Factors associated with hepatitis B virus infection in indigenous communities of Colombia / Factores asociados con la infección por el virus de la hepatitis B en comunidades indígenas de Colombia.

Introduction. Colombia is home to 2 million indigenous people who live in conditions of poverty and with health deficiencies, making them vulnerable to contracting hepatitis B (HBV). Amazonas has a high virus prevalence, and there are barriers to accessing vaccination; thus, part of the population is susceptible to infection. Objective. To identify factors associated with HBV in Colombian indigenous people. Materials and Methods. A case-control study of people over 18 years from four departments of Colombia. Cases were identified through the national hepatitis B notification registry (2015-2022). Controls were selected and matched to cases (2:1) by age, sex, ethnicity, and department. Sociodemographic characteristics, factors associated with contact with body fluids, cultural practices, and vaccination history were identified by means of a survey. The ethics committee of the Universidad de Antioquia approved the project. Results. Seventy five cases and 150 controls from 13 ethnic groups were surveyed. Amazonas contributed 49% of participants, 83% were women, and the median age of cases was 30 years (IQ range: 27-37). The associated factors were a family history of hepatitis B [adjusted OR: 2.61 (95% CI: 1.09-6.27)] and, in women, the number of pregnancies [adjusted OR: 1.61 (95% CI 1.02- 2.54)]. The vaccination history showed a protective effect, but the association was not significant. Conclusion. Aspects associated with family life and unprotected sexual relations seem to be responsible for the potential transmission of the virus. It was not possible to identify associated cultural practices. Innovative and differential strategies are required for indigenous people to achieve a reduction of HBV.

Introducción. Colombia alberga dos millones de indígenas, que viven en condiciones de pobreza y tienen deficiencias en salud, por lo cual están expuestos a contraer infecciones virales como la hepatitis B. El departamento del Amazonas presenta una gran prevalencia del virus y barreras para acceder a la vacunación; por esto, parte de la población es propensa a la infección. Objetivo. Identificar factores asociados con la infección por el virus de la hepatitis B en indígenas colombianos. Materiales y métodos. Se llevó a cabo un estudio de casos y controles en mayores de 18 años de cuatro departamentos del país. Los casos se identificaron mediante el registro nacional de notificación de hepatitis B (2015-2022). Los controles seleccionados de manera concurrente fueron pareados con los casos por edad, sexo, etnia y departamento. En una encuesta se consignaron las características sociodemográficas, los factores asociados con el contacto con sangre y fluidos, las prácticas socioculturales y los antecedentes de vacunación. El proyecto fue aprobado por Comité de Ética de la Universidad de Antioquia. Resultados. Participaron 75 casos y 150 controles de 13 grupos étnicos. El departamento del Amazonas aportó el 49 % de los participantes (83 % mujeres) con una mediana de edad de 30 años (RIC = 27-37). Los factores asociados con una mayor probabilidad de contraer la infección fueron el antecedente de algún familiar infectado con el virus de la hepatitis B (OR ajustado = 2,61) (IC95%: 1,09-6,27) y número de embarazos en mujeres, (OR ajustado = 1,61) (IC95%: 1,02-2,54). La vacunación mostró un efecto protector sin asociación significativa. Conclusión. Los aspectos asociados con la convivencia familiar y el número de embarazos contribuyen a una potencial transmisión vertical y horizontal del virus. No se identificaron prácticas culturales asociadas. Se requieren estrategias novedosas y diferenciales para reducir la transmisión del virus de la hepatitis B en poblaciones indígenas.

Epidemiology and Genetic Diversity of Hepatitis B Virus and Hepatitis Delta Virus Infection in Indigenous Communities in Colombia.

