HPV+: M 35.9 [SD: 19.91]; p < 0.001), trait anxiety (HPV-: M 15.4 [SD 12.73]; HPV+: M 22.9 [SD 13.29]; p = 0.001), and state anxiety (HPV-: M 10.7 [SD 11.25]; HPV+: M 21.4 [SD 14.81]; p < 0.001). Conclusions: HPV testing as a triage strategy for women with ASCUS does not differ from colposcopies or Pap-smears in terms of psychosocial outcomes.
Assuntos
Células Escamosas Atípicas do Colo do Útero/patologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/psicologia , Estresse Psicológico/psicologia , Displasia do Colo do Útero/psicologia , Neoplasias do Colo do Útero/psicologia , Adulto , Idoso , Células Escamosas Atípicas do Colo do Útero/virologia , Colômbia , Colposcopia , Feminino , Testes de DNA para Papilomavírus Humano , Humanos , Pessoa de Meia-Idade , Teste de Papanicolaou , Papillomaviridae/genética , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Gravidez , Triagem/métodos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia , Adulto Jovem , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/virologiaRESUMO
Resumen Objetivo: caracterizar los conocimientos sobre el cáncer de seno, y los saberes, las actitudes y las prácticas sobre su detección temprana en mujeres entre 30 y 69 años de edad del área urbana del municipio de Amalfi, Antioquia. Metodología: estudio de corte utilizando una encuesta con 335 mujeres, seleccionadas mediante muestreo aleatorio simple a partir de las direcciones de viviendas proporcionadas por la Secretaría de Planeación Municipal. Resultados: El puntaje combinado de conocimientos de cáncer de seno, factores de riesgo y síntomas fue 14 (desviación estándar: 3,6) de 22 puntos posibles, evidenciando un conocimiento intermedio en este tema. En mujeres entre 30 y 49 años, el 82, 14 y 68 % sabían qué era el autoexamen, el examen clínico y la mamografía respectivametne, comparado con el 62, 10 y 63 % en mujeres entre 50 y 69 años. El 95 % de las participantes reportó que los métodos de detección temprana son importantes para la prevención o el tratamiento oportuno del cáncer. El 71,9 % de las participantes entre 30 y 49 años de edad, y el 67,1 % entre 50 y 69 años se realizó el autoexamen de seno. El examen clínico de seno se lo hizo el 41,5 % de las mujeres, sin diferencias significativas entre los grupos de edad. Solamente el 39,2 % de las mujeres entre los 50 y 69 años de edad se habían realizado la mamografía. Conclusiones: Los conocimientos sobre el cáncer de seno, y las actitudes y las prácticas de su detección temprana presentan deficiencias en las edades comparadas; sin embargo, existe una disposición favorable por parte de las mujeres hacia la detección temprana, que puede favorecer el fortalecimiento de conocimientos sobre este tipo de cáncer y motivar la práctica de su detección.
Abstract Objective: to characterize knowledge, attitudes and practices of breast cancer and its early detection in women between 30 and 69 years of age of the urban area of the municipality of Amalfi, Antioquia. Methodology: A cross-sectional study was conducted using a 20-minute survey with 335 women selected by simple random sampling, using the household addresses from the mayor´s office records. Results: The combined score of breast cancer knowledge, risk factors and symptoms was 14 (standard deviation: 3.6) of 22 possible points, showing intermediate knowledge in this topic. In women between 30 and 49 years of age 82%, 14% and 68% knew what was self-examination, clinical examination and mammography compared with 62%, 10% and 63% in women between 50 and 69 years. 95% of the participants reported that early detection methods are important for the prevention and/or timely treatment of cancer. 71,9% of the participants between 30 and 49 years of age, and 67,1% between 50 and 69 years old, underwent breast self-examination. The clinical breast examination was performed by 41,5% of the women without significant differences between the age groups. Only 39,2% of women between 50 and 69 years of age had undergone mammography. Conclusions: the knowledge, attitudes and practices of early detection of breast cancer have deficiencies. However, there is a favorable disposition towards early detection that can favor the strengthening of knowledge and motivate the practice.
