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BMC Public Health ; 21(1): 102, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419406


BACKGROUND: Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs-Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services. METHODS: Semi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk's Domains of Healthcare Access framework. RESULTS: Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system. CONCLUSIONS: FARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.

J Am Coll Emerg Physicians Open ; 1(5): 757-765, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33145516


Objectives: In the 2016 Peace Accord with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate 14,000 ex-combatants into the healthcare system. However, FARC ex-combatants have faced significant challenges in receiving healthcare, and little is known about physicians' abilities to address this population's healthcare needs. Methods: An electronic questionnaire sent to the Colombian Emergency Medicine professional society and teaching hospitals assessed physicians' knowledge, attitudes, and experiences with the FARC ex-combatant reincorporation process. Results: Among 53 participants, most were male (60.4%), and ∼25% were affected by the FARC conflict (22.6%). Overall knowledge of FARC reincorporation was low, with nearly two-thirds of participants (61.6%) scoring in the lowest category. Attitudes around ex-combatants showed low bias. Few physicians received training about reincorporation (7.5%), but 83% indicated they would like such training. Twenty-two participants (41.5%) had identified a patient as an ex-combatant in the healthcare setting. Higher knowledge scores were significantly correlated with training about reincorporation (r = 0.354, n = 53, P = 0.015), and experience identifying patients as ex-combatants (r = 0.356, n = 47, P = 0.014). Conclusion: Findings suggested high interest in training and low knowledge of the reincorporation process. Most physicians had low bias, frequent experiences with ex-combatants, and cared for these patients when they self-identify. The emergency department (ED) serves as an entrance into healthcare for this population and a potential setting for interventions to improve care delivery, especially those related to mental healthcare. Future studies could evaluate effects of care delivery following training on ex-combatant healthcare reintegration.

R I Med J (2013) ; 102(7): 40-43, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31480819


INTRODUCTION: Colombia represents a country in transition, from decades of devastating civil war to a post-conflict era of peace building, to the recent management of the influx of thousands of Venezuelan migrants. Brown University, along with Colombian partners, are leading the way in an international, multi-institutional consortium with the goal of emergency medicine capacitation across Colombia. Program Implementations: Through these collaborative efforts, exchange programs for residents and faculty alike have been successfully established. A baseline assessment of emergency medicine education for medical students is underway. By the end of 2019, the Harvard Humanitarian Initiative (HHI) will launch an online tool in multiple languages, including Spanish, to help medical and nursing educators conduct systematic needs assessments of the way in which conflict has impacted medical and nursing schools. CONCLUSIONS: Successful avenues for collaboration and partnership are described between Brown Emergency physicians and Colombian collaborating universities. These programs help to build capacity in Colombia and also provide education and support for residents and faculty at Brown University. Current work will see these programs grow into the future.

Serviços Médicos de Emergência/organização & administração , Medicina de Emergência/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Hospitais Universitários/organização & administração , Médicos/organização & administração , Guerra , Colômbia/epidemiologia , Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/normas , Medicina de Emergência/normas , Acesso aos Serviços de Saúde/normas , Humanos , Cooperação Internacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Refugiados , Rhode Island/epidemiologia
Rev. colomb. cardiol ; 25(3): 230-235, mayo-jun. 2018. tab
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-978229


Resumen Objetivo dar a conocer los efectos cardiovasculares secundarios al consumo de marihuana según lo reportado en la literatura médica. Métodos se realizó una búsqueda con los términos MESH "Cannabis", "Marijuana smoking" y "adverse effects" en la base de datos PubMed hasta el año 2016. Se obtuvieron 265 referencias. Se excluyeron cartas de editores, protocolos de investigación en proceso, población pediátrica (menores de 18 años), embarazadas, referencias en idiomas diferentes a inglés y español y se escogieron solo referencias relacionadas con efectos cardiovasculares. Resultados se han establecido dos tipos de receptores de cannabinoides, los CB1 y los CB2, con localizaciones a nivel del sistema nervioso central, endotelial, renal y músculo liso. En la actualidad el consumo de marihuana ha venido en aumento y los médicos poco conocen de sus efectos y los diferentes nombres comerciales para esta sustancia. Existen efectos protectores a nivel vascular con detención de la progresión de la placa aterosclerótica y a la vez múltiples efectos no deseados como taquicardia, hipotensión y bradicardia. Múltiples reportes de caso documentan la relación de la marihuana con el infarto agudo de miocardio con o sin lesión de las arterias coronarias, así como con hemorragia subaracnoidea, pero no existen mecanismos claramente descritos que expliquen una relación directa con estos desenlaces. Conclusiones se conoce la fisiopatología y los receptores donde actúan los cannabinoides generando efectos tanto protectores como dañinos. Existe fuerte correlación con enfermedad cardiovascular, principalmente síndrome coronario agudo, pero el mecanismo fisiopatológico aún no es claro.

