Performance of cervical cytology and HPV testing for primary cervical cancer screening in Latin America: an analysis within the ESTAMPA study.

Background: Cervical cytology remains widely used as the initial tool in cervical cancer screening worldwide. WHO guidelines recommend replacing cytology with primary HPV testing to reach cervical cancer elimination goals. We assessed the performance of cytology and high-risk HPV testing to detect cervical precancer, cervical intraepithelial neoplasia (CIN) grade 3 or worse (CIN3+) among women aged 30-64 years participating in the ESTAMPA study. Methods: Women were screened with cytology and HPV across ESTAMPA study centres in Latin America. Screen-positives were referred to colposcopy with biopsy collection and treatment as needed. Those with no evident precancer were recalled at 18-months for a second HPV test to complete disease ascertainment. Performance indicators for cytology and HPV to detect CIN3+ were estimated. Findings: 30,606 participants with available cytology and HPV results were included in the analysis. A total of 440 histologically confirmed CIN3s and 30 cancers were diagnosed. Cytology sensitivity for CIN3+ was 48.5% (95% CI: 44.0-53.0), whereas HPV testing had a sensitivity of 98.1% (95% CI: 96.3-96.7). Specificity was 96.5% (95% CI: 96.3-96.7) using cytology and 88.7% (95% CI: 88.3-89.0) with HPV. Performance estimates varied substantially by study centre for cytology (ranging from 32.1% to 87.5% for sensitivity and from 89.2% to 99.5% for specificity) while for HPV results were more consistent across sites (96.7%-100% and 83.6-90.8%, respectively). Interpretation: The limited and highly variable sensitivity of cytology strongly supports transition to the more robust and reproducible HPV-based cervical screening to ensure progress towards global cervical cancer elimination targets in Latin America. Funding: IARC/WHO, UNDP, HRP/WHO, NCI and local funders.

Ecological drivers and consequences of torpor in Andean hummingbirds.

Daily torpor allows endotherms to save energy during energetically stressful (e.g. cold) conditions. Although studies on avian torpor have mostly been conducted under laboratory conditions, information on the usage of torpor in the wild is limited to few, predominantly temperate-zone species. We studied torpor under seminatural conditions from 249 individuals from 29 hummingbird species across a 1920 m elevational gradient in the western Andes of Colombia using cloacal thermistors. Small birds were more likely to use torpor than large birds, but only at low ambient temperatures, where torpor was prolonged. We also found effects of proxy variables for body condition and energy expenditure on the use of torpor, its characteristics, and impacts. Our results suggest that context-dependency and phylogenetic variation in the probability of deploying torpor can help understand clade-wide patterns of elevational distribution in Andean hummingbirds.

First Colombian consensus on congenital Chagas and clinical approach for women of child-bearing age diagnosed with Chagas / Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas

Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. To generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: «Chagas disease/congenital¼, «prevention and control¼, «diagnosis¼, «therapeutics¼ and «pregnancy¼. Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-to-face discussion focusing on those questions without consensus in the previous consultations. The evidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia.

La transmisión congénita de la enfermedad de Chagas ha sido poco estudiada en Colombia y existen pocos procedimientos rutinarios en el sistema de salud para el manejo de esta enfermedad. Por ello se desarrolló un consenso de expertos dirigido a generar recomendaciones de diagnóstico y tratamiento de Chagas con- génito y orientación a mujeres en edad fértil. Con ese propósito se realizó una búsqueda extensiva de la literatura, empleando una combinación de términos Mes (Chagas, Chagas congénito, prevención, control, diagnóstico, tratamiento y embarazo) para reflejar el estado del arte en cada tema de interés. Después de ello, se leyeron los resúmenes y aquellos seleccionados para análisis del texto completo. La literatura relevante se sintetizo, clasifico y organizo en tablas y se presentó al panel de expertos, el cual estaba constituido por 30 profesionales en diferentes áreas. Mediante la metodología Delphi se realizaron 2 rondas de cuestionarios virtuales y una reunión presencial en los cuales se evaluaron los niveles de acuerdo entre los participantes. Los puntos con falta de consenso durante las 2 rondas virtuales se expusieron durante las mesas de discusión en la ronda presencial. La evidencia utilizada se adaptó a las particularidades nacionales según el caso y se aprobó el contenido del documento final. Se propone que estas recomendaciones sean usadas por profesionales de la salud en Colombia.

