Prevalence of HIV, Treponema pallidum and Their Coinfection in Men Who Have Sex with Men, Medellín-Colombia.

Introduction: In Colombia, HIV and gestational syphilis are notifiable events; however, they are poorly investigated infections in men who have sex with men (MSM). Objective: To determine the prevalence of HIV, Treponema pallidum, and their co-infection in MSM treated at a Health Services Provider Institution (HSPI) specialized in infectious diseases from Medellín. Methods: Cross-sectional study with 3454 MSM. Prevalence was determined with its 95% confidence interval; associated factors were identified using Fisher's Exact test, Pearson's Chi-square, and trend Chi-square. Multivariate adjustment was performed using logistic regression. Analyses were performed using SPSS 29.0. Results: The prevalence of HIV was 5.7%, T. pallidum 0.7%, and co-infection 0.6%. The prevalence of HIV was higher in MSM aged between 24-40 years (7.5%), with technical or university studies (10.0%), without health insurance affiliation (12.4%), and those who have had a sexual partner with HIV (36.2%). T. pallidum was higher in MSM without health insurance affiliation (3.4%), who had sexual relations with people diagnosed with an STI (5.9%), and a sexual partner with HIV (12.1%). Co-infection was higher in MSM without health insurance affiliation (2.7%), and those who had a partner with HIV (11.2%). Conclusion: Compared with the general Colombian population, MSM have a higher risk of HIV, but are similar to T. pallidum. The identification of the main associated factors in each infection demonstrates the need to prioritize subgroups of MSM that show greater vulnerability to these events. This research demonstrates the urgency of implementing health education strategies in MSM who have a sexual partner with HIV or other STIs. Large gaps were also evident in the magnitude of the three events according to the health insurance affiliation regime, which demonstrates problems of social and health injustice, especially with MSM without health insurance affiliation.

Social representations of cancer in patients from Medellín, Colombia: a qualitative study.

Background: Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia. Methods: This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages. Results: SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic. Conclusion: In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.

HIV in Three Groups of Young People from Medellín: General Population, Organizations for People with Socioeconomic Vulnerability, and Men Who Have Sex with Other Men.

Introduction: In Colombia, there are no studies that analyze the effect of socioeconomic vulnerability and belonging to the group of men who have sex with other men (MSM) on the prevalence of HIV in young people. Objective: To compare the prevalence of HIV in three groups of young people from Medellín-Colombia: general population, socioeconomic vulnerability and MSM. Methods: This cross-sectional analytical study included 2449 young people from the general population, 1736 from institutions that serve young people in situations of socioeconomic vulnerability, and 2269 MSM. The prevalence of infection in each group was determined, statistical differences were identified using Pearson's Chi-square and Trend's Chi-square, and crude and adjusted odds ratios were estimated using logistic regression with 95% confidence intervals. Analyses were performed in SPSS 29.0. Results: HIV prevalence was 0.8% in the general population group, 1.3% in young people with socioeconomic vulnerability, and 5.6% in MSM. The groups with the highest HIV were as follows: (i) in MSM it was 4.1 compared to the general population, (ii) between 25-28 years of age it was 2.9 times compared to those under 20 years, (iii) in men it was 10 times that registered in women, (iv) in young people with primary, secondary, technical and university studies it was 7.1; 6.7; 11.0 and 14.5 times that found in those who did not register studies, (v) in affiliates of the subsidized health regime it was 2.2 times and in those without affiliation 2.4 times compared to the infection in affiliates of the contributory health regime. Conclusion: HIV prevalence was high, and explained by socioeconomic vulnerability, having sex between men, gender, age, education, and health affiliation, demonstrating the intersectionality of determinants of the health system, socioeconomic status, and determinants individuals in the occurrence of HIV in young people in Medellín.

Influence of Positive Thinking Ideology on Physician Representations of Cancer.

To understand the influence of positive thinking ideology on cancer representations among physicians in the city of Medellín. METHODS: This qualitative study was conducted on the basis of the theoretical and methodological elements of Corbin and Strauss's grounded theory. Fourteen physicians were included and selected according to the criteria of maximum variation for education, years of study, and personal and family history of cancer. The information was collected through semi-structured interviews and analyzed with open, axial, and selective coding. RESULTS: the ideology of positive thinking has managed to permeate the medical discourse and the representations that they form about the etiology and treatment of cancer. Physicians place the mind, emotions, attitude, and positive thinking as determinants of the origin of the disease and the response to therapy. To argue this link, they use two strategies: (i) a sophisticated and specialized discourse that involves relationships among thoughts, genetics, the neurological, immune and endocrine system and (ii) a mystical and less rational discourse that emphasizes the omnipotence of the mind and thoughts. In no case was the idea of positive thinking rejected or in disagreement with this style of thinking expressed. CONCLUSION: The fact of linking the disease with mental factors refers to the mind-body dualism and generates a responsibility of the patients on the etiology and therapeutics of the disease, as well as an erasure of the social and political determinants of cancer. The technical discourse and the symbolic capital of physicians offer scientific legitimacy to these ideas and can become performative for patients.

