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Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes. [ABSTRACT FROM AUTHOR]

Young people in Colombia present high rates of mental health problems, to which the country’s history of armed internal conflict contributes in complex ways. Mental health services in Colombia are fragmented, inadequate, and difficult to access for many. Young people’s help)seeking is often hindered by mental health stigma and/or poor experiences with services. This paper presents a thematic analysis of qualitative data from a mixed-methods study aimed at developing and testing a mental health intervention for Colombian youths. We draw upon theoretical lenses from scholarly work on stigma and Sen’s ‘capabilities approach’ to inform our analysis of interviews and group discussions with staff and young people involved in the state-funded human capital building programme ‘Jovenes en Acción’ (JeA). By illustrating how study participants talked about stigma, vulnerability, mental health services organisation, and the challenges of discussing mental health topics in a learning environment, we illuminate aspects of mental health support and anti-stigma interventions that might need enhancing. In particular, we suggest that more emphasis on ‘community competencies’ as complementary to and interrelated with individual competencies would strengthen young people’s individual and collective resources for mental wellbeing while being in line with the sociocritical principles of existing human capital-enhancing programmes. [ABSTRACT FROM AUTHOR]

Background: In Colombia, the rapid rise of illicit opioid use has become a major public health concern. Medications for opioid use disorder (MOUD) are well established and effective. However, access to MOUD remains suboptimal in this country. This paper aims to understand barriers to accessing MOUD in Colombia to inform the integration of this treatment modality in health systems. Methods: This study is a cross-sectional survey among persons with opioid use disorder (OUD) not enrolled in MMT in four Colombian cities with high known OUD prevalence. Survey domains consisted of the Barriers to Treatment Inventory, attitudes pertaining to MOUD treatments, and perceptions regarding interventions to ease access to Methadone. Results: A total of 84 subjects completed the survey. The most commonly endorsed barriers were related to admission difficulties, including concerns with "too many steps to get into treatment" (84.3%), experiencing withdrawal symptoms (78.1%), being placed on waiting lists (48.2%), and cost (44.6%). Nearly all participants were receptive to Methadone dispensation in primary care (96.4%) or mobile vans (91.6%). Conclusions: Findings from this study highlight persistent barriers to linking with MOUD among adults with OUD in Colombia requiring increased outpatient treatment programs, flexible methadone dosing, and administrative and financial support for patients. [ABSTRACT FROM AUTHOR]

The neoliberal reforms of the early 1990s in Colombia, mainly labour and social security reforms, transformed capital-labour relations and contributed to the erosion of working conditions and health protection at work, with devastating impacts on workers' health. In the context of these dramatic changes, Colombian workers mobilised around collective identities that have shaped new forms of workers' struggle and resistance. Since 2006, associations of workers suffering work-related illnesses have been active in Colombia. The associated workers engaged in collective actions have demanded from employers, the Ministry of Work, occupational risk administrators, disability rating boards and the judicial system the recognition of certain diseases as being of occupational origin and that these entities guarantee corresponding labour, economic and social security rights. This paper describes and analyses the dynamics of the struggle for the right to health at work undertaken by these associations in Colombia, adopting an analytical perspective inspired by collective action theory. [ABSTRACT FROM AUTHOR]

Concepts such as active citizenship and critical consciousness are increasingly relevant to enable students to meet the challenges of tomorrow. Additionally, self-reflection is a powerful tool to observe the development of abstract concepts such as these. This qualitative exploratory study examined the extent to which university students in Colombia enhanced their critical consciousness and a sense of active citizenship through projects focused on cases of violence against social leaders in their region. During the project, 93 students in four academic cohorts wrote a total of 155 reflections related to their experiences. These were analyzed using qualitative content analysis with the AtlasTi software. The results evidenced a shift in students' critical consciousness including a deeper understanding, a recognition of significance, an acknowledgement of privilege, and an awareness of the connection between local and global issues in relation to the topic of the project. In addition, traits of active citizenship were observed such as a sense of collective responsibility, a desire to contribute, a sense of empowerment, and growth in empathy. This research demonstrates the potential for authentic locally based project topics for developing active citizenship and enhancing critical consciousness as well as reinforcing the potential for reflections to demonstrate such development. [ABSTRACT FROM AUTHOR]

