Impact of the universal health insurance benefits on cervical cancer mortality in Colombia.

BACKGROUND: Cervical cancer patients in Colombia have a lower likelihood of survival compared to breast cancer patients. In 1993, Colombia enrolled citizens in one of two health insurance regimes (contributory-private insurance and subsidized- public insurance) with fewer benefits in the subsidized regime. In 2008, the Constitutional Court required the Colombian government to unify services of both regimes by 2012. This study evaluated the impact of this insurance change on cervical cancer mortality before and after 2012. METHODS: We accessed 24,491 cervical cancer mortality records for 2006-2020 from the vital statistics of Colombia's National Administrative Department of Statistics (DANE). We calculated crude mortality rates by health insurance type and departments (geopolitical division). Changes by department were analyzed by rate differences between 2006 and 2012 and 2013-2020, for each health insurance type. We analyzed trends using join-point regressions by health insurance and the two time-periods. RESULTS: The contributory regime (private insurance) exhibited a significant decline in cervical cancer mortality from 2006 to 2012, characterized by a noteworthy average annual percentage change (AAPC) of -3.27% (P = 0.02; 95% CI [-5.81, -0.65]), followed by a marginal non-significant increase from 2013 to 2020 (AAPC 0.08%; P = 0.92; 95% CI [-1.63, 1.82]). In the subsidized regime (public insurance), there is a non-significant decrease in mortality between 2006 and 2012 (AAPC - 0.29%; P = 0.76; 95% CI [-2.17, 1.62]), followed by a significant increase from 2013 to 2020 (AAPC of 2.28%; P < 0.001; 95% CI [1.21, 3.36]). Examining departments from 2013 to 2020 versus 2006 to 2012, the subsidized regime showed fewer cervical cancer-related deaths in 5 out of 32 departments, while 6 departments had higher mortality. In 21 departments, mortality rates remained similar between both regimes. CONCLUSION: Improvement of health benefits of the subsidized regime did not show a positive impact on cervical cancer mortality in women enrolled in this health insurance scheme, possibly due to unresolved administrative and socioeconomic barriers that hinder access to quality cancer screening and treatment.

Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

Armed conflict disproportionately affects the morbidity, mortality, and wellbeing of women, newborns, children, and adolescents. Our study presents insights from a collection of ten country case studies aiming to assess the provision of sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition interventions in ten conflict-affected settings in Afghanistan, Colombia, Democratic Republic of the Congo, Mali, Nigeria, Pakistan, Somalia, South Sudan, Syria, and Yemen. We found that despite large variations in contexts and decision making processes, antenatal care, basic emergency obstetric and newborn care, comprehensive emergency obstetric and newborn care, immunisation, treatment of common childhood illnesses, infant and young child feeding, and malnutrition treatment and screening were prioritised in these ten conflict settings. Many lifesaving women's and children's health (WCH) services, including the majority of reproductive, newborn, and adolescent health services, are not reported as being delivered in the ten conflict settings, and interventions to address stillbirths are absent. International donors remain the primary drivers of influencing the what, where, and how of implementing WCH interventions. Interpretation of WCH outcomes in conflict settings are particularly context-dependent given the myriad of complex factors that constitute conflict and their interactions. Moreover, the comprehensiveness and quality of data remain limited in conflict settings. The dynamic nature of modern conflict and the expanding role of non-state armed groups in large geographic areas pose new challenges to delivering WCH services. However, the humanitarian system is creative and pluralistic and has developed some novel solutions to bring lifesaving WCH services closer to populations using new modes of delivery. These solutions, when rigorously evaluated, can represent concrete response to current implementation challenges to modern armed conflicts.

Health-related quality of life of women after HPV testing as triage strategy for an abnormal Pap smear: a nested randomized pragmatic trial in a middle-income country.