Social determination of malaria in pregnancy in Colombia: a critical ethnographic study.

BACKGROUND: The meanings and experiences related to malaria in pregnancy (MiP) and its processes of social determination of health (PSDH) have not been reported in the world scientific literature. The objective was to understand the meanings and experiences of MiP, and to explain their PSDH in an endemic area from Colombia, 2022. METHODS: Critical ethnography with 46 pregnant women and 31 healthcare workers. In-depth and semi-structured interviews, focus group discussions, participant and non-participant observations, and field diaries were applied. A phenomenological-hermeneutic analysis, saturation and triangulation was carried out. The methodological rigor criteria were reflexivity, credibility, auditability, and transferability. RESULTS: At the singular level, participants indicated different problems in antenatal care and malaria control programmes, pregnant women were lacking knowledge about MiP, and malaria care was restricted to cases with high obstetric risk. Three additional levels that explain the PSDH of MiP were identified: (i) limitations of malaria control policies, and health-system, geographic, cultural and economic barriers by MiP diagnosis and treatment; (ii) problems of public health programmes and antenatal care; (iii) structural problems such as monetary poverty, scarcity of resources for public health and inefficiency in their use, lacking community commitment to preventive actions, and breach of institutional responsibilities of health promoter entity, municipalities and health services provider institutions. CONCLUSION: Initiatives for MiP control are concentrated at the singular level, PDSH identified in this research show the need to broaden the field of action, increase health resources, and improve public health programmes and antenatal care. It is also necessary to impact the reciprocal relationships of MiP with economic and cultural dimensions, although these aspects are increasingly diminished with the predominance and naturalization of neoliberal logic in health.

Clinical and Parasitological Profiles of Gestational, Placental and Congenital Malaria in Northwestern Colombia.

This study compared the clinical-parasitological profiles of gestational (GM), placental (PM), and congenital (CM) malaria in northwestern Colombia. A cross-sectional study with 829 pregnant women, 549 placentas, and 547 newborns was conducted. The frequency of GM was 35.8%, PM 20.9%, and CM 8.5%. P. vivax predominated in GM; in PM, the proportion of P. vivax and P. falciparum was similar; in CM, P. falciparum predominated. The main clinical findings were headache (49%), anemia (32%), fever (24%), and musculoskeletal pain (13%). The clinical manifestations were statistically higher in P. vivax infections. In submicroscopic GM (positive with qPCR and negative with thick blood smear), the frequency of anemia, sore throat, and a headache was statistically higher compared with pregnant women without malaria. GM, PM, and CM reduce birth weight and head circumference. In Colombia, this is the first research on the clinical characteristics of GM, PM, and CM; contrary to evidence from other countries, P. vivax and submicroscopic infections are associated with clinical outcomes.

A systematic review of mixed studies on malaria in Colombia 1980-2022: what the "bifocal vision" discovers.

Mixed methods are essential in public health research and malaria control, because they allow grasping part of the complexity and diversity of the factors that determine health-disease. This study analyzes the mixed studies on malaria in Colombia, 1980-2022, through a systematic review in 15 databases and institutional repositories. The methodological quality was assessed with Mixed Methods Appraisal Tool (MMAT), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), and Standards for Reporting Qualitative Research (SRQR). The qualitative and quantitative findings were grouped into a four-level hierarchical matrix. The epidemiological profile of malaria morbidity, from traditional epidemiology, has been sustained by environmental problems, armed conflict, individual risk behaviors, and low adherence to recommendations from health institutions. However, the qualitative component reveals deeper causes that are less studied, of greater theoretical complexity, and that reflect challenges to design and implement health interventions, such as socioeconomic and political crises, poverty, and the neoliberal orientation in the malaria control policy; the latter reflected in the change in the role of the State, the fragmentation of control actions, the predominance of insurance over social assistance, the privatization of the provision of health services, the individualistic and economistic predominance of health, and low connection with popular tradition and community initiatives. The above confirms the importance of expanding mixed studies as a source of evidence to improve malaria research and control models in Colombia, and to identify the underlying causes of the epidemiological profile.

Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005-2022: A Systematic Review.

Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal-sexist gender roles, and predominance of local conceptions on maternal-fetal-neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.

Explanatory Model of Psychogenic, Behavioral and Environmental Causal Attributions of Cancer, and Their Psychogenic, Biomedical and Alternative Treatment in the General Population of Medellín, Colombia.

BACKGROUND: Understanding the causal attributions for cancer, the elements affecting therapeutic adherence, and behaviors that may compromise people's health or even put them at risk of dying from this disease has garnered a considerable degree of attention. METHODS: This study was designed in the city of Medellín with the aim to develop and validate a model for the study of (i) the categories that can be attributable to cancer etiology, (ii) the categories that can be attributed to the efficacy of treatment, and (iii) the relationship between the categories that can be attributed to the etiology and to the efficacy of the treatment. Structural equations were performed on 611 participants. RESULTS: The analysis revealed that attributing the disease to psychogenic factors distances people from biomedical treatments (ß coefficient, -0.12), and brings them closer to psychogenic (ß coefficient, 0.22) and alternative treatments (ß coefficient, 0.24). Attributing cancer to behavioral factors brings people closer to psychogenic treatments (ß coefficient, 0.40) over biomedical treatments (ß coefficient, 0.24). CONCLUSIONS: Symbolic, cultural, and social factors were evidenced, thereby leading to the underestimation of biomedical treatments and imparting a greater degree of importance to psychogenic or alternative therapies. These therapies will subsequently affect the achievement of therapeutic objectives such as increased survival.

Impact of COVID-19 Pandemic on Seroprevalence of HIV, HBV, HCV and HTLV I-II in a Blood Bank in Medellín, Colombia, 2019-2022.

The objective of this research was to analyze the impact of the COVID-19 pandemic on seroprevalence of HIV, HBV, HCV and HTLV I-II in donors from a blood bank in Medellin, Colombia, 2019-2022. A cross-sectional analytical study was carried out with three groups: pre-pandemic with 14,879 donors; preventive isolation with 9035; and selective isolation + new normality with 26,647 subjects. Comparisons were made with Chi2 and Bonferroni adjustment, Kruskal-Wallis' H with Dunnett's post-hoc, prevalence ratios, and multivariate logistic regression. COVID-19 decreased donations of men, altruistic and repetitive donors, and increased the age of donors. HIV increased with the COVID-19 pandemic, while HBV, HCV, and HTLV I-II decreased. The pandemic had an independent effect on these viral infections. These findings constitute an alert about what may be happening in the general population and show the importance of improving epidemiological surveillance and the investigation of these infections.

Diagnostic Accuracy of a Thick Blood Smear Compared to qPCR for Malaria Associated with Pregnancy in Colombia.

This study aimed to evaluate the accuracy of the thick blood smear (TBS) versus quantitative polymerase chain reaction (qPCR) for the diagnosis of malaria associated with pregnancy (MAP) caused by P. falciparum or P. vivax in Colombia in its gestational malaria (GM), placental malaria (PM), and congenital malaria (CM) forms as well as to compare its accuracy in different subgroups of pregnant women according to the presence of fever, anemia and a history of malaria. This was a diagnostic evaluation of 829 pregnant women, 579 placentas, 381 umbilical cord samples, and 221 neonatal peripheral blood samples. Accuracy was evaluated based on the parameters of sensitivity, specificity, predictive values, likelihood ratios, and validity index, with their 95% confidence intervals. The frequency of GM was 36% (n = 297/829), PM 27% (n = 159/579), and CM 16.5% (n = 63/381) in umbilical cord samples and 2% (n = 5/221) in neonatal peripheral blood samples. For GM, the sensitivity was 55%, with higher rates in those infected with P. vivax (68%), with a history of malaria (69%), and with fever (96%). These three subgroups presented the best results in terms of the negative likelihood ratio and validity index. For PM, sensitivity was 8%; in subgroup analyses in terms of species, symptomatology (anemia and fever), and history of malaria, it was 1-18%, and the negative likelihood ratio was >0.80 in all subgroups. No false positives were recorded in any of the subgroups. The TBS did not detect any cases of CM. This study found the TBS yielded satisfactory results in terms of diagnosing GM for P. vivax, pregnant women with previous malaria and febrile. It also showed that the TBS is not useful for diagnosing PM and CM. It is necessary to conduct surveillance of MAP with molecular methods in in groups where TBS is deficient (asymptomatic GM, P. falciparum, and pregnant women without history of malaria) to optimize the timely treatment of PM and CM, avoid the deleterious effects of MAP and achieve the malaria elimination goals in Colombia.