Despite the universal vaccination program, there are still regions and territories with a high prevalence of Hepatitis B Virus infection (HBV), such as the Amazon basin, where several indigenous communities live. Additionally, Hepatitis Delta Virus (HDV) is a defective that requires the hepatitis B surface antigen (HBsAg) for the assembly and release of de novo viral particles. Therefore, hepatitis D could be the result of HBV/HDV coinfection or HDV superinfection in individuals with chronic hepatitis B. Among the high prevalence HDV populations are indigenous communities of America. This study aims to describe and characterize the frequency of HBV and HDV infection, viral genotypes and HBV immune escape mutants in indigenous populations from different regions of Colombia. The diagnosis of hepatitis B and hepatitis D was confirmed by serological markers. Moreover, the HBV and HDV genome were amplified by PCR and RT-PCR, respectively, and, subsequently, the phylogenetic analysis was performed. We characterized 47 cases of chronic hepatitis B, 1 case of reactivation and 2 cases of occult hepatitis B infection (OBI). Furthermore, a high prevalence of HDV infection was identified in the study population (29.33%, 22/75) and the circulation of several HBV genotypes and subgenotypes (F1b, F3, F4, and D). Interestingly, this is the first report of the HDV genotype I circulation in this country. These findings demonstrated that HBV and HDV infections are still public health problems in indigenous communities in Colombia.

Identification of social innovation in health criteria in Latin America.

OBJECTIVES: Understanding the Latin American Social Innovation in Health (SIH) approach requires a process of typifying and identifying main criteria of the approach based on the employed practices of different health initiatives implemented throughout the region. This article presents a descriptive analysis of the main criteria of SIH. DESIGN: To identify the theoretical and methodological developments of SIH between the years 2013 and 2018, a scoping review was conducted using a mixed approach. 80 texts in English, Spanish and Portuguese were screened through a reflexive analysis process involving intratextual and intertextual reading. SETTING AND PARTICIPANTS: The documentary research covered journals, books and higher degree theses addressing experiences or theoretical constructs developed in the Latin American region. PRIMARY AND SECONDARY OUTCOME MEASURES: The approaches identified in the studied initiatives were mutually complementary; moreover, based on the typification of the main criteria between approaches and implementation proposals, the convergences and divergences between SIH and other approaches found in the sample were identified. In most cases, the different approaches in the sample are committed to initiatives that include some degree of innovation, improve access to healthcare services and recognise in one way or another a public policy in line with the Sustainable Development Goals (SDGs). RESULTS: Eighteen characteristic criteria were identified, of which nine particularly differentiate SIH from other approaches conceptually and methodologically. Further work is essential to eliminate the vague delimitation between social and technological aspects of innovation. CONCLUSIONS: The findings indicate that although the SIH concept is in construction, it is advancing down a path of recognition in the region, defining its role as an important field of study on social transformation in health and development.

[Hepatitis B in indigenous people in Latin America: a literature reviewHepatite B em indígenas na América Latina: revisão da literatura]. / Hepatitis B en indígenas de América Latina: una revisión de la literatura.

Objective: Identify publications from 2000 to 2020 on hepatitis B in indigenous people in Latin America, to learn about advances and gaps in this field in the last 20 years. Methods: Exploratory review and systematic evidence review. Documents were organized using Excel and Rayyan® software. Results: We selected 30 of 107 articles found: 17 epidemiological studies, 10 document reviews, 2 clinical studies, and 1 letter to the editor. Brazil was the country with the most publications (50%), most of them with an epidemiological approach. The topic most often addressed was hepatitis B prevalence with 22 publications, followed by 11 studies reporting results of molecular studies of the virus, 7 studies on vaccination, 5 studies on risk factors, and 4 publications with topics such as vertical transmission and studies of social issues. Conclusion: Compared to previous reviews by other authors, we saw greater diversity in topics and research methods; however, conventional epidemiological approaches that focus on measuring prevalence of serological markers still predominate. Thus, there is a need for other types of research focused on sociocultural determinants.