BACKGROUND: Information obtained in studies on the impact of human papilloma virus (HPV) testing on health-related quality of life is contradictory. OBJECTIVE: To assess the impact on health-related quality of life of the HPV test, colposcopy, and cytology as triage strategies after a cytology with atypical squamous cells of undetermined significance (ASCUS) in Medellín, Colombia. METHODS: We carried out a nested analysis on the randomized pragmatic trial (ASCUS-COL). Women with ASCUS were assigned randomly to one of the 3 arms (Pap smear, colposcopy, HPV). Participants completed a questionnaire at baseline, two weeks after receiving the results of the triage tests and one year after the second questionnaire. We used the SF-36 to assess health-related quality of life. RESULTS: The sum score of the physical health component (PHC) and mental health component (MHC) increased significantly over time for the whole sample and there were no statistically significant differences between arms of PHC = survey 1: mean 52.4 (SD 8.21) vs. survey 3: mean 54.4 (SD 8.16) p < 0.0001 and of MHC = survey 1: mean 44.9 (SD 11.72) vs. survey 3: mean 48.1 (SD 11.20) p < 0.0001. A lower MHC occurred in women with lesser schooling, belonging to the public health care regimen, higher number of live births, and separated. A lower PHC was associated with the cytology arm, higher age, lesser schooling, and belonging to the subsidized regime. The risk of having depression went from 42% in the first survey to 26% in the third. CONCLUSION: The triage strategies affected health-related quality of life in the same manner. ClinicalTrials.gov Identifier: NCT02067468.

Association between violence during pregnancy and preterm birth and low birth weight in Colombia: Analysis of the demographic and health survey.

To explore the association between low birth weight and preterm birth with violence during pregnancy, we conducted a cross-sectional study by using the 2010 Colombian Demographic and Health Survey. We conducted bivariate analyses, binomial logistic regression, and stratified models by age, and 14,520 women were included. There was no association between violence and low birth weight. Nonetheless, an association with preterm birth in women aged over 35 was observed (OR 1.98, 95%CI 1.23, 3.17). Prenatal care appeared to be a protective factor for both outcomes. This research unexpectedly showed that supplementation with folic acid and iron was associated with preterm birth.

Evaluation of Entertainment Education Strategies to Promote Cervical Cancer Screening and Knowledge in Colombian Women.

Cervical cancer is considered to be a major health problem for women in developing countries, but it is also problematic for more developed countries as global migration increases and health behaviors move from the countries of origin to new places of residence. We designed and produced a testimonial video and a fotonovela (printed short story) to educate women about cervical cancer and screening. The development of the materials included formative research, production, pretesting, dissemination, and evaluation. The evaluation included 100 women that completed a pretest and a posttest at eight health clinics in Medellin. The pretest and posttest were analyzed using McNemar's test for categorical variables and paired t test for continuous variables. Women in the study had a high initial Stage of Change as defined by the Transtheoretical Model and a high baseline knowledge of HPV and cervical cancer, with the caveat of specific knowledge deficiencies especially for HPV. While not statistically significant, postintervention Transtheoretical Model status in both interventions changed towards higher stages, specifically, from Precontemplation to Contemplation and Preparation. Women who participated in the study liked the educational materials and their knowledge increased, especially for HPV. However, the perception of risk did not change.

Impacts of attacks to female health care workers in three territories of Colombia.

BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.

Latin America and the Caribbean Code Against Cancer 1st edition: Building capacity on cancer prevention to primary healthcare professionals.