Systematic review of the diagnostic accuracy of thick smear compared to polymerase chain reaction for pregnancy-associated malaria, 2010-2022. / Revisión sistemática de la exactitud diagnóstica de la gota gruesa en comparación con la reacción en cadena de la polimerasa para malaria asociada al embarazo, 2010-2022.

OBJECTIVE.: To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). MATERIALS AND METHODS.: We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. RESULTS.: We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. CONCLUSIONS.: We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.

OBJETIVOS.: Evaluar la exactitud de gota gruesa (GG) frente a la reacción en cadena de la polimerasa (PCR) cuantitativa para la malaria asociada al embarazo (MAE). MATERIALES Y MÉTODOS.: Se realizó una revisión sistemática de pruebas diagnósticas en nueve bases de datos. Se evaluó la calidad metodológica con QUADAS. Se estimó sensibilidad, especificidad, cociente de probabilidad positivo (CPP) y negativo (CPN), razón de odds diagnóstica (ORD) y área bajo la curva ROC. Se determinó la heterogeneidad con el estadístico Q de Der Simonian-Laird y la incertidumbre con el porcentaje de peso de cada estudio sobre el resultado global. RESULTADOS.: Se incluyeron diez estudios con 5691 gestantes, 1415 placentas y 84 neonatos. En los estudios con nPCR (PCR anidada) y qPCR (PCR cuantitativa) como estándar, los resultados de exactitud diagnóstica fueron estadísticamente similares, con sensibilidad muy baja (50 y 54%, respectivamente), alta especificidad (99% en ambos casos), alto CPP y deficiente CPN. Usando nPCR la OR diagnóstica fue 162 (IC95%=66-401) y el área bajo la curva ROC fue 95%, mientras que con qPCR fueron 231 (IC95%=27-1951) y 78%, respectivamente. CONCLUSIONES.: Mediante un protocolo exhaustivo se demostró el bajo desarrollo de investigaciones sobre la exactitud diagnóstica de la GG en MAE. Se demostró que la microscopía tiene un desempeño deficiente para el diagnóstico de infecciones asintomáticas o de baja parasitemia, lo que afianza la importancia de implementar otro tipo de técnicas en el seguimiento y control de las infecciones por malaria en las gestantes, con el fin de lograr el control y posible eliminación de la MAE.

Systematic Review of Mixed Studies on Malaria in Pregnancy: Individual, Cultural and Socioeconomic Determinants of Its Treatment and Prevention.

Malaria in pregnancy (MiP) is a global public health problem; its research is predominantly quantitative. The objective was to analyze the individual, cultural and socioeconomic determinants of the treatment and prevention of MiP with a systematic review of mixed studies (search had no date restriction). Reproducibility and evaluation of the methodological quality were guaranteed. 21 studies were included (20 from Africa). The quantitative component included 7816 pregnant women and 483 health workers. The qualitative component included 800 subjects (pregnant women, health workers, family members and community leaders). The main topics were the use and acceptability of WHO strategies to prevent MiP, individual determinants related with knowledge, perceptions, attitudes and behaviors on MiP, and cultural and socioeconomic barriers for its treatment and prevention. The main determinants of MiP were long distance to the clinic, lack of economic resources, low-coverage antenatal care, few health workers in the communities, drug shortages, cultural rules that prevent women's participation in health issues, and misconceptions about MiP. MiP has determinants related to economic conditions, the structure and functioning of the health system, symbolic and cultural aspects, as well as knowledge, beliefs, perceptions and behavior of pregnant women, which prevent optimal access and use of preventive strategies. This study evidences the importance of intersectional, intersectoral, and interdisciplinary work to prevent MiP.

Metaanálisis de la validez diagnóstica de las pruebas de tamización del virus de inmunodeficiencia humana en bancos de sangre, 2000-2020

