One-year outcomes of two community-based mental health interventions for Afro-Colombian survivors of the armed conflict and displacement.

The objective of the study is to assess the middle-term effects (1 year after intervention) of two community-based mental health interventions, Common Elements Treatment Approach intervention, CETA, and Narrative Community Group Therapy intervention, NCGT, in two cities of the Colombian Pacific region (Buenaventura and Quibdó). A follow-up study was conducted on a cohort of trial participants. In this trial, the positive effects of two mental health interventions were evaluated; assessment was carried out in separate groups (CETA arm, NCGT arm and a control group) of the reduction of symptoms of anxiety, depression, post-traumatic stress and function impaired mentality. The participants were Afro-Colombian survivors of the armed conflict and displacement living in Buenaventura and Quibdó. They were surveyed using the same instrument used in the original trial. Intent-to-treat analyses were performed, and longitudinal mixed-effects regression models with random effects were used to analyse the middle-term effects of the interventions. At 1-year post-intervention, participants in Buenaventura who received the CETA intervention experienced a decrease in depression (-0.23; p = 0.02), post-traumatic stress symptoms (-0.23; p = 0.02) and total mental health symptoms (-0.14; p = 0.048). In Quibdó, the NCGT intervention significantly improved function impairment (-0.30; p = 0.005). CETA and NCGT interventions have the potential to maintain a reduction of mental health symptoms in participants from the Colombian Pacific region.

Mental health Narrative Community-Based Group Therapy in violence-displaced Afro-Colombians: a randomized controlled trial.

This study aims to evaluate the effect of a mental health Narrative Community-Based Group Therapy (NCGT) in Afro-Colombian violence survivors. A randomized controlled trial was conducted in Buenaventura and Quibdó, Colombia. Afro-Colombian adults (n=521) were randomly allocated to a NCGT (n1=175), a wait-control group (n2=171) or a Common Elements Treatment Approach (CETA, n3=175). The CETA was described separately given conceptual/methodological differences. Lay psychosocial community workers delivered the NCGT. Symptoms were assessed before and after intervention/wait with culturally adapted mental health symptoms and gender-specific functionality scales. Intent to treat analysis and mean difference of differences were used for comparisons. In Buenaventura, a significant reduction in functional impairment (mean difference: -0.30, 95% Confidence Interval [95% CI]: -0.55, -0.05) and depression (mean difference: -0.24, 95% CI: -0.42, -0.07) were found, with small and moderate effect size, respectively. In Quibdó, functionality improved significantly (mean difference: -0.29, 95% CI: -0.54, -0.04, small effect size). Even though differences in depression and anxiety were not significant, there were reductions in symptoms. The NCGT is effective in improving daily functioning among violence victims in the Colombian Pacific and has the potential to reduce symptoms of depression. Further exploration is required to understand the effects of a narrative group therapy for mental health in Afro-Colombian populations.Trial Registration: ClinicalTrials.gov number: NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants' survivors of systemic violence in Colombia.

BACKGROUND: Exposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors. METHODS AND FINDINGS: A referred sample of 521 adult Afro-descendants from Buenaventura and Quibdó, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12-14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList-Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d  =  0.70) and a small effect size in Quibdó (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdó, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city. CONCLUSIONS: This trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors. TRIAL REGISTRATION: ClinicalTrials.gov NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

Medical student researchers in Colombia and associated factors with publication: a cross-sectional study.

BACKGROUND: Gaps between evidence-based research and clinical-public health practice have been evident for decades. One of the aims of medical student research is to close this gap. Accordingly, evaluating individual and environmental factors that influence participation of medical students in research are needed to understand and identify potential targets for action. This study aims to identify characteristics of medical student researchers in Colombia and the associated factors with scientific publications. METHODS: A cross-sectional study of Colombian medical students involved in research using a validated, self-administered, online survey. The survey was distributed through the Colombian Association of Medical Students' Associations (ASCEMCOL). Data sets were analyzed using descriptive and summary statistics. Bivariate analysis and a multiple logistic regression model were conducted to identify predictors of scientific publications. RESULTS: A total of 133 responses were analyzed from students at 12 Colombian cities and 20 higher-education institutions. Although 94% of responders had at least one research proposal, only 57% had completed a project, and 17% had published their findings. Barriers for undertaking research included time restrictions and a lack of mentorship. Motivational factors included opportunity to publish findings and good mentorship. Students planning to do a specialization (OR = 3.25; 95% Confidence interval [CI] = 1.27-8.30), innovators (OR = 3.52; 95%CI = 1.30-9.52) and committed (OR = 3.39; 95%CI = 1.02-11.29), those who had previously published their findings (OR 9.13 IC95% 2.57-32.48), and were further in their medical education (OR 2.26 IC95% 1.01-5.07), were more likely to publish scientific papers. CONCLUSIONS: Our findings describe medical students understanding of the process of conducting research in Colombia. Although there appears to be motivation to participate in research, very few students achieve publication. Barriers such as time constraints and mentorship seem to play a critical role. This highlights opportunities where barriers to research can be overcome in medical school and other levels.