INTRODUCTION: Every year 1.5 million new cancer cases are diagnosed in Latin America and the Caribbean (LAC). Of these, about 40 % could be prevented. Health illiteracy has been identified as a main barrier for cancer prevention. Primary healthcare professionals (HCP) are key in cancer prevention as they are the first entry point of the population into the healthcare system. The LAC Code Against Cancer 1st edition aims to improve health literacy and awareness of cancer prevention in the LAC population, through building capacity of primary HCP. METHODS: The definition and development of the learning objectives, curriculum, structure, and evaluation of an online learning program for primary HCP was led by a dedicated group of experts from the LAC Code Against Cancer project. A pedagogical guideline and a template to ensure harmonization across topics were produced to guide the program development. Two rounds of internal revisions and an editorial process were performed. RESULTS: An online competency-based microlearning program for primary HCP was produced, taking the LAC Code Against Cancer as a basis. The competences addressed in the curriculum are core knowledge, communication skills, decision-making and applying knowledge to real-world situations. A comprehensive evaluation to assess acquisition of these competences, based on the Miller's Pyramid, was designed with three data collection points: a) immediately before, to assess baseline knowledge and skills; b) immediately after, to determine acquired competences; and c) at 3-6 months follow-up, to assess performance in daily practice. The e-learning will be freely available in the Virtual Campus for Public Health of the Pan American Health Organization in Spanish, English, and Portuguese. CONCLUSION: Primary HCP, perceived as trustworthy sources of information, are key actors to increase the population's awareness and literacy on cancer prevention. Building capacity of these professionals has the potential to increase dissemination and impact of the LAC Code Against Cancer by prompting communication with the public and offering personalized actionable preventive messages through counselling.

Factors associated with perceived susceptibility to cervical cancer among Latina immigrants in Alabama.

To examine factors associated with perceived susceptibility to cervical cancer among Latina immigrants in two counties in Alabama. Datasets from two anonymous cross-sectional surveys from two studies were combined for these analyses. The total sample size was 743 women. Participants' average age was 30 ± 6.8 years and they were mainly from Mexico (89.2%). Almost 36% of the participants did not perceive themselves as being susceptible to cervical cancer, 33.9% did not know if they were susceptible, and 30.4% perceived themselves as susceptible. Educational attainment, thinking they may have been exposed to an STI in the past, thinking they may be at risk of HPV currently, having had a Pap smear within the last year, and having a relative with cancer were significantly associated with perceived susceptibility to cervical cancer in the multinomial logistic regression. Greater knowledge about cervical cancer risk factors reduced the uncertainty about perceived susceptibility. Perceived susceptibility to cervical cancer seems to be influenced more importantly by the current or past perception of HPV/STI exposure, and by having a relative with cancer. This finding is critical in the development of interventions that are tailored to Latina immigrants as well as efforts to educate providers in a state where Latino immigration is a recent phenomenon.

A successful guide in understanding Latino immigrant patients: an aid for health care professionals.

The recent growth of Latino immigrants in the United States has presented great challenges to the health care system, particularly in "emerging Latino states." An educational DVD was developed to aid professionals in providing culturally competent care to Latino immigrants and better understand their expectations when seeking care, as well as common cultural beliefs and practices. Knowledge and confidence was assessed through pre- and posttest measurements among 515 health care professionals nationwide. Results indicated significant increase (P < .001) in overall knowledge/confidence in Latino cultural beliefs as they relate to health care seeking, differences in health care systems between the United States and Latin America, and barriers to health care. Such multimedia training may be a promising approach to improving health care with Latino immigrants in the United States.

Contribution of health care coverage in cervical cancer screening follow-up: findings from a cross-sectional study in Colombia.

