Feasibility and Acceptability of Personalized Breast Cancer Screening (DECIDO Study): A Single-Arm Proof-of-Concept Trial.

The aim of this study was to assess the acceptability and feasibility of offering risk-based breast cancer screening and its integration into regular clinical practice. A single-arm proof-of-concept trial was conducted with a sample of 387 women aged 40-50 years residing in the city of Lleida (Spain). The study intervention consisted of breast cancer risk estimation, risk communication and screening recommendations, and a follow-up. A polygenic risk score with 83 single nucleotide polymorphisms was used to update the Breast Cancer Surveillance Consortium risk model and estimate the 5-year absolute risk of breast cancer. The women expressed a positive attitude towards varying the frequency of breast screening according to individual risk and, especially, more frequently inviting women at higher-than-average risk. A lower intensity screening for women at lower risk was not as welcome, although half of the participants would accept it. Knowledge of the benefits and harms of breast screening was low, especially with regard to false positives and overdiagnosis. The women expressed a high understanding of individual risk and screening recommendations. The participants' intention to participate in risk-based screening and satisfaction at 1-year were very high.

Views of health professionals on risk-based breast cancer screening and its implementation in the Spanish National Health System: A qualitative discussion group study.

BACKGROUND: With the aim of increasing benefits and decreasing harms, risk-based breast cancer screening has been proposed as an alternative to age-based screening. This study explores barriers and facilitators to implementing a risk-based breast cancer screening program from the perspective of health professionals, in the context of a National Health Service. METHODS: Socio-constructivist qualitative research carried out in Catalonia (Spain), in the year 2019. Four discussion groups were conducted, with a total of 29 health professionals from primary care, breast cancer screening programs, hospital breast units, epidemiology units, and clinical specialties. A descriptive-interpretive thematic analysis was performed. RESULTS: Identified barriers included resistance to reducing the number of screening exams for low-risk women; resistance to change for health professionals; difficulties in risk communication; lack of conclusive evidence of the benefits of risk-based screening; limited economic resources; and organizational transformation. Facilitators include benefits of risk-based strategies for high and low-risk women; women's active role in their health care; proximity of women and primary care professionals; experience of health professionals in other screening programs; and greater efficiency of a risk-based screening program. Organizational and administrative changes in the health system, commitment by policy makers, training of health professionals, and educational interventions addressed to the general population will be required. CONCLUSIONS: Despite the expressed difficulties, participants supported the implementation of risk-based screening. They highlighted its benefits, especially for women at high risk of breast cancer and those under 50 years of age, and assumed a greater efficiency of the risk-based program compared to the aged-based one. Future studies should assess the efficiency and feasibility of risk-based breast cancer screening for its transfer to clinical practice.

Barriers and Facilitators to the Implementation of a Personalized Breast Cancer Screening Program: Views of Spanish Health Professionals.

This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included the advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. The risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, the workload of health professionals, and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance, and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges.

Qualitative evaluation of a support group for women with children with Zika congenital syndrome in Southern Colombia.

PURPOSE: To qualitatively evaluate the perceived benefits of participation in a support group (SG) for mothers of children with Congenital Zika Syndrome (CZS) in Southern Colombia. METHODS: The "Women of Zika" SG was running in Sourthern Colombia from August 2018 to December 2019. The evaluation was carried out between October and December 2019, 21 women participated and the information was collected in three group discussions and non-participant observation. A thematic content analysis of the data was carried out with the support of Atlas ti-v8. RESULTS: Women's discourses assessing the perceived benefits of participating in the SG were organized under three categories according to the three dimensions of social support: "Teaching and learning from each other: the SG as a source of information support," "Coping with adversity: the SG as a source of emotional support" and "Creating your own identity: the SG as a source of relational support." CONCLUSION: The SG has been an important source of social support for women with children with CZS and it meant had a shared space where they developed individual and collective agency capacities. SGs can be a useful strategy for social and therapeutic support for families with children with multiple disabilities, such as CZS.Implications for rehabilitationCaring after children with CZS has negative implications on the mental health and quality of life of these women.Specific interventions need to be developed to improve the quality of life of mothers of children with CZS.Support groups are an effective strategy for providing social support to women with children with different disabilities such as CZS.

Caring for children with Congenital Zika Syndrome: The unmet needs of mothers in Southern Colombia.