Physical activity in a rural community in Colombia / Actividad física en una comunidad rural de Colombia

ABSTRACT Objective To characterize physical activity profiles in a rural community in the southwest of Colombia and to identify knowledge gaps on this issue in the country. Methods Cross-sectional study conducted in a rural area in Puerto Caldas, Pereira, Risaralda. The population of the study was obtained by convenience sampling from people participating in the activities of the Second Multidisciplinary Camp for Research and Services (CUMIS, for its acronym in Spanish), which was organized by the Colombian Association of Medical Students' Scientific Societies (ASCEMCOL, for its acronym in Spanish). The International Physical Activity Questionnaire (IPAQ) was used in order to measure and classify the physical activity behaviors of this population. Results Data from 100 subjects with a mean age of 43±18 years were collected. 6 % of the population did not perform any kind of physical activity, while 61 % performed vigorous physical activity. Men spent more time in doing vigorous and moderate physical activity than women did (p<0.05). The World Health Organization (WHO) recommendations on physical activity were followed by 72.29 % (n=60) and 82.35 % (n=14) of the people with an age of 18 to64 and ≥65 years, respectively. Conclusion It is necessary to build up evidence regarding physical activity in rural areas in order to implement public policies that promote its practice in communities where socioeconomic and health inequities exist. Part of the population living in the community where the study was carried out does not follow the WHO recommendations on physical activity; therefore, the lack of public health interventions is highlighted. A better coherence between international resolutions, national public policies and their implementation could lead to an increase in practice levels of physical activity.(AU)

RESUMEN Objetivo Caracterizar la actividad física en una comunidad rural del suroeste de Colombia e identificar los vacíos de conocimiento alrededor del tema en el país. Métodos Estudio de corte transversal en una zona rural de Puerto Caldas, Pereira, Risaralda. La población fue seleccionada, mediante muestreo por conveniencia, entre las personas que participaron en las actividades del II Campamento Multidisciplinar de Investigación y Servicios (CUMIS), dirigido por la Asociación Colombiana de Sociedades Científicas de Estudiantes de Medicina (ASCEMCOL). Se utilizó el International Physical Activity Questionnaire (IPAQ) para medir y clasificar los comportamientos de esta población en términos de actividad física. Resultados Se recogieron datos de 100 sujetos con edad promedio de 43±18 años. El 6 % de la población no realizó ningún tipo de actividad física, mientras que el 61 % realizó actividad física vigorosa. Los hombres dedicaron más tiempo a la práctica de actividad física vigorosa y moderada que las mujeres (p<0,05). Las recomendaciones sobre actividad física de la Organización Mundial de la Salud (OMS) fueron seguidas por el 72,3 % (n=60) y el 82,4 % (n=14) de las personas en los grupos de edad de 18 a 64 y ≥65 años, respectivamente Conclusión Es necesario construir evidencia en torno a la actividad física en el área rural, a fin de implementar políticas públicas que promuevan su práctica en comunidades que presenten desigualdades socioeconómicas y en salud. Parte de la población de la comunidad donde se llevó a cabo el estudio no sigue las recomendaciones de la OMS para actividad física, en consecuencia, la falta de intervenciones en salud pública se pone en evidencia. Una mayor coherencia entre las resoluciones internacionales, las políticas públicas nacionales y su aplicación podría conducir a un aumento en los niveles de actividad física.(AU)

Physical activity in a rural community in Colombia.

OBJECTIVE: To characterize physical activity profiles in a rural community in the southwest of Colombia and to identify knowledge gaps on this issue in the country. METHODS: Cross-sectional study conducted in a rural area in Puerto Caldas, Pereira, Risaralda. The population of the study was obtained by convenience sampling from people participating in the activities of the Second Multidisciplinary Camp for Research and Services (CUMIS, for its acronym in Spanish), which was organized by the Colombian Association of Medical Students' Scientific Societies (ASCEMCOL, for its acronym in Spanish). The International Physical Activity Questionnaire (IPAQ) was used in order to measure and classify the physical activity behaviors of this population. RESULTS: Data from 100 subjects with a mean age of 43±18 years were collected. 6 % of the population did not perform any kind of physical activity, while 61 % performed vigorous physical activity. Men spent more time in doing vigorous and moderate physical activity than women did (p<0.05). The World Health Organization (WHO) recommendations on physical activity were followed by 72.29 % (n=60) and 82.35 % (n=14) of the people with an age of 18 to64 and ≥65 years, respectively. CONCLUSION: It is necessary to build up evidence regarding physical activity in rural areas in order to implement public policies that promote its practice in communities where socioeconomic and health inequities exist. Part of the population living in the community where the study was carried out does not follow the WHO recommendations on physical activity; therefore, the lack of public health interventions is highlighted. A better coherence between international resolutions, national public policies and their implementation could lead to an increase in practice levels of physical activity.