Objetivo: Evaluar la validez diagnóstica del ensayo de inmunoabsorción ligado a enzima (Enzyme-Linked Immunosorbent Assay, ELISA) para el virus de inmunodeficiencia humana (VIH) en bancos de sangre, con base en estudios publicados entre 2000 y 2020. Metodología: Se realizó una revisión sistemática y metaanálisis de pruebas diagnósticas, mediante un modelo de efectos aleatorios para la sensibilidad, la especificidad, el cociente de probabilidad positivo y negativo, la razón de odds (OR) diagnóstica y la curva ROC, con sus intervalos de confianza del 95 %. La heterogeneidad se evaluó con el estadístico Q(χ2) DerSimonian-Laird y el I2 de inconsistencia, y la incertidumbre, con el porcentaje de peso de cada estudio. Resultados: Se incluyeron 15 investigaciones; la ELISA de tercera generación (detección de anticuerpos) se aplicó en 2992 infectados y 4076 sanos; las de cuarta generación (determinación simultánea de antígeno-anticuerpo), en 967 infectados y 154 264 sanos; ambas presentaron sensibilidad cercana al 100 %, pero la especificidad fue mejor en los ensayos de cuarta generación (98 vs. 100 %). Para ambas tecnologías, los cocientes de probabilidad, OR diagnóstica y curva ROC evidenciaron excelente discriminación de sanos e infectados. Conclusión: Se confirmó que las ELISA de tercera y cuarta generación presentan excelente validez y utilidad diagnóstica en donantes de sangre, lo que es importante para las políticas de sangre segura y control del VIH.

Objective: To evaluate the diagnostic validity of the enzyme-linked immunosorbent assay (ELISA) for human immunodeficiency virus (HIV) in blood banks, based on studies published between 2000 and 2020. Methodology: We performed a systematic review and meta-analysis of diagnostic tests, using a random-effects model for the sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio (DOR), and ROC curve, with 95% confidence intervals. Heterogeneity was assessed with the DerSimonianLaird Q(χ2) statistic and the I2 inconsistency statistic. Uncertainty was assessed using percentage study weights. Results: 15 studies were included. The third-generation ELISA (antibody detection) was applied for 2,992 infected and 4,076 healthy individuals, and the fourth-generation ELISA (simultaneous antigen-antibody detection) was used for 967 infected and 154,264 healthy individuals. Both showed close to 100% sensitivity, but there was an improved specificity in the fourth-generation assays (98% vs. 100%). Both technologies' likelihood ratios, DOR, and ROC curve aptly distinguished between healthy and infected individuals. Conclusion: The third and fourth-generation ELISA were confirmed to have excellent validity and diagnostic utility in blood donors, which is important for HIV control and blood safety policies.

Objetivo: Avaliar a validade diagnóstica do ensaio de imunoabsorção ligado à enzima (Enzyme-Linked Immunosorbent Assay, ELISA) para o vírus de imunodeficiência humana (VIH) em bancos de sangue, com base em estudos publicados entre 2000 e 2020. Medotologia: Realizou-se uma revisão sistemática e meta-análise de provas diagnósticas, por meio de um modelo de efeitos aleatórios para a sensibilidade, a especificidade, o cociente de probabilidade positivo e negativo, a razão de odds (OR) diagnóstica e a curva de ROC, com seus intervalos de confiança do 95%. A heterogeneidade foi avaliada com o estatístico Q(χ2) DerSimonian-Laird e o I2 de inconsistência, e a incerteza, com a porcentagem de peso de cada estudo. Resultados: Foram incluídas 15 pesquisas; a ELISA de terceira geração (detecção de anticorpos) aplicouse em 2992 infetados e 4076 sadios; as de quarta geração (determinação simultânea de antígeno-anticorpos), em 967 infetados e sadios; ambas as duas apresentaram sensibilidade próxima ao 100%, mas a especificidade foi melhor nos ensaios de quarta geração (98 vs. 100%). Para ambas as tecnologias, os cocientes de probabilidade, OR diagnóstica e curva ROC evidenciaram excelente discriminação de sadios e infetados. Conclusão: Confirmou-se que as ELISA de terceira e quarta geração apresentam excelente validade e utilidade diagnóstica em doadores de sangue, o que é importante para as políticas de sangue seguro e controle do VIH.

Desempeño psicométrico e intervalos de referencia del WHOQOL-BREF en población sana, Medellín-Colombia / Psychometric performance and WHOQOL-BREF reference intervals in a healthy population, Medellín-Colombia

