Understanding antibiotic knowledge, attitudes, and practices: a cross-sectional study in physicians from a Colombian region, 2023.

BACKGROUND: Antibiotic resistance has been identified as a global health threat. Knowledge, attitudes, and inappropriate prescription practices of antibiotics by physicians play a crucial role in this problem. In Colombia, research addressing this issue is scarce. METHODS: A cross-sectional study involving 258 physicians was conducted. A scale with questions on sociodemographic aspects, level of education, satisfaction with antibiotic education received, and knowledge, attitudes, and practices was administered. The scale was designed for each item to be analyzed individually or as a total score ranging from 0 to 100 (0 being the lowest and 100 the highest). RESULTS: 31.5% of physicians rated the education received on antibiotics as fair to poor. The knowledge score was 80.1 (IQR 70.5-87.5); however, 25.2% agreed to some extent that amoxicillin is useful in treating most respiratory infections, and 15% agreed that antibiotics are effective in treating upper respiratory infections. Attitudes scored 80.2 (IQR 75.0-86.5), with 99% stating that bacterial resistance is a public health problem in Colombia, but only 56.9% considering it a problem affecting their daily practice. Practices scored 75.5 (IQR 68.8-81.2), and 71.7% affirmed that if they refuse to prescribe antibiotics to a patient who does not need them, the patient can easily obtain them from another physician. General practitioners were found to have lower scores in all three indices evaluated. CONCLUSION: The study reveals enduring misconceptions and concerning practices in antibiotic prescription, particularly among general practitioners. Enhancing knowledge necessitates the implementation of continuous medical education programs that focus on updated antibiotic guidelines, and resistance patterns. Fostering positive attitudes requires a culture of trust and collaboration among healthcare professionals. Practical enhancements can be realized through the establishment of evidence-based prescribing guidelines and the integration of regular feedback mechanisms. Moreover, advocating for the inclusion of antimicrobial stewardship principles in medical curricula is crucial, emphasizing the significance of responsible antibiotic use early in medical education.

Social determination of malaria in pregnancy in Colombia: a critical ethnographic study.

BACKGROUND: The meanings and experiences related to malaria in pregnancy (MiP) and its processes of social determination of health (PSDH) have not been reported in the world scientific literature. The objective was to understand the meanings and experiences of MiP, and to explain their PSDH in an endemic area from Colombia, 2022. METHODS: Critical ethnography with 46 pregnant women and 31 healthcare workers. In-depth and semi-structured interviews, focus group discussions, participant and non-participant observations, and field diaries were applied. A phenomenological-hermeneutic analysis, saturation and triangulation was carried out. The methodological rigor criteria were reflexivity, credibility, auditability, and transferability. RESULTS: At the singular level, participants indicated different problems in antenatal care and malaria control programmes, pregnant women were lacking knowledge about MiP, and malaria care was restricted to cases with high obstetric risk. Three additional levels that explain the PSDH of MiP were identified: (i) limitations of malaria control policies, and health-system, geographic, cultural and economic barriers by MiP diagnosis and treatment; (ii) problems of public health programmes and antenatal care; (iii) structural problems such as monetary poverty, scarcity of resources for public health and inefficiency in their use, lacking community commitment to preventive actions, and breach of institutional responsibilities of health promoter entity, municipalities and health services provider institutions. CONCLUSION: Initiatives for MiP control are concentrated at the singular level, PDSH identified in this research show the need to broaden the field of action, increase health resources, and improve public health programmes and antenatal care. It is also necessary to impact the reciprocal relationships of MiP with economic and cultural dimensions, although these aspects are increasingly diminished with the predominance and naturalization of neoliberal logic in health.

Knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Colombia: a cross-sectional descriptive study.

