Social determinants of health in post-treatment cancer survivors: Scoping review.

PURPOSE: To identify, analyze and describe the available scientific evidence about the influence of social determinants of health on cancer survivors. METHODS: A scoping review was outlined according to the steps described by the Joanna Brigs Institute Reviewer's Manual: selection of studies, data mapping, and results grouping, synthesis and report, was conducted. PubMed, CINAHL, Scopus and LILACS databases were searched from 2011 to 2023. RESULTS: Out of a total of 1783 papers initially screened, only 19 studies met the inclusion criteria for the scoping review, focusing on the primary social determinants impacting the health of cancer survivors. These studies were categorized into six main themes: a) employment (challenges in work reintegration and work-place difficulties); b) variations among different ethnic groups; c) disparities based on sex; d) barriers and facilitators in accessing health and social security services; e) the role of support networks and social environments; and f) socioeconomic lever (influence of income and socioeconomic status). CONCLUSIONS: Understanding the impact of social determinants on the post-treatment quality of life for cancer survivors is crucial. Comprehensive survivorship care should address not just medical needs but also holistic aspects like social support, education, overall well-being, and improvements in physical and social environments. This multifaceted approach ensures the well-rounded support needed for optimal survivorship outcomes.

Percepciones sobre salud (física, mental y bucal) en un grupo de mujeres en situación de prostitución en la ciudad de Medellín

Introducción: las mujeres y las personas trans que han ejercido el trabajo sexual se encuentran vulneradas puesto que son víctimas de discriminación por su condición laboral, por su género y por los riesgos que acarrea esta labor, y esto impacta en su situación de salud. Este estudio tuvo como objetivo conocer las percepciones sobre salud (física, mental y bucal) en cuatro mujeres que ejercen la prostitución en Medellín, a partir de sus experiencias de vida y aquellas relacionadas con su contexto social. Métodos: se realizó una investigación cualitativa con enfoque etnográfico para analizar las situaciones mencionadas de acuerdo con el objetivo general. Se contó con la participación de cuatro mujeres: dos de nacionalidad venezolana y dos de nacionalidad colombiana; se llevaron a cabo entrevistas semiestructuradas. Se realizó análisis de contenido cualitativo, lo cual permitió la generación de cuatro categorías (salud mental, salud bucal, salud general y calidad de vida). Resultados: sus discursos permitieron elucidar la conexión entre las condiciones de vida y la situación de salud. La falta de oportunidades laborales, un proceso migratorio de profundos cambios económicos y sociales, y una Colombia con inequidades y barreras de acceso a servicios de salud y sociales, son procesos determinantes de orden general, particular y singular de las precarias condiciones de salud bucal y general. Conclusiones: la población participante se encuentra en situación de vulnerabilidad social y de salud, lo cual evidencia la necesidad de políticas públicas y estrategias basadas en la realidad social que contribuyan a generar equidad en salud.

Introduction: women and trans people who have engaged in sex work are triply vulnerable since they are victims of discrimination due to their employment status, their gender, and the risks that this work entails, this impacts their health situation. This study aimed to know the perceptions about health (physical, mental, and oral) of four women who work in prostitution in Medellin, based on their life experiences and those related to their social context. Methods: qualitative research with an ethnographic approach was conducted to analyze the situations mentioned. Four women participated, two Venezuelans and two Colombians, and semi-structured interviews were conducted. Qualitative content analysis was performed, which allowed the generation of four categories (mental health, oral health, general health, and quality of life). Results: her discourses made it possible to elucidate the connection between the living conditions and the health situation. Lack of job opportunities, a migratory process of profound economic and social changes, and a Colombia with inequities and barriers to access to health and social services are determining processes of a general and singular order of the precarious conditions of oral health and general. Conclusions: the participating population is in a situation of social and health vulnerability, which shows the need for public policies and strategies based on the social reality that contribute to generating equity in health.

Acceso de mujeres en embarazo, parto y post parto a servicios de salud según clase social / Access of women in pregnancy, childbirth and postpartum to health services according to social class

Resumen Objetivo: comprender el acceso que tienen las mujeres en situación de embarazo, parto y post parto a los servicios de salud según la clase social en Bogotá (Colombia). Métodos: estudio cualitativo. Perspectiva hermenéutica crítica. Método etnografía crítica. Muestreo teórico. Análisis por triangulación en Atlas Ti. Participaron 9 mujeres y 8 profesionales de la salud. Se realizaron 38 entrevistas a profundidad durante 13 meses y 62 acompañamientos a las maternas en las actividades de control prenatal, vacunación, trabajo de parto, consulta post parto, exámenes de seguimiento, curso Psicoprofiláctico, hospitalización y sala de espera, tanto en servicios públicos como privados. Resultados: existen desigualdades según la clase social en el acceso que tienen las mujeres a los servicios de salud en los siguientes aspectos: acceso a servicio a especialistas, hacer la fila para esperar la atención, la disponibilidad de citas y agenda para programar la cita, perder la cita habiendo llegado al servicio, la prioridad que le dan las instituciones a las maternas, madrugar para conseguir atención, pedir la cita, las condiciones de la espera y elegir la clínica o el personal. Conclusiones: los anteriores aspectos se intensifican en clases sociales con menos ventajas. Se requiere disminuir las desigualdades sociales para disminuir las inequidades en salud.

