"Barriers and Advantages of Self-Sampling Tests, for HPV Diagnosis: A Qualitative Field Experience Before Implementation in a Rural Community in Ecuador".

Introduction: Cervical cancer screening has demonstrated high efficacy in reducing cervical cancer mortality worldwide. However, clinician sampling is often perceived as an uncomfortable procedure that could reduce screening uptake. Self-sampling methods for HPV diagnosis have shown high sensitivity, which could increase acceptance and screening rates among women. Purpose: This study aims to identify the perceived barriers and advantages of self-sampling methods versus clinician sampling for cervical cancer screening in a rural setting in Ecuador. Patients and Methods: A qualitative study was conducted. Seven focus group discussions took place in the rural Parish of El Valle in Azuay Province, Cuenca, Ecuador. Women native to this rural area were included in the study. FGDs were recorded and transcribed, and content analysis was performed to categorize and analyze the data. Results: A total of 45 women participated in the study. Clinician sampling was perceived as a painful and intrusive method. However, participants believed that it is more reliable compared to self-sampling methods, attributing this to the direct visualization of the cervix, which facilitates the detection of cervical pathologies. The perceived advantages of self-sampling included increased comfort, pain reduction, time savings, the ability to perform the test at home, and the potential for widespread availability through pharmacies or local traditional healers. Nevertheless, doubts about the test's reliability as well as the user's proficiency in self-testing posed barriers to the adoption of this technique. Conclusion: Self-sampling methods offer several advantages over clinician sampling, such as enhanced privacy, comfort, and accessibility to cancer screening. Barriers primarily revolved around users' proficiency in performing the test and the reliability of the results. Providing training for using self-sampling tests could address these barriers.

Factores de riesgo predisponentes al desarrollo de preeclampsia y eclampsia en el embarazo / Risk factors for the development of preeclampsia and eclampsia in pregnancy

Resumen La preeclampsia es una patología de origen desconocido, de alta incidencia en la salud materna y neonatal. Caracterizada como una hipertensión gestacional grave multisistémica a partir de las 20 semanas de gestación hasta el parto y posparto, siendo de los trastornos más prevalentes en el mundo y la principal causa de muerte materna en Ecuador durante 2022. El objetivo fue realizar una revisión bibliográfica respecto de los factores de riesgo que predisponen preeclampsia en embarazadas. Mediante una revisión bibliográfica de estudios correspondientes a factores predisponentes al desarrollo de preeclampsia y eclampsia en embarazadas cuyos resultados se enfocaron a pacientes adultas diagnosticadas con dichas patologías mediante estrategia PICO, aplicando criterios de inclusión y exclusión. La preeclampsia conlleva una diversidad de factores de riesgo familiares patológicos como preeclampsia previa, hipertensión o enfermedades renales, diabéticas y obesidad; otros factores incluyen: edad, raza, embarazos gemelares, multiparidad, progenitores de distinta índole. Los factores significativos para presentar la enfermedad fueron en su mayoría factores ginecoobstétricos donde destacaron multiparidad, edad, obesidad, malnutrición, hipertensión previa y factores hereditarios.

Abstract Preeclampsia is a condition of unknown origin, with a high incidence in maternal and neonatal health, characterized as a severe multisystemic gestational hypertension from the 20th week of gestation until childbirth and postpartum. Among the most prevalent disorders worldwide, in Ecuador was the main cause of maternal death during 2022. The objective was to conduct a literature review regarding risk factors that predispose pregnant women to preeclampsia. Through a literature review of studies corresponding to predisposing factors for the development of preeclampsia and eclampsia in pregnant women, whose results were focused on adult patients diagnosed with said pathologies through the PICO strategy, applying inclusion and exclusion criteria. Preeclampsia involves a variety of pathological familial risk factors such as prior preeclampsia, hypertension, renal diseases, diabetes, and obesity; other factors include age, race, twin pregnancies, multiparity, and diverse parental lineage. The significant factors for presenting the disease were mostly gynecobstetric factors, prominently multiparity, age, obesity, malnutrition, prior hypertension, and hereditary factors.

Knowledge and Perceptions about Cervical Cancer and HPV Screening in Women in Rural Areas of Ecuador: A Qualitative Research Study.