BACKGROUND: This study was designed to describe the knowledge, attitude, and practice regarding antibiotic use and resistance among medical students in Medellín, Colombia. METHODS: A cross-sectional study was conducted among medical students from three universities from September to December 2018. The sample size was calculated, the classrooms were visited, and those students who were willing to participate were invited to do so. The data collection instrument was constructed in three stages: i) the literature was systematically reviewed, ii) the items from the studies identified were extracted, and iii) item reduction was performed with exploratory factor analysis. Data were analyzed by calculating absolute and relative frequencies and means for quantitative variables. The indexes of knowledge, attitude, and practice were transformed to a scale from 0 (worst possible score) to 100. Comparisons were performed using the Mann-Whitney U test, Kruskall-Wallis H test, and linear regressions. RESULTS: Five hundred and thirty-two medical students were included with a response rate of 96%. Of the total participants, 49.1% reported having used antibiotics within the past year. Regarding knowledge, only 18.2% had heard of the term "antimicrobial stewardship" and 69.3% were aware that empiric antibiotic therapy contributes to antibiotic resistance. Regarding attitude, 11.6% considered that antibiotics should be discontinued as soon as symptoms disappear and 24.6% stated that it is better to prescribe broad-spectrum antibiotics to ensure that the patient is cured. Regarding practice, 28.5% recognized that resistance is a multifactorial problem, but they do not act on it because they consider that individual actions would have little impact. The adjusted linear regression showed that the variables associated with knowledge, attitude, and practice were socioeconomic status, training cycle, university, previous experience of research or education, the general perception of the training received, and antibiotic consumption. CONCLUSION: Knowledge, attitude, and practice differ widely depending on the university, training cycle, and socioeconomic status, and a significant proportion of students consider that the standard of training received at the university on antibiotics and bacterial resistance is poor or mediocre. These findings show that there is a need to strengthen the medical students' curriculum on antibiotics, mechanisms of antibiotic resistance, and the prudent use of antibiotics as an important strategy to combat problem-resistant public health, primarily in endemic countries.

Knowledge regarding antibiotic use among students of three medical schools in Medellin, Colombia: a cross-sectional study.

BACKGROUND: The objective of the present study was to describe the knowledge regarding the antibiotic therapy of students of three medical schools in Medellín, Colombia. METHODS: The study population comprised medical students who were enrolled in three universities. The instrument contained questions regarding their current academic term, the university, the perceived quality of the education received on antibiotic therapy and bacterial resistance, and specific questions on upper respiratory tract infections, pneumonia, urinary tract infections, and skin and soft tissue infections. The information was analyzed by calculating frequencies and measures of dispersion and central tendency. Knowledge regarding the treatment for each type of infection was compared using the Mann-Whitney U test and the Kruskal-Wallis H test. RESULTS: We included 536 medical students, of which 43.5% students consider that the university has not sufficiently trained them to interpret antibiograms and 29.6% students consider that the quality of information received on the subject at their university ranges from regular to poor. The mean score for knowledge regarding antibiotic therapy for upper respiratory tract infections was 44.2 (9.9) on a scale from 0 to 100. The median score with regard to the treatment of pneumonia was 52.9 (14.7), that of urinary tract infection was 58.7 (14.8), and that of skin and soft tissue infections was 63.1 (19.4). The knowledge regarding antibiotic therapy for upper respiratory tract infections, pneumonia, and urinary tract infection does not improve with the academic term, the university, or perceived quality of the education received. CONCLUSION: A large proportion of medical students perceive that the training received from the university is insufficient with regard to antibiotic use and bacterial resistance, which is consistent with the limited knowledge reflected in the selection of antibiotic treatment for respiratory, urinary tract, and skin and soft tissue infections. Overall, the situation was identical among all universities, and it did not significantly increase with the completion of an academic term.

Knowledge, Attitudes, and Practices Regarding Air Pollution among Medical Students.