OBJECTIVE: To determine the role of health care coverage (HCC) in follow-up of cervical cancer screening (seeking Papanicolaou test results and follow-up when abnormal results were found) among Colombian women. METHODS: A population-based cross-sectional study of 24,717 women, using the 2005 Colombian Demographic and Health Survey, was conducted. RESULTS: Nearly 4% of women screened did not seek their results. For approximately 17% of the women, there was no follow-up when abnormal results were found. Women in the contributory regime (private insurance) and those in the subsidized regime (public insurance) were more likely to seek Papanicolaou test results than women without HCC, even after adjusting for sociodemographic factors (adjusted odds ratio [ORa], 1.96; 95% confidence interval [CI], 1.60-2.41 and ORa, 1.34; 95% CI, 1.14-1.58, respectively). For follow-up when abnormal results were found, there was no difference between the subsidized regime and no HCC, but women in the contributory regime were more likely to follow-up than women without HCC (ORa, 1.40; 95% CI, 1.05-1.86). CONCLUSIONS: Seeking Papanicolaou test results is relatively high among Colombian women; however, there are differences according to HCC. Follow-up when abnormal Papanicolaou test results were found was positively associated only with private insurance; follow-up is the same for women without insurance and with public insurance. Exploring strategies to promote follow-up among women and to improve cervical cancer follow-up services for those enrolled in the subsidized regime may increase follow-up rates among Colombian women.

Vaginal douching among Latina immigrants.

Little is known about vaginal douching among Latina immigrants in the U.S. Understanding factors associated with douching is important due to the negative reproductive outcomes associated with this practice. This study examined demographic and behavioral factors associated with vaginal douching among Latina immigrants. A cross-sectional anonymous survey was administered among a convenience sample of 206 Latina immigrants aged 19-44 years (mean = 28 years) living in the U.S. at least 6 months (mean = 4 years). Demographic and behavioral characteristics, history of regular douching (at least once a month for 6 months), and current regular douching (at least once a month for the last 6 months) were assessed. Adjusted odds ratios (adj. OR) were estimated using multiple logistic regression. Overall, 25% (n = 50) of women reported ever douching regularly and 15% (n = 31) reported current regular douching. Ever douching regularly was significantly associated with a woman's number of lifetime sex partners (adj. OR = 1.6 per additional partner over one, 95% CI: 1.1-2.5), hormonal contraceptive use (adj. OR = 0.3, 95% CI: 0.1-0.9), and healthcare seeking behavior (adj. OR = 2.3, 95% CI: 1.1-5.2). Regular vaginal douching is a common practice among Latina immigrants. Factors associated with douching in this population vary from those in other U.S. populations and, therefore, it needs to be addressed in a culturally appropriate manner.

Awareness and knowledge about human papillomavirus among Latina immigrants.

OBJECTIVE: Few studies have examined associations with the public's awareness and knowledge of the human papillomavirus (HPV) among Latina immigrants. The primary purpose of this study was to assess HPV awareness and knowledge, while examining demographic and healthcare utilization associations. METHODS: From 2007-2009 as part of a larger randomized control trial, 543 Latina immigrants living in Birmingham, Alabama completed an interviewer-administered questionnaire. RESULTS: Only 47% of the participants were aware of HPV. Women aged 40-50 years were more likely to be aware of HPV than women 19 to 29 (odds ratio [OR] 2.54; 95% confidence interval [CI] 1.34, 4.78). Having a Pap smear in the past year was associated with awareness (OR 1.82; 95% CI 1.14, 2.90). Among those aware of HPV, the mean knowledge score was 7.5 out of 11. Deficiencies in knowledge were noted for vaccinations, genital warts, and the clearing of HPV without treatment. Multivariable analysis found a Pap smear in the past year (OR 4.10; 95% CI 1.93, 8.69), and number of HPV information sources (OR 1.38; 95% CI 1.09, 1.75) significantly associated with higher knowledge. Also, women aged 30 to 39 years and 40 to 50 were more likely to have higher HPV knowledge than those 19 to 29 (OR 2.64; 95% CI 1.35, 5.17 and OR 4.46; 95% CI 1.53, 12.98, respectively). CONCLUSIONS: Less than half of the participants were aware of HPV. However, among those aware, knowledge scores were high. Age and having a Pap smear within the last year were associated with HPV awareness and knowledge.

Engagement in Tobacco Use Prompting During Childhood or Adolescence and Its Association with Tobacco Use in Adulthood among Colombian Women.