Abstract Objective: to understand the access that women in pregnancy, childbirth and postpartum have to health services according to social class in Bogotá (Colombia). Methods: qualitative study. Critical hermeneutical perspective. Critical ethnography method. Theoretical sampling. Analysis by triangulation in Atlas Ti. 9 women and 8 health professionals participated. 38 in-depth interviews were carried out during 13 months and 62 accompaniments to the maternal in the activities of prenatal control, vaccination, labor, postpartum consultation, follow-up examinations, Psychoprophylactic course, hospitalization and waiting room, both in public services as private. Results: there are inequalities according to social class in the access that women have to health services in the following aspects: access to specialist services, queuing to wait for care, availability of appointments and schedule to schedule the appointment, Missing the appointment having arrived at the service, the priority that institutions give to maternal mothers, getting up early to get care, requesting an appointment, waiting conditions and choosing the clinic or staff. Conclusions: the previous aspects are intensified in social classes with less advantages. Reducing social inequalities is required to decrease health inequities.

Relations established by women during pregnancy, delivery and postpartum with health personnel according to social class in Bogotá: qualitative study. / Relaciones que establecen las mujeres durante el embarazo, parto y posparto con el personal de salud según clase social en Bogotá: estudio cualitativo.

OBJECTIVE: To understand the relationship established between women in a situation of pregnancy, childbirth and postpartum with the health services personnel according to social class in Bogotá (Colombia). MATERIALS AND METHODS: Qualitative study. Critical hermeneutical perspective and critical ethnography. Theoretical sampling. Analysis by triangulation in Atlas.ti. 9 women and 8 health professionals participated. 38 in-depth interviews were conducted for 13 months and 62 accompaniments to the maternal in the activities of prenatal control, vaccination, labor, postpartum consultation, follow up exams, prophylactic pisco course, hospitalization and waiting room, both in public services as private. RESULTS: There are inequalities according to social class in which the relationship between women and staff is configured in the following aspects: permeability to the needs of women, recognition of psychosocial aspects, having different points of view against a medical recommendation and right to complain or demand to improve. CONCLUSIONS: The situation described above intensifies gender issues in women with a less advantageous social class. It is necessary to develop interventions in educational and health institutions that consider aspects where human resources are sensitized on social issues related to the theoretical proposals of research and the democratization of medical information. It is unfair that the condition of social class and gender affects the quality of care and economically stratifies people's rights.

OBJETIVO: Comprender la relación que se establece entre las mujeres en situación de embarazo, parto y posparto con el personal de los servicios de salud según la clase social en Bogotá (Colombia). MATERIALES Y MÉTODOS: Estudio cualitativo, perspectiva hermenéutica crítica y etnografía crítica con muestreo teórico. Análisis por triangulación en Atlas.ti. Participaron nueve mujeres y ocho profesionales de la salud. Se realizaron 38 entrevistas a profundidad durante 13 meses y 62 acompañamientos a las mujeres en las actividades de control prenatal, vacunación, trabajo de parto, consulta posparto, exámenes de seguimiento, curso psicoprofiláctico, hospitalización y sala de espera, tanto en servicios públicos como privados. RESULTADOS: Existen desigualdades según la clase social en la forma en que se configura la relación entre las mujeres y el personal en los siguientes aspectos: permeabilidad a las necesidades de la mujer, reconocimiento de aspectos psicosociales, tener diferentes puntos de vista frente a una recomendación médica y derecho a quejarse o exigir para mejorar la atención de los servicios de salud. CONCLUSIONES: Lo anterior intensifica las problemáticas relacionadas con el género en las mujeres con una clase social menos aventajada. Es necesario el desarrollo de intervenciones en las instituciones educativas y de salud que tengan en cuenta aspectos donde se sensibilice el recurso humano en temas sociales relacionados con las propuestas teóricas de la investigación y la democratización de la información médica. Es injusto que la condición de clase social y de género afecte la calidad en la atención y estratifique económicamente los derechos de las personas.

Relaciones que establecen las mujeres durante el embarazo, parto y posparto con el personal de salud según clase social en Bogotá: estudio cualitativo / Relations established by women during pregnancy, delivery and postpartum with health personnel according to social class in Bogotá: qualitative study

RESUMEN Objetivo: Comprender la relación que se establece entre las mujeres en situación de embarazo, parto y posparto con el personal de los servicios de salud según la clase social en Bogotá (Colombia). Materiales y métodos: Estudio cualitativo, perspectiva hermenéutica crítica y etnografía crítica con muestreo teórico. Análisis por triangulación en Atlas.ti. Participaron nueve mujeres y ocho profesionales de la salud. Se realizaron 38 entrevistas a profundidad durante 13 meses y 62 acompañamientos a las mujeres en las actividades de control prenatal, vacunación, trabajo de parto, consulta posparto, exámenes de seguimiento, curso psicoprofiláctico, hospitalización y sala de espera, tanto en servicios públicos como privados. Resultados: Existen desigualdades según la clase social en la forma en que se configura la relación entre las mujeres y el personal en los siguientes aspectos: permeabilidad a las necesidades de la mujer, reconocimiento de aspectos psicosociales, tener diferentes puntos de vista frente a una recomendación médica y derecho a quejarse o exigir para mejorar la atención de los servicios de salud. Conclusiones: Lo anterior intensifica las problemáticas relacionadas con el género en las mujeres con una clase social menos aventajada. Es necesario el desarrollo de intervenciones en las instituciones educativas y de salud que tengan en cuenta aspectos donde se sensibilice el recurso humano en temas sociales relacionados con las propuestas teóricas de la investigación y la democratización de la información médica. Es injusto que la condición de clase social y de género afecte la calidad en la atención y estratifique económicamente los derechos de las personas.