Abstract Objective To determine the cardiovascular side-effects of smoking marihuana according to that reported in the medical literature. Methods A search was performed using the MeSH terms, "Cannabis", "Marijuana smoking" and "adverse effects", in the PubMed database up to the year 2016. A total of 265 references were obtained. The exclusion criteria were; Letters to the editor, protocols of research in process, paediatrics (less than 18 years), pregnancy, articles in languages other than English or Spanish. Only references associated with cardiovascular effects were collected. Results Two types of cannabinoid receptors, CB1 and CB2, have been defined and are located in the central nervous system, as well as in endothelial, renal and smooth muscle. The consumption of marijuana is increasing, and doctors know little about its effects, as well as the different marketing names used for this substance. There are protective effects at vascular level, with the slowing down of atherosclerotic plaques, as well as the many undesired effects such as, tachycardia, hypotension, and bradycardia. Many case reports document the association of marijuana with acute myocardial infarction with or without coronary artery lesions, as well as with subarachnoid haemorrhage, but there are no clearly described mechanisms that could explain a direct relationship with these events. Conclusions The pathophysiology is known, as well as where the cannabinoid receptors act to generate their protective and harmful effects. There is a strong association with cardiovascular disease, mainly acute coronary syndrome, but the pathophysiological is still not clear.

West J Emerg Med ; 18(6): 1120-1127, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29085546


INTRODUCTION: Emergency medicine (EM) is in different stages of development around the world. Colombia has made significant strides in EM development in the last two decades and recognized it as a medical specialty in 2005. The country now has seven EM residency programs: three in the capital city of Bogotá, two in Medellin, one in Manizales, and one in Cali. The seven residency programs are in different stages of maturity, with the oldest founded 20 years ago and two founded in the last two years. The objective of this study was to characterize these seven residency programs. METHODS: We conducted semi-structured interviews with faculty and residents from all the existing programs in 2013-2016. Topics included program characteristics and curricula. RESULTS: Colombian EM residencies are three-year programs, with the exception of one four-year program. Programs accept 3-10 applicants yearly. Only one program has free tuition and the rest charge tuition. The number of EM faculty ranges from 2-15. EM rotation requirements range from 11-33% of total clinical time. One program does not have a pediatric rotation. The other programs require 1-2 months of pediatrics or pediatric EM. Critical care requirements range from 4-7 months. Other common rotations include anesthesia, general surgery, internal medicine, obstetrics, gynecology, orthopedics, ophthalmology, radiology, toxicology, psychiatry, neurology, cardiology, pulmonology, and trauma. All programs offer 4-6 hours of protected didactic time each week. Some programs require Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Trauma Life Support, with some programs providing these trainings in-house or subsidizing the cost. Most programs require one research project for graduation. Resident evaluations consist of written tests and oral exams several times per year. Point-of-care ultrasound training is provided in four of the seven programs. CONCLUSION: As emergency medicine continues to develop in Colombia, more residency programs are expected to emerge. Faculty development and sustainability of academic pursuits will be critically important. In the long term, the specialty will need to move toward certifying board exams and professional development through a national EM organization to promote standardization across programs.

Educação de Pós-Graduação em Medicina/normas , Medicina de Emergência/educação , Internato e Residência/normas , Desenvolvimento de Programas/normas , Colômbia , Currículo , Medicina de Emergência/normas , Humanos , Avaliação de Programas e Projetos de Saúde