Physical activity and health-related quality of life among adult women in Cali, Colombia: a cross-sectional study.

OBJECTIVES: To examine the associations of leisure-time physical activity (LTPA) and walking for transportation (WT) with the physical and mental dimensions of health-related quality of life (HR-QOL) among women. METHODS: A cross-sectional study was carried out in 2009 among 1,263 women ages 18-59 years living in neighborhoods with low and middle-low socioeconomic status in the urban area of Cali. HR-QOL was assessed using the Short Form 8 (SF-8). LTPA and WT were measured using the long version of the International Physical Activity Questionnaire (IPAQ). Associations were assessed using linear regression models adjusting for potential confounders. RESULTS: Low (10-149 min) and medium-high (at least 150 min) levels of WT were negatively associated with the mental and physical dimensions of HR-QOL. Low (10-149 min of moderate intensity PA, or 10-74 min of vigorous intensity PA) and medium-high (at least 150 or 75 min of moderate or vigorous intensity PA, respectively) levels of LTPA were positively associated with both dimensions. Significant interactions were observed between education level and perceived safety from traffic. CONCLUSIONS: This study found that WT and LTPA were associated with HR-QOL both in the physical and mental dimensions; however, the direction and magnitude of the association varied by domain. These results highlight the need to better understand the links between PA and HR-QOL in urban contexts from Latin America.

[Evaluation of an educational strategy on malaria in rural areas of the Colombian Pacific Coast]. / Evaluación de una estrategia educativa en malaria aplicada en localidades rurales del Pacífico colombiano.

INTRODUCTION: Health education interventions have proved effective in improving knowledge, preventing practices and decreasing occurrence of malaria. OBJECTIVE: To evaluate the impact of the educational intervention "The World of Malaria: Let's Learn to Manage it in Community" developed in Colombian malarial areas, in terms of increasing knowledge, preventive practices, treatment-seeking, and decreasing malaria occurrence. MATERIALS AND METHODS: A quasi-experimental post-test study with a non-equivalent control group was carried out. Four hundred and fifty people living in 20 rural villages were interviewed. These localities were randomly selected from 110 intervened localities. Paired "t" test was performed to evaluate the effect on malaria knowledge of the community health workers (n=243). The effect of the intervention on the effect variables was measured by using logistic regression and by comparing people who were exposed and non-exposed to the educational strategy. RESULTS: Knowledge on malaria in community health workers increased after the intervention (p < 0.05). In the communities, 170/447 (38%) interviewed individuals had contact with the intervention in the communities. Those exposed to the intervention showed improvements in knowledge about breeding sites (OR: 2.53, 95% IC:1.7-3.76), bed-nets use (OR:1.81, 95% IC:1.10-2.97) and a decrease in self-medication with antimalarial drugs (OR:1.97, 95% IC: 1.04-3.73). Contact with the intervention reduced reported episodes of malaria (OR:0.58, 95% CI: 0.39-0.87). CONCLUSION: Significant improvements in preventive practices may be achieved with educational interventions, which in turn may reduce malaria ocurrence.

[Effects of an educational and participatory community intervention on malaria control in Buenaventura, Colombia]. / Efectos de una intervención educativa y de participación comunitaria en el control de la malaria en Buenaventura, Colombia.

INTRODUCTION: A four-component, non randomized, primary-care based intervention for malaria control was implemented in Buenaventura, Colombia. OBJECTIVE: To evaluate the effect of the applied intervention on knowledge about malaria, attention of febrile events and frequency of malaria occurrence in three communities of Buenaventura. MATERIALS AND METHODS: A post-intervention evaluation with a non-equivalent control group was performed. Two non-intervened groups (those residing more and less than six months, respectively, in the area) and one intervened group were identified. We interviewed 661 women household heads. Contact was defined as having been exposed to at least one of the four intervention components. RESULTS: Fourteen percent of the respondents had contact with the intervention. The attention of a febrile episode was better in those who had contact with the intervention than in the nonintervened ones who had resided in the area for more than six months. Those without contact and with less than six months stay in the area reported lower use of bed-nets (OR:0.46; 95% CI:0.23-0.93) and less fumigation practices (OR:0.38; 95% CI:0.19-0.75). The analysis of the malaria case trend showed a reduction in the proportion of cases contributed by the intervened communities, from 25% to 17%, six years after the intervention. CONCLUSION: An educational strategy is effective to enhance knowledge and modify the practices of the urban population of Buenaventura with respect to malaria.