Objective(s):Colombia has the third largest black population in the Americas after Brazil and the USA. In 2005 mortality rate under 5 in Colombia was 21.5 per 1000, with a reduction of 82% between 2005 and 1955. That rate is not in line with rates for Cuba (6.8), Chile (9.1) or Costa Rica (10.4). Here we aim to provide evidence that a further reduction of child mortality relates to the unspoken racial gap in a pioneering country in family planning and praised in the 2000 WHO report as having the world’s fairest health care reform in terms of coverage and financial access. Design:The lack of nationally representative data to estimate black/white differences in child mortality is overcome by using the ratio of children born and alive as the measure of mortality and the 2005 census data from IPUMS-I, which provides racial categories based on self-identification. The working sample contains 617,985 mothers between 15 and 49 years of age, of whom 7.7% have experienced the death of at least one child. Using individual weights, a logistic regression is regressed on race, individual and community socio-economic status (SES), and demographic variables. Second, a model by cohort is regressed to capture the evolution of the racial gap over time. Third, interactions are run to examine the racial gap across SES groups. Results:The chances of losing a child are over 25% higher among black mothers relative to white mothers after controlling for individual and community SES characteristics. The racial gap remains stagnant and high for the period 1955–2005. The racial gap also is robust to changes in education and income levels. Conclusion:Failing to account for race slows down the improvement of child survival in Colombia relative to other countries of the region. [ABSTRACT FROM PUBLISHER]

The assessment and promotion of the psychological well-being in people and communities affected by the armed conflict are pending tasks for the Colombian health system. This study aimed to analyze the extent to which the dimensions of social support and quality of life significantly predict psychological well-being in survivors of the armed conflict in Colombia. For this purpose, a structural equation model describing the links between these variables was developed. A predictive cross-sectional design allowed confirming significant differences between a sample of 272 survivors (Mage = 43.24, SD = 14.25, range 18–85) and other 212 participants not affected by the armed conflict (Mage = 32.42, SD = 12.03, range 18–69). Using a Mann Whitney U test, the results revealed that both samples differed in all the dimensions of quality of life and social support, with the exception of the dimensions Environment and Instrumental. In survivors specifically, psychological well-being positively correlated with both quality of life (r =.40, p. <.01) and social support (r =.30, p. <.01). A binary logistic regression correctly classified 72.4% of the sample of survivors revealing that the model acceptably classifies this population according to their level of well-being. The structural equation model developed showed a good fit GFI y TLI ≥.93, RMSEA ≤.06, CFI e IFI ≥.95. In addition to contributing to the existing knowledge about psychological well-being in survivors, the findings provide guidelines that allow the improvement and reinforcement of public health actions and comprehensive reparation policies. [ABSTRACT FROM AUTHOR]

People with psychosocial disabilities are often discriminated against and experience violations of their human rights. With the QualityRights program, World Health Organisation highlights that one of element founding the quality of services is the respect for users' rights, in the belief that there is no quality of care without respect for human rights and vice versa. To date, studies explored the issue mainly in Europe. In this sense, the purpose of the study is to verify if the perception of respect for patients' rights is a component of organisational well-being for mental health workers in three countries of Latin America (Argentina, Colombia, Peru). A random sample representative of professionals working in three mental healthcare networks in Argentina, Colombia, and Peru was enrolled (n = 310). Each health worker completed a questionnaire on sociodemographic data and the Well-Being at work and respect for human rights (WWRR). The WWRR consists of seven items on satisfaction at work, beliefs about users' satisfaction in received care, the satisfaction of work's organisation, respect of users' and staff's human rights, adequacy of resources, and perceived needs of resources in the mental health service. The principal components analysis of the instrument was carried out with Varimax rotation and Kaiser normalisation (including all components with Eigen value > 1). The total explained variance was 67.2%. Item 6 saturated in one single factor, and the first five items saturated in factor 1 with factor loadings ranging from 0.52 to 0.86. Parallel test suggested a one-factor structure as acceptable. The results show in three countries of Latin America that the more workers perceive that the human rights of users are respected, the more satisfied they are of own work. This article confirms previous observations in Italy, North Macedonia, Tunisia and Palestine. [ABSTRACT FROM AUTHOR]