Resumen Introducción: El instrumento de calidad de vida de la Organización Mundial de la Salud es ampliamente utilizado en personas sanas y enfermas; sin embargo, son pocos los estudios colombianos que han analizado sus dimensiones en población sana. Objetivo: Evaluar las propiedades psicométricas del WHOQOL-BREF en población sana de Medellín, y estimar los intervalos de referencia para sus cuatro dimensiones. Métodos: Estudio transversal y de evaluación psicométrica en 1938 personas. Se evaluó fiabilidad con el α de Cronbach, consistencia interna y poder discriminante con Rho de Spearman, validez de contenido con coeficientes λ y varianza explicada mediante un análisis factorial exploratorio con extracción por componentes principales. Se eliminaron valores aberrantes mediante el estadístico de Grubbs, se estimaron los intervalos de referencia globales para cada dimensión del WHOQOL-BREF y los específicos, según variables demográficas y socioeconómicas, mediante intervalos de confianza del 95% para la media, y comparaciones mediante T- Student y Anova. Los análisis se realizaron en SPPS 25.0®. Resultados: Se halló una excelente fiabilidad, consistencia interna, poder discriminante y validez de contenido en las cuatro dimensiones del instrumento en población sana. Los valores de referencia fueron 64,3-65,6 en salud física, 70,8-72,0 en salud psicológica, 64,3-65,9 en salud social y 60,5-61,6 en salud ambiental, con diferencias estadísticamente significativas según las características demográficas y socioeconómicas Conclusión: El excelente desempeño psicométrico de la escala en población sana, permitió la estimación de los intervalos de referencia para las cuatro dimensiones, así como los valores para subgrupos conformados por variables demográficas y socioeconómicas, lo que resulta determinante para incluir los desenlaces centrados en las personas en los programas de medicina y salud pública, así como comparadores adecuados para población enferma.

Abstract Introduction: The Quality of Life Instrument of the World Health Organization is widely used in healthy and sick people; however, few Colombian studies have analyzed its dimensions in a healthy population. Objective: To evaluate the psychometric properties of the WHOQOL-BREF in a healthy population of Medellín and to estimate the reference intervals for it's four dimensions. Methods: Cross-sectional study and psychometric evaluation in 1938 people. Reliability was evaluated with Cronbach's α, internal consistency and discriminant power with Spearman's Rho, content validity with λ coefficients and variance explained by means of an exploratory factor analysis with extraction by principal components. Aberrant values were eliminated using the Grubbs statistic, the global reference intervals were estimated for each dimension of the WHOQOL-BREF and the specific ones, according to demographic and socioeconomic variables, using 95% confidence intervals for the mean, and comparisons using Student's t and Anova. The analyzes were carried out in SPPS 27.0®. Results: Excellent reliability, internal consistency, discriminating power, and content validity were found in the four dimensions of the instrument in a healthy population. The reference values were 64.3-65.6 in physical health, 70.8-72.0 in psychological health, 64.3-65.9 in social health and 60.5-61.6 in environmental health, with statistically significant differences according to demographic and socioeconomic characteristics Conclusion: The excellent psychometric performance of the scale in the healthy population allowed the estimation of the reference intervals for the four dimensions, as well as the values for subgroups made up of demographic and socioeconomic variables, which is decisive for including the outcomes centered on people in medicine and public health programs, as well as suitable comparators for the sick population.

Prevalencia de VIH y sus factores asociados en personas que se inyectan drogas atendidos en una institución prestadora de servicios de salud de Medellín-Colombia / HIV prevalence and associated factors in people who inject drugs attended in an institution that provides health services from Medellín-Colombia

Resumen Introducción: En Colombia, la investigación sobre el VIH en Personas que se Inyectan Drogas (PID) es escaso, pese a ser un grupo clave para el control de la infección. Objetivo: Determinar la prevalencia de VIH y sus factores asociados en PID atendidos en una Institución Prestadora de Servicios de salud (IPS) de Medellín-Colombia. Métodos: Estudio de prevalencia en 293 PID en una IPS especializada en la atención de enfermedades infecciosas. Se aplicó una encuesta para recolectar datos sociodemográficos y de salud, una inmunocromatografía para la tamización de la infección y los casos positivos se confirmaron con Western blot. Los análisis se realizaron en SPSS 27.0. Resultados: La edad mediana 29 años, 84% hombres, 52% sin escolaridad y alta frecuencia de factores de riesgo sexual. La prevalencia del VIH fue de 5,5%, de estos 87,5% coinfectados con virus de la hepatitis C y 53,6% con la B. La prevalencia de VIH fue estadísticamente más elevada en sujetos mayores de 29 años de edad (10,4%), quienes viven en condición de calle (25,5%), sin escolaridad (9,9%) y quienes reciben dinero o drogas a cambio de sexo (11,6%). Conclusión: Se obtuvo una prevalencia de VIH mayor a la reportada en estudios previos de la ciudad, alta proporción de coinfección con virus de las hepatitis B y C, y se identificaron grupos con mayor ocurrencia de VIH. Estos resultados, además de permitir disponer de una línea base para evaluar intervenciones posteriores en este grupo, demuestra la interseccionalidad en el riesgo de VIH, consumo de drogas inyectables, hepatitis virales, baja escolaridad, condición de calle, y otros que muestran la complejidad clínica, epidemiológica y social para impactar el VIH en este grupo.