Background: Air pollution has emerged as a global public health concern. Specifically, in Medellín, Colombia, episodes of elevated air pollution have been documented. Medical students' knowledge of air pollution is paramount for implementing future interventions directed toward patients. The aim of this research was to delineate the knowledge, attitudes, and practices regarding air pollution among medical students at a private university in Medellín. Methods: A cross-sectional study involving 352 medical students was conducted. A questionnaire was administered, generating scores ranging from 0 to 100, where a higher score signified better knowledge, attitudes, and practices. Data were analyzed using frequencies, summary measures, non-parametric tests, and linear regression. Results: In total, 31% rated the education received at the university on the relationship between health and air quality as fair to poor, and 81% perceived the air quality in the city as poor. The knowledge score was 77.8 (IQR 71.1-85.6), with 90% acknowledging that exposure to air pollution increases the risk of various diseases. The attitudes score was 82.1 (IQR 71.8-87.2), and 25.9% believed that air pollution is a multifactorial problem, rendering their actions ineffective. In terms of practices, the score was 50 (IQR 42.9-57.1), indicating that students either did not employ protective measures against pollution or used inappropriate practices such as masks or air purifiers. Regression analysis revealed no association between knowledge and practices. Conclusion: The findings of this study underscore that medical students possess commendable knowledge regarding the health effects of air pollution. However, their adoption of inappropriate practices for self-protection is evident. The lack of correlation between knowledge and practices highlights the necessity of educational initiatives to be complemented by regulatory and cultural interventions.

Prevalence of HIV, Treponema pallidum and Their Coinfection in Men Who Have Sex with Men, Medellín-Colombia.

Introduction: In Colombia, HIV and gestational syphilis are notifiable events; however, they are poorly investigated infections in men who have sex with men (MSM). Objective: To determine the prevalence of HIV, Treponema pallidum, and their co-infection in MSM treated at a Health Services Provider Institution (HSPI) specialized in infectious diseases from Medellín. Methods: Cross-sectional study with 3454 MSM. Prevalence was determined with its 95% confidence interval; associated factors were identified using Fisher's Exact test, Pearson's Chi-square, and trend Chi-square. Multivariate adjustment was performed using logistic regression. Analyses were performed using SPSS 29.0. Results: The prevalence of HIV was 5.7%, T. pallidum 0.7%, and co-infection 0.6%. The prevalence of HIV was higher in MSM aged between 24-40 years (7.5%), with technical or university studies (10.0%), without health insurance affiliation (12.4%), and those who have had a sexual partner with HIV (36.2%). T. pallidum was higher in MSM without health insurance affiliation (3.4%), who had sexual relations with people diagnosed with an STI (5.9%), and a sexual partner with HIV (12.1%). Co-infection was higher in MSM without health insurance affiliation (2.7%), and those who had a partner with HIV (11.2%). Conclusion: Compared with the general Colombian population, MSM have a higher risk of HIV, but are similar to T. pallidum. The identification of the main associated factors in each infection demonstrates the need to prioritize subgroups of MSM that show greater vulnerability to these events. This research demonstrates the urgency of implementing health education strategies in MSM who have a sexual partner with HIV or other STIs. Large gaps were also evident in the magnitude of the three events according to the health insurance affiliation regime, which demonstrates problems of social and health injustice, especially with MSM without health insurance affiliation.

Metabolically Unhealthy Normal Weight: Prevalence and Associated Factors in an Adult Population from Northwest Colombia.

Background and Aim: Individuals with a normal weight may have metabolic alterations at risk for chronic non-communicable diseases. The prevalence of this condition and associated factors have not been reported in Latin American populations. We aimed to estimate the presence and associated factors of Metabolically Unhealthy Normal Weight (MUNW) in adults from a public program for the control and prevention of chronic diseases in Medellín, Colombia. Methods: Cross-sectional study. Overweight and normal weight were characterized according to the absence or presence of one or more components of the metabolic syndrome, obtaining four phenotypes: Metabolically Healthy Normal Weight (MHNW), MUNW (phenotype of interest), Metabolically Healthy Overweight (MHO), and Metabolically Unhealthy Overweight (MUO). The association of these phenotypes with sociodemographic variables of lifestyles and increased waist circumference was conducted by using logistic regression. Results: In 37,558 individuals (72.7% women), the prevalence of MUNW was 23.3%. Among the additional phenotypes, MUO was found to be more prevalent (71.6%), while MHNW and MHO were very slightly common, 2% and 3.1%, respectively. In a multiple model, the factors associated with MUNW were age over 60 years (trend [OR 1.56 95% CI 0.97-2.52] p-value = 0.066), living in a rural area ([OR 1.58 95% CI 1.09-2.29] p-value = 0.015), and increased waist circumference ([OR 1.68 95% CI 1.45-1.95] p-value < 0.001). Male gender was inversely associated with all phenotypes (P < 0.05). Conclusion: Almost a quarter of the analyzed population presented MUNW. People living in a rural area and over 60 years old were more likely to present MUNW. Men were less likely to present the weight phenotypes studied, although they could have been underrepresented.