Objetivo: Identificar artigos publicados entre 2000 e 2020 sobre hepatite B em indígenas da América Latina, visando a conhecer as conquistas obtidas nos últimos 20 anos e as lacunas existentes com relação a esta doença. Métodos: Foi realizada uma revisão exploratória da literatura com síntese das evidências. O material obtido foi organizado com o uso de Excel® e Rayyan®. Resultados: De 107 artigos encontrados, 30 foram selecionados ­ 17 estudos epidemiológicos, 10 revisões documentais, 2 estudos clínicos e 1 carta ao editor. O Brasil foi o país com o maior percentual de artigos publicados (50%), na sua maioria estudos com enfoque epidemiológico. As áreas temáticas abordadas foram a prevalência de infecção pelo vírus da hepatite B (22 artigos), estudos moleculares do vírus da hepatite (11 estudos), vacinação (7), fatores de risco (5), e temas como transmissão materno-fetal e aspectos sociais (4). Conclusões: Comparado aos estudos de revisão anteriores conduzidos por outros autores, o presente estudo demonstra uma maior variedade de áreas temáticas e metodologias empregadas. No entanto, ainda predominam enfoques epidemiológicos convencionais com foco na avaliação da prevalência de marcadores sorológicos. São necessárias outras linhas de pesquisas enfocando os determinantes socioculturais.

Hepatitis B en indígenas de América Latina: una revisión de la literatura / Hepatitis B in indigenous people in Latin America: a literature review / Hepatite B em indígenas na América Latina: revisão da literatura

RESUMEN Objetivo. Identificar publicaciones realizadas entre los años 2000 y 2020 sobre hepatitis B en indígenas de América Latina, con el fin de conocer avances y vacíos en el tema durante los últimos 20 años. Métodos. Revisión exploratoria y síntesis rápida de la evidencia. El proceso de organización documental se realizó con los programas Excel® y Rayyan®. Resultados. Se seleccionaron 30 de 107 artículos encontrados, 17 corresponden a estudios epidemiológicos, 10 a revisiones documentales, dos estudios clínicos y una carta al editor. Brasil fue el país con más publicaciones (50%), la mayoría con enfoque epidemiológico. La temática más abordada fue la medición de prevalencia de la infección por hepatitis B con 22 publicaciones, le siguieron 11 estudios que informan resultados de estudios moleculares del virus, siete estudios sobre vacunación, cinco estudios sobre factores de riesgo y cuatro publicaciones con temas como la transmisión vertical y estudios sociales. Conclusión. En comparación con revisiones previas realizadas por otros autores, se observa una mayor diversidad en los temas y métodos de investigación utilizados; sin embargo, aún prevalecen los enfoques epidemiológicos convencionales centrados en la medición de la prevalencia de marcadores serológicos. Esto hace necesario encarar otro tipo de investigaciones centradas en los determinantes socioculturales.

ABSTRACT Objective. Identify publications from 2000 to 2020 on hepatitis B in indigenous people in Latin America, to learn about advances and gaps in this field in the last 20 years. Methods. Exploratory review and systematic evidence review. Documents were organized using Excel and Rayyan® software. Results. We selected 30 of 107 articles found: 17 epidemiological studies, 10 document reviews, 2 clinical studies, and 1 letter to the editor. Brazil was the country with the most publications (50%), most of them with an epidemiological approach. The topic most often addressed was hepatitis B prevalence with 22 publications, followed by 11 studies reporting results of molecular studies of the virus, 7 studies on vaccination, 5 studies on risk factors, and 4 publications with topics such as vertical transmission and studies of social issues. Conclusion. Compared to previous reviews by other authors, we saw greater diversity in topics and research methods; however, conventional epidemiological approaches that focus on measuring prevalence of serological markers still predominate. Thus, there is a need for other types of research focused on sociocultural determinants.