ABSTRACTIn Latin America, the Zika virus (ZIKV) epidemic of 2015-2016 resulted in children being born with a spectrum of neurological disorders called Congenital Zika Syndrome (CZS). Women are the primary caregivers of those children. The objective of the study was to identify the perceived needs of women to care for their children with CZS in Southern Colombia. In 2019, a qualitative ethnographic study was conducted in southern Colombia, including 21 women belonging to a self-managed support group and who had prenatal ZIKV between 2015 and 2016 and, as a consequence, their children were born with CZS. Three discussion groups and six semi-structured interviews were conducted and analyzed through qualitative content analysis. Three main perceived needs to care for their children were identified: knowledge and skills to provide the complex care their children require and for which they did not feel prepared, economic and social support. This study showed that women face unmet needs when caring for their children with CZS, especially regarding social support. Therefore, it is urgent to generate public policies and intervention strategies for professionals to support these women in order to meet not only the needs of their children but also their own.

Experiencias de mujeres jóvenes colombianas mastectomizadas: un estudio etnográfico / Experiences of young mastectomised Colombian women: An ethnographic study

Objetivo: Explorar las experiencias de un grupo de mujeres jóvenes en relación con la reconstrucción de sus senos posterior a la mastectomía. Método: Etnografía focalizada realizada en la Liga Contra el Cáncer-Seccional Huila, Colombia. Mediante un muestreo casual orientado por criterio se realizaron entrevistas semiestructuradas a 8 mujeres jóvenes (diagnosticadas a los 45 años o antes) con cáncer de mama (reconstruidas o no después de la mastectomía) hasta conseguir saturación del discurso. La recogida de datos se efectuó entre agosto-noviembre de 2017, después de contar con el aval del comité de ética y el consentimiento de las participantes. Los datos se analizaron mediante la técnica del análisis temático posteriormente a ser anonimizados. Resultados: En los discursos de las mujeres emergieron 3 temas: el estigma social de ser una mujer joven con cáncer de mama; aprendiendo a vivir con un cuerpo transformado por la enfermedad y el tratamiento, y sobrevivir, eso es lo importante. Conclusiones: Ser una mujer joven y padecer cáncer de mama implica una diversidad de cambios que alteran de forma permanente las vidas de las mujeres y su corporalidad. Las mujeres priorizan sobrevivir para cuidar de los otros sobre la reconstrucción de los senos. A nivel sanitario, se debe incorporar la perspectiva cultural y de género para diseñar intervenciones enfermeras individualizadas que contribuyan a una mejor atención.(AU)

Objective: To explore the experiences of a group of young women in relation to the reconstruction of their breasts after mastectomy. Method: Focused ethnography, performed in the League against Cancer- Huila Section (Colombia). Through casual sampling oriented by criteria, semi-structured interviews were conducted with eight young women (diagnosed at 45 years or earlier) with breast cancer (reconstructed or not reconstructed after mastectomy) until saturation of discourse. Data collection was carried out between August-November 2017, after the endorsement of the Ethics Committee and the consent of the participants. Data was analysed using the thematic analysis technique after being anonymised. Results: Three issues emerged in the women's discourses: The social stigma of being a young woman with breast cancer; learning to live with a body transformed by disease and treatment, and surviving, which is the most important thing. Conclusions: Being a young woman, and suffering from breast cancer implies a diversity of changes that permanently alter the lives of women and their bodies. Women prioritise survival in order to take care of others over breast reconstruction. At a healthcare level, the cultural and gender perspective must be incorporated to design individualised nursing interventions that contribute to better care.(AU)

Experiences of young mastectomised Colombian women: An ethnographic study. / Experiencias de mujeres jóvenes colombianas mastectomizadas: un estudio etnográfico.

OBJECTIVE: To explore the experiences of a group of young women in relation to the reconstruction of their breasts after mastectomy. METHOD: Focused ethnography, performed in the League against Cancer- Huila Section (Colombia). Through casual sampling oriented by criteria, semi-structured interviews were conducted with eight young women (diagnosed at 45 years or earlier) with breast cancer (reconstructed or not reconstructed after mastectomy) until saturation of discourse. Data collection was carried out between August-November 2017, after the endorsement of the Ethics Committee and the consent of the participants. Data was analysed using the thematic analysis technique after being anonymised. RESULTS: Three issues emerged in the women's discourses: The social stigma of being a young woman with breast cancer; learning to live with a body transformed by disease and treatment, and surviving, which is the most important thing. CONCLUSIONS: Being a young woman, and suffering from breast cancer implies a diversity of changes that permanently alter the lives of women and their bodies. Women prioritise survival in order to take care of others over breast reconstruction. At a healthcare level, the cultural and gender perspective must be incorporated to design individualised nursing interventions that contribute to better care.