Impact of COVID-19 Pandemic on Seroprevalence of HIV, HBV, HCV and HTLV I-II in a Blood Bank in Medellín, Colombia, 2019-2022.

The objective of this research was to analyze the impact of the COVID-19 pandemic on seroprevalence of HIV, HBV, HCV and HTLV I-II in donors from a blood bank in Medellin, Colombia, 2019-2022. A cross-sectional analytical study was carried out with three groups: pre-pandemic with 14,879 donors; preventive isolation with 9035; and selective isolation + new normality with 26,647 subjects. Comparisons were made with Chi2 and Bonferroni adjustment, Kruskal-Wallis' H with Dunnett's post-hoc, prevalence ratios, and multivariate logistic regression. COVID-19 decreased donations of men, altruistic and repetitive donors, and increased the age of donors. HIV increased with the COVID-19 pandemic, while HBV, HCV, and HTLV I-II decreased. The pandemic had an independent effect on these viral infections. These findings constitute an alert about what may be happening in the general population and show the importance of improving epidemiological surveillance and the investigation of these infections.

Clinical and Parasitological Profiles of Gestational, Placental and Congenital Malaria in Northwestern Colombia.

This study compared the clinical-parasitological profiles of gestational (GM), placental (PM), and congenital (CM) malaria in northwestern Colombia. A cross-sectional study with 829 pregnant women, 549 placentas, and 547 newborns was conducted. The frequency of GM was 35.8%, PM 20.9%, and CM 8.5%. P. vivax predominated in GM; in PM, the proportion of P. vivax and P. falciparum was similar; in CM, P. falciparum predominated. The main clinical findings were headache (49%), anemia (32%), fever (24%), and musculoskeletal pain (13%). The clinical manifestations were statistically higher in P. vivax infections. In submicroscopic GM (positive with qPCR and negative with thick blood smear), the frequency of anemia, sore throat, and a headache was statistically higher compared with pregnant women without malaria. GM, PM, and CM reduce birth weight and head circumference. In Colombia, this is the first research on the clinical characteristics of GM, PM, and CM; contrary to evidence from other countries, P. vivax and submicroscopic infections are associated with clinical outcomes.

Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia.

BACKGROUND: Understanding the causal attributions for cancer, the elements affecting therapeutic adherence, and behaviors that may compromise people's health or even put them at risk of dying from this disease has garnered a considerable degree of attention. METHODS: This study was designed in the city of Medellín with the aim to develop and validate a model for the study of (i) the categories that can be attributable to cancer etiology, (ii) the categories that can be attributed to the efficacy of treatment, and (iii) the relationship between the categories that can be attributed to the etiology and to the efficacy of the treatment. Structural equations were performed on 611 participants. RESULTS: The analysis revealed that attributing the disease to psychogenic factors distances people from biomedical treatments (ß coefficient, -0.12), and brings them closer to psychogenic (ß coefficient, 0.22) and alternative treatments (ß coefficient, 0.24). Attributing cancer to behavioral factors brings people closer to psychogenic treatments (ß coefficient, 0.40) over biomedical treatments (ß coefficient, 0.24). CONCLUSIONS: Symbolic, cultural, and social factors were evidenced, thereby leading to the underestimation of biomedical treatments and imparting a greater degree of importance to psychogenic or alternative therapies. These therapies will subsequently affect the achievement of therapeutic objectives such as increased survival.

HIV in Three Groups of Young People from Medellín: General Population, Organizations for People with Socioeconomic Vulnerability, and Men Who Have Sex with Other Men.