RESUMO Objetivo. Identificar artigos publicados entre 2000 e 2020 sobre hepatite B em indígenas da América Latina, visando a conhecer as conquistas obtidas nos últimos 20 anos e as lacunas existentes com relação a esta doença. Métodos. Foi realizada uma revisão exploratória da literatura com síntese das evidências. O material obtido foi organizado com o uso de Excel® e Rayyan®. Resultados. De 107 artigos encontrados, 30 foram selecionados - 17 estudos epidemiológicos, 10 revisões documentais, 2 estudos clínicos e 1 carta ao editor. O Brasil foi o país com o maior percentual de artigos publicados (50%), na sua maioria estudos com enfoque epidemiológico. As áreas temáticas abordadas foram a prevalência de infecção pelo vírus da hepatite B (22 artigos), estudos moleculares do vírus da hepatite (11 estudos), vacinação (7), fatores de risco (5), e temas como transmissão materno-fetal e aspectos sociais (4). Conclusões. Comparado aos estudos de revisão anteriores conduzidos por outros autores, o presente estudo demonstra uma maior variedade de áreas temáticas e metodologias empregadas. No entanto, ainda predominam enfoques epidemiológicos convencionais com foco na avaliação da prevalência de marcadores sorológicos. São necessárias outras linhas de pesquisas enfocando os determinantes socioculturais.

Joint international consensus statement on crowdsourcing challenge contests in health and medicine: results of a modified Delphi process.

OBJECTIVES: To develop a consensus statement to provide advice on designing, implementing and evaluating crowdsourcing challenge contests in public health and medical contexts. DESIGN: Modified Delphi using three rounds of survey questionnaires and one consensus workshop. SETTING: Uganda for face-to-face consensus activities, global for online survey questionnaires. PARTICIPANTS: A multidisciplinary expert panel was convened at a consensus-development conference in Uganda and included 21 researchers with experience leading challenge contests, five public health sector workers, and nine Ugandan end users. An online survey was sent to 140 corresponding authors of previously published articles that had used crowdsourcing methods. RESULTS: A subgroup of expert panel members developed the initial statement and survey. We received responses from 120 (85.7%) survey participants, which were presented at an in-person workshop of all 21 panel members. Panelists discussed each of the sections, revised the statement, and participated in a second round of the survey questionnaire. Based on this second survey round, we held detailed discussions of each subsection with workshop participants and further revised the consensus statement. We then conducted the third round of the questionnaire among the 21 expert panelists and used the results to finalize the statement. This iterative process resulted in 23 final statement items, all with greater than 80% consensus. Statement items are organised into the seven stages of a challenge contest, including the following: considering the appropriateness, organising a community steering committee, promoting the contest, assessing contributions, recognising contributors, sharing ideas and evaluating the contest (COPARSE). CONCLUSIONS: There is high agreement among crowdsourcing experts and stakeholders on the design and implementation of crowdsourcing challenge contests. The COPARSE consensus statement can be used to organise crowdsourcing challenge contests, improve the rigour and reproducibility of crowdsourcing research and enable large-scale collaboration.

Exploring social innovation in health in Central America and the Caribbean.

Universal health coverage is a public health priority in the Americas. Social innovation in health offers novel solutions to unmet needs, by enabling health care delivery to be more inclusive, affordable, and effective. In 2017, an international collaborative consortium launched an open call for solutions that sought to identify social innovations in health in Central America and the Caribbean. The focus was set on how these solutions can strengthen health care delivery, with emphasis on reducing the impact of neglected transmissible diseases. A crowdsourcing strategy was implemented to identify social innovations in health. These were evaluated by an external panel of experts and practitioners and civil society representing the health and social innovation sectors, based on the appropriateness, innovativeness, and affordability of the solution. The three top-scoring solutions were analyzed through case studies including site visits by a team of investigators. Two key findings emerged from the response to the call: 1) innovative solutions were based on the knowledge and experience of individuals and communities facing adverse situations; 2) this knowledge was shared through health promotion and education, leading to empowerment of the communities. The principal challenges addressed by the solutions were the limited access to quality health care services and failed traditional strategies for vector control. The solutions identified demonstrated how social innovation can strengthen health systems by delivering novel solutions to health needs and articulating communities to enable them to work hand-in-hand with the health system toward universal health.