[Experience of women with prenatal Zika virus infection who continued gestation in Colombia]. / Experiencia de mujeres con infección prenatal por virus Zika que continuaron la gestación en Colombia.

OBJECTIVE: To understand the decision-making process of a group of women to continue gestation following a prenatal Zika virus infection and the diagnosis of microcephaly of their fetuses. METHOD: Qualitative study. Two discussion groups and semi-structured interviews were conducted with 21 women residing in the Department of Huila (Colombia) who presented a prenatal Zika virus infection between 2015 and 2016, their children were born with congenital microcephaly. The data were analyzed following the Grounded Theory approach. RESULTS: Four categories emerged from the analysis of the data showing a temporal process, from before to taking the decision to continue gestation following prenatal Zika virus infection to its consequences. The process begins with the diagnosis virus infection during the first trimester of gestation, continuing with medical recommendations to interrupt gestation and women's refusal to interrupt gestation, and ending with the birth of children with congenital microcephaly. CONCLUSION: Women rejected abortion due to ethical conflicts based on religious beliefs and the value of motherhood. It is necessary to design social support policies for women and families affected by this problem in Colombia. Due to the international impact of the epidemic, governments should take appropriate measures to deal with future cases of Zika infections in other countries.

Una aproximación desde la etnografía focalizada al papel de la religiosidad durante la vivencia del cáncer de mama / An approach from ethnography focused on the role of religiosity during the experience of breast cancer

Resumen En este trabajo se exploró el papel de la religiosidad durante la vivencia del cáncer de mama de un grupo de mujeres del sur de Colombia. Se realizó una etnografía focalizada donde participaron 17 mujeres que padecen cáncer de mama en cualquier estadio de la enfermedad y que habían concluido el primer año de tratamiento. La información se recolectó a través de un grupo de discusión y diez entrevistas semiestructuradas. El análisis temático se utilizó para el tratamiento de los datos. Para las mujeres, la religiosidad fue esencial para la aceptación del padecimiento, al asumirlo como una oportunidad de crecimiento personal y, además, la consideraron una fuente de afrontamiento durante el padecimiento. Se concluye que acercarse al papel de la religiosidad, desde las voces de las mujeres, devela el esencial papel que juega durante la trayectoria del cáncer de mama y la imperiosidad de la inclusión de la atención religiosa como un componente esencial para las mujeres durante el padecimiento del cáncer de mama. Asimismo, es un llamado a la importancia que la investigación sobre este padecimiento no se centre solo desde una perspectiva biomédica.

Abstract This work explored the role of religiosity during the experience of breast cancer of a group of women in southern Colombia. A focused ethnography was carried out where 17 women who suffer from breast cancer at any stage of the disease and who had completed the first year of treatment participated. The information was collected through a discussion group and ten semi-structured interviews. The thematic analysis was used to treat the data. For the women, religiosity was essential for the acceptance of the illness, assuming it as an opportunity for personal growth and also, they considered it a source of coping during the illness. It is concluded that approaching the role of religiosity, from the voices of women, reveals the essential role it plays during the breast cancer trajectory and the need of the inclusion of religious care as an essential component for women during the illness. It also calls for the importance that research on this illness not be focused only from a biomedical perspective.

Feasibility and acceptability of personalised breast cancer screening (DECIDO study): protocol of a single-arm proof-of-concept trial.

INTRODUCTION: Personalised cancer screening aims to improve benefits, reduce harms and being more cost-effective than age-based screening. The objective of the DECIDO study is to assess the acceptability and feasibility of offering risk-based personalised breast cancer screening and its integration in regular clinical practice in a National Health System setting. METHODS AND ANALYSIS: The study is designed as a single-arm proof-of-concept trial. The study sample will include 385 women aged 40-50 years resident in a primary care health area in Spain. The study intervention consists of (1) a baseline visit; (2) breast cancer risk estimation; (3) a second visit for risk communication and screening recommendations based on breast cancer risk and (4) a follow-up to obtain the study outcomes.A polygenic risk score (PRS) will be constructed as a composite likelihood ratio of 83 single nucleotide polymorphisms. The Breast Cancer Surveillance Consortium risk model, including age, race/ethnicity, family history of breast cancer, benign breast disease and breast density will be used to estimate a preliminary 5-year absolute risk of breast cancer. A Bayesian approach will be used to update this risk with the PRS value.The primary outcome measures will be attitude towards, intention to participate in and satisfaction with personalised breast cancer screening. Secondary outcomes will include the proportions of women who accept to participate and who complete the different phases of the study. The exact binomial and the Student's t-test will be used to obtain 95% CIs. ETHICS AND DISSEMINATION: The study protocol was approved by the Drug Research Ethics Committee of the University Hospital Arnau de Vilanova. The trial will be conducted in compliance with this study protocol, the Declaration of Helsinki and Good Clinical Practice.The results will be published in peer-reviewed scientific journals and disseminated in scientific conferences and media. TRIAL REGISTRATION NUMBER: NCT03791008.