ABSTRACT Objective: To understand the relationship established between women in a situation of pregnancy, childbirth and postpartum with the health services personnel according to social class in Bogotá (Colombia). Materials and methods: Qualitative study. Critical hermeneutical perspective and critical ethnography. Theoretical sampling. Analysis by triangulation in Atlas.ti. 9 women and 8 health professionals participated. 38 in-depth interviews were conducted for 13 months and 62 accompaniments to the maternal in the activities of prenatal control, vaccination, labor, postpartum consultation, follow up exams, prophylactic pisco course, hospitalization and waiting room, both in public services as private. Results: There are inequalities according to social class in which the relationship between women and staff is configured in the following aspects: permeability to the needs of women, recognition of psychosocial aspects, having different points of view against a medical recommendation and right to complain or demand to improve. Conclusions: The situation described above intensifies gender issues in women with a less advantageous social class. It is necessary to develop interventions in educational and health institutions that consider aspects where human resources are sensitized on social issues related to the theoretical proposals of research and the democratization of medical information. It is unfair that the condition of social class and gender affects the quality of care and economically stratifies people's rights.

Precarious employment and health: A qualitative study in Venezuelan immigrant population in Colombia.

BACKGROUND: Employment and working conditions are considered as an element that impacts on health inequalities, especially among vulnerable groups such as the immigrant population. This study aims to describe the characteristics of precarious employment in the Venezuelan immigrant population in Medellín (Colombia) according to its theoretical model and its relationship with the perception of their physical, mental, and psychosocial health. METHODS: A qualitative study was conducted with a focused ethnography perspective. 31 people with Venezuelan origin and work experience were interviewed in the city of Medellin and its metropolitan area and 12 key informants from different formal and informal social organizations that work with the immigrant population. A narrative content analysis was carried manually and by using the Atlas.Ti 8.0 software. The principles of analytical induction were applied to carry out a thematic analysis of the main categories defined in the precarious employment framework. RESULTS: The following characteristics of precarious employment were found: instability in employment conditions, work in the informal or submerged economy, limited empowerment, absence of social benefits, high vulnerability, low income, and a limited capacity for exercising labor rights. This situation affects mental health conditions, access to health services, and the presence of risks due to the work they perform. CONCLUSIONS: The Venezuelan working population in Medellín is found in a precarious employment situation. Inclusive social strategies and policies that take into account the reality of this population are required.

La migración sur/sur como un determinante social de impacto en las desigualdades e inequidades en salud bucal en Latinoamérica / South-south migration as a social determinant of impact on oral health inequalities and inequities in Latin America

Los países latinoamericanos vienen enfrentando un fenómeno social y demográfico importante conocido como migración sur/sur, que difiere del patrón clásico de migración sur/norte debido a que la capacidad de respuesta social y gubernamental es menor y por las condiciones sociales y de salud similares en ambas poblaciones (migrantes y autóctonos). La salud bucal no es ajena a esta situación y debe analizarse desde una propuesta integradora que involucra factores demográficos, sociales, económicos y aquellos propios del proceso migratorio. En el presente artículo se hace una revisión de la literatura existente en diferentes contextos geográficos, identificando los vacíos conceptuales y metodológicos, haciendo una propuesta de análisis de la migración como un determinante social con impacto en las desigualdades e inequidades en salud bucal. Esto es el punto de partida para presentar un marco conceptual explicativo desde las etapas y momentos que enfrentan los grupos de migrantes, identificando los factores que inciden en la salud bucal de esta población. En conclusión, la migración y su relación con la salud bucal en el contexto latinoamericano se encuentra en una etapa de construcción científica y esto implica la necesidad de generar propuestas de investigación basadas en la realidad social que viven los directamente involucrados y desde diferentes metodologías. De igual forma se requieren estrategias de acción en diferentes niveles y con diferentes actores desde enfoques interdisciplinarios, reconociendo la salud bucal como un derecho fundamental ligado a la salud general, para todos los ciudadanos, independiente de su procedencia.

Latin American countries have been facing an important social and demographic phenomenon known as South-South migration, which differs from the classic South-North migration pattern due to the lower social and governmental response capacity and similar social and health conditions in both populations (migrants and natives). Oral health is not excluded from this situation and must be analyzed from an integrative proposal that involves demographic, social, and economic factors and those of the migratory process. This article reviews the existing literature in different geographical contexts, identifying conceptual and methodological gaps, and proposing an analysis of migration as a social determinant with an impact on oral health inequalities and inequities. This is the starting point for presenting a conceptual framework that explains the stages and moments faced by migrant groups, identifying the factors that affect the oral health of this population. In conclusion, migration and its relationship with oral health in the Latin American context are in a scientific construction stage and it implies the need to generate research proposals based on the social reality lived by those directly involved and from different methodologies. Similarly, action strategies are required at different levels and with different actors from interdisciplinary approaches, recognizing oral health as a fundamental right linked to general health, for all citizens, regardless of their origin.

[South-South migration as a social determinant of impact on oral health inequalities and inequities in Latin America]. / La migración Sur/Sur como un determinante social de impacto en las desigualdades e inequidades en salud bucal en Latinoamérica.