La cobertura universal de salud es una prioridad de salud pública en la Región de las Américas. La innovación social en materia de salud ofrece soluciones novedosas a las necesidades insatisfechas, al permitir que la prestación de servicios de salud sea más inclusiva, asequible y eficaz. En 2017, un consorcio de colaboración internacional lanzó una convocatoria abierta de soluciones con el fin de identificar innovaciones sociales en materia de salud en América Central y el Caribe. Esta se centró en la forma en que esas soluciones pueden fortalecer la prestación de atención sanitaria, con énfasis en la reducción de los efectos de las enfermedades transmisibles desatendidas. Para identificar las innovaciones sociales en materia de salud se aplicó una estrategia de colaboración masiva (crowdsourcing). Las propuestas fueron evaluadas por un grupo externo conformado por expertos, profesionales y la sociedad civil que representaban a los sectores de la salud y la innovación social, sobre la base de la idoneidad, la capacidad de innovación y la asequibilidad de la solución. Se analizaron las tres soluciones mejor calificadas mediante estudios de casos que incluyeron visitas al lugar por parte de un equipo de investigadores. De la respuesta a la convocatoria surgieron dos conclusiones clave: 1) las soluciones innovadoras se basaron en el conocimiento y la experiencia de las personas y las comunidades que se enfrentaban a situaciones adversas, y 2) este conocimiento se compartió a través de actividades de promoción de la salud y educación, lo que condujo al empoderamiento de las comunidades. Los principales problemas que abordaron las soluciones fueron el acceso limitado a servicios de atención sanitaria de calidad y el fracaso de las estrategias tradicionales de control de vectores. Las soluciones identificadas demostraron cómo la innovación social puede fortalecer los sistemas de salud proporcionando soluciones novedosas a las necesidades de salud y apoyando a las comunidades para que puedan colaborar estrechamente con el sistema de salud hacia la salud universal.

Universities as catalysts of social innovation in health systems in low-and middle-income countries: a multi-country case study.

BACKGROUND: Social innovation (SI) in health holds potential to contribute to health systems strengthening and universal health coverage (UHC). The role of universities in SI has been well described in the context of high-income countries. An evidence gap exits on SI in healthcare delivery in the context of low- and middle-income countries (LMICs) as well as on the engagement of universities from these contexts. There is thus a need to build capacity for research and engagement in SI in healthcare delivery within these universities. The aim of this study was to examine the adoption and implementation of network of university hubs focused on SI in healthcare delivery within five countries across Africa, Asia and Latin America. The objectives were to describe the model, components and implementation process of the hubs; identify the enablers and barriers experienced and draw implications that could be relevant to other LMIC universities interested in SI. METHODS: A case study design was adopted to study the implementation process of a network of university hubs. Data from documentation, team discussions and post-implementation surveys were collected from 2013 to 2018 and analysed with aid of a modified policy analysis framework. RESULTS/DISCUSSION: SI university-based hubs serve as cross-disciplinary and cross-sectoral platforms, established to catalyse SI within the local health system through four core activities: research, community-building, storytelling and institutional embedding, and adhering to values of inclusion, assets, co-creation and hope. Hubs were implemented as informal structures, managed by a small core team, in existing department. Enablers of hub implementation and functioning were the availability of strong in-country social networks, legitimacy attained from being part of a global network on SI in health and receiving a capacity building package in the initial stages. Barriers encountered were internal institutional resistance, administrative challenges associated with university bureaucracy and annual funding cycles. CONCLUSIONS: This case study shows the opportunity that reside within LMIC universities to act as eco-system enablers of SI in healthcare delivery in order to fill the evidence gap on SI and enhance cross-sectoral participation in support of achieving UHC.

Documentary research on social innovation in health in Latin America.