"It was God's will": Continuing pregnancy after perinatal infection by Zika virus.

OBJECTIVE: to understand the influence of the religious beliefs on the decision of a group of women residing in the Huila Department to continue their pregnancies despite perinatal infection by the Zika virus. METHOD: a focused ethnography. The participants were 21 women who had presented a perinatal infection by the Zika virus and whose babies were born with congenital microcephaly. 2 discussion groups and 6 semi-structured interviews were conducted, and thematic analysis was used for data treatment. RESULTS: three themes emerged, namely: "God, why me?" is the initial questioning of the women to God for the prenatal diagnosis of microcephaly in their babies, "Clinging to a divine miracle" describes how the women did not lose their faith and begged for a divine miracle for their babies to be born healthy, and "It was God's will" means acceptance, resignation, and respect for God's will, as well as the denial to abort despite the medical recommendations. CONCLUSION: religiosity and religious beliefs were determinant factors in the women's decision to continue their pregnancies. It becomes necessary to continue investigating this theme to understand their experiences and to generate follow-up and support actions from nursing care.

"It was God's will": Continuing pregnancy after perinatal infection by Zika virus / "Era a vontade divina": continuar a gestação depois da infecção perinatal pelo vírus Zika / "Era la voluntad divina": continuar el embarazo después de una infección perinatal por el virus del Zika

Objective: to understand the influence of the religious beliefs on the decision of a group of women residing in the Huila Department to continue their pregnancies despite perinatal infection by the Zika virus. Method: a focused ethnography. The participants were 21 women who had presented a perinatal infection by the Zika virus and whose babies were born with congenital microcephaly. 2 discussion groups and 6 semi-structured interviews were conducted, and thematic analysis was used for data treatment. Results: three themes emerged, namely: "God, why me?" is the initial questioning of the women to God for the prenatal diagnosis of microcephaly in their babies, "Clinging to a divine miracle" describes how the women did not lose their faith and begged for a divine miracle for their babies to be born healthy, and "It was God's will" means acceptance, resignation, and respect for God's will, as well as the denial to abort despite the medical recommendations. Conclusion: religiosity and religious beliefs were determinant factors in the women's decision to continue their pregnancies. It becomes necessary to continue investigating this theme to understand their experiences and to generate follow-up and support actions from nursing care.

Objetivo: compreender a influência das crenças religiosas na decisão de um grupo de mulheres residentes no Departamento de Huila de continuar a gestação apesar da infecção perinatal pelo vírus Zika. Método: etnografia focalizada. Participaram 21 mulheres que haviam apresentado infecção perinatal pelo vírus Zika, cujos filhos nasceram com microcefalia congênita. Foram realizados 2 grupos de discussão e 6 entrevistas semi-estruturadas e foi utilizada a análise temática para o tratamento dos dados. Resultados: três temas surgiram: "Deus: por que comigo?" é um questionamento inicial das mulheres a Deus devido ao diagnóstico pré-natal de microcefalia do(a) filho(a), "Apegar-se a um milagre divino" descreve como as mulheres não perderam a fé e imploraram por um milagre divino para que seus filhos nascessem sadios e "Era a vontade divina" significa a aceitação, resignação e respeito pela vontade divina e a negação a abortar, apesar das recomendações médicas. Conclusão: a religiosidade e as crenças religiosas foram determinantes na decisão das mulheres de continuar a gestação. Faz-se necessário continuar a indagação sobre esse tema, para compreender as experiências dessas mulheres e criar ações de acompanhamento e apoio a partir dos cuidados de enfermagem.