Abstract Introduction: In Colombia, research on HIV in people who inject drugs (PID) is scarce, despite being a key group for infection control. Objective: To determine the prevalence of HIV and its associated factors in PID treated in a health service provider institution (IPS) in Medellín-Colombia. Methods: Prevalence study in 293 PID from an IPS specialized in the care of infectious diseases. A survey was applied to collect sociodemographic and health data, immunochromatography for infection screening, and positive cases were confirmed with Western blot. Analyzes were performed in SPSS 27.0. Results: The median age was 29 years, 84% men, 52% without schooling and high frequency of sexual risk factors. HIV prevalence was 5.5%, of these 87.5% co-infected with hepatitis C virus and 53.6% with hepatitis B virus. HIV prevalence was statistically higher in subjects older than 29 years of age (10.4%), those who live on the streets (25.5%), without schooling (9.9%) and those who receive money or drugs in exchange for sex (11.6%). Conclusion: A higher prevalence of HIV was obtained in comparison with previous studies of the city; a high proportion of co-infection with hepatitis B and C viruses, and groups with a higher occurrence of HIV were identified. These results, in addition to providing a baseline to evaluate subsequent interventions in this group, demonstrate the intersectionality in the risk of HIV, injecting drug use, viral hepatitis, low schooling, homelessness, and others social and health conditions, that show the clinical, epidemiological and social complexity to impacting HIV in this group.

The Relation of Ideology of Positive Thinking with the Perception of Cancer Risk and Ways of Treating It in Medellin, Colombia.

Purpose: This study has the following objectives: i) to construct an instrument to measure positive thinking ideology (PTI) regarding cancer, and to evaluate its psychometric properties, ii) to describe the effects of PTI on cancer risk and its treatment, and iii) to identify the associated factors with PTI in the study group. Methods: A cross-sectional study was conducted with 611 people from the Medellin, Colombia. Participants were selected through stratified sampling with proportional assignment. A survey with three constructs was applied: the role of negative emotions in cancer etiology, cancer as a redeeming event, and the effects of PTI in cancer treatment. Results: In negative emotions construct 47% considered that holding anger, resentment, and hatred represent a moderate or high risk of generating cancer. In redeeming power construct 46.5% found that cancer is a battle that the best warriors win. Concerning the treatment, 77.3% considered that facing the disease with a fighting spirit had a moderate to high positive effect in response to the treatment. The associated factors with PTI were reading self-help books and education level. Conclusion: The results show that PTI affects perceptions about the cancer, its etiology and treatment. This effect is greater in undereducated people and in self-help book readers. The instrument showed excellent reliability, internal consistency, discriminating power, content, and construct validity properties.

Revisión sistemática de la exactitud diagnóstica de la gota gruesa en comparación con la reacción en cadena de la polimerasa para malaria asociada al embarazo, 2010-2022 / Systematic review of the diagnostic accuracy of thick smear compared to polymerase chain reaction for pregnancy-associated malaria, 2010-2022

RESUMEN Objetivos. Evaluar la exactitud de gota gruesa (GG) frente a la reacción en cadena de la polimerasa (PCR) cuantitativa para la malaria asociada al embarazo (MAE). Materiales y métodos. Se realizó una revisión sistemática de pruebas diagnósticas en nueve bases de datos. Se evaluó la calidad metodológica con QUADAS. Se estimó sensibilidad, especificidad, cociente de probabilidad positivo (CPP) y negativo (CPN), razón de odds diagnóstica (ORD) y área bajo la curva ROC. Se determinó la heterogeneidad con el estadístico Q de Der Simonian-Laird y la incertidumbre con el porcentaje de peso de cada estudio sobre el resultado global. Resultados. Se incluyeron diez estudios con 5691 gestantes, 1415 placentas y 84 neonatos. En los estudios con nPCR (PCR anidada) y qPCR (PCR cuantitativa) como estándar, los resultados de exactitud diagnóstica fueron estadísticamente similares, con sensibilidad muy baja (50 y 54%, respectivamente), alta especificidad (99% en ambos casos), alto CPP y deficiente CPN. Usando nPCR la OR diagnóstica fue 162 (IC95%=66-401) y el área bajo la curva ROC fue 95%, mientras que con qPCR fueron 231 (IC95%=27-1951) y 78%, respectivamente. Conclusiones. Mediante un protocolo exhaustivo se demostró el bajo desarrollo de investigaciones sobre la exactitud diagnóstica de la GG en MAE. Se demostró que la microscopía tiene un desempeño deficiente para el diagnóstico de infecciones asintomáticas o de baja parasitemia, lo que afianza la importancia de implementar otro tipo de técnicas en el seguimiento y control de las infecciones por malaria en las gestantes, con el fin de lograr el control y posible eliminación de la MAE.