BACKGROUND: Identifying social innovation in health initiatives, promoting quality of life through them, and transforming current health conditions demand the knowledge, comprehension and appropriation of the theoretical and methodological developments of this concept. Academic developments in social innovation have mainly occurred in and been documented for English-speaking countries, although relevant experiences have been implemented in Latin America. In this article, we describe and analyze how social innovation in health is being approached and understood in this region. MAIN TEXT: To identify the theoretical and methodological developments of social innovation in health between 2013 and 2018, a scoping review with a mixed approach was carried out. Eighty texts in English, Spanish and Portuguese were selected for a process of reflexive analysis of intra and intertextual reading. The approaches identified in the studied initiatives were complementary. The most applied approaches were innovation in health, technological innovation in health and social innovation, each with twelve publications, and social innovation in health and ecohealth with ten and seven publications respectively. The approaches showed a general interest in reaching the goals of the Sustainable Development Goals (SDGs), the Alma Ata Declaration and the Ottawa Letter. CONCLUSIONS: The social innovation in health approach in Latin America adopts educational strategies, identifies risk factors, optimizes resources, promotes interculturality, participation, community empowerment, and enhances intersectorality and interdisciplinarity. As an approach, process, program or solution, social innovation in health is a conceptual category under construction. This research provides a baseline for other systematic reviews on the subject.

Integrated vector control of Chagas disease in Guatemala: a case of social innovation in health.

BACKGROUND: Improved access to health care and quality of services require integrated efforts and innovations, including community empowerment and participation in transformation processes. Chagas disease is a neglected tropical disease that is generally controlled by insecticide spraying. To achieve community empowerment in a health program, actions for social innovations may include: community-based research, interdisciplinary and intersectoral participation, community perception of direct benefits and participation in health or environmental improvements. The aim of this study was to describe and analyze the processes by which an interdisciplinary team, in collaboration with communities of Comapa, Guatemala, developed an effective solution to address the risk for Chagas disease. METHODS: A qualitative study involving interviews semi-structured and direct observation was conducted using a case study approach to describe and understand the community-based research and intervention process developed by researchers from the Laboratory of Applied Entomology and Parasitology of the Universidad de San Carlos of Guatemala (Laboratorio de Entomologia y Parasitologia Aplicada). Nine interviews were conducted with the investigators, innovators, members of the community in which the intervention had been implemented. NVivo software (version 12) was used for the emergent coding and analysis of the interviews. RESULTS: Processes of social transformation were evident within households, and the communities that transcended the mere improvement of walls and floors. New social dynamics that favored the household economy and conditions of hygiene and home care that positively impacted the health of the community. We describe how the integration of criteria of social innovation into a home improvement strategy for Chagas disease control, can generate processes of transformation in health by considering sociocultural conditions, encouraging dialogue between public health approaches and traditional practices. We identify and discuss processes for Social Innovations in Health and identify their potential in improving community health in Latin America. CONCLUSIONS: When social innovation criteria are included in a health control initiative, the community-based research and the interdisciplinary and intersectoral participation facilitate the implementation of the control strategy, the perceived benefits by the community and its empowerment to sustain and share the strategy. The case study provided understanding of the intersectoral and interdisciplinary dynamics in particular contexts, and documented the relevance of innovation criteria in health processes.

Relaciones médico-paciente en instituciones prestadoras de servicios de salud en Medellín, Colombia / Doctor-Patient relationship in healthcare institutions of Medellin, Colombia