Objetivo: comprender la influencia de las creencias religiosas en la decisión de un grupo de mujeres residentes en el Departamento de Huila de continuar sus embarazos a pesar de la infección perinatal por el virus del Zika. Método: etnografía focalizada. Participaron 21 mujeres que habían presentado una infección perinatal por el virus del Zika y cuyos hijos nacieron con microcefalia congénita. Se realizaron 2 grupos de discusión y 6 entrevistas semi-estructuradas y se utilizó el análisis temático para el tratamiento de los datos. Resultados: surgieron tres temas: "Dios: ¿Por qué a mí?" es el cuestionamiento inicial de las mujeres a Dios por el diagnóstico prenatal de microcefalia de sus hijos(as), "Aferrarse a un milagro divino" describe cómo las mujeres no perdieron la fe e imploraron por un milagro divino para que sus hijos nacieran sanos, y "Era la voluntad divina" significa la aceptación, resignación y respeto por la voluntad divina y la negación a abortar a pesar de las recomendaciones médicas. Conclusión: la religiosidad y las creencias religiosas fueron factores determinantes en la decisión de las mujeres de continuar sus embarazos. Se hace necesario profundizar la investigación en este tema para comprender sus experiencias y generar acciones de acompañamiento y apoyo desde el cuidado de Enfermería.

Viviendo con "Él" en la casa: experiencia del cáncer de mama hereditario / Living with "it" at home: the experience on hereditary breast cancer

El cáncer de mama hereditario es un fenómeno que afecta de manera particular a mujeres jóvenes. Sus experiencias están fuertemente influenciadas por la convivencia con mujeres de sus familias que lo han padecido. Por esto vivir en sus hogares con "él", el cáncer de mama, da cuenta de la cercanía de este padecimiento en la cotidianidad de la vida. Este relato biográfico nos acerca a la experiencia de una mujer joven que padece cáncer de mama, quien ha convivido con "él" y las consecuencias de su tratamiento en la figura de su madre, una sobreviviente de la enfermedad. así, ante el diagnóstico, este hecho tuvo gran influencia en su firme decisión de sobrevivir con un cuerpo lo más parecido al anterior de la irrupción de la enfermedad. De esta manera la reconstrucción de sus senos se convirtió no solo en su fin último, sino también en la forma de sentir que venció la batalla contra el cáncer

Hereditary breast cancer is a phenomenon afflicting mainly young women. their experiences are strongly influenced by living altogether with female relatives who suffered it. Therefore, to live at home with "it", that breast cancer, reflects how close is the disease in their daily lives. This biographical correlate brings us a young woman's experience who suffers breast cancer, who lives with "it" and its treatment consequences looking into the mirror of her mother, a cancer survivor. So, in this way, given the diagnosis, this fact exerted great influence in her stubbornness to survive with a body resembling that one before disease. Hence, her breasts reconstruction became not only her ultimate end, but also a way to feel she won her battle against cancer

El aborto legal en Colombia: opiniones de un grupo de estudiantes de Enfermería / Legal abortion in Colombia: Opinion by colombian nursing students' opinions / O aborto legal na Colômbia: conceitos dum grupo de estudantes de Enfermagem

Resumen Introducción: En el año 2006, el Estado colombiano legalizó el aborto en tres situaciones específicas, mediante la Sentencia C-355, marcando un hito importante en una sociedad impregnada por fuertes valores patriarcales. Sin embargo, han sido escasos los estudios adelantados sobre las experiencias de los principales actores implicados en este fenómeno social, como los profesionales de la salud y las mujeres. Objetivo: Indagar por las opiniones de los estudiantes de último año del Programa de Enfermería de la Universidad Surcolombiana acerca de la Sentencia C-355 de 2006, que legaliza el aborto en tres situaciones específicas, en Colombia. Metodología: Se realizó un estudio cualitativo exploratorio. Participaron veintiséis estudiantes, seleccionados con un muestreo por conveniencia hasta saturar la información. Para recolectar esta, se crearon tres grupos de discusión y se hicieron tres entrevistas a profundidad, observados mediante análisis de contenido. Resultados: Las opiniones acerca de la Sentencia son favorables, por sus beneficios sociales y en pro de la defensa de los derechos de las mujeres. El tema emergente en los discursos construidos fue el impedimento que significan, para la aceptación del aborto en Colombia, los fuertes valores patriarcales impregnados en la sociedad, los cuales son reforzados por los "discursos de verdad" de la Iglesia y la institucionalidad médica. Conclusiones: Se hace necesario persistir en la socialización de la Sentencia entre las intuiciones y los profesionales de la salud, y en el aborto legal y los derechos de las mujeres como un tema de discusión pública y política; para esto, es imprescindible la labor conjunta de la academia e investigadores, con las organizaciones sociales defensoras de los derechos de las mujeres.