Prevention capacity of local health organisations is associated with the performance and outcomes in public health. In Colombia, where cardiovascular disease is the leading cause of morbidity and mortality, there is limited knowledge about the capacity of local health departments to prevent this condition. Efforts are needed to address problems, potential solutions and expected outcomes regarding cardiovascular disease. In this study, a conceptual model for cardiovascular disease prevention capacity in Colombian local health departments was developed, a questionnaire based on this model was validated, the overall cardiovascular disease prevention capacity in a subsample of these organisations was measured, and the association between cardiovascular disease prevention capacity and political, population, and organisational factors was examined. Once the acceptable performance of the questionnaire was verified, variability in cardiovascular prevention capacity was found among a subsample of local health departments. Furthermore, this study provides primary evidence regarding the association between the size of local health departments and overall cardiovascular disease prevention capacity in Colombia. Future studies should focus on measuring this capacity on a larger scale and developing, implementing, and evaluating interventions aimed at strengthening cardiovascular prevention capacity in Colombian local jurisdictions. [ABSTRACT FROM AUTHOR]

In some countries (e.g. Colombia), graphic health warnings (GHWs) for cigarette packages include both implicit and explicit images and certain keywords bolded in the text. The purpose of this study was to evaluate how these factors impact both perceived message effectiveness and message reactance in a group of non-smokers. We conducted an on-line experiment with a sample of 221 non-smoking young adults (ages 18–22 years). Participants were randomly divided into three groups (i.e. GHWs with regular font, GHWs with keywords in bold font and GHWs with keywords in bolder font). Each group was presented with four GHWs (two with implicit pictures and two with explicit pictures). The participants were asked a series of questions as a pre- and post-measure of attitudes toward smoking, smoking intentions, confidence in their ability not to smoke and crave. After viewing each image, participants were asked to answer questions pertaining to perceived message effectiveness, attention, message reactance and motivation not to smoke. A main effect of the picture was found for perceived message effectiveness, attention, reactance, and motivation not to smoke, pointing out that explicit pictures lead to significantly greater scores in all these measures. No significant effect was found for the alterations in font weight. GHWs containing explicit images proved to be more effective in preventing cigarette smoking in young adults. The results suggest that the change in the text design does not have an effect on the motivation not to smoke. [ABSTRACT FROM AUTHOR]

COVID-19 vaccination is a global priority. Latin American countries have some of the highest COVID-19 death rates worldwide with vaccination hampered by a variety of reasons, including mis- and disinformation, vaccine hesitancy, and vaccine supply constraints. Addressing vaccine hesitancy through effective messages has been found to help increase vaccine uptake. Participatory processes could be used to co-design health messages for this purpose. This article describes the methodology used to co-design evidence-based audio messages to be deployed in a cohort of individuals through an interactive voice response (IVR) mobile phone survey intervention, aimed towards increasing vaccination uptake in an adult population in Colombia. Participants of the COVID-19 vaccination message co-design process included a sample of the general population of the country, representatives of the funder organisation, and research team members. The co-design process consisted of four phases: (1) formative quantitative and qualitative research, (2) message drafting based on the results of the formative research, (3) message content evaluation, and (4) evaluation of the voices to deliver the audio messages; and was informed by reflexive meetings. Three categories of evidence-based audio messages were co-designed, each corresponding to an arm of the mHealth intervention: (1) factual messages, (2) narrative messages, and (3) mixed messages. An additional fourth arm with no message was proposed for control. The iterative co-design process ended with a total of 14 audio messages recorded to be deployed via the intervention. Co-developing health messages in response to health emergencies is possible. Adopting more context-relevant, participatory, people-centred, and reflexive multidisciplinary approaches could help develop solutions that are more responsive to the needs of populations and public health priorities. Investing resources in message co-design is deemed to have a greater potential for influencing behaviours and improving health outcomes. [ABSTRACT FROM AUTHOR]