Asociación entre incidencia de tuberculosis e Índice de Desarrollo Humano en 165 países del mundo / Association between tuberculosis incidence and the Human Development Index in 165 countries of the world

Objetivos. Evaluar la relación entre el índice de desarrollo humano (IDH) y la incidencia de tuberculosis (TB) en 165 países del mundo en el período 2005-2011. Materiales y métodos. Se realizó un estudio ecológico para el cual el IDH se obtuvo de la base de datos del Fondo de Naciones Unidas para el Desarrollo (PNUD) y la incidencia de TB del Programa Alto a la TB de la Organización Mundial de la Salud (OMS). Se evaluó la variación anual de las variables y se realizaron modelos de regresión no lineales (exponencial). Resultados. Al analizar los datos con los modelos de regresión no lineal, se observó que los países con mayores tasas de incidencia de TB fueron aquellos con menores valores de IDH, siendo significativa su asociación (p<0,01). De igual forma se observó que en los países, la variación en el tiempo se asoció significativamente con la variación en el IDH. Conclusiones. Se ha encontrado una relación inversa y significativa entre el IDH y la morbilidad por TB en los países estudiados, incluidos tanto los países de mayor carga de enfermedad como los de la región andina en Latinoamérica. Esta información refleja la influencia significativa de indicadores socioeconómicos como el IDH sobre la tasa de incidencia de la TB, especialmente en países endémicos, siendo inversa entre ambos tipos de variables; con el incremento o mejoría del IDH la tasa de incidencia de la enfermedad disminuyó o se encontró siendo significativamente menor.

Objectives. Assess relationship between the Human Development Index (HDI) and the incidence of tuberculosis (TB) in 165 countries in the World in the period 2005-2011. Materials and methods. An ecological study was done, using HDI data that were obtained from the United Nations Development Program (UNDP), and the incidence rates from the Stop TB Program of the World Health Organization (WHO). The annual variation of the variables was assessed and non-linear regression models (Exponential), were done. Results. At the non-linear regression models, it was observed that the relationship between epidemiological and HDI was significant, those countries with higher rates presented lower values of HDI (p<0.01). Additionally the variation in time was significantly associated with HDI variation. Conclusions. This information reflect the significant influence of socioeconomical indicators such as the HDI on the TB incidence rates in the World, particularly in endemic countries, being an inverse relationship between both types of variables; with an increase or improvement in the HDI, the disease incidence rate decreased or it is found lower.

[Association between tuberculosis incidence and the Human Development Index in 165 countries of the world]. / Asociación entre incidencia de tuberculosis e Índice de Desarrollo Humano en 165 países del mundo.

OBJECTIVES: Assess relationship between the Human Development Index (HDI) and the incidence of tuberculosis (TB) in 165 countries in the World in the period 2005-2011. MATERIALS AND METHODS: An ecological study was done, using HDI data that were obtained from the United Nations Development Program (UNDP), and the incidence rates from the Stop TB Program of the World Health Organization (WHO). The annual variation of the variables was assessed and non-linear regression models (Exponential), were done. RESULTS: At the non-linear regression models, it was observed that the relationship between epidemiological and HDI was significant, those countries with higher rates presented lower values of HDI (p<0.01). Additionally the variation in time was significantly associated with HDI variation. CONCLUSIONS: This information reflect the significant influence of socioeconomical indicators such as the HDI on the TB incidence rates in the World, particularly in endemic countries, being an inverse relationship between both types of variables; with an increase or improvement in the HDI, the disease incidence rate decreased or it is found lower.

Impacto de una actividad formativa en los conocimientos, actitudes y percepciones sobre tuberculosis de estudiantes de medicina de una universidad de Risaralda Colombia / Impact of one formative activity in the students`knowledge, attitudes and perceptions on tuberculosis from one university in Risaralda Colombia