Abstract Introduction: In 2006, the Colombian government legalized abortion for three specific situations by means of sentence C-355, setting an important milestone in a society soaked by strong patriarchal values. Nevertheless, studies regarding these experiences of the main actors, as well as Healthcare professionals and women involved in this social phenomenon have been scarce. Objective: To ask senior students of the nursing program at Universidad Surcolombiana their opinion regarding sentence C-355 of 2006, which legalized abortion for three specific situations in Colombia. Methodology: A qualitative exploratory study was conducted. 26 students participated and they were selected using convenience sampling until saturation of the information. To collect the data, three discussion groups were created, and three in-depth interviews were conducted. Both were observed using content analysis. Results: Opinions regarding the sentence are favorable, because of its social benefits and it is in Pro of Defending women's rights. The topic arising in the constructed discourses was the impediment to accept abortion in Colombia, as a result of those strong patriarchal values that have soaked society, which are reinforced by the church's "discourses of the truth" as well as those of medical institutions. Conclusions: it is necessary to persist on the socialization of the sentence in institutions and among healthcare professionals, and to persist on legal abortion and women's rights as a topic for public and political discussion. To do so, academia and investigators must work together with social organizations defending women's rights

Resumo Introdução: No ano 2006, o Estado colombiano legalizou o aborto em três situações específicas, mediante a Sentencia C-355, gravando um hit importante numa sociedade imbuída por fortes valores patriarcais. Contudo, tem sido escassos os estudos adiantados alusivos aos experienciais dos mais relevantes atores envolvidos neste fenómeno social, como os professionais da saúde e as mulheres. Objetivo: Pesquisar pelos pareceres dos alunos de último ano do Programa de Enfermagem da Universidade Surcolombiana concernente da Sentencia C-355 de 2006, que legaliza o aborto nas três situações específicas, na Colômbia. Metodologia: Se realizou um estudo qualitativo exploratório. Participaram vinte e seis alunos, escolhidos com uma amostragem por conveniência até saturar a informação. Para colher ela, se criaram três grupos de discussão e se fizeram três entrevistas a profundidade, enxergados mediante análises de conteúdo. Resultados: As repercussões alusivas a esta Sentencia são favoráveis, pelos seus proveitos sociais em pro da defesa dos direitos das mulheres. O tema emergente nos discursos construídos foi a barragem que traduzem, para a aceitação do aborto na Colômbia, as fortes crenças patriarcais inseridas na sociedade, as quais são reforçadas pelas "palestras da verdade" das Igrejas e a institucionalidade médica. Conclusões: Se faz quesito teimar na socialização da Sentencia entre as instituições e os profissionais da saúde, e no aborto legal e os direitos das mulheres como um tópico de discussão pública e política; para isto, é imprescindível o trabalho enxuto da academia e investigadores de mãos dadas com as organizações sociais paladinas dos direitos das mulheres.

Prácticas discursivas y resistencias como nuevas subjetividades femeninas en el riesgo heredado del cáncer de mama / Discursive practices and resistance as new female subjectivities in the inherited risk of breast cancer

La biopolítica de la molecularización de la vida argumenta como en las sociedades contemporáneas, a partir de los desarrollos de la industria biotecnológica y las amplias posibilidades de capitalización de sus resultados, el cuerpo lejos de pensarse como un ensamblaje de todas sus partes, se construye a partir de visibilizar lo que en otras épocas era invisible: los genes. Esto trae consigo que el interés no se centre en la enfermedad sino en el riesgo, su control y modificación. Así, se propone un análisis de la emergencia de las nuevas subjetividades femeninas que produce la molecularización de la vida: las prácticas discursivas de optimización de la supervivencia, y las prácticas de resistencias, la vigilancia y las ciudadanías biológicas construidas desde abajo. Un resultado de lo anterior se refleja en el desarrollo de herramientas para la identificación de biomarcadores moleculares específicos BRCA 1/2 que identifican y cuantifican el riesgo heredado del cáncer de mama en las mujeres con antecedentes familiares de la enfermedad. Con esto, la susceptibilidad al cáncer de mama hereditario se ha convertido en una forma emergente de la vida y un proyecto biomédico que identifica y trata a las personas sin síntomas con el fin de prevenir la aparición de la enfermedad(AU)

The molecularization of Biopolitics substantiates how in contemporary societies, based on the achievements of biotechnological industry and the great possibilities of results' applications, the body is built by making visible the invisible instead of an assembly of its parts: the genes. This brings about that the interest is not centered in disease but in risk, its control and modification. An example of the above-mentioned is seen in the development of tools to identify precise molecular biomarkers BRCA 1/2 capable of identifying and quantifying the inherited risk of breast cancer in women with family history of this disease. Therefore, an analysis of the emergence of the new female subjectivities, resulting from such life molecularization, was suggested: the discursive practices of survival optimization and the practices of resistance, the surveillance and the biological citizenships built from the bottom(AU)