With the Peace Agreement between Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised healthcare to 13,000 'reincorporating' FARC ex-combatants. Shortages of healthcare workers in reincorporation camps means this promise is in danger of going unfulfilled. More information is needed to determine incentives, disincentives, and recruitment of healthcare providers to address this shortage. Semi-structured interviews were conducted with healthcare providers across FARC reincorporation camps, and a multidisciplinary team conducted analysis in NVivo12 using a team-based coding method. Twenty-four healthcare professionals from 15 camps participated, of which 75% were female. Incentives to work with FARC included improved clinical skills, professional advancement, increased comfort with FARC, and contributing to the peace process. Disincentives included poor living conditions, lack of support, biases, familial commitments, and sacrificing career opportunities. Three-fourths of the sample recommended working with FARC, and 92% reported a shortage of healthcare workers. Recruitment strategies included improved resources and specialised career development for healthcare workers, facilitating interactions between FARC and healthcare professionals outside clinical scenarios, and integrating medicine for vulnerable populations into health education. This study shows the impact that working with FARC ex-combatants can have on healthcare providers and tangible suggestions for increasing provider participation to address the healthcare worker shortage. [ABSTRACT FROM AUTHOR]

Customer's trust in vendors' reputation is a key factor that facilitates economic transactions in e-commerce platforms. Although the trust-sales relationship is assumed robust and consistent, its empirical evidence remains neglected for Latin American countries. This work aims to provide a data-driven comprehensive framework for extracting valuable knowledge from public data available in the leading Latin American e-commerce platform with commercial operations in 18 countries. Only Argentina, Brasil, Chile, Colombia, Ecuador, Mexico, Uruguay, and Venezuela showed the highest trust indexes among all nations analyzed. The trust-sales relationship was statistically inconsistent across nations but worked as the most important predictor of sales, followed by purchase intention and price. [ABSTRACT FROM AUTHOR]

The present study's main objective was to evaluate the mediating role of spirituality in the relationship between sexual attraction and suicide risk. A cross-sectional study was designed for students' participation from colleges and universities in Barranquilla, Bogotá, and Villavicencio, Colombia. Sexual attraction was investigated using one question with six response options: opposite-sex attraction (OSA) and sexual minorities young (SMY), and with scales, suicide risk (Plutchik Suicide Risk Scale), and spirituality (three items). Three thousand and sixty four young people between 14 and 24 years old participated (M = 16.8, SD = 2.2); 61% were women. The group of SMY participants showed higher scores in suicide risk than the participants OSA. The OSA group showed greater spirituality than the SMY group. Spirituality mediated the relationship between sexual attraction and suicide risk, both in men and women, even after controlling for age. New research is needed in Colombian youth. [ABSTRACT FROM AUTHOR]

The study aimed to adapt and explore the psychometric performance of the Fear of COVID-19 Scale (FCV-19S) in the general Colombian population. The original FCV-19S is a 7-item scale that underwent an adaptation (Item 1 and 5 were deleted). From an online sample of 1,687 adults (59% female), exploratory and confirmatory factor analyses were performed for versions of the scale with 6 and 5 items. Cronbach's alpha and McDonald's omega were calculated. The confirmatory factor analysis showed that the 5-item scale (Fear of COVID-5) presented better indicators. In conclusion, the Fear of COVID-5 has acceptable performance in the Colombian population. [ABSTRACT FROM AUTHOR]