La tuberculosis continúa siendo una de las principales enfermedades tropicales en términos de morbimortalidad. De allí la importancia de mejorar su prevención, a través de diferentes estrategias, incluida la educación médica continua. En el marco del Día Mundial de la lucha contra la tuberculosis se realizó un simposio eduactivo incluyendo charlas y una obra de teatro sobre diferentes aspectos de la enfermedad (duración 280 minutos). Antes de iniciar se aplicó una encuesta para evaluar conocimientos, actitudes y percepciones sobre tuberculosis, basada en guía para encuestas ACMS, de STOP Tuberculosis Partnership de la OMS. Al finalizar esta fue aplicada de nuevo. Se comparan las diferecias entre los resultados antes u después con la prueba X², confianza 95%. Se evaluó un total de 109 universitarios antes de iniciar (pre) y 103 después (pos) (total, 211 encuestas). Sobre las preguntas realizadas, la primera de ella fue "¿Cuán serio percibe usted el problema de la tuberculosis en su comunidad?". En la encuesta pre solo 50,9% lo consideró un problema muy serio. En la pos se incrementó a 94,1% (X²= 49,602; P<0,001). En la encuesta pre, 31,5% lo consideró como algo serio, 2,8% no tan serio, 8,3% no sabía y 6,5% no contestó. En la pos, el restante 5,9% correspondió solo a considerarlo como algo serio. En general se observó mejoría significativa sobre los conocimientos, actitudes y percepciones en síntomas, trasmisión, prevención, curación, que sentiría al ser diagnosticado y otros aspectos evaluados (P<0,05). Este tipo de abordajes, especialmente a nivel comunitario, debe ser replicado, con el fin de mejorar los conocimientos, actitudes y percepciones de la población no solo universitaria, sino también general, sobre la tuberculosis. Se requiere dar mayor información en las poblaciones afectadas y sus familiares sobre las formas de transmisión, para mitigar los mitos y el estigma, que es también prevalente

Tuberculosis continues to be one of the most principal tropical diseases in terms of its morbidity and mortality. Since there the importance to improve its prevention, through different strategies, included the continuing medical eduaction. In the context of the World Tuberculosis Day an educative symposium, including conferences and a theater play about different disease aspects (lasting 280 minutes), was done. Before start them, a questionnaire to assess knowledges, attitudes and perceptions about tuberculosis, based on the guide for surveys ACMS, of STOP Tuberculosis Partnership from the who, was applied. Finishing them this questionnaire was applied again. Differences between before and after results, using the X²-test, 95% confidence level, were compared. A total 109 universitary students (before) and 102 (after) were evaluated. About the applied questions, first of them was "How serious do you perceive the tuberculosis problem in your community?" In the pre-test survey only 50.9% considered it as a very serious problem. In the post-test it increased to 94.1% (X²=49.602; P<0.001). In the pre-test, 31.5% considered as something serious, 2.8% not so serious, 8.3% did not knew and 6.5% did not answered. In the post-test, resting 5.9% corresponded just no considered it as something serious. In genral a significant improvement about the knowledges, attitudes and perceptions in symptoms, transmission, prevention, cure, how feel about been diagnosed and other evaluated aspect was observed (P<0.05). This type of approach, especially at community level, should be replicated, with the goal to improve the knowledges, attitudes and perceptions of the population not just universitary, but also general, about tuberculosis. It is requerid to give more information in the affected populations and their families about the transmission, in order to mitigate the myths and stigma, which is also prevalent

Campamento universitario multidisciplinario de investigación y servicio (CUMIS) como estrategia de intervención comunitaria / Multidisciplinary college camp for services and research (CUMIS) as a strategy for community intervention

Introducción: la intervención comunitaria y el trabajo en las poblaciones vulneradas, la vocación social y la investigación, han sido iniciativas promovidas por varias sociedades científicas estudiantiles de diferentes universidades y facultades de ciencias de la salud. Metodología: el objetivo del presente trabajo es describir el Campamento Universitario Multidisciplinario de Investigación y Servicio (CUMIS), como estrategia de participación comunitaria y estudiantil, de un conjunto de universidades de Colombia lideradas por la Universidad Tecnológica de Pereira. Resultados: la primera versión en Colombia tuvo lugar del 27 al 30 de marzo de 2010 en el corregimiento de Caimalito, Pereira. Se realizaron brigadas de salud, sesiones educativas y trabajos de investigación en este periodo. Conclusión: el CUMIS 2010 permitió a los alumnos aplicar los conocimientos adquiridos durante la formación universitaria y llevar a cabo proyectos de investigación científica desde el pregrado, apoyando a una población vulnerable del departamento de Risaralda, Colombia.

Introduction: community intervention and social work in vulnerable populationsare initiatives led by the urge to research the health impact of various students’ scientific societies. Methods: the purpose of this project is to describe how the Multidisciplinary College Camp for Services and Research (CUMIS) is a student strategy of community work and scientific research. Universities from Colombia are the main participants andare led by the Universidad Tecnologica de Pereira. Results: the first version of this strategy took place in Caimalito, Pereira, Risaralda from the 27th to the 30th of March 2010. Health brigades, educational talks and scientific research were performed. Conclusion: CUMIS allowed students to apply their theoretical knowledge and develop research projects to help a community in need.