[Effects of the health sector reform upon tuberculosis control interventions in Valle del Cauca, Colombia]. / Efectos de la reforma en salud en las acciones de control de tuberculosis en el Valle del Cauca, Colombia.

Implementation of the General System of Social Security in Health (GSSSH) was initiated for the control of tuberculosis (TBC) in the state of Valle del Cauca, Colombia, between 1991-2000. A study of its effects was centered in 7 municipalities of Valle del Cauca with a complementary set of qualitative and quantitative techniques for data collection and analysis. A reduction in planning, control and regulation of TBC activities by state agencies was observed. New administrative structures and new funding sources did not produce the expected positive effects on tuberculosis control. Instead, the quantity and quality of tuberculosis control activity were reduced as a consequence of the health sector reform. In conclusion, GSSSH implementation affected negatively tuberculosis control activity.

Transcultural adaptation to Spanish of the instrument "Effectiveness of Auditory Rehabilitation" for the assessment of quality of life in patients using hearing aids.

INTRODUCTION AND OBJECTIVES: It is becoming increasingly important to have reliable and valid questionnaires. This becomes especially important when evaluating hearing loss. THE AIM OF THIS WORK WAS TO VALIDATE: the "Effectiveness of Auditory Rehabilitation" (EAR) questionnaire for the Spanish-speaking population. This instrument assesses quality of life and hearing aspects in patients using hearing aids. MATERIAL AND METHOD: Cross-sectional validation study. A cultural adaptation through the use of English to Spanish translations and re-translations was carried out. The validity and reliability of the newly adapted instrument were evaluated. RESULTS: A total of 69 individuals (44 older adults and 25 younger adults) were examined. The pure-tone averages (PTA, 500, 1,000 and 2,000 Hz) were 47.3 dB HL and 47.1 dB HL for the left and right ears, respectively. The mean maximum speech discrimination in silence for monosyllables were 83.3% and 82.9% for the left and right ears, respectively. Internal consistency presented Cronbach alpha values of 0.85 and 0.77 for the internal and external dimensions, respectively. The intraclass correlation coefficients were 0.80 for the internal module and 0.85 for the external module. Construct validity reported a correlation coefficient of 0.71 at baseline and 0.76 at 3 months after the initial assessment for the internal module, and 0.62 at baseline and 0.74 at 3 months after the initial assessment for the external module. The size effects were 1.3 and 1.1 for the internal and external modules, respectively. DISCUSSION: The Spanish version of the EAR questionnaire seems to be a reliable and valid instrument. The evaluation of audiological aspects, as well as aspects relating to aesthetics and comfort are the main strengths of this instrument. Finally, the EAR scale is more sensitive to change than other scales.

Evaluación del programa "Active Communication Education" para rehabilitación auditiva en adultos mayores con hipoacusia usuarios de audífonos / Assessment of the "Active Communication Education" program for audiological rehabilitation in patients with hearing loss users of hearing aids

Introducción: La hipoacusia es una condición prevalente en adultos mayores. Sin embargo, la baja adherencia al uso del audífono representa una realidad. Objetivo: Evaluar la utilidad de un programa de intervención para mejorar adherencia en pacientes con hipoacusia mayores de 65 años usuarios de audífono. Material y método: Ensayo clínico aprobado por Comité de Ética. Se incluyeron pacientes beneficiarios del GES de hipoacusia. Se evaluó adherencia al audífono en un corte a 6 meses. Resultados: Fueron evaluados 180 pacientes, correspondiendo a 90 pacientes control y 90 intervenidos. La adherencia global al uso del audífono fue de 78%. No hubo diferencia en los grupos por sexo, edad, ni grado de hipoacusia. El promedio de horas diarias de uso en el grupo control fue de 6,9 horas, comparado con el del grupo intervenido que fue 9,6 horas (p <0,0001). Hubo una asociación significativa entre la intervención y la regularidad del uso del audífono, con 80% de pacientes que lo usaban regularmente en el grupo intervenido contra el 8,9% en el grupo control (p <0,001). Discusión: La intervención implementada ha demostrado excelentes resultados preliminares en términos de tiempo de uso del audífono, por lo que sería de utilidad implementaria como parte de la política GES y difundir su uso.