Latin American countries have been facing an important social and demographic phenomenon known as South-South migration, which differs from the classic South-North migration pattern due to the lower social and governmental response capacity and similar social and health conditions in both populations (migrants and natives). Oral health is not excluded from this situation and must be analyzed from an integrative proposal that involves demographic, social, and economic factors and those of the migratory process. This article reviews the existing literature in different geographical contexts, identifying conceptual and methodological gaps, and proposing an analysis of migration as a social determinant with an impact on oral health inequalities and inequities. This is the starting point for presenting a conceptual framework that explains the stages and moments faced by migrant groups, identifying the factors that affect the oral health of this population. In conclusion, migration and its relationship with oral health in the Latin American context are in a scientific construction stage and it implies the need to generate research proposals based on the social reality lived by those directly involved and from different methodologies. Similarly, action strategies are required at different levels and with different actors from interdisciplinary approaches, recognizing oral health as a fundamental right linked to general health, for all citizens, regardless of their origin.

Los países latinoamericanos vienen enfrentando un fenómeno social y demográfico importante conocido como migración sur/sur, que difiere del patrón clásico de migración sur/norte debido a que la capacidad de respuesta social y gubernamental es menor y por las condiciones sociales y de salud similares en ambas poblaciones (migrantes y autóctonos). La salud bucal no es ajena a esta situación y debe analizarse desde una propuesta integradora que involucra factores demográficos, sociales, económicos y aquellos propios del proceso migratorio. En el presente artículo se hace una revisión de la literatura existente en diferentes contextos geográficos, identificando los vacíos conceptuales y metodológicos, haciendo una propuesta de análisis de la migración como un determinante social con impacto en las desigualdades e inequidades en salud bucal. Esto es el punto de partida para presentar un marco conceptual explicativo desde las etapas y momentos que enfrentan los grupos de migrantes, identificando los factores que inciden en la salud bucal de esta población. En conclusión, la migración y su relación con la salud bucal en el contexto latinoamericano se encuentra en una etapa de construcción científica y esto implica la necesidad de generar propuestas de investigación basadas en la realidad social que viven los directamente involucrados y desde diferentes metodologías. De igual forma se requieren estrategias de acción en diferentes niveles y con diferentes actores desde enfoques interdisciplinarios, reconociendo la salud bucal como un derecho fundamental ligado a la salud general, para todos los ciudadanos, independiente de su procedencia.

Comparing Oral Health Services Use in the Spanish and Immigrant Working Population.

We aim to analyze oral health services use and related factors in the immigrant working population compared to the Spanish counterparts. Cross-sectional study of working population (n = 8591) that responded Spanish National Health Survey (SNHS), 2011-2012. The association between oral health services use and migration status was estimated using logistic regression. Immigrant men presented a greater probability of oral health service use a year or more prior (aOR 1.63; 95% CI 1.26-2.02), independently of oral health, sociodemographic and socioeconomic characteristics. In immigrant women, greater probability of use of oral health services one year or more prior disappeared after adjusting for the same variables (aOR 1.15; 95% CI 0.91-1.45). Occupational social class and education level could explain better a high percentage of oral health service use one year or more prior in immigrant women but there is a persistent inequality in oral health service use in immigrant men.

Calidad de vida relacionada con la salud bucal en mujeres en situación de prostitución en Medellín (Colombia) y sus factores relacionados / Oral health-related quality of life of women in prostitution in Medellin (Colombia) and its associated factors

Resumen Introducción y objetivo: La calidad de vida es un elemento a considerar en el análisis de los determinantes sociales en grupos vulnerables. Se pretende determinar la calidad de vida relacionada con la salud bucal (CVRSB) en un grupo de mujeres en situación de prostitución de Medellín y sus factores relacionados. Materiales y métodos: Estudio descriptivo transversal en una muestra a conveniencia de 53 mujeres que ejercen la prostitución. Se aplicó encuesta y examen clínico con información sociodemográfica, uso de servicios de salud y situación de salud bucal. Aplicación del instrumento OHIP-14 (Perfil de Impacto de la Salud Oral en la Calidad de Vida). Descripción del OHIP-14 y sus medidas de resumen según diferentes variables. Resultados: Las dimensiones de malestar psicológico y minusvalía son las que presentaron mayores puntajes. El 85% de las mujeres reportaron uno o más impactos de su salud bucal en la calidad de vida, lo que representa un promedio de 4,8 impactos IC95% (3,8-5,9). Se observaron indicadores de impacto más altos según factores sociodemográficos como: nivel educativo, tiempo en el oficio, cargas familiares, apoyo social o consumo de sustancias psicoactivas. Igualmente, se reportaron mayores impactos de acuerdo a factores como: estar insatisfechas con su salud bucal, estado de salud bucal bajo, tener problemas bucodentales, requerir atención prioritaria y reportar problemas de acceso a la atención odontológica. Conclusiones: Se observaron gradientes en la CVRSB de acuerdo a características sociodemográficas, salud bucal y acceso a la atención odontológica. Se evidencian situaciones de inequidad que deben ser consideradas para promover acciones colectivas en esta población.

Abstract Introduction and objective: The quality of life is an element to consider in the analysis of social determinants in vulnerable social groups. This study aims to determine to determine the oral health related quality of life (OHRQOL) in a group of women in situation of prostitution situation in Medellín (Colombia) and its related factors. Materials and methods: A descriptive study was conducted in a convenience sample of 53 women. A survey and clinical examination was carried out with sociodemographic information, use of health services and oral health status. The instrument OHIP-14 (Profile of Impact of Oral Health on Quality of Life) was used. A description of the OHIP-14 and its summary measures according to different variables was applied. Results: Psychological distress and disability were the dimensions that presented highest scores in the sample. 85% of women reported one or more impacts of their oral health on quality of life, representing an average of 4.8 impacts 95%CI (3.8-5.9). Higher impact indicators were observed according to sociodemographic factors such as: educational level, time at work, family burden, social support or use of psychoactive substances. Likewise, greater impacts were reported according to factors such as: being unsatisfied with their oral health, low oral health status, having oral problems, requiring priority oral health attention and reporting problems of access to dental care. Conclusions: There were gradients in the OHRQOL according to sociodemographic characteristics and oral health and access to oral health care variables. Situations of inequity are evidenced that must be considered in order to promote collective actions in this population.