RESUMEN Objetivo Comprender las percepciones que tienen médicos y pacientes sobre sus relaciones y cómo las condiciones actuales del Sistema General de Seguridad Social en Salud (SGSSS) influyen en su relacionamiento. Materiales y Métodos La recolección y análisis de información se basó en el principio de saturación que propone la investigación cualitativa, mediante entrevistas semiestructuradas aplicadas a 17 pacientes y 15 médicos durante el ejercicio de sus roles, en el ambiente de la espera y la consulta en cinco IPS seleccionadas. Las entrevistas fueron grabadas, trascritas y analizadas bajo los preceptos de la Teoría Fundamentada de Corbin y Strauss. El diseño muestral fue teórico por conveniencia. Resultados Las condiciones del SGSSS sobre el hacer del médico, el abuso del derecho por parte de algunos pacientes y la percepción de calidad desigual entre Entidades Administradores de Planes de Beneficios (EAPB), así como las fallas de comunicación en las Relaciones Médico-Paciente (RMP), el desprestigio de los médicos generales, la percepción de incredulidad hacia médicos jóvenes, entre otras percepciones identificadas dejan entrever que los cambios en el SGSSS contribuyen en la construcción de las RMP actuales. Conclusiones Es fundamental que los actores del SGSSS propongan intervenciones que refuercen en los médicos capacidades comunicativas y psicosociales desde sus procesos de formación profesional, además de la disposición del SGSSS para proveer condiciones que permitan al médico desarrollar una atención en salud centrada en el paciente.(AU)

ABSTRACT Objective To understand the perceptions that doctors and patients have about their relationships and how the current conditions of the General System of Social Security in Health (GSSSH) influence their relationship. Materials and Methods The collection and analysis of information was based on the saturation principle proposed by qualitative research, through direct observation and semi-structured interviews applied to 17 patients and 15 physicians during the exercise of their roles, in the waiting and consultation environment within the selected healthcare institutions. The interviews recorded, transcribed and analyzed under five precepts of the Grounded Theory of Corbin and Strauss. The sample design was theoretical for convenience. Results Health system conditions on the doctor's doing, abuse of the right by some patients, the perception of uneven quality between health care promotion entities, communication failures in the Doctor-Patient Relationships, loss of prestige of the general doctors, perception of disbelief towards young doctors, among other identified perceptions, hint that changes in the GSSSH contribute to the construction of current Doctor-Patient Relationships. Conclusions It is essential that the actors of the GSSSH propose interventions that reinforce the communicative and psychosocial capacities in the doctors from their formative processes, as well as the provision of the GSSSH to provide conditions that allow the doctor to develop a health care focused on the patient.(AU)

[Doctor-Patient relationship in healthcare institutions of Medellin, Colombia]. / Relaciones médico-paciente en instituciones prestadoras de servicios de salud en Medellín, Colombia.

OBJECTIVE: To understand the perceptions that doctors and patients have about their relationships and how the current conditions of the General System of Social Security in Health (GSSSH) influence their relationship. MATERIALS AND METHODS: The collection and analysis of information was based on the saturation principle proposed by qualitative research, through direct observation and semi-structured interviews applied to 17 patients and 15 physicians during the exercise of their roles, in the waiting and consultation environment within the selected healthcare institutions. The interviews recorded, transcribed and analyzed under five precepts of the Grounded Theory of Corbin and Strauss. The sample design was theoretical for convenience. RESULTS: Health system conditions on the doctor's doing, abuse of the right by some patients, the perception of uneven quality between health care promotion entities, communication failures in the Doctor-Patient Relationships, loss of prestige of the general doctors, perception of disbelief towards young doctors, among other identified perceptions, hint that changes in the GSSSH contribute to the construction of current Doctor-Patient Relationships. CONCLUSIONS: It is essential that the actors of the GSSSH propose interventions that reinforce the communicative and psychosocial capacities in the doctors from their formative processes, as well as the provision of the GSSSH to provide conditions that allow the doctor to develop a health care focused on the patient.