ABSTRACT Objective. To evaluate the accuracy of thick smear (TS) versus quantitative polymerase chain reaction (PCR) for pregnancy-associated malaria (PAM). Materials and methods. We carried out a systematic review of diagnostic tests in nine databases. Methodological quality was evaluated with QUADAS. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the ROC curve were estimated. Heterogeneity was determined with the Der Simonian-Laird Q method and uncertainty with the weighted percentage of each study on the overall result. Results. We included 10 studies with 5691 pregnant women, 1415 placentas and 84 neonates. In the studies with nested PCR (nPCR) and quantitative PCR (qPCR) as the standard, the diagnostic accuracy results were statistically similar, with very low sensitivity (50 and 54%, respectively), high specificity (99% in both cases), high PLR and poor NLR. When nPCR was used, the DOR was 162 (95%CI=66-401) and the area under the ROC curve was 95%, while with qPCR it was 231 (95%CI=27-1951) and 78%, respectively. Conclusions. We demonstrated that research on the diagnostic accuracy of TS in PAM is limited. Microscopy showed poor performance in the diagnosis of asymptomatic or low parasitemia infections, which reinforces the importance of implementing other types of techniques for the follow-up and control of malaria infections in pregnant women, in order to achieve the control and possible elimination of PAM.

Healthcare Inequities Experienced by Patients with Cancer: A Qualitative Study in Medellín, Colombia.

Purpose: This study aimed to understand the lived experiences of patients with cancer that facing inequities in oncological care in the city of Medellín. Patients and Methods: A qualitative study was conducted based on the theoretical and methodological elements of the grounded theory, specifically the description and conceptual ordering of Corbin and Strauss. Sixteen patients with cancer, who belonged to low (n=5), middle (n=4) and high (n=7) social classes, were included by theoretical sampling with category saturation. Data were collected using semi-structured interviews and analyzed in a category system based on the three social classes. Results: The patients were aged between 23 and 71 years old, and they were diagnosed with different types of cancer such as breast, cervical, prostate, stomach, leukemia and lymphoma. Patients' experiences showed that diagnosis, specialized care, treatment and hospital discharge were different based on their social class. Conclusion: Patients' lived experiences associated with cancer reflect complex social situations, in which social determinants affect the level of citizens' empowerment and self-management against the risks of get disease and die. Being part of low and middle social classes meant being subjected to a dehumanized, cold, impersonal and discontinuous treatment, in which healthcare was focused on the disease instead of individuals' preferences and values. In contrast, patients belonging to the high class had the resources necessary to face risks, which ensured access to more humanized and individualized healthcare.

Frequency of gestational malaria and maternal-neonatal outcomes, in Northwestern Colombia 2009-2020.

Research on Gestational Malaria (GM) is scarce in America's. In the few available studies in Colombia, the analysis of immunological or parasitological aspects predominates, with few analyzes of epidemiological aspects. The objectives were to determine the frequency of GM and submicroscopic infections (positive with PCR and negative with thick blood smears), to identify obstetric and malaria history associated with GM, and to describe maternal and neonatal outcomes associated with GM, in northwestern Colombia. A retrospective study with records of 825 pregnant women was conducted. qPCR and thick blood smear were performed. Frequencies were determined with 95% confidence intervals. Comparisons were made with the Chi-square test, Mann-Whitney U test, and prevalence ratios adjusted in a log-binomial model. The frequency of GM was 35.8% (95% CI 32.4-39.1) of submicroscopic infection was 16.2% (95% CI 13.7-18.8). According to the multivariable model, the subgroups with the highest frequency of GM were pregnant women without healthcare coverage (32.3%), in the third trimester of pregnancy (30.5%), nulliparous (35.6%), and with a previous diagnosis of malaria in the current pregnancy (64.0%). GM was associated with more frequency of gestational anemia, infection in neonates, and lower birth weight. The results indicate in a precise and direct way that malaria control in this northwestern region of Colombia is far from adequate, which is even more serious considering the affectations for the mother and the neonate.