Introduction: In Colombia, there are no studies that analyze the effect of socioeconomic vulnerability and belonging to the group of men who have sex with other men (MSM) on the prevalence of HIV in young people. Objective: To compare the prevalence of HIV in three groups of young people from Medellín-Colombia: general population, socioeconomic vulnerability and MSM. Methods: This cross-sectional analytical study included 2449 young people from the general population, 1736 from institutions that serve young people in situations of socioeconomic vulnerability, and 2269 MSM. The prevalence of infection in each group was determined, statistical differences were identified using Pearson's Chi-square and Trend's Chi-square, and crude and adjusted odds ratios were estimated using logistic regression with 95% confidence intervals. Analyses were performed in SPSS 29.0. Results: HIV prevalence was 0.8% in the general population group, 1.3% in young people with socioeconomic vulnerability, and 5.6% in MSM. The groups with the highest HIV were as follows: (i) in MSM it was 4.1 compared to the general population, (ii) between 25-28 years of age it was 2.9 times compared to those under 20 years, (iii) in men it was 10 times that registered in women, (iv) in young people with primary, secondary, technical and university studies it was 7.1; 6.7; 11.0 and 14.5 times that found in those who did not register studies, (v) in affiliates of the subsidized health regime it was 2.2 times and in those without affiliation 2.4 times compared to the infection in affiliates of the contributory health regime. Conclusion: HIV prevalence was high, and explained by socioeconomic vulnerability, having sex between men, gender, age, education, and health affiliation, demonstrating the intersectionality of determinants of the health system, socioeconomic status, and determinants individuals in the occurrence of HIV in young people in Medellín.

Knowledge, Attitudes, and Practices Regarding Antibiotic Sales in Pharmacies in Medellín, Colombia 2023.

OBJECTIVE: Describe the knowledge, attitudes, and practices regarding the sale of antibiotics in pharmacies in Medellín, Colombia. METHOD: A cross-sectional descriptive study was conducted in 277 selected pharmacies using a stratified sampling method with proportional allocation to represent all areas of the city. Knowledge, attitudes, and practices (KAPs) were assessed using a scale, analyzed with absolute and relative frequencies for each item, and represented in a global score ranging from 0 to 100, with a higher score indicating better KAPs. Data were analyzed using relative frequencies with 95% confidence intervals, the Mann-Whitney U test, the Kruskal-Wallis test, and linear regression. RESULTS: Of the included pharmacies, 52.6% were chain pharmacies, 48.4% were attended by pharmacy assistants, and 59% of pharmacists had more than 5 years of experience. The median knowledge score was 70.8 (IQR 58.3-87.5), with 35.3% of pharmacists believing that antibiotics are effective in treating the common cold, 35.2% for treating COVID-19, and 29.4% considering them available for sale without a medical prescription. The attitude score was 53.3 (40.0-66.7), with 60.9% agreeing that prohibiting the sale of antibiotics without a prescription would decrease their sales. The practice score was 62.5 (40.0-79.2), with 65.4% of pharmacists stating that they sometimes sell antibiotics without a prescription due to patients struggling to obtain a medical consultation, 61.3% admitting to selling antibiotics without a prescription for urinary tract infections, and 41.3% for upper respiratory tract infections. Practices were predominantly influenced by pharmacy type (chain or independent) and, to a lesser extent, by knowledge and attitudes. CONCLUSION: Pharmacists in Medellín exhibit inadequate knowledge, attitudes, and practices regarding the use and sale of antibiotics without a medical prescription. These findings align with international evidence highlighting the need for educational and regulatory strategies promoting rational antibiotic use in pharmacies.

Social representations of cancer in patients from Medellín, Colombia: a qualitative study.

Background: Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia. Methods: This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages. Results: SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic. Conclusion: In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.

Knowledge, Attitude and Practice Regarding Antibacterial and Their Resistance in Medellín-Colombia: A Cross-Sectional Study.