Condición periodontal y su relación con variables sociodemográficas y clínicas en pacientes adultos de una institución docencia-servicio / Periodontal disease and its relationship with clinical and sociodemographic variables in adult patients treated in a service/teaching institution

RESUMEN: Objetivo: Determinar la prevalencia de enfermedad periodontal y los factores sociodemográficos y clínicos relacionados. Material y métodos: Se diseñó un estudio observacional, descriptivo y retrospectivo. Se incluyeron historias clínicas con los siguientes criterios: ≥ 35 años de edad, historia clínica y ficha periodontal completa y mínimo 10 dientes presentes en boca. Se analizaron variables sociodemográficas y clínicas periodontales y se estableció el diagnóstico periodontal de acuerdo con dos sistemas de clasificación (AAP y CDC-AAP). Se calculó el χ2 para analizar las diferencias entre variables sociodemográficas y clínicas con relación a la severidad de la periodontitis. Para variables cuantitativas se utilizó la prueba de la mediana. Resultados: La frecuencia de periodontitis fue 67.2% (periodontitis severa 43.2%) y gingivitis fue 32.8%. En 155 casos hubo acuerdo entre las dos clasificaciones cuando la periodontitis fue severa. La clasificación CDC-AAP produjo más casos de periodontitis moderada y sólo 47 casos en concordancia con el sistema AAP. Los pacientes con periodontitis presentaron mayor sangrado al sondaje, pérdida de inserción y bolsas periodontales (p < 0.001). Los pacientes con periodontitis perdieron más dientes que pacientes con gingivitis. La periodontitis fue más frecuente en hombres que en mujeres (p = 0.025). Los pacientes con periodontitis tuvieron un nivel educativo más bajo, enfermedades sistémicas, consumo de cigarrillo y alcohol y problemas de afiliación a la seguridad social. Conclusiones: La frecuencia de periodontitis en la población de estudio fue muy alta (60%) y se encontró relacionada con enfermedades sistémicas, cigarrillo, afiliación a la seguridad social y nivel educativo. La frecuencia de periodontitis se ve determinada por el sistema de clasificación que se utilice.

ABSTRACT: Objective: To determine prevalence of periodontal disease and related clinical and sociodemographic factors. Material and methods: An observational, descriptive and retrospective study was undertaken. Criteria to select patients were as follows: ≥ 35 years of age, full clinical history and periodontal chart and a minimum of ten teeth present in the mouth. Clinical periodontal and sociodemographic variables were examined; periodontal diagnosis was established according to two classification systems (AAP and CDC-AAP). χ2 was calculated in order to analyze differences among sociodemographic and clinical variables with respect to periodontitis severity. Median test was used for quantitative variables. Results: Periodontitis frequency was 67.2% (severe periodontitis 43.2%). Gingivitis frequency was 32.8%. In 155 cases there was concordance of two observers in cases of severe periodontitis. CDC-AAP classification established more cases of moderate periodontitis and only 47 cases in concordance with AAP system. Periodontitis patients exhibited greater bleeding upon probing, insertion loss and periodontal pockets (p < 0.001). Patients with periodontitis lost more teeth that patients with gingivitis. Periodontitis was more frequent in males than in females (p = 0.025). Patients with periodontitis exhibited lower educational levels, suffered systemic diseases, were addicted to tobacco and alcohol use and had encountered problems with their affiliation to social security services. Conclusions: Periodontitis frequency in studied population was high (60%), and found to be related to systemic diseases, tobacco use, affiliation to social security services and educational level. Periodontitis frequency was determined by used classification system.

Revisiting the Healthy Migrant Paradox in Perinatal Health Outcomes Through a Scoping Review in a Recent Host Country.

Ample evidence shows that, in many developed countries, immigrants have similar or better perinatal health outcomes than natives despite facing socioeconomic disadvantages in the host country ("healthy migrant paradox" -HMP). This scoping review aims to: (1) summarize the literature on perinatal health among immigrants and natives in Spain and (2) examine whether there is evidence of the HMP in a context of recent migration. A total of 25 articles published between 1998 and 2014 were reviewed. Overall, we found evidence of the HMP in low birthweight and to a lesser extent in preterm, though the patterns vary by origin, but not in macrosomia and post-term. The results are consistent across settings, levels of adjustment, and birth year. Policies should be oriented towards identifying the modifiable risk factors leading to a higher risk of macrosomia and post-term among immigrants.

Inequidades en salud de la primera infancia en el municipio de Andes, Antioquia, Colombia. Un análisis desde la epidemiología crítica / Inequities in Early Childhood Health in the Municipality of Andes, Antioquia, Colombia. A Critical Epidemiology Analysis / As desigualdades na saúde na infância na cidade de Andes, Antioquia, Colombia. Uma análise da epidemiología crítica

Resumen En Colombia persisten inequidades en la salud de la primera infancia. Se realizó un estudio descriptivo para estimar las desigualdades en salud de la primera infancia del municipio de Andes, Antioquia. Las categorías teóricas utilizadas fueron la clase social y los modos de vida. Se hizo valoración clínica del crecimiento, del desarrollo y del estado de la dentición de 642 niños de cero a cinco años. Se encuestó a los adultos acompañantes para clasificar su posición de clase. El muestreo fue probabilístico en la zona urbana y por concentración en la rural. La población se clasificó en cinco fracciones de clase. Se observaron desigualdades en los modos de vida, en el desarrollo infantil y en la experiencia de caries dental; más graves en los niños de las familias subasalariadas. Las disparidades constituyen inequidades sociales, puesto que son producto de las condiciones de vida que les son impuestas a los grupos humanos de acuerdo con su posición social.