BACKGROUND: Cervical cancer continues to be a major health problem in developing countries. Educational programs, as well as Pap and HPV screening and vaccination, are important tools to reduce the morbidity and mortality rates associated with this disease. The objective of this study is to explore the diverse knowledge and perceptions about cervical cancer and the different diagnostic tests for HPV of populations living in the rural parish "El Valle". METHOD: A qualitative study was conducted through eight focus groups, which included 46 participants from mixed ethnic groups. A phenomenological analysis was performed. RESULTS: Four topics and seven sub-topics were identified. By analyzing all the narratives, it was possible to identify that the perception of cervical cancer was focused on its severity, secondary to its infectious process and screening periodicity. However, despite the diverse knowledge, indigenous people do not relate it to the human papilloma virus; in addition, there is also certain resistance to undergo the Pap smear test, for reasons such as inaccessibility and its sampling process. CONCLUSIONS: It is necessary to develop educational programs for the prevention of cervical cancer and to implement diagnostic alternatives to reach populations with precarious accessibility, as well as women who refuse to undergo the Pap smear test.

Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador.

Self-sampling methods for HPV testing have been demonstrated to be highly sensitive and specific. The implementation of these methods in settings with a lack of infrastructure or medical attention has been shown to increase the coverage of cervical cancer screening and detect cervical abnormalities in the early stages. The aim of this study is to compare the acceptability of urine and vaginal self-sampling methods versus clinician sampling among rural women. A total of 120 women participated. Each participant self-collected urine and vaginal samples and underwent clinician sampling for Pap smear and HPV testing. After the sample collection, a questionnaire to qualify the device, technique, and individual acceptability was applied, and the additional overall preference of three sample tests was evaluated. Results: The characteristics of the participants were as follows: median age of 35 years; 40.8% were married; 46.7% had a primary level of education; median age of sexual onset of 17.6 years. Compared with clinician sampling, both vaginal self-sampling, OR 20.12 (7.67-52.8), and urine sampling, OR 16.63 (6.79-40.72), were more comfortable; granted more privacy: vaginal self-sampling, OR 8.07 (3.44-18.93), and urine sampling, OR 19.5 (5.83-65.21); were less painful: vaginal self-sampling, OR 0.07 (0.03-0.16), and urine sampling, OR 0.01 (0-0.06); were less difficult to apply: vaginal self-sampling, OR 0.16 (0.07-0.34), and urine sampling, OR 0.05 (0.01-0.17). The overall preference has shown an advantage for vaginal self-sampling, OR 4.97 (2.71-9.12). No statistically significant preference was demonstrated with urine self-sampling versus clinician sampling. Conclusions: Self-sampling methods have a high acceptance in rural communities. Doubts on the reliability of self-sampling often appear to be a limitation on its acceptability. However, the training and education of the community could increase the uptake of these methods.

Estado nutricional de la mujer embarazada y su relación con las complicaciones de la gestación y el recién nacido / Nutrition status of pregnant women and its relationship with complications of pregnancy and the newborn

RESUMEN: El estado nutricional materno determina las condiciones de salud y nutricionales del recién nacido, así como las complicaciones durante el embarazo y el parto. Se realizó el estudio en 894 mujeres que tuvieron su parto en los Hospitales de la ciudad de Loja Ecuador durante el periodo enero - junio del 2019. Se determinó la antropometría de la madre y de su hijo, así como se tomó datos de complicaciones durante el embarazo y el parto, de su historia clínica. Además, se efectuó la correlación entre el estado nutricional pre-gestacional de la madre con el recién nacido, de igual forma con el estado de salud de la madre. El objetivo de este trabajo fue determinar el estado nutricional pre-gestacional y su relación con la condición de salud y nutricional del niño. El IMC pre-gestacional reportó 47,3 % de sobrepeso y obesidad y 2,6 % de bajo peso. En un porcentaje mayor al 10 % las madres con sobrepeso y obesidad tuvieron hijos grandes para la edad gestacional, de igual forma las madres con bajo peso tuvieron el 26,1 % recién nacidos pequeños. Las principales complicaciones de las madres relacionadas con sobrepeso y obesidad fueron: diabetes gestacional, hemorragia postparto y pre-eclampsia durante el embrazo. Importante señalar la alta frecuencia de infecciones de las vías urinarias 53,9 % (478); y vaginitis 22,3 % (199); aunque estas no están directamente relacionadas con procesos metabólicos como etiología, más si están favorecidos por ellos. Durante el parto la complicación más frecuente fue el parto distócico con un 8,9 % (77), además del total de partos el 41,8 % (374) terminaron en cesárea, de estos el 51, 6 % (193) corresponden a sobrepeso y obesidad. Las complicaciones del recién nacido fueron: Síndrome de dificultad respiratoria aguda, asfixia neonatal e hipoglicemia. En conclusión, el estado nutricional pre-gestacional de la madre está relacionado directamente con el estado de salud y nutricional del recién nacido.