Percepción del aborto: voces de los médicos en el Hospital de San José (Bogotá) / The perception of abortion: voices from physicians at Hospital de San Jose (Bogotá) / Percepção do aborto: as vozes dos médicos no Hospital de San José (Bogotá)

Resumen Objetivo.Comprender la percepción acerca de la interrupción voluntaria del embarazo (IVE), bajo las tres causales definidas en la Sentencia C-355 del 2006, en un grupo de médicos del Hospital de San José, Bogotá-Colombia. Metodología.Estudio cualitativo hermenéutico. La muestra se configuró con quince médicos del servicio de Ginecología y Obstetricia seleccionados por muestreo teórico y el tamaño de la muestra se determinó por saturación de la información. Los datos se obtuvieron mediante entrevistas a profundidad que fueron analizadas con la propuesta de Heidegger, Diekelman, Allen y Tanner. Resultados.La Sentencia C-355 de 2006, fue percibida como una disposición necesaria que le reconoce a la mujer el derecho a decidir sobre su vida y reproducción; además, ofrece una interrupción del embarazo segura. Asimismo, aporta a la disminución de problemáticas sociales, del sistema de salud y familiares; aunque en la sociedad colombiana persiste una percepción negativa de la IVE. No obstante, señalaron las falencias de la Sentencia: ausencia en las definiciones del concepto de salud y del límite de semanas de gestación para acceder a la IVE; y de atención psicológica y genética posterior a la interrupción. Discusión.La Sentencia es un avance significativo para Colombia. A pesar de aceptar la IVE, los participantes reconocen los cuestionamientos que nacen de esta práctica y que son producto de sus valores religiosos y familiares, y de la estigmatización social del aborto. Conclusiones Es inminente la revisión de la Sentencia y la participación de los médicos en este proceso.

Abstract Objective:to understand the perception that a group of physicians at Hospital de San Jose (Bogota-Colombia) have regarding voluntary abortion (VA) under the three causes defined by Sentence C-355/2006. Methodology: a qualitative hermeneutic study with a sample of 15 doctors from the Gynecology & Obstetrics ward who were selected by theoretical sampling. Sample size was defined through information saturation. Data were obtained through in-depth interviews which were analyzed using the approaches proposed by Heidegger, Diekelman, Allen and Tanner. Results:Sentence C-355/2006 was perceived as a necessary concept to empower woman´s right to decide on her life and reproduction; besides, it offers a safe form of VA. Also, the sentence helps in reducing social, health system and family problems; although a negative view of VA persists in Colombian society in general. However, the physicians did point out the sentence´s limitations: the lack of a definition of health, the fact that there is not a defined limit of pregnancy weeks to apply for VA and no psychological or genetic care after the procedure. Discussion:the sentence is a significant advancement in Colombia. In spite of accepting VA, participants do recognize the questioning regarding VA, which are derived from their religious and family values and the social stigma around abortion. Conclusions it is highly necessary to review this sentence, and physicians should participate in this process.

Resumo Objetivo:Compreender a percepção sobre a interrupção voluntária da gravidez (IVG), sob três as causais definidas na Sentença C-355 do ano 2006, em um grupo de médicos do Hospital de San José, Bogotá-Colômbia. Metodologia:Pesquisa qualitativa hermenêutica. A amostra configurou-se com quinze médicos do serviço de Ginecologia e Obstetrícia selecionados por amostragem teórica, e o tamanho da amostra determinou-se por saturação da informação. Os dados obtiveram-se por meio de entrevistas de profundidade que foram analisadas com a proposta de Heidegger, Diekelman, Allen e Tanner. Resultados:A Sentença C-355 de 2006 foi percebida como uma disposição necessária que reconhece às mulheres os direitos a decidir sobre a sua vida e reprodução; além disso, oferece uma segura interrupção da gravidez. Do mesmo modo, contribui com a diminuição de problemas sociais, do sistema de saúde e familiares, mesmo que a sociedade colombiana continua com uma percepção negativa da IVG. Contudo, indicam-se a falências da Sentença: ausência nas definições do conceito de saúde e do limite de semanas de gravidez para aplicar a IVG; e de atendimento psicológico e de genética posterior à interrupção. Discussão:A Sentença é um avanço significativo na Colômbia. Embora aceitem a IVG, os participantes reconhecem seus questionamentos a esta prática, consequência dos seus valores religiosos e familiares, também da estigmatizarão social do aborto. Conclusões:É necessarío revisar a Sentença e que os médicos participem neste processo.