Abstract Colombia recognizes health as a fundamental right, however persistent inequities in early childhood. The objective was to describe the situation of early childhood and health inequalities between social groups in the municipality of Andes-Antioquia. A descriptive study framed in critical epidemiology was conducted, included assessment of growth and development and the State of dentition of642 children 0 to 5 years. The accompanying adult was also surveyed. The sampling was probabilistic in urban areas and for concentration in rural areas. The population was classified into five social groups. Indicators of nutritional status and dental caries experience behaved unevenly, being better in children from families of employees/independent with higher education and worse in the group of day laborers. Inequities in oral health and child development among children sub-salaried families and other groups are evident.

Resumo Colômbia desigualdades na saúde persistem na primeira infância. Um estudo descritivo para estimar as desigualdades na saúde na primeira infância no município de Andes, Antioquia foi realizada. As categorias teóricas utilizadas eram de classe social e estilo de vida. Avaliação clínica de crescimento, desenvolvimento e estado de dentição de 642 crianças de zero a cinco anos foi feita. Os adultos acompanhantes foram entrevistados para classificar a sua posição de aula. A amostragem foi probabilística na concentração urbana e rural. A população foi classificada em cinco frações de classe. desigualdades no estilo de vida, o desenvolvimento da criança e da experiência de cárie dentária foram observadas; mais grave em crianças de famílias subasalariadas. As disparidades são as desigualdades sociais, uma vez que são o resultado das condições de vida que lhes são impostas grupos humanos de acordo com a sua posição social.

Acceso a servicios de salud dental en menores de doce años en Perú, 2014 / Access to oral health services in children under twelve years of age in Peru, 2014

RESUMEN El objetivo del estudio fue explorar los patrones de acceso a servicios de salud dental en menores de doce años en Perú. Se revisaron datos de 25.285 niños menores de 12 años que participaron en la Encuesta Demográfica y de Salud Familiar 2014. Se realizó un análisis exploratorio espacial para proyectar las proporciones de menores con acceso a servicios de salud dental según regiones a nivel nacional, tipo de servicio de salud y lugar de residencia urbana o rural. Los resultados muestran que el 26,7% de la muestra tuvo acceso a los servicios de salud dental en los últimos seis meses. El 39,6% pertenecía al grupo etario de 0 a 4 años, el 40,6% habitaba en la zona andina y un 58,3% residía en zonas urbanas. Las regiones de Huancavelica, Apurímac, Ayacucho, Lima y Pasco tuvieron los mayores porcentajes de población que accedió a servicios de salud dental a nivel nacional. En conclusión, existe un bajo acceso a los servicios de salud dental para la población menor de 12 años en Perú. La distribución espacial del acceso a los servicios de salud dental permitiría identificar y agrupar regiones según patrones comunes de acceso para enfocar acciones en materia de salud pública.

ABSTRACT The aim of the study was to explore the patterns of dental health services access in children under twelve years of age in Peru. Data from 25,285 children under 12 years who participated in the Demographic and Family Health Survey of 2014 were reviewed. An exploratory spatial analysis was performed to project the proportions of children with access to dental health services, according to national regions, type of health service and urban or rural place of residence. The results show that of the total sample, 26.7% had access to dental health services in the last six months, 39.6% belonged to the age group 0-4 years, 40.6% lived in the Andean region and 58.3% lived in urban areas. The regions of Huancavelica, Apurimac, Ayacucho, Lima and Pasco had the highest percentages of access nationwide. In conclusion, there is low access to dental health services in the population under 12 years of age in Peru. The spatial distribution of access to dental health services allows regions to be identified and grouped according to similar access patterns, in order to better focus public health actions.

La invisibilidad de estudios en salud oral en mujeres en situación de prostitución: una revisión sistemática exploratoria / The invisibility of oral health studies about women in situation of prostitution: a scoping review

El objetivo fue describir los estudios existentes a nivel mundial relacionados con salud oral en mujeres en situación de prostitución. Para ello se realizó una revisión exploratoria (Scoping Review) sobre el tema en cuestión en estudios publicados en forma de artículos científicos originales en revistas de revisión por pares, sin restricción en el periodo de búsqueda e indexados en 4 bases de datos internacionales (PubMed, EMBASE, LILACS y SCOPUS). Descripción de las principales características de los estudios. Como resultados principales, luego de hacer el proceso de selección se encontraron 10 estudios con diferentes enfoques metodológicos (cuantitativos, cualitativos o mixtos y estudios de intervención). Seis de los estudios fueron realizados en países asiáticos (Japón y Singapur). Las temáticas abordadas fueron: manifestaciones orales del VIH, uso del condón, prácticas y actitudes frente al sexo oral. Solamente se encontró un estudio específico en salud oral realizado en Senegal el cual analiza la situación periodontal en trabajadoras sexuales con y sin VIH. Los estudios en salud oral para la población en situación de prostitución son escasos. Siendo un grupo sensible y vulnerable socialmente, se requiere fomentar la investigación en estas mujeres para identificar las posibles situaciones de desigualdad social que impactan en las condiciones de salud oral en este colectivo.