Primer consenso colombiano sobre Chagas congénito y orientación clínica a mujeres en edad fértil con diagnóstico de Chagas / First Colombian consensus on congenital Chagas and clinical approach to women of fertile age diagnosed with Chagas

La transmisión congénita de la enfermedad de Chagas ha sido poco estudiada en Colombia y existen pocos procedimientos rutinarios en el sistema de salud para el manejo de esta enfermedad. Por ello se desarrolló un consenso de expertos dirigido a generar recomendaciones de diagnóstico y tratamiento de Chagas congénito y orientación a mujeres en edad fértil. Con ese propósito se realizó una búsqueda extensiva de la literatura, empleando una combinación de términos MeSH (Chagas, Chagas congénito, prevención, control, diagnóstico, tratamiento y embarazo) para reflejar el estado del arte en cada tema de interés. Después de ello, se leyeron los resúmenes y aquellos seleccionados para análisis del texto completo. La literatura relevante se sintetizó, clasificó y organizó en tablas y se presentó al panel de expertos, el cual estaba constituido por 30 profesionales en diferentes áreas. Mediante la metodología Delphi se realizaron 2 rondas de cuestionarios virtuales y una reunión presencial en los cuales se evaluaron los niveles de acuerdo entre los participantes. Los puntos con falta de consenso durante las 2 rondas virtuales se expusieron durante las mesas de discusión en la ronda presencial. La evidencia utilizada se adaptó a las particularidades nacionales según el caso y se aprobó el contenido del documento final. Se propone que estas recomendaciones sean usadas por profesionales de la salud en Colombia.

Congenital transmission of Chagas disease has not been extensively studied in Colombia, and there are no standardized processes in the health system regarding the specific diagnosis, treatment and follow-up of this disease. In order to generate recommendations on congenital Chagas disease and Chagas in women of childbearing age in Colombia, a consensus of experts was developed. An extensive literature search through the Medline database was carried out using the MeSH terms: " Chagas disease/congenital " , " prevention and control " , " diagnosis " , " therapeutics " and " pregnancy " . Appropriate abstracts were selected and the full texts were analyzed. The relevant information was synthesized, classified, and organized into tables and figures and was presented to a panel of experts, which was composed of 30 professionals from various fields. Based on the Delphi methodology, three rounds of consultation were conducted. The first and second rounds were based on electronic questionnaires that measured the level of consensus of each question among the participants. The third round was based on a face-toface discussion focusing on those questions without consensus in the previous consultations. The evidence was adapted to national circumstances on a case-by-case basis, and the content the final document was approved. These recommendations are proposed for use in routine medical practice by health professionals in Colombia.

Prevalencia y factores asociados al resultado anormal de la citología vaginal en estudiantes universitarias en Bucaramanga, Colombia / Prevalence and factors associated with abnormal cytology result in female College Students in Bucaramanga, Colombia

Objetivo: Identificar la frecuencia de anormalidad en el reporte de la citología y sus factores asociados en estudiantes atendidas en los Servicios de Salud de Bienestar Universitario de la Universidad Industrial de Santander. Métodos: Estudio de corte transversal, incluyó 1 549 registros de estudiantes que se tomaron la citología en el Servicio de Salud de la División de Bienestar Universitario de la Universidad Industrial de Santander en el periodo de Enero de 2009 a Diciembre de 2011 y cuyo resultado y variables de estudio estuviesen almacenados en el sistema de información de los Servicios de Salud de Bienestar Universitario. Fue determinada la prevalencia de anormalidad en los resultados de la citología y por medio de análisis multivariados fueron explorados los factores asociados a dicho reporte citológico. Resultados: La prevalencia de anormalidad fue de 17,8 %. La anormalidad fue más frecuente en mujeres con antecedentes de embarazo, sexarquia temprana y con dos o más compañeros sexuales. Permanecieron asociadas al reporte de anormalidad después de ajustar: el número de compañeros sexuales y la sexarquia. Discusión: Existe un aumento de la prevalencia de anormalidad en los resultados citológicos de la población universitaria. Son necesarias estrategias de prevención sobre el cáncer de cuello uterino haciendo énfasis en sus principales factores de riesgo y en la citología como medio de tamizaje para la detección temprana.

Objective: To identify the frequency of abnormal cytology reports and associated factors in students that attended the Health Service University Welfare Divisionof the Universidad Industrial de Santander. Methods: Cross-sectional study that included 1 549 records of students who had a cytology in the Health Service University Welfare Division of the Universidad Industrial de Santander during the period extending from January 2009 to December 2011 and whose results and variables of study were stored in the information system at the Health Services University Welfare. The prevalence of abnormal cytology results was determined and through multivariate analysis the factors associated with this cytological report were explored. Results: The prevalence of abnormality was 17,8 %. The abnormality was more frequent in women with a history of pregnancy, early first sexual intercourse and with two or more sexual partners. After adjusting, the number of sexual partners and age of first sexual intercourse remained associated to the report of abnormality. Discussion: There is an increased prevalence of abnormal cytology results in the university population. Prevention strategies are needed for cervical cancer with emphasis on its main risk factors and cytology as a means of screening for early detection.