La vivencia de la pre-eclampsia: una dura travesía para la cual no se está preparada / Experience of preeclampsy: hardship for an unprepared woman

Objetivo: Describir las experiencias vividas por las mujeres con una gestación por preeclampsia severa en el Hospital de San José de la ciudad de Bogotá, Colombia. Método: Estudio cualitativo fenomenológico. Participaron diez mujeres puérperas que presentaron preeclampsia severa y fueron atendidas en el Hospital de San José durante el año 2012. Las participantes fueron seleccionaron mediante un muestreo intencional. El tamaño de la muestra se determinó por el criterio de saturación de la información. La información se recolectó mediante de una entrevista a profundidad y los datos se analizaron mediante la propuesta de Colaizzi. Resultados: La vivencia de la enfermedad dio cuenta de tres grandes categorías. Dos de ellas, la vivencia de la mujer, y con su hijo prematuro, emergieron como travesías que narraron el duro camino recorrido por el binomio madre-hijo desde su hospitalización hasta la recuperación de los dos en el hogar y los diferentes soportes con los que contó. Estas trayectorias estuvieron marcadas por sentimientos de miedo, angustia, incertidumbre; el sufrimiento por los síntomas físicos y el sometimiento a dolorosos procedimientos médicos. La tercera categoría dio cuenta de la falta de preparación de las participantes para enfrentarse a la enfermedad y todo lo que conllevaba. Conclusiones: Es necesario el fortalecimiento de las redes de apoyo primario y el papel de Enfermería como soporte para las gestantes; así como la revisión de las condiciones de hospitalización. La preparación para el impacto emocional y las consecuencias de afrontar una preeclampsia es un aspecto que se pudiera abordar durante el control prenatal.

Objective: To describe life experiences suffered by pregnant women with severe preeclampsia who were attended at Hospital de San José (Bogotá). Method: Qualitative phenomenological study. Ten puerperal women who suffered severe preeclampsia and were attended at Hospital San José during 2012 participated in the study. They were selected by intentional sampling; sample size was defined by saturation criteria. Information was collected by in-depth interview and data were analyzed by Colaizzi's proposal. Results: Study on disease's experiences rendered three categories. Two of them, the woman's life experience and women-premature newborn perception emerged as hardships who narrated the pathway of the pair from their hospitalization to their recovery at home. This pathway was signed by feelings such as fear, anguish, uncertainty, suffering due physical symptoms and to undergo painful medical procedures; their different supports are mentioned as well. Third category referred to lack of preparation of participants to engage disease and its implications. Conclusions: Primary health support networks, role of Nursing as support service for those pregnant women so affected and review of hospitalization conditions should be strenghtened. Preparation for emotional impact and the consequences of preeclampsia are issues to be discussed during antenatal control.

La realidad de la práctica: vivencias de un médico frente a la interrupción voluntaria del embarazo / The reality of the practice: experiences of a physician on voluntary interruption of pregnancy

La Interrupción voluntaria del embarazo (IVE) irrumpió en la sociedad colombiana en medio de un controvertido debate no ajeno a los profesionales de la salud, al despenalizarse el aborto bajo tres situaciones: cuando la gestación constituye peligro para la vida o la salud de la mujer, ante malformaciones del feto y cuando el embarazo es producto de acceso carnal o acto sexual sin consentimiento. En este contexto, Carlos, un médico ginecólogo que realiza la subespecialidad en Medicina Materno-fetal nos describe su vivencia frente a la IVE y relata cómo se convierte en un recurso cuando la gestación no se considera viable, sin dejar de ser una dolorosa vivencia para las mujeres que se someten a este procedimiento. A pesar de sus fuertes valores religiosos, con la experiencia de la práctica médica, considera la IVE como una manera para mitigar algunas problemáticas sociales y la mortalidad materna en Colombia

Voluntary interruption of pregnancy (VIPR) burst into colombian society amidst a controversy quite related to health professionals. Abortion was decriminalized under three circumstances: a) when pregnancy is a danger for woman's life or health; b) when there are fetal malformations; c) when pregnancy derives from rape or sexual intercourse without consent. In this context, Carlos, a gynecologist and fellow of maternal-fetal medicine, describes us his experiences on VIPR and describes how it becomes a resource when pregnancy is non-viable, being at the same time a painful remembrance for women who underwent it. In spite of strong religious beliefs, he considers VIPR as physician as a way to mitigate some social problems and maternal mortality in Colombia