Although most tobacco users initiate this behavior before the age of 18, little is known about engaging in tobacco use prompting behaviors (TPBs) during childhood/adolescence and tobacco use in adulthood, particularly among women in low- and middle-income countries (LMICs). The purpose of this study was to examine engagement in TPBs during childhood or adolescence and tobacco use in adulthood among Colombian women and whether or not current/past tobacco users who were engaged in TPBs during their childhood or adolescence had more odds of engaging other children or adolescents in these behaviors as adults. There were 4262 adult women who were recruited and completed an interviewer-administered survey through a door-to-door approach across the 9 regions of Antioquia, Colombia using a multi-stage probabilistic sampling. TPBs were defined as someone being asked to: (1) empty an ashtray, (2) buy cigarettes, (3) put the cigarette in their mouth and light it, (4) light a cigarette without putting it in their mouth, or (5) smoke with the adult during childhood or adolescence. We conducted bivariate regression logistic models where variables with a P < .25 were included in a parsimonious model. Approximately 40% of participants (41%) reported engaging in TPBs in childhood or adolescence. Buying cigarettes, lighting cigarettes with their mouth, and smoking with an adult were significantly associated with tobacco use in adulthood. Current/past tobacco users who reported being engaged in TPBs during childhood or adolescence (except for smoking with an adult) had higher odds of prompting these behaviors as adults. TPBs during childhood or adolescence are relevant contributors to tobacco use in adulthood among Colombian women.

Validation of Spanish version of the human papilloma virus impact profile (HIP).

Objective: To examine the construct validity and reliability of the Spanish version of the HPV Impact Profile scale (HIP) among women in Medellin, Colombia.Methods: We conducted a nested analysis of data from the pragmatic randomized controlled trial "Evaluation of Strategies for Optimal Clinical Management of Women with Atypical Squamous Cells of Undetermined Significance" (ASCUS-COL; NCT02067468). Women with Atypical Squamous Cells of Undetermined Significance (ASCUS) were randomly assigned to one of three triage strategies (Pap smear, colposcopy, HPV). Participants completed a questionnaire with sociodemographic information and the HIP scale translated into Spanish at baseline, two weeks after receiving triage test results, and one year after the second questionnaire. We conducted exploratory and confirmatory factorial analysis, and then assessed test reliability using Cronbach's alpha. Subsequently, we conducted multigroup confirmatory factor analysis to assess differences according to women´s age, and configurational invariance of the factor structure over the three time measures.Results: The sample consisted of 675 women, with a mean age of 40 years. The exploratory and confirmatory factor analysis for the HIP showed a seven-factor structure with appropriate adjustment indicators ([Formula: see text]= 1466.783, p < .0001). Only two items (1 and 10) had low factor loads and were removed from the confirmatory analysis. Multigroup analysis according to women's age showed acceptable goodness of fit (RMSEA = 0.037, CFI/TLI:0.998/0.998). The factor structure was similar among the tree measures and the model preserved acceptable goodness of fit (RMSEA = 0.079, CFI:0.86). The Cronbach's alpha for the total score was 0.91, with the lowest score for sexual impact (0.49) and the highest score for worries and concerns (0.90).Conclusions: The Spanish version of the HIP had adequate reliability and construct validity, and its use could be considered in clinic and research settings.

Psychosocial impact of inclusion of HPV test on the management of women with atypical squamous cells of undetermined significance: a study within a randomised pragmatic trial in a middle-income country.