OBJECTIVE: To describe the knowledge, attitudes, and practices (KAPs) profile on bacterial resistance and antibiotic in the general population of Medellín. MATERIAL AND METHODS: A cross-sectional study was conducted from September to December 2022, with 902 participants selected through stratified sampling with proportional allocation of different sectors of the city. The KAP scale was developed through a literature review, elimination of duplicate items, validity assessment, and reliability evaluation using Cronbach's alpha. Each item was presented with absolute and relative frequencies on a Likert scale, with a total score ranging from 0 to 100, where a higher score indicates better knowledge, attitudes, and practices. Comparisons were made using Mann-Whitney U, Kruskal-Wallis H, and linear regression. RESULTS: The knowledge score median was 73.3 (IQR 63.3-93.3), with 36.9% reporting that antibiotics can be stopped once symptoms improve and 26.1% considering them as analgesics or antipyretics. The attitudes score was 83.3 (IQR 73.3-93.3), with 95.3% expressing concern about the impact on their health or that of their family and over 90% agreeing that more information is needed on antibiotic resistance. The practice score was the lowest at 63.9 (IQR 50-75), with 48% having been prescribed antibiotics at the pharmacy and 42.6% taking them to treat flu symptoms. Economic status (ß 2.645), education in health-related areas (ß 6.224), gender (ß 2.892), and education level (ß 3.257) determined knowledge. Knowledge (ß 0.387), gender (ß 2.807), and education level (ß 0.686) influenced attitudes, but practices were only determined by Knowledge (ß 0.084) attitudes (ß 0.552) and age group (ß 2.858). CONCLUSIONS: Knowledge about antibiotics and bacterial resistance does not significantly influence the practices of the population. Therefore, interventions aimed at improving knowledge need to be reconsidered as they may not contribute to the appropriate use of antibiotics and prevention of resistance to these drugs.

Influence of Positive Thinking Ideology on Physician Representations of Cancer.

To understand the influence of positive thinking ideology on cancer representations among physicians in the city of Medellín. METHODS: This qualitative study was conducted on the basis of the theoretical and methodological elements of Corbin and Strauss's grounded theory. Fourteen physicians were included and selected according to the criteria of maximum variation for education, years of study, and personal and family history of cancer. The information was collected through semi-structured interviews and analyzed with open, axial, and selective coding. RESULTS: the ideology of positive thinking has managed to permeate the medical discourse and the representations that they form about the etiology and treatment of cancer. Physicians place the mind, emotions, attitude, and positive thinking as determinants of the origin of the disease and the response to therapy. To argue this link, they use two strategies: (i) a sophisticated and specialized discourse that involves relationships among thoughts, genetics, the neurological, immune and endocrine system and (ii) a mystical and less rational discourse that emphasizes the omnipotence of the mind and thoughts. In no case was the idea of positive thinking rejected or in disagreement with this style of thinking expressed. CONCLUSION: The fact of linking the disease with mental factors refers to the mind-body dualism and generates a responsibility of the patients on the etiology and therapeutics of the disease, as well as an erasure of the social and political determinants of cancer. The technical discourse and the symbolic capital of physicians offer scientific legitimacy to these ideas and can become performative for patients.

Antibiotic Self-Medication Patterns and Associated Factors in the Context of COVID-19, Medellín, Colombia: A Survey Based Cross Sectional Study.

Objective: To describe the frequency of self-medication with antibiotics and its associated factors in Medellín, Colombia. Methods: A descriptive study was conducted on 778 individuals surveyed regarding sociodemographic characteristics, self-medication with antibiotics, reasons for using these drugs, and types of antibiotics used. The analysis was performed in SPSS using absolute and relative frequencies with their corresponding confidence intervals, chi-square test, and logistic regression. Results: The frequency of self-medication with antibiotics was 46% (95% CI 42.5-49.5), with 47.4% (95% CI 42.2-52.5) of the population using antibiotics without medical prescription for flu-like symptoms related to COVID-19. Amoxicillin (33.7%), azithromycin (10.9%), and cephalexin (4.7%) were the most used antibiotics. The main factors associated with self-medication were age group, zone of residence, and lack of information on the appropriate use of these medications. Conclusion: The city exhibits a high frequency of self-medication with antibiotics, predominantly in conditions where they are ineffective, such as flu-like symptoms related to COVID-19. These findings highlight the contribution of the COVID-19 pandemic to bacterial resistance through self-medication and underscore the need to implement targeted actions to control the use of these medications.

Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia.

This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.

Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008-2020: Produced Vials Do Not Meet the Needs.