OBJETIVO: Comprender las percepciones que tienen médicos y pacientes sobre sus relaciones y cómo las condiciones actuales del Sistema General de Seguridad Social en Salud (SGSSS) influyen en su relacionamiento. MATERIALES Y MÉTODOS: La recolección y análisis de información se basó en el principio de saturación que propone la investigación cualitativa, mediante entrevistas semiestructuradas aplicadas a 17 pacientes y 15 médicos durante el ejercicio de sus roles, en el ambiente de la espera y la consulta en cinco IPS seleccionadas. Las entrevistas fueron grabadas, trascritas y analizadas bajo los preceptos de la Teoría Fundamentada de Corbin y Strauss. El diseño muestral fue teórico por conveniencia. RESULTADOS: Las condiciones del SGSSS sobre el hacer del médico, el abuso del derecho por parte de algunos pacientes y la percepción de calidad desigual entre Entidades Administradores de Planes de Beneficios (EAPB), así como las fallas de comunicación en las Relaciones Médico-Paciente (RMP), el desprestigio de los médicos generales, la percepción de incredulidad hacia médicos jóvenes, entre otras percepciones identificadas dejan entrever que los cambios en el SGSSS contribuyen en la construcción de las RMP actuales. CONCLUSIONES: Es fundamental que los actores del SGSSS propongan intervenciones que refuercen en los médicos capacidades comunicativas y psicosociales desde sus procesos de formación profesional, además de la disposición del SGSSS para proveer condiciones que permitan al médico desarrollar una atención en salud centrada en el paciente.

Guías bilingües: una estrategia para disminuir las barreras culturales en el acceso y la atención en salud de las comunidades wayuu de Maicao, Colombia / Bilingual guides: a strategy to decrease cultural barriers to health care access in the Wayuu communities of Maicao, Colombia

RESUMEN Este artículo estudia la función del guía bilingüe como actor en la disminución de la brecha en el acceso y la atención en salud de las comunidades indígenas wayuu de Colombia. En el marco de un proyecto de VIH llevado a cabo entre los años 2012 y 2014, se realizaron 24 entrevistas a actores claves del área administrativa y de salud, incluyendo guías bilingües wayuu. A partir del análisis cualitativo se identificaron tres barreras culturales respecto al acceso a la atención en salud: a) idioma; b) cosmovisión wayuu sobre el cuerpo, la salud y la enfermedad; c) información sobre salud sexual y reproductiva y VIH culturalmente no adaptada. El estudio identifica al guía bilingüe como actor clave en la disminución de estas barreras y finaliza con una discusión sobre el rol de los guías, las tensiones inherentes a su labor, y la complejidad de su aporte como mediadores culturales.

ABSTRACT The article examines the use of bilingual guides to decrease cultural barriers to health care access in the Wayuu indigenous communities of Colombia. Within a larger project on HIV carried out between 2012 and 2014, 24 interviews were conducted with key actors in the administrative and health areas, including Wayuu bilingual guides. As a result of the qualitative analysis, the study identified three cultural barriers to health care access: a) language; b) the Wayuu worldview regarding the body, health, and illness; and c) information about sexual and reproductive health and HIV not adapted to the Wayuu culture. The study identifies the bilingual guides as key actors in reducing these barriers and concludes with a discussion of the role of the guides, the tensions inherent to their work, and the complexity of their contributions as cultural mediators.

[Bilingual guides: a strategy to decrease cultural barriers to health care access in the Wayuu communities of Maicao, Colombia]. / Guías bilingües: una estrategia para disminuir las barreras culturales en el acceso y la atención en salud de las comunidades wayuu de Maicao, Colombia.

The article examines the use of bilingual guides to decrease cultural barriers to health care access in the Wayuu indigenous communities of Colombia. Within a larger project on HIV carried out between 2012 and 2014, 24 interviews were conducted with key actors in the administrative and health areas, including Wayuu bilingual guides. As a result of the qualitative analysis, the study identified three cultural barriers to health care access: a) language; b) the Wayuu worldview regarding the body, health, and illness; and c) information about sexual and reproductive health and HIV not adapted to the Wayuu culture. The study identifies the bilingual guides as key actors in reducing these barriers and concludes with a discussion of the role of the guides, the tensions inherent to their work, and the complexity of their contributions as cultural mediators.