To identify potential protective mechanisms that might buffer the effects of the COVID-19 pandemic on well-being, the current set of studies (NStudy 1 = 1172, NStudy 2 = 451) examined the roles of hope and religious coping (positive and negative) in promoting well-being during periods when stringent stay-at-home orders were implemented in Colombia and South Africa to control the spread of SARS-CoV-2. After controlling for relevant sociodemographic characteristics (Studies 1 and 2), subjective health complaints, and sleep quality (Study 2), hope was positively associated with well-being and the relation between hope and well-being was moderated by religious coping. Whilst well-being was highest when levels of hope were high (irrespective of positive or negative religious coping levels), when reported hope was low, well-being tended to be higher when positive religious coping was high (Study 1) and negative religious coping was low (Study 2). Implications of the findings for maintaining well-being during a public health crisis are discussed. [ABSTRACT FROM AUTHOR]

The Unmet need for contraception increases unintended pregnancies and jeopardizes women's health and reproductive rights. Social determinants are associated with an unmet need for contraception. Still, it is unclear if age is a social determinant of disparities in reproductive health-related outcomes in all Colombian women regardless of marital status. This study used the 2015 Colombian Demographic and Health Survey to determine the unmet need for contraception among 24,245 sexually active women aged 13–49. Age was associated with the unmet need for contraception using a multivariate analysis. Absolute and relative inequalities were estimated using differences in prevalence and odds ratios, respectively. The prevalence of unmet need for contraception was significantly higher in married women aged 13–19 years old (19.8%) than their unmarried counterparts (16.8%), and all older age groups either married or unmarried. Women 13–19 years old [OR = 2.98 (2.49–3.57)] and 20–29 years old [OR = 1.71(1.48–1.97)] are more likely to have an unmet need for contraception than those 40–49 years old. Age disparities are barriers to attaining the Sustainable Development Goals for sexual and reproductive health. Cultural, social, and access barriers demand societies to tailor health care services to meet younger women's needs to narrow the age gap. [ABSTRACT FROM AUTHOR]

Objective: Worldwide research trends on the prevalence of hearing loss within young rural populations are scarce. Current evidence suggests extended high-frequency audiometry could be a sensitive predictor to detect subclinical hearing loss. This study aimed to determine the prevalence of hearing loss through conventional pure tone (0.25-8 kHz) and extended high-frequency (9-20 kHz) audiometry tests in a group of adolescents aged 13 to 19 years old from two rural areas of Colombia. A sociodemographic and associated factor for hearing loss questionnaire was applied. Design: Cross-sectional study. Study Sample: Three hundred sixty-six adolescents aged 13 to 19 years old from two rural municipalities in Colombia: Soracá, and Palmas del Socorro. Results: Hearing loss prevalence assessed through pure tone audiometry was 3.28% in right ears and 3.83% in left ears while through extended high-frequency audiometry was 14.21% and 13.11%, respectively. Associated factors found by the logistic regression were age (OR: 1.36; CI 95% 1.13-1.64) and obesity (OR: 3.74; CI 95% 1.07-13.11). Conclusions: Using 15 dB as the normal hearing threshold parameter for audiometric frequencies, our results suggest that extended high-frequency hearing loss is already widespread among rural adolescents. This highlights the need for research on extended high-frequency audiometry in rural schoolaged children. [ABSTRACT FROM AUTHOR]