SUMMARY: The maternal nutritional status determines the health and nutritional conditions of the newborn, as well as complications during pregnancy and childbirth. The study was carried out in 894 women who had their delivery in the Hospitals of the city of Loja Ecuador during the period January - June 2019. The anthropometry of the mother and her child was determined, as well as data on complications during pregnancy and delivery, from their clinical history. In addition, the correlation was made between the pre-gestational nutritional status of the mother with the newborn, in the same way with the health status of the mother. The objective of this work was to determine the pre-gestational nutritional status and its relationship with the health and nutritional condition of the child. The pre-gestational BMI reported 47.3 % overweight and obesity and 2.6 % underweight. In a percentage higher than 10 %, mothers with overweight and obesity had large children for gestational age, in the same way, mothers with low weight had 26.1 % small newborns. The main complications of the mothers related to overweight and obesity were: gestational diabe- tes, postpartum hemorrhage and pre-eclampsia during pregnancy. It is important to note the high frequency of urinary tract infections 53.9% (478); and vaginitis 22.3% (199; although these are not directly related to metabolic processes such as etiology, more if they are favored by them. During delivery, the most frequent complication was dystocic delivery with 8.9 % (77), in addition to the total deliveries 42.5 % (374) that ended in cesarean section, of which 51.6 % (193) correspond to overweight and obesity. The complications of the newborn were: Acute respiratory distress syndrome, neonatal asphyxia and hypoglycemia. In conclusion, the pre-gestational nutritional status of the mother is directly related to the health and nutritional status of the newborn.

Los términos corpus rubrum, corpus luteum y corpus albicans en terminologia anatomica del ovario / The terms rubrum, luteum and albicans in terminologia anatomica of the ovary

RESUMEN: El objetivo del presente artículo fue revisar la etimología de los términos Corpus rubrum, Corpus luteum y Corpus albicans, identificar si la forma de nombrarlos en las diferentes nóminas y terminologías internacionales están acorde a las sugerencias de la FIPAT y, analizar y reflexionar respecto de la pertinencia de estos términos en la Terminologia Anatomica. Se buscó en primer lugar el significado de las raíces latinas de los términos: Corpus rubrum, Corpus luteum y Corpus albicans, en el Diccionario de la Real Academia de la Lengua, última actualización; en el Diccionario Términos Médicos de la Real Academia Nacional de Medicina en España y en el Diccionario Vox, Español Latín. Indagamos en la historia para conocer desde cuando se utilizan estos términos, así como la revisión de las diferentes nomenclaturas, nóminas y terminologías anatómicas, histológicas y embriológicas, desde 1955 hasta la fecha. La búsqueda reportó que estos adjetivos latinos deberían traducirse al español de la siguiente manera: rubrum como rojo; luteum como amarillo y albicans como albicante que significa blanquear, por lo que la traducción correcta debiera ser: Cuerpo rojo, Cuerpo amarillo y Cuerpo albicante o blanco del ovario, estructuras transitorias y funcionales. Los términos Corpus rubrum, Corpus luteum y Corpus albicans que identifican estructuras del ovario en Terminologia Anatomica y Terminologia Histologica deberían ser revisados, puesto que son estructuras transitorias y su nombre sólo indica el color que adquieren en el momento funcional y es referente a los cambios que presenta la misma estructura.