Objective: To assess the psychosocial impact of human papillomavirus (HPV) testing, colposcopy, and Pap-smear, as triage strategies after a Pap-smear with atypical squamous cells of undetermined significance (ASCUS). We also sought to evaluate the psychosocial impact based on the results of the strategies. Methods: Nested within a randomised pragmatic trial, which compared an immediate colposcopy, repeat Pap-smear, and high risk HPV test, we enrolled 675 women between 2012 and 2014. Participants completed surveys at enrollment, two weeks after triage test results, and 1 year thereafter to assess cervical cancer and HPV knowledge, self-esteem, anxiety and HPV impact (HIP). Results: Knowledge, self-esteem, anxiety and HIP improved with no differences among arms. At the baseline, 31.4% and 32.7% of the participants had state anxiety and trait anxiety, respectively, which decreased to 10.7% and 13.3% in the last survey. Compared to HPV-negative women, HPV-positive women in the second survey had worse HIP scores (HPV-: M 22.9 [SD: 15.20]; HPV+: M 35.9 [SD: 19.91]; p < 0.001), trait anxiety (HPV-: M 15.4 [SD 12.73]; HPV+: M 22.9 [SD 13.29]; p = 0.001), and state anxiety (HPV-: M 10.7 [SD 11.25]; HPV+: M 21.4 [SD 14.81]; p < 0.001). Conclusions: HPV testing as a triage strategy for women with ASCUS does not differ from colposcopies or Pap-smears in terms of psychosocial outcomes.

Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia.

BACKGROUND: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. OBJECTIVE: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. METHODS: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. RESULTS: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the post-conflict context. CONCLUSIONS: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.

Perspectivas comunitarias e institucionales acerca del cáncer cervicouterino en indígenas del Amazonas colombiano / Community and Institutional Perspectives on Cervical Cancer in Indigenous People of the Colombian Amazon / Perspectivas comunitárias e institucionais sobre o câncer de colo de útero em indígenas da Amazônia colombiana

Introducción: la información en cáncer en poblaciones indígenas colombianas es escasa; de ahí que el objetivo de este estudio sea conocer las perspectivas comunitarias y de los prestadores de servicios de salud acerca del cáncer de cuello uterino (CaCU) en mujeres indígenas del Amazonas colombiano. Materiales y métodos: estudio cualitativo, derivado de una investigación de métodos mixtos de triangula-ción convergente. Se realizaron 40 entrevistas semiestructuradas que incluían profesionales de la salud y actores clave comunitarios representados en curacas, médicos tradicionales o chamanes, parteras, pro-motores de salud, auxiliares de salud pública, líderes y lideresas, abuelos, abuelas y mujeres indígenas en general. Para el análisis se utilizó la técnica de análisis de contenido. Resultados: emergieron cuatro categorías:1) concepciones y factores de riesgo alrededor del cáncer en general y el CaCU, 2) prácticas de cuidado y de atención occidentales y ancestrales para el CaCU, 3) dificultades socioculturales y del sistema de salud para la prevención y atención del CaCU y 4) recomendaciones para el fortalecimiento de la de prevención del CaCU. Conclusión: los participantes reconocen la citología cervicouterina como una forma de prevenir el cáncer y aunque los participantes mencionaron algunos aspectos culturales y personales que podrían constituirse en una barrera para la prevención y control del CaCU, se hizo hinca-pié en los problemas estructurales del sistema de salud, la falta de integración cultural y las dificultades de acceso al tamizaje, diagnóstico y tratamiento.

Introduction: Information on cancer in Colombian indigenous populations is scarce, the objective of this study was to know the community and health care providers' perspectives on cervical cancer (CaCU) in indigenous women of the Colombian Amazon. Materials and methods: Qualitative study, derived from a mixed methods research of convergent triangulation, 40 semi-structured interviews were conducted, including health professionals and key community actors represented by curacas, traditional doctors or shamans, midwives, health promoters, public health assistants, leaders, grandfathers, grandmothers, and indigenous women in general. The content analysis technique was used for the analysis. Results:Four categories emerged: (a) conceptions and risk factors surrounding cancer in general and CaCU; (b) western and ancestral care and attention practices for CaCU; (c) sociocultural and health system diffi-culties for the prevention and attention of CaCU, and (d) recommendations for strengthening CaCU pre-vention. Conclusion: Participants recognize cervical cytology as a way to prevent cancer and although participants mentioned some cultural and personal aspects that could constitute a barrier to cervical cancer prevention and control, the greatest emphasis was given to structural problems of the health system, lack of cultural integration and difficulties of access to screening, diagnosis and treatment.