Introduction: Hearing loss is a prevalent condition in elderly population. However, the low adherence to hearing aids is a fact. Aim: To evaluate the utility of a standardized counselling program in elderly patients with hearing loss. Material and methods: A clinical trial was carried out, approved by the Hospital ethics committee. Patients with 65years and older with hearing loss were included. We assessed adherence at a follow-up of 6 months. Results: 180 patients were evaluated, corresponding to 90 control and 90 rehabilitated patients. The overall adherence of hearing aids use was 78%. There was no difference in sex, age, and level of hearing loss between groups. The average daily hours of use in the control group was 6.9 hours, compared with the 9.6 hours in the intervention group (p <0.0001). There was a significant association between the intervention and regular hearing aid use, with 80% of patients who used it regularly in the intervention group compared with 8.9% in the control group (p <0.001). Discussion: The intervention implemented has shown excellent preliminary results in terms of time of use of the hearing aid. It would be useful to include this intervention in the hearing loss national public policy.

The world of malaria: a health educational experience in the Colombian Pacific coast / El mundo de la malaria: una experiencia educativa en salud en la costa pacífica colombiana

Objective: To describe the design, validation, and implementation of the education material The world of malaria: let´s learn to handle it in the community. Methods: The development of the educational material was carried out in the urban area of Buenaventura (main city in the Colombian Pacific coast) in 1995. The design was based on the results of a knowledge, beliefs, and practices study in the city. By using the PRECEDE- PROCEED MODEL strategy, community groups were brought together with the research team to design the materials. Results: The educational materials were designed according to cultural and ethnographic characteristics of the population studied. These materials are table games, comics, videotapes and cassettes, magazines, altogether in a black bag called "The world of malaria: let´s learn to handle it in the community". Conclusions: This innovative educational material shows that interventions in public health should be based on results from scientific projects, because control strategies are based on local realities.

Objetivo: Describir el proceso de diseño, validación e implementación de la estrategia educativa ®El mundo de la malaria¼. Métodos: La estrategia educativa se desarrolló con el modelo de promoción de la salud PRECEDE-PROCEED. Esta estrategia educativa se diseñó a partir de los resultados obtenidos en la investigación sobre conocimientos, actitudes y prácticas en malaria en la población de Buenaventura en 1995. Los grupos comunitarios, el grupo de investigación de la División de Salud de la Fundación FES y los expertos en elaboración de materiales educativos diseñaron la estrategia. Resultados: Se diseñó y validó un conjunto de materiales educativos acordes con las características culturales y etnográficas de los habitantes de la región. Los materiales educativos constan de juegos, formatos de diagnóstico y seguimiento para el control de la malaria, que se recopilan en un maletín llamado: "El mundo de la malaria: Aprendamos a manejarlo en comunidad". Conclusiones: El desarrollo e implementación de la estrategia educativa "El mundo de la malaria: Aprendamos a manejarlo en comunidad" muestra la importancia de las intervenciones en salud pública basadas en resultados de investigaciones, lo cual permite generar alternativas de intervención acordes con las realidades locales.

Efectos de una intervención educativa y de participación comunitaria en el control de la malaria en Buenaventura, Colombia / Effects of an educational and participatory community intervention on malaria control in Buenaventura, Colombia

Introducción. Una intervención para el control de la malaria no aleatoria compuesta por cuatro componentes y basada en atención primaria fue implementada en Buenaventura, Colombia. Objetivo. Evaluar el efecto de la intervención en conocimientos y prácticas en malaria, atención de eventos febriles y frecuencia de malaria en tres comunas de Buenaventura. Materiales y métodos. Se realizó una evaluación post-intervención con grupo control no equivalente. Se identificaron dos grupos de no contacto de más y menos seis meses de residencia en la zona, respectivamente, y un grupo contacto con la intervención. Se entrevistaron 661 mujeres jefes de hogar. El contacto fue el haber estado expuesto al menos a uno de los cuatro componentes de la intervención. Resultados. El 14 por ciento de los entrevistados tuvieron contacto con la intervención. El evento febril fue mejor atendido en el grupo de personas contacto que en el grupo "sin contacto" que habían vivido en el lugar por más de seis meses. Los sin contacto con menos de seis meses en el lugar reportaron menor uso de toldillos (OR: 0,46; IC 95 por ciento: 0,23-0,93) y de práctica de fumigación (OR: 0,38; IC 95 por ciento: 0,19-0,75). El análisis de tendencia de casos de malaria mostró disminución de 25 por ciento a 17 por ciento de casos aportados por los grupos intervenidos, seis años después de la intervención. Conclusión. La estrategia educativa es efectiva para elevar los conocimientos y modificar las prácticas de la población urbana de Buenaventura frente a la malaria.