SUMMARY: The aim of this article was to review the etymology of the terms Corpus rubrum, Corpus luteum and Corpus albicans, to identify if the way of naming them in the different lists and international terminologies are in accordance with the FIPAT suggestions and to analyze and reflect on the relevance of these terms in the Terminologia Anatomica. Firstly, the meaning of the Latin roots of the terms: Corpus rubrum, Corpus luteum and Corpus albicans were searched in the dictionaries: of the Royal Academy of Language, latest update; of the Medical Terms of the Royal National Academy of Medicine in Spain; in the Vox dictionary, Spanish Latin. Then we investigate the history to know since when these terms are used, as well as the review of the different anatomical, histological and embryological lists and terminologies from 1955 to date. The search reported that these Latin adjectives should be translated as follows: rubrum as red; luteum as yellow and albicans as albicante which means to whiten, therefore, the correct translation should be: Red body, Yellow body and Albicans or white body of the ovary, they are also transitory and functional structures. The terms Corpus rubrum, Corpus luteum and Corpus albicans that identify ovarian structures in the Terminologia Anatomica and Terminologia Histologica should be reviewed since they are transitory structures and their name only indicates the color they acquire at the functional moment and refers to the changes that the same structure presents.

El término cuerpo amigdaloide en la terminología médica / The term amygdaloid body in medical terminology

RESUMEN: En terminología médica el término amígdala cerebral es utilizado para denominar a la estructura que según la Terminologia Neuroanatomica y Terminologia Anatomica se conoce como cuerpo amigadaloide, la cual está constituida por diversos núcleos y es responsable de las emociones, el comportamiento, regulación de la ansiedad, la agresión, el miedo, la memoria emocional, la cognición social y las respuestas al estrés. Siendo la amígdala cerebral una estructura tan importante el objetivo de este estudio fue: analizar el significado del término amígdala cerebral en la Terminologia Neuronatomica y en la Terminologia Anatomica y contrastar si el origen de sus raíces greco latinas concuerdan con la función de esta estructura acorde con los requerimientos de la FIPAT. Para ello se consultó los diccionarios de la Lengua Española, Diccionario DGE Griego Español, Diccionario VOX Griego Español, Diccionario Médico, Biológico, Histológico y Etimológico de la Universidad de Salamanca y Diccionario de Términos Médicos de la Real Academia Nacional de Medicina, así como algunos artículos y libros clásicos de anatomía. Los resultados indicaron que el término amígdala tiene el mismo significado en griego como en latín, en donde ἀμυγδαλέα, ἀμυγδαλέας (pr. amygdaléa, amygdaléas) es el árbol del almedro y ἀμυγδάλη, ἀμυγδάλης (pr. amygdále, amygdáles) significa almendra. Conociendo tanto la anatomía como la fisiología de esta estructura su forma no se asemeja a la de una almendra y su denominación actual no está acorde con los requerimientos de la FIPAT por lo cual consideramos que esta debe ser revisada.

SUMMARY: In medical terminology the term brain amygdala is used to refer to the structure that according to the Terminologia Neuroanatomica and Terminologia Anatomica is known as the amydaloid body, which is made up of various nuclei and is responsible for emotions, behavior, regulation of the anxiety, aggression, fear, emotional memory, social cognition, and responses to stress. Being the cerebral amygdala such an important structure, the objective of this study was: to analyze the meaning of the term cerebral amygdala in Terminologia Neuroanatomica and in Terminologia Anatomica and to contrast if the origin of its Greek Latin roots agrees with the function of this structure according to the requirements of the FIPAT. For this, the dictionaries of the Royal Spanish Academy, the DGE Greek Spanish Dictionary, the VOX Greek Spanish Dictionary, the Medical, Biological, Histological and Etymological Dictionary of the University of Salamanca, the Dictionary of the Royal National Academy of Medicine, as well as some articles and classic books of anatomy. The results indicated that the term amygdala has the same meaning in Greek as in Latin, where? ἀμυγδαλέα, ἀμυγδαλέας (pr. Amygdaléa, amygdaléas) is the almond tree andἀμυγδάλη, ἀμυγδάλης (pr. amygdále, amygdáles) means almond. Knowing both the anatomy and the physiology of this structure, its shape does not resemble that of an almond and its current name is not in accordance with the requirements of the FIPAT, for which we consider that it should be revised.

Perceptions of Ecuadorian indigenous healers on their relationship with the formal health care system: barriers and opportunities.