This study aimed to describe the existing studies worldwide related to oral health in women in prostitution. For this exploratory review (Scoping Review) on the subject in question in studies published in the form of original scientific articles in journals peer review was conducted without restriction in the search period and indexed in 4 international databases (PubMed, EMBASE, LILACS and SCOPUS). Description of the main characteristics of the studies. The main results, after making the selection process 10 studies with different methodological approaches (quantitative, qualitative or mixed and intervention studies) were found. Six of the studies were conducted in Asian countries (Japan and Singapore). The themes were: oral manifestations of HIV, condom use, practices and attitudes towards oral sex. Only a specific oral health study conducted in Senegal which analyzes the periodontal situation of sex workers with and without HIV was found. In conclusion, studies on oral health for individuals in prostitution are scarce. Being a socially sensitive and vulnerable group, it is essential to encourage research in these women to identify potential situations of social inequality that impact oral health conditions in this group.

Ethnicity and Health in Colombia: What Do Self-Perceived Health Indicators Tell Us?

OBJECTIVE: To compare self-perceived health indicators between ethnic groups in Colombia. METHODS: Cross-sectional study with data from the 2007 National Public Health Survey (ENSP-2007). Data from 57,617 people ≥18 years were used. Variables included: belonging to an ethnic group (exposure); self-rated health; mental health problems, injuries for accidents/violence (outcomes); sex, age, education level and occupation (explicative/control). A descriptive study was carried out of the explicative variables, and the prevalence of the outcomes was calculated according to ethnicity, education level and occupation. The association between the exposure variable and the outcomes was estimated by means of adjusted odds ratios (OR) with 95% CI using logistic regression. Analyses were conducted separately for men and women. RESULTS: The prevalence of outcomes was higher in people reporting to belong to an ethnic group and differences were found by sex, ethnic groups and health outcomes. Women from the Palenquero group were more likely to report poor self-rated health (aOR 7.04; 95%CI 2.50-19.88) and injuries from accidents/violence (aOR 7.99; 95%CI 2.89-22.07). Indigenous men were more likely to report mental health problems (aOR 1.75; 95%CI 1.41-2.17). Gradients according to ethnicity, education, occupation and sex were found. CONCLUSIONS: Minority ethnic groups are vulnerable to reporting poor health outcomes. Political actions are required to diminish health inequalities in these groups.

Condiciones de salud oral y estado protésico de la población adulta mayor atendida en la red hospitalaria pública de Medellín (Colombia) / Oral health conditions and prosthetic status in elderly population assisted by the public hospital network of Medellin (Colombia)

Este estudio pretendió analizar las condiciones de salud oral y el estado protésico de la población adulta mayor atendida en la red hospitalaria pública de Medellín (Colombia). Se realizó un estudio transversal mediante muestreo bi-etápico en las unidades hospitalarias y centros de salud adscritos a esta red. Participaron 342 adultos de 65 y más años (58,2 % mujeres). Se recogió información a través de encuesta y examen clínico. Variables: Sociodemográficas: edad, sexo, estrato socioeconómico, nivel educativo, zona de residencia, apoyo social (Duke-11). Salud oral: Percepción de salud oral, presencia de problemas orales en el último mes. Indicadores clínicos: Índice COPD, dientes presentes, estado de prótesis dentales, problemas de la mucosa oral. Análisis univariado y bivariado y cálculo de pruebas Chi cuadrado para observar diferencias estadísticamente significativas entre las variables. Se encontró que las personas 75 años, los hombres, la población de estratos socioeconómicos y nivel educativo bajos, ubicados en área urbana y con apoyo social bajo tienden a reportar mala salud oral autopercibida. El promedio de dientes presentes en la población fue de 5,7 (±7,8), lo que implica un COPD promedio de 24,2 (±5,9), con diferencias de acuerdo a variables sociodemográficas. Más del 55 % de los hombres y las mujeres requieren cambio de prótesis inferior y un 70 % requieren cambio de prótesis superior. Se encontraron problemas de la mucosa oral: candidiasis (12 %), ulceras (7 %), leucoplasia (7 %), liquen plano (1 %). En conclusión se evidencian deficientes condiciones de salud oral que pueden ser explicadas por la situación de vulnerabilidad social que enfrenta esta población y barreras de acceso a servicios de salud oral preventivos y curativos.

This study aimed to analyze oral health conditions and prosthetic status in elderly population assisted by the public hospital network in Medellin (Colombia). A cross sectional study was conducted by means a two-stage sampling in hospital units and health centers attached to this network. 342 adults aged 65 and over (58.2 % women) participated and the information was collected through survey and clinical examination. Variables: Sociodemographic: age, sex, socioeconomic status, educational level, place of residence, social support (Duke-11). Oral Health: Self-perceived Oral health, presence of oral problems in the last month. Clinical indicators: DFMT Index, present teeth, state of dentures, oral mucosa problems. Univariate and bivariate analysis and calculation of chi-square tests were carried out to observe statistically significant differences among different variables. As main findings people 75 years, men, people of socioeconomic and educational level lower, located in urban areas and with low social support tend to report poor self-perceived oral health. The average teeth in the population was 5.7 (±7.8), implying a 24.2 average DFMT (±5.9), differing according to demographic variables. Over 55 % of men and women require lower denture change and 70 % of them require change of upper prostheses. Main oral mucosa problems were observed: Candidiasis (12 %), ulcers (7 %), leukoplakia (7 %), lichen planus (1 %). As a conclusion poor oral health conditions was observed and they can be explained on the situation of social vulnerability faced o this population and barriers to preventive and curative oral health care.