Introduction. A four-component, non randomized, primary-care based intervention for malaria control was implemented in Buenaventura, Colombia. Objective. To evaluate the effect of the applied intervention on knowledge about malaria, attention of febrile events and frequency of malaria occurrence in three communities of Buenaventura. Materials and methods. A post-intervention evaluation with a non-equivalent control group was performed. Two non-intervened groups (those residing more and less than six months, respectively, in the area) and one intervened group were identified. We interviewed 661 women household heads. Contact was defined as having been exposed to at least one of the four intervention components. Results. Fourteen percent of the respondents had contact with the intervention. The attention of a febrile episode was better in those who had contact with the intervention than in the nonintervened ones who had resided in the area for more than six months. Those without contact and with less than six months stay in the area reported lower use of bed-nets (OR:0.46; 95% CI:0.23-0.93) and less fumigation practices (OR:0.38; 95% CI:0.19-0.75). The analysis of the malaria case trend showed a reduction in the proportion of cases contributed by the intervened communities, from 25% to 17%, six years after the intervention. Conclusion. An educational strategy is effective to enhance knowledge and modify the practices of the urban population of Buenaventura with respect to malaria.

Efectos de la reforma en salud en las acciones de control de tuberculosis en el Valle del Cauca, Colombia

Se describen efectos de la implementación del Sistema General de Seguridad Social en Salud - SGSSS, en la década de los noventa, sobre las acciones de control de tuberculosis en el Valle del Cauca, Colombia. El estudio se llevó a cabo en siete municipios del departamento mediante un abordaje complementario de técnicas de recolección y análisis de información cualitativa y cuantitativa. Se presentó una reducción en el papel de planeación, control y regulación de las acciones de tuberculosis por parte de las entidades estatales. Los nuevos actores y las nuevas fuentes de financiación no produjeron los efectos positivos esperados en las acciones de control de tuberculosis; la cantidad y calidad de las acciones de tuberculosis se redujeron por el efecto de la reforma sectorial. Se concluye que la implementación del SGSSS afectó de manera negativa las acciones de control de tuberculosis.

Effects of the health sector reform upon tuberculosis control interventions in Valle del Cauca, Colombia Implementation of the General System of Social Security in Health (GSSSH) was initiated for the control of tuberculosis (TBC) in the state of Valle del Cauca, Colombia, between 1991- 2000. A study of its effects was centered in 7 municipalities of Valle del Cauca with a complementary set of qualitative and quantitative techniques for data collection and analysis. A reduction in planning, control and regulation of TBC activities by state agencies was observed. New administrative structures and new funding sources did not produce the expected positive effects on tuberculosis control. Instead, the quantity and quality of tuberculosis control activity were reduced as a consequence of the health sector reform. In conclusion, GSSSH implementation affected negatively tuberculosis control activity.

Percepciones de los efectos de la implementación del Sistema General de Seguridad Social en Salud sobre las acciones de control de tuberculosis en el Valle del Cauca, Colombia / Perceptions of implementation effects of the Social Security General Health System on control actions of tuberculosis in Valle del Cauca, Colombia

ANTECEDENTES: La reforma en salud en Colombia tuvo un profundo efecto en los programas de salud pública. Los cambios en la estructura organizativa y en las actividades de intervención en las acciones de control de la tuberculosis (TBC) fue provocado por el surgimiento de nuevos actores en la prestación de servicios, el diseño de nuevos planes de salud, la diversificación y ambigüedad de responsabilidades y la descentralización del sistema. OBJETIVO: Conocer las percepciones que tienen actores clave del control de la tuberculosis acerca de los efectos generados por la implementación del Sistema General de Seguridad Social en Salud (SGSSS) de Colombia. MATERIALES Y MÉTODOS: Se presentan los hallazgos cualitativos de un estudio de caso. La técnica de recolección de información fue la entrevista semi-estructurada. En total se entrevistaron 15 informantes clave, todos personal de salud responsables de las acciones de control de la tuberculosis en el ámbito nacional, departamental y local. RESULTADOS: Los efectos negativos más relevantes de la implementación del SGSSS en las acciones de control de la TBC fueron: falta de voluntad política, corrupción en el manejo de los recursos, pobre destreza en el desarrollo técnico-administrativo, deficiencia del Estado en las actividades de supervisión a nivel local, inadecuado cumplimiento del Estado en sus obligaciones administrativas y financieras. La diversificación de las fuentes de financiación para salud fue descrita como factor facilitante porque incrementa la distribución de los recursos en las acciones de control. DISCUSIÓN: La reducción del papel del Estado en las actividades de regulación y control fue percibido como el principal efecto. La introducción de nuevos actores en la entrega de servicios de salud y el aumento de la distribución de los recursos en las acciones de la TBC no dieron los efectos positivos esperados y la cantidad y calidad de las acciones se redujeron