Introdução: a informação sobre o câncer nas populações indígenas colombianas são escassas, o objetivo deste estudo foi conhecer as perspectivas da comunidade e dos prestadores de serviços de saúde sobre o câncer do colo do útero (CaCU), em mulheres indígenas da Amazônia colombiana. Materiais e méto-dos: estudo qualitativo, derivado de uma investigação de métodos mistos de triangulação convergente. Foram realizadas 40 entrevistas semiestruturadas que incluíram profissionais de saúde e principais atores comunitários representados em curacas, médicos tradicionais ou xamãs, parteiras, promotores de saúde, assistentes de saúde pública, lideranças, avôs, avós e mulheres indígenas em geral. Para a análise foi uti-lizada a técnica de análise de conteúdo. Resultados: emergiram quatro categorias, a) concepções e fatores de risco em torno do câncer em geral e do CaCU; b) cuidados e práticas de cuidado ocidentais e ancestrais para CaCU; c) dificuldades socioculturais e do sistema de saúde para a prevenção e cuidado do CaCU, e d) recomendações para fortalecer a prevenção de CaCU. Conclusão: as participantes reconhecem a citolo-gia cervical como forma de prevenção do câncer e embora as participantes tenham mencionado alguns aspectos culturais e pessoais que poderiam constituir uma barreira para a prevenção e controle do câncer do colo do útero, a maior ênfase foi dada aos problemas estruturais do sistema de saúde, a falta de integra-ção cultural e as dificuldades de acesso ao rastreio, ao diagnóstico e ao tratamento

Perception about barriers and facilitators of the school-based HPV vaccine program of Manizales, Colombia: A qualitative study in school-enrolled girls and their parents.

In 2012, Colombia implemented a school-based HPV vaccination program of a 3-dose series for nine year old girls. Following a mass psychogenic response after vaccination in a Colombian town, vaccination rates dropped from 80% in 2012-2013 to 5% in 2016. The study aimed to identify barriers and facilitators of HPV vaccine uptake among girls eligible for vaccination in the initial years of vaccine implementation from 2012 to 2014, and their parents. We conducted 19 individual qualitative interviews and 18 focus groups with an average of 5 girls, in Manizales, Colombia between 2016 and 2017. In total, 49 girls from six schools and 58 of their parents participated in the study. Participants had some degree of awareness about cervical cancer, especially among those of middle and upper socioeconomic level. However, the vaccine was known as a prevention measure only after pap-smears and condoms. The main facilitator for vaccine uptake for parents was the desire to prevent diseases in general and for girls, it was facilitated by receiving positive information about the vaccine. The main barriers for vaccine uptake or for three doses completion were the event in Carmen de Bolivar, fear of adverse effects and fear of needles. Girls and parents stated that they received little or no information from schools or health care services about the HPV vaccine prior to vaccination. Our results suggest that improving HPV vaccination rates in Colombia will require a comprehensive education program including mass media information about HPV vaccine.

Contraceptive knowledge and use among low-income Hispanic immigrant women and non-Hispanic women.