Salud bucal y género en relación a la población adulta mayor atendida en la red hospitalaria pública de Medellín: Los puntos de vista del personal de salud / Oral health and gender in relation to the elderly population assisted by the public hospital network of Medellin: The health personnel points of view

Objetivo: Explorar las percepciones sobre salud bucal y género con relación a la población adulta mayor que consulta la red hospitalaria pública de Medellín desde la perspectiva de los prestadores de servicios de salud. Materiales y métodos: Estudio cualitativo con perspectiva etnográfica mediante 34 entrevistas semi-estructuradas en personal que presta servicios de salud en la Empresa Social del Estado -E.S.E- Metrosalud. Las entrevistas se transcribieron textualmente y se realizó análisis de contenido según categorías propias de los discursos de los participantes. Resultados: Se encontraron tres categorías principales: 1) Necesidades y problemas de salud general y bucal y sus determinantes; 2) Símbolos y significados de la población adulta mayor; 3) Perspectiva y roles de género y su relación con las prácticas sociales en salud bucal. En general, los prestadores perciben alta carga de enfermedad y barreras de acceso a los servicios de salud. Se percibieron diferencias de género relacionadas con los roles que asumen las personas, las prácticas de autocuidado, y los perfiles de utilización de los servicios de salud. Conclusiones: Los prestadores entrevistados perciben como la población adulta mayor que consulta a la red prestadora de servicios pública de Medellín se encuentra en situación de vulnerabilidad social que impacta en las condiciones de salud bucal. De igual manera, se perciben diferencias de género relacionadas. Se requieren políticas sociales que garanticen equidad para este grupo poblacional.

Objective: To explore the perceptions about oral health and gender in relation to the elderly population assisted by the public hospital network of Medellin from the health personnel perspective. Materials and methods: A qualitative and ethnographic study was conducted through 34 semi-structured interviews in health personnel in the State Social Enterprise E.S.E Metrosalud. Interviews were transcribed and a content analysis was carried out according to categories from the participants' discourses. Results: Three main categories were found: 1) Needs and problems of general and oral health and their determinants; 2) Symbols and significances of the elderly; 3) Perspectives and gender roles and its relationship with social practices on oral health. In general terms, participants perceived high disease burden and barriers of access to health services. In addition, gender differences were perceived related to the roles that people assume, self-care practices and health services utilization profiles. Conclusions: Interviewed providers perceived that the elderly population assisted by the public hospital network of Medellin is exposed to social vulnerability that affects oral health conditions. In addition, gender related differences were found. Social policies that ensure equity in this population group are required.

Social Context and Dental Pain in Adults of Colombian Ethnic Minority Groups: A Multilevel Cross-Sectional Study.

AIMS: To estimate the effect of social context on dental pain in adults of Colombian ethnic minority groups (CEGs). METHODS: Information from 34,843 participants was used. A multilevel model was constructed that had ethnic groups (ie, CEGs and non-CEGs) at level 1 and Colombian states at level 2. Contextual variables included gross domestic product (GDP), Human Development Index (HDI), and Unmet Basic Needs Index (UBNI). RESULTS: Dental pain was observed in 12.3% of 6,440 CEGs. In an unadjusted logistic regression model, dental pain was associated with being a CEG (odds ratio [95% confidence interval], 1.34 [1.22-1.46]; P = .0001). This association remained significant after adjusting for possible confounding variables. An unconditional multilevel analysis showed that the variance in dental pain was statistically significant at the ethnic group level (ß = 0.047 ± 0.015; P = .0009) and at the state level (ß = 0.038 ± 0.019; P = .02) and that the variation between ethnic groups was higher than the variation between states (55% vs 45%, respectively). In a multivariate model, the variance in dental pain was also statistically significant at the ethnic group level (ß = 0.029 ± 0.012; P = .007) and the state level (ß = 0.042 ± .019; P = .01), but the variation between states was higher (40% vs 60%). The results of multilevel multivariate analyses showed that dental pain was associated with increasing age (ß = 0.009 ± 0.001; P = .0001), lower education level (ß = 0.302 ± 0.103; P = .0001), female sex (ß = 0.031 ± 0.069; P = .003), GDP (ß = 5.136 ± 2.009; P = .002) and HDI (ß = 6.862 ± 5.550; P = .004); however, UBNI was not associated with dental pain. CONCLUSION: The variance in dental pain was higher between states than between ethnic groups in the multivariate multilevel model. Dental pain in CEGs was associated with contextual and individual factors. Considering contextual factors, GDP and HDI may play a major role in dental pain prevalence.

Intimate Partner Violence and Its Associated Factors in a Sample of Colombian Immigrant Population in Spain.

Immigrants are vulnerable to Intimate partner violence (IPV). This study aims at characterising IPV among Colombian immigrants, and to identify its associated factors. Cross-sectional study on 336 Colombian immigrants (46 % women), aged 15-70 years, living in Spain. Self-reported questionnaire information on IPV suffered throughout the last year was collected face-to-face. Multivariable logistic regression was used to identify factors associated with IPV. Almost 30 % of participants reported IPV, without differences by gender (p = 0.339). Partner's alcohol consumption was associated with a higher frequency of being victim of IPV in both sexes. In women, low educational level, and discrimination were further associated to IPV. Younger age, and poorer self-perceived health in Spain as compared to Colombia were factors associated in men. Results showed similarly high levels of IPV among immigrant men and women. Alcohol consumption, education, discrimination, age, and poor self-perceived health were factors associated to IPV.