BACKGROUND: The new paradigm of intercultural policies focuses on rethinking the common public culture. In Ecuador, the "Buen Vivir" plan seeks to incorporate the ancestral medical knowledge, experience and beliefs of traditional healers into the formal health services. This study explores views on the formal health system from the perspective of the healers belonging to the Kichwa and Shuar ethnicities in the South of Ecuador. METHODS: A qualitative study with a phenomenological approach was performed. Focus groups were conducted in three locations in Southern Ecuador. Shuar, Kichwa and Mestizo ethnic groups were included in the research. RESULTS: Eleven focus groups with a total of 110 participants belonging to the Shuar, Kichwa and Mestizo ethnic groups participated in the study. Six themes were created through analysis: 1) conflicts with health professionals, 2) acceptance of traditional healers, 3) respect, 4) work as a team, 5) environment and patient care, and 6) salary and recognition. CONCLUSION: This study indicated the perceived barriers compromising respectful collaboration between health staff and traditional healers from an indigenous perspective. Power inequalities and a historically unidirectional relationship and, in addition, differences in health beliefs, seem to create misunderstandings regarding each other's approach when faced with health and disease. However, insight in these barriers can create opportunities towards collaboration, which will have a positive effect on patient confidence in one or both systems and support continuity between traditional healers and the formal health system.

Uso del lexema δερµα (derma) en terminologia embryologica / Use of the lexeme δερµα (derm) in terminologia embryologica

Al lexema δερµα (derma) que proviene de las raíces griegas δέρ-µα/µατος se lo define como piel, pellejo, cuero, odre (Cortez, 2011). Lo encontramos en los términos ectodermo, mesodermo y endodermo, utilizados para describir las estructuras durante la tercera semana del desarrollo embriológico humano. Se consultó el significado y sus raíces en el diccionario Manuel Griego clásico-Español Vox (Pabón, 1967) y Diccionario Médico-Biológico, Histórico y Etimológico (DICCIOMED) de la Universidad de Salamanca (Cortez); de igual manera se investigó la utilización de los términos ectodermo, mesodermo y endodermo en la Terminologia Embryologica (FIPAT, 2013) y en su última versión (FIPAT, 2017). La búsqueda reportó que estos términos están compuestos por dos raíces griegas el sufijo δέρµα (derma) presente en los tres términos; más los prefijos ἐκτός que significa externo; µÎ­σος definido como medio y ἐνδο cuyo significado es dentro. Estos tres tejidos se derivan a la vez del epiblasto que viene de dos raíces griegas ἐπί- ep(í) que significa sobre + ßλαστός - blast(o) que se traduce como germen, retoño, forma celular inmadura; y del hipoblasto que cuyo término se forma de las raíces griegas ὑπό (hypó) que significa 'debajo de' + ßλαστός - blast(o). Podemos señalar que el mejor término para denominar a estas tres estructuras debiera ser ßλαστός (blasto); y por lo tanto, se deberían denominar a estas tres estructuras como ectoblasto, mesoblasto y endoblasto; debido a que son células o tejidos inmaduros, transitorios y no tejidos definitivos como es la piel; lo cual a su vez se corresponde con los objetivos determinados por la FIPAT.

The lexeme δέρ-µα (derma) that comes from the Greek δέρ-µα/µατος is defined as skin, hide, leather, wineskin (Cortez, 2011). We find it in the term ectoderm, mesoderm and endoderm, used to describe the structures during the third week of human embryological development. The meaning and its roots were consulted in the Manuel Greek-Spanish Vox dictionary (Pabón, 1967) and Medical-Biological, Historical and Etymological Dictionary (DICCIOMED) of the University of Salamanca (Cortez); the same way, the use of the terms ectoderm, mesoderm and endoderm was investigated in Terminologia Embryologica (FIPAT, 2013) and in its latest version Terminologia Embryologica (FIPAT, 2017). The search reported that these terms are composed of two Greek roots, the suffix δέρµα (derma) present in the three terms; plus the prefixes ἐκτός which means external; µÎ­σος defined as medium and ἐνδο whose meaning is within. These three tissues are derived in turn from the epiblast that comes from two Greek roots ἐπί- ep (í) which means over + ßλαστός - blast (o) which translates as germ, shoot, immature cell form; and from the hypoblast whose term is formed from the Greek roots ὑπό (hypó) meaning 'under' + ßλαστός - blast (o). We can say that the best term to name these three structures should be ßλαστός (blast); and therefore, these three structures should be named as ectoblast, mesoblast and endoblast; because they are immature, transitory cells or tissues and definitive non-tissues such as the skin; which in turn corresponds to the objectives determined by FIPAT.