Introduction: Snakebite envenomation is a public health event of mandatory reporting in Colombia. It is considered a medical emergency in which the government must guarantee antivenom availability. We describe snakebite epidemiological figures in Colombia between 2008 and 2020 and correlate them with antivenom manufacturing figures to determine rate coverage and the need for antivenom. Methods: We performed an ecological study based on secondary official figures from the National Health Institute, the National Institute for Surveillance of Medicines and Foods, the National Administrative Department of Statistics and the Ministry of Health and Social Protection. Absolute and relative frequencies were calculated with 95% confidence intervals, position measurements, dispersion and central tendency. Results: Through our research, we revealed that in the last 13 years (2008-2020), there were an average of 4467 annual snakebite envenomation cases affecting all the departments in Colombia. Antioquia reported the highest number of snakebites with 647 (95% CI 588-706) cases per year. The population incidence per 100,000 inhabitants was 9.5; the highest rates were found in Vaupés at 116.1 and Guaviare at 79.24. During the last seven years (2014-2020) Colombia produced an average of 21,104 antivenom vials per year, while the annual demand for antivenom is estimated at 54,440 units needed to guarantee access. Discussion: Colombia does not produce sufficient vials to cover their needs, and this is why only 74.4% of accidents (out of the 92% not classified as dry bites) were treated, and even 9.7% of the severe accidents did not receive the specific treatment (8% of the victims were classified as dry bites). Figures support the regular antivenom shortages declared by the Ministry of Health and Social Protection in the last 13 years (11 health emergency declarations). New efforts are needed to: 1) boost the production of GMP-based high-quality antivenom, that covers the national needs and is made availability, 2) a better estimation method to calculate the need for antivenom in Colombia, and 3) implementation of production-distribution chains guaranteeing access in remote communities.

The Relation of Ideology of Positive Thinking with the Perception of Cancer Risk and Ways of Treating It in Medellin, Colombia.

Purpose: This study has the following objectives: i) to construct an instrument to measure positive thinking ideology (PTI) regarding cancer, and to evaluate its psychometric properties, ii) to describe the effects of PTI on cancer risk and its treatment, and iii) to identify the associated factors with PTI in the study group. Methods: A cross-sectional study was conducted with 611 people from the Medellin, Colombia. Participants were selected through stratified sampling with proportional assignment. A survey with three constructs was applied: the role of negative emotions in cancer etiology, cancer as a redeeming event, and the effects of PTI in cancer treatment. Results: In negative emotions construct 47% considered that holding anger, resentment, and hatred represent a moderate or high risk of generating cancer. In redeeming power construct 46.5% found that cancer is a battle that the best warriors win. Concerning the treatment, 77.3% considered that facing the disease with a fighting spirit had a moderate to high positive effect in response to the treatment. The associated factors with PTI were reading self-help books and education level. Conclusion: The results show that PTI affects perceptions about the cancer, its etiology and treatment. This effect is greater in undereducated people and in self-help book readers. The instrument showed excellent reliability, internal consistency, discriminating power, content, and construct validity properties.

Healthcare Inequities Experienced by Patients with Cancer: A Qualitative Study in Medellín, Colombia.

Purpose: This study aimed to understand the lived experiences of patients with cancer that facing inequities in oncological care in the city of Medellín. Patients and Methods: A qualitative study was conducted based on the theoretical and methodological elements of the grounded theory, specifically the description and conceptual ordering of Corbin and Strauss. Sixteen patients with cancer, who belonged to low (n=5), middle (n=4) and high (n=7) social classes, were included by theoretical sampling with category saturation. Data were collected using semi-structured interviews and analyzed in a category system based on the three social classes. Results: The patients were aged between 23 and 71 years old, and they were diagnosed with different types of cancer such as breast, cervical, prostate, stomach, leukemia and lymphoma. Patients' experiences showed that diagnosis, specialized care, treatment and hospital discharge were different based on their social class. Conclusion: Patients' lived experiences associated with cancer reflect complex social situations, in which social determinants affect the level of citizens' empowerment and self-management against the risks of get disease and die. Being part of low and middle social classes meant being subjected to a dehumanized, cold, impersonal and discontinuous treatment, in which healthcare was focused on the disease instead of individuals' preferences and values. In contrast, patients belonging to the high class had the resources necessary to face risks, which ensured access to more humanized and individualized healthcare.