Resumo Objetivo: caracterizar conhecimento, atitudes e práticas de câncer de mama e sua detecção precoce em mulheres entre 30 e 69 anos de idade da área urbana do município de Amalfi, Antioquia. Métodologia: um estudo transversal foi realizado utilizando uma pesquisa de 20 minutos com 335 mulheres selecionadas por amostragem aleatória simples, utilizando os endereços habitacionais do secretário municipal de planejamento. Resultados: O escore combinado de conxhecimento de câncer de mama, fatores de risco e sintomas foi de 14 (desvio padrão: 3,6) de 22 pontos possíveis, evidenciando conhecimento intermediário neste tópico. Em mulheres entre 30 e 49 anos 82%, 14% e 68% sabiam que era auto-exame, exame clínico e mamografia em comparação com 61%, 10% e 63% em mulheres entre 50 e 69 anos. 95% dos participantes relataram que os métodos de detecção precoce são importantes para a prevenção e / ou tratamento atempado do câncer. 71,9% dos participantes entre 30 e 49 anos de idade, e 67,1% entre 50 e 69 anos, foram submetidos a auto-exame de mama. O exame clínico de mama foi realizado por 41,5% das mulheres sem diferenças significativas entre os grupos etários. Apenas 39,2% das mulheres entre 50 e 69 anos de idade foram submetidas a mamografia. Conclusões: o conhecimento, atitudes e práticas de detecção precoce do câncer de mama têm deficiências; No entanto, existe uma disposição favorável para a detecção precoce que pode favorecer o fortalecimento do conhecimento e motivar a prática.
RESUMO
In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012-2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.
RESUMO
To explore the association between low birth weight and preterm birth with violence during pregnancy, we conducted a cross-sectional study by using the 2010 Colombian Demographic and Health Survey. We conducted bivariate analyses, binomial logistic regression, and stratified models by age, and 14,520 women were included. There was no association between violence and low birth weight. Nonetheless, an association with preterm birth in women aged over 35 was observed (OR 1.98, 95%CI 1.23, 3.17). Prenatal care appeared to be a protective factor for both outcomes. This research unexpectedly showed that supplementation with folic acid and iron was associated with preterm birth.
Assuntos
Recém-Nascido de Baixo Peso , Violência por Parceiro Íntimo/estatística & dados numéricos , Gestantes/psicologia , Nascimento Prematuro/epidemiologia , Violência/estatística & dados numéricos , Adulto , Colômbia/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Recém-Nascido , Violência por Parceiro Íntimo/etnologia , Gravidez , Complicações na Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Cuidado Pré-Natal , Adulto JovemRESUMO
Cervical cancer is considered to be a major health problem for women in developing countries, but it is also problematic for more developed countries as global migration increases and health behaviors move from the countries of origin to new places of residence. We designed and produced a testimonial video and a fotonovela (printed short story) to educate women about cervical cancer and screening. The development of the materials included formative research, production, pretesting, dissemination, and evaluation. The evaluation included 100 women that completed a pretest and a posttest at eight health clinics in Medellin. The pretest and posttest were analyzed using McNemar's test for categorical variables and paired t test for continuous variables. Women in the study had a high initial Stage of Change as defined by the Transtheoretical Model and a high baseline knowledge of HPV and cervical cancer, with the caveat of specific knowledge deficiencies especially for HPV. While not statistically significant, postintervention Transtheoretical Model status in both interventions changed towards higher stages, specifically, from Precontemplation to Contemplation and Preparation. Women who participated in the study liked the educational materials and their knowledge increased, especially for HPV. However, the perception of risk did not change.
Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Educação de Pacientes como Assunto/métodos , Neoplasias do Colo do Útero/diagnóstico , Gravação em Vídeo , Adolescente , Adulto , Idoso , Colômbia , Detecção Precoce de Câncer/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Motivação , Narração , Aceitação pelo Paciente de Cuidados de Saúde , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto JovemRESUMO
Latinas in the U.S. are disproportionately affected by breast and cervical cancer. This project sought to develop and evaluate a culturally relevant training for Community Health Advisors (CHA) to promote breast and cervical cancer screening among Latina immigrants in Alabama. The Empowerment Model guided training development and implementation supported by a formative evaluation and a Community Advisory Committee. The 16-hour CHA training included two intertwined components: knowledge and skills.Fifty-six (56) Latinas participated in the CHA training in six Alabama counties. The training increased the CHAs' (1) knowledge of cancer screening and other health topics and (2) their perceived confidence to communicate with women in their communities about cancer screening and to motivate them to attain cancer screenings. This work demonstrates the application of a transformative philosophical framework to promote capacity-building among CHAs toward the development and implementation of strategies to promote breast and cervical cancer screening among Latina immigrants.
Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer , Emigrantes e Imigrantes , Hispânico ou Latino , Neoplasias do Colo do Útero/diagnóstico , Adulto , Alabama , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Saúde PúblicaRESUMO
BACKGROUND: Human papillomavirus (HPV) DNA testing has been shown to be an effective approach to cervical cancer screening, and self-collection sampling for HPV testing could be a potential alternative to Pap test, provided that women who tested positive by any method get timely follow-up and care. This feasibility study examined acceptability and usability of self-collected sampling for HPV testing among African-American (AA) women in the Mississippi Delta to inform the development of interventions to promote cervical cancer screening in this population. METHODS: The study consisted of two phases. Phase I consisted of eight focus groups (n = 87) with AA women to explore knowledge, attitudes, and beliefs about cervical cancer and HPV infection as well as acceptability of self-collected sampling for HPV testing. In phase II, we examined the usability of this technology through one discussion group (n = 9). The Health Belief Model guided data collection and analysis. RESULTS: Although participants perceived themselves as susceptible to cervical cancer and acknowledged its severity, there was a lack of knowledge of the link between HPV and cervical cancer, and they expressed a number of misconceptions. The most frequent barriers to screening included embarrassment, discomfort, and fear of the results. Women in both phases were receptive to self-collected sampling for HPV testing. All participants in the usability phase expressed that self-collection was easy and they did not experience any difficulties. CONCLUSION: Self-collection for HPV testing is an acceptable and feasible method among AA women in the Mississippi Delta to complement current cytology cervical cancer screening programs.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Autoexame , Manejo de Espécimes/estatística & dados numéricos , Esfregaço Vaginal/métodos , Adolescente , Adulto , Negro ou Afro-Americano/psicologia , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer/métodos , Estudos de Viabilidade , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Mississippi , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , População Rural , Sensibilidade e Especificidade , Fatores Socioeconômicos , Manejo de Espécimes/métodos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/psicologia , Adulto Jovem , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/prevenção & controle , Displasia do Colo do Útero/virologiaRESUMO
This study aims to describe the utilization of curative and preventive care among Mexican immigrant women in the country of origin versus the US, and to identify factors associated with preventive and curative care utilization. A cross-sectional sample of 185 Mexican immigrant women living in Birmingham, AL between 2004 and 2005 were included in this study. Fisher's Exact tests showed that there was a statistically significant difference between seeking curative care (p < 0.0001) and preventive care (p < 0.0001) in country of origin versus the US. Differences in the reasons for lack of utilization of both curative and preventive care were also observed in the US and the country of origin. These findings suggest that difference in healthcare-seeking behaviors and utilization among Mexican immigrant women between the US and their country of origin may be useful in the development of interventions aimed at increasing the use of preventive and curative care services to this immigrant population in the US.