The identification of two Trypanosoma cruzi I genotypes from domestic and sylvatic transmission cycles in Colombia based on a single polymerase chain reaction amplification of the spliced-leader intergenic region.

A single polymerase chain reaction (PCR) reaction targeting the spliced-leader intergenic region of Trypanosoma cruzi I was standardised by amplifying a 231 bp fragment in domestic (TcIDOM) strains or clones and 450 and 550 bp fragments in sylvatic strains or clones. This reaction was validated using 44 blind coded samples and 184 non-coded T. cruzi I clones isolated from sylvatic triatomines and the correspondence between the amplified fragments and their domestic or sylvatic origin was determined. Six of the nine strains isolated from acute cases suspected of oral infection had the sylvatic T. cruzi I profile. These results confirmed that the sylvatic T. cruzi I genotype is linked to cases of oral Chagas disease in Colombia. We therefore propose the use of this novel PCR reaction in strains or clones previously characterised as T. cruzi I to distinguish TcIDOMfrom sylvatic genotypes in studies of transmission dynamics, including the verification of population selection within hosts or detection of the frequency of mixed infections by both T. cruzi I genotypes in Colombia.

Percepción de riesgo y compras por internet: su relación con la personalidad y el tipo de Producto / Risk perception and on-line shopping: their relationship with personality and product type

Teniendo en cuenta que el comportamiento del consumidor implica la toma de riesgo y que hay escasez de estudios específicos al contexto de compras por Internet que traten de incorporar los dos principales enfoques con los que se ha estudiado la toma de riesgo, el presente trabajo buscó determinar la relación existente entre los factores de personalidad, el tipo de producto (factor situacional), la percepción de riesgo y la intención y realización de compras por Internet. Para esto se diseñó una encuesta online que contenía situaciones hipotéticas a propósito del comercio electrónico y escalas de medición de factores de personalidad y de percepción de riesgo. Los participantes fueron personas de un rango de edad amplio, parte de una muestra por conveniencia. Se realizó un análisis correlacional de las variables de interés y se encontró que el género, la familiaridad, el factor de personalidad de escrupulosidad y los productos intangibles se relacionan significativamente con la percepción de riesgo general. Los factores de personalidad no parecen ser significativos a la hora de determinar la intención y realización de compras por Internet, brindando así apoyo al enfoque situacional.

Consumer behavior involves risk taking but there are few studies related to electronic commerce that integrate the two main approaches to study risk taking. The present study sought to determine the relationship between personality factors, product type (situational factor), risk perception and the intention and execution of internet shopping. An online survey containing hypothetical scenarios and scales measuring personality factors and risk perception was developed. Participants were individuals of a wide age range, from a convenience sample. A correlational analysis of the variables of interest was performed and it was found that gender, familiarity, conscientiousness personality factor and intangible products are significantly related to the perception of overall risk. Personality factors do not appear to be significant in determining the intention and execution of internet shopping, thus providing support for the situational approach.

Haplotypes associated with resistance to sulfadoxine-pyrimethamine in Plasmodium falciparum in two malaria endemic locations in Colombia.

Colombia has four main malaria transmission zones. In vivo efficacy studies carried out in these areas showed big differences in the response of Plasmodium falciparum to treatment with sulphadoxine-pyrimethamine. In addition, there is still insufficient information about the genetics of P. falciparum populations. The objective of this study was to determine the haplotypes in dhfr and dhps genes of P. falciparum circulating in two distinct endemic zones. Samples from patients with non-complicated P. falciparum malaria were collected: 135 from Tumaco and 206 from Tierralta. Alleles 108 and 51 of the dhfr gene, and 437 and 540 of the dhps gene were analyzed by PCR/enzymatic restriction, while alleles 59 and 164 (dhfr), and 581(dhps) by PCR/dot blot/hybridization. Five different haplotypes were found, of which the triple mutant 51I/C59/108N/I164/437G/K540/A581 was the most frequent (54.6%). In Tumaco, the parasites with wild haplotype predominated, while mutant parasites predominated in Tierralta. Another interesting finding is the presence of the C59R mutation in the dhfr gene in two samples, a mutation rarely found in South America. These data provide information about parasite population genetics and highlight the importance of starting a long term molecular surveillance program.