BACKGROUND: With the rising influx of Hispanics to the United States, there is an ongoing need to promote health and wellness care to this non-English-speaking, minority population group. Programs, specifically developed to address the unique cultural mores of Hispanics, need to focus on increasing knowledge about health issues, particularly in the area of reproductive health. A study was conducted in Memphis, TN, to examine the differences between low-income Hispanic immigrants' and low-income non-Hispanics' (1) contraceptive use; (2) reproduction and contraception knowledge; as well as (3) the demographic and knowledge factors associated with their choice of contraceptive, in order to better formulate successful educational programs for area Hispanics. STUDY DESIGN: A cross-sectional survey of 226 women, recruited through a federal assistance program in Tennessee, was performed over a 5-month period in 2000 to 2001. Women, between the ages of 18 and 42, were individually interviewed to learn more about their reproduction knowledge and method of contraception. RESULTS: This study found that knowledge about reproduction and contraceptive use was significantly lower among Hispanics than non-Hispanics. Furthermore, contraceptive use was significantly lower among Hispanics than among non-Hispanics. Hispanics were less likely to use the oral contraceptive or have a tubal ligation, preferring injectable contraceptive. Non-Hispanics, who were more likely to use contraceptive methods, were less likely to use injectables, preferring the oral contraceptive. Among Hispanics, knowledge about contraceptives, number of children and marital status were associated with contraceptive use. Among non-Hispanics, only education was associated with contraceptive use. CONCLUSION: Interventions targeting Hispanic immigrants should be developed to increase their knowledge about contraceptive methods.

Salud sexual y reproductiva en exguerrilleras colombianas antes del Acuerdo de Paz y después de este / Sexual and Reproductive Health of Former Colombian Female Guerrillas before and after the Peace Agreement / Saúde sexual e reprodutiva em ex-guerrilheiras colombianas antes e depois do Acordo de Paz

El objetivo de este artículo es describir las experiencias en salud sexual y reproductiva de exguerrilleras de las Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo (fARC-EP) durante el conflicto armado y después de la firma del Acuerdo de Paz. A lo largo de 2018 se realizó un estudio de caso interpretativo a través de observación participante, once entrevistas y dos grupos focales. En las fARC-EP no hubo un enfoque de salud sexual y reproductiva integral ni con perspectiva de género; se privilegió la prevención del embarazo con métodos y sanciones para las mujeres. Debido a su carácter de ejército clandestino, las decisiones no eran tomadas de manera individual, y la autoridad del superior implicaba las relaciones erótico-afectivas, aunque se garantizaba una atención expedita para casos de urgencias. Posterior a la firma del acuerdo, con su consiguiente inserción en el sistema de salud colombiano, se amplían las posibilidades de atención para casos no urgentes, pero persisten las barreras de atención del sistema de salud.

This study examined the sexual and reproductive health statuses of former female guerrillas of the Revolutionary Armed Forces of Colombia-People's Army (fARC-EP) during the armed conflict and after the signing of the peace agreement. During 2018, an interpretive case study was conducted through the participant observation, 11 interviews, and 2 focus groups. In the fARC-EP group, no comprehensive approach to sexual and reproductive health was noted from a gender perspective, but pregnancy prevention using methods and sanctions for women was found to be privileged. Owing to its characteristic as a clandestine army, decisions were not made individually, and the authority of the superior involved erotic-affective relationships, although expedited attention was guaranteed for emergency cases. After the signing of the agreement, with its consequent insertion into the Colombian health system, the possibilities of care for non-urgent cases have been expanded, with the barriers to healthcare being emphasized

O objetivo deste artigo é descrever as experiências em saúde sexual e reprodutiva de ex-guerrilheiras das Forças Armadas Revolucionárias da Colômbia - Exército Popular (fARC-EP) durante o conflito armado e após a assinatura do acordo de paz. Durante o ano de 2018, foi realizado um estudo de caso interpretativo através da observação participante, 11 entrevistas e dois grupos focais. Nas fARC-EP não havia abordagem integral da saúde sexual e reprodutiva ou perspectiva de gênero; privilegiou-se a prevenção da gravidez com métodos e sanções para as mulheres. Por ser um exército clandestino, as decisões não eram tomadas individualmente, e a autoridade do superior implicava relações erótico-afetivas, embora garantisse atendimento ágil em casos de emergência. Após a assinatura do convênio, com sua consequente inserção no sistema de saúde colombiano, ampliam-se as possibilidades de atendimento aos casos não urgentes, mas enfatizam-se as barreiras para o atendimento no sistema de saúde.