Incidencia de la violencia familiar en el inicio del consumo de sustancias psicoactivas por personas privadas de libertad en una unidad carcelaria de la provincia de Córdoba / Incidence of family violence in the beginning of psychoactive substances by detainees in a prison unit in the province of Córdoba

El objetivo central propuesto para el presente trabajo final de Maestría fue conocer la incidencia de la violencia familiar en el inicio de consumo de sustancias psicoactivas en personas de entre 18 a 30 años de edad que se encuentren privadas de libertad en la prov. de Córdoba. La metodología de trabajo estuvo centrada en la revisión de legajos criminológicos de 50 internos alojados en el Complejo Carcelario Nº 1, análisis y articulación teórica en relación a las variables seleccionadas: características de la dinámica familiar, edad de inicio del consumo, nivel de instrucción, lugar de origen y sustancias psicoactivas de mayor consumo. Se parte de la hipótesis que las experiencias infantiles signadas por la violencia intrafamiliar, pueden impactar desfavoerablemente en la construcción psíquica de una persona tornandolo vulnerable al consumo de sustancias pscoactivas. Del análisis realizado se destaca que estas vivencias a temprana edad impactan desfavorablemente en la organización de la personalidad y aprendizaje de modelos de resolución de conflictos, apareciendo de esta forma la violencia y la droga como un intento fallido por compensar vacíos internos, frustraciones, sentimientos de desvalorización, baja autoestima y todo aquello que pudiera generar tensión interna y/o externa, para la cual, dadas las vicisitudes transitadas, el psiquismo no ha podido desarrollar recursos ni estrategias de afrontamiento que le permitan elaborar adecuadamente dichos conflictos.

ABSTRACT: The main objetive proposed for this final master work is to know the family violence incidence to start consuming psychoactive drugs by perons among 18 to 30 years old who are in preson in the Nº 1 state prison from Córdoba. The work methodology is focused in the revision of the criminologist files of 50 prisoners from Complejo Carcelario Nº 1, the analysis and the theoretical articulation related to the selected variables: characteristics of the dynamics of the family, age in which they start consuming, educational level, city, town or village where the inmates come from and psychoactive drugs that are usually taken. It starts from the hipothesis that the violent family ´s relationships stamped in childhood´s experiences, can imapct unfavorable in the psychological construct of a person, who becomes more vulnerable in drug addiction. From this analysis it stands out that this experiences in early years imact unfavorably in the personality organization and in learning how to resolve the conflict, appearing thes way, violence and drugs as a lack or success to compensate inner empties, frustrations, invaluable feelingas, low self esteem and everything which could generate inner or outer tension, as a consequence, the psyche couldn´t develop neither resources nor strategies which could elaborate properly thes conflicts.

Incidencia de la violencia familiar en el inicio del consumo de sustancias psicoactivas por personas privadas de libertad en una unidad carcelaria de la provincia de Córdoba / Incidence of family violence in the beginning of psychoactive substances by detainees in a prison unit in the province of Córdoba

El objetivo central propuesto para el presente trabajo final de Maestría fue conocer la incidencia de la violencia familiar en el inicio de consumo de sustancias psicoactivas en personas de entre 18 a 30 años de edad que se encuentren privadas de libertad en la prov. de Córdoba. La metodología de trabajo estuvo centrada en la revisión de legajos criminológicos de 50 internos alojados en el Complejo Carcelario Nº 1, análisis y articulación teórica en relación a las variables seleccionadas: características de la dinámica familiar, edad de inicio del consumo, nivel de instrucción, lugar de origen y sustancias psicoactivas de mayor consumo. Se parte de la hipótesis que las experiencias infantiles signadas por la violencia intrafamiliar, pueden impactar desfavoerablemente en la construcción psíquica de una persona tornandolo vulnerable al consumo de sustancias pscoactivas. Del análisis realizado se destaca que estas vivencias a temprana edad impactan desfavorablemente en la organización de la personalidad y aprendizaje de modelos de resolución de conflictos, apareciendo de esta forma la violencia y la droga como un intento fallido por compensar vacíos internos, frustraciones, sentimientos de desvalorización, baja autoestima y todo aquello que pudiera generar tensión interna y/o externa, para la cual, dadas las vicisitudes transitadas, el psiquismo no ha podido desarrollar recursos ni estrategias de afrontamiento que le permitan elaborar adecuadamente dichos conflictos.(AU)

ABSTRACT: The main objetive proposed for this final master work is to know the family violence incidence to start consuming psychoactive drugs by perons among 18 to 30 years old who are in preson in the Nº 1 state prison from Córdoba. The work methodology is focused in the revision of the criminologist files of 50 prisoners from Complejo Carcelario Nº 1, the analysis and the theoretical articulation related to the selected variables: characteristics of the dynamics of the family, age in which they start consuming, educational level, city, town or village where the inmates come from and psychoactive drugs that are usually taken. It starts from the hipothesis that the violent family ´s relationships stamped in childhood´s experiences, can imapct unfavorable in the psychological construct of a person, who becomes more vulnerable in drug addiction. From this analysis it stands out that this experiences in early years imact unfavorably in the personality organization and in learning how to resolve the conflict, appearing thes way, violence and drugs as a lack or success to compensate inner empties, frustrations, invaluable feelingas, low self esteem and everything which could generate inner or outer tension, as a consequence, the psyche couldn´t develop neither resources nor strategies which could elaborate properly thes conflicts.(AU)