Neuropsychological normative data for Latin America have been recently published, and for Colombia, in particular, but longitudinal neuropsychological outcomes after stroke have not yet been examined in this global region. The purpose of the current study was to compare functioning of individuals with stroke in Colombia, South America during the first year post-stroke to healthy controls across neuropsychological assessments of memory, language, and visuoperceptual impairments. A sample of 50 individuals with stroke (mean age = 51.58) and 50 matched healthy controls (mean age = 51.54) from Colombia were included in this study. Because of a lack of access to health services, individuals with stroke did not receive any inpatient or outpatient cognitive or behavioral rehabilitation. Participants were assessed on 10 visuoperceptual, language, and memory tasks at 3, 6, and 12 months. Trajectories of neuropsychological performance were significantly worse among individuals with stroke than healthy controls across every index. Further, hierarchical linear models suggested that although both individuals with stroke and controls generally improved over time on these assessments, the improvements among individuals with stroke were often of no greater magnitude than the improvements seen in controls, suggesting extremely low levels of rehabilitation gains in Colombia. Only three of the 10 neuropsychological assessments did a significant time*group interaction occur, suggesting greater gains for the stroke group than controls. These findings suggest profound disparities in post-stroke cognitive functioning in Colombia compared to other more developed global region and underscore the importance of comprehensive cognitive rehabilitation services for individuals with stroke in Colombia and other similar global regions. Because this study found only negligible cognitive improvements beyond practice effects over the first year after stroke in Colombia among individuals without access to acute rehabilitation, it is imperative that comprehensive cognitive rehabilitation services be implemented immediately during the acute rehabilitation period. Memory, language, and visuoperceptual training strategies can be implemented for people with stroke in underserved global regions as part of the standard of care for stroke rehabilitation. Cognitive rehabilitation strategies should be adapted into Spanish and pilot tested in Latin America to ensure cultural equivalence. Culturally competent cognitive rehabilitation strategies should be tailored based on varied educational and literacy levels. [ABSTRACT FROM AUTHOR]

These two cross-sectional studies examined whether trauma impacts disaster survivors' psychological well-being through its influence on positive and negative religious coping and on dispositional forgivingness and hope. Colombia was selected because it is a highly religious country that has endured a protracted armed conflict (1964-present) and recent, devastating natural disaster (2017 Mocoa landslide). Study 1 focused on 272 conflict survivors in Monteria; Study 2 focused on 1,651 landslide survivors. All participants completed Spanish versions of the PTSD CheckList-5, Kessler-10, Brief RCOPE, Trait Forgivingness Scale, Herth Hope Index, and Positive Psychotherapy Inventory. In Study 1, survivors' trauma contributed to greater negative religious coping, then to lower dispositional forgivingness and hope, and ultimately to lower well-being. Study 2 results replicated this finding and also revealed evidence that survivors' trauma contributed to higher positive religious coping, then greater dispositional forgivingness and hope, and ultimately better well-being. Implications for disaster research and practice are discussed. [ABSTRACT FROM AUTHOR]

People around the world spend hours of their daily lives using smartphones; therefore, it is important to conduct cross-cultural research on the effects of smartphone use on health and well-being as culture influences values, motivations and communication patterns. The purpose of this study was to explore 5 popular uses of the smartphone – messaging, browsing the Internet, posting social content, reading social content, and playing games – how they relate to anxiety and depression scores, and how they vary depending on the country of the participants: Spain, the United States, and Colombia. In all three countries the ranking of most popular uses was the same: (1) Messaging, (2) Reading social content, and (3) Browsing the Internet. In the USA, game playing contributed to anxiety scores whereas reading social content was a protective factor; regarding depression scores, text messaging was a contributing factor. In Spain, browsing the Internet contributed to anxiety scores; regarding depression scores, messaging was a contributing factor and posting social content was a protective factor. In Colombia, no specific use influenced anxiety scores; regarding depression scores, only game playing was a protective factor. Our results showed that in all the countries, problematic smartphone use contributed to anxiety scores. [ABSTRACT FROM AUTHOR]

Malnutrition contributes to nearly half of all preventable deaths in children under the age of five. While the burden of disease is heaviest in Sub-Saharan Africa, South, and Southeast Asia, malnutrition in Latin America remains high, especially within indigenous communities. This study evaluates the prevalence of malnutrition and its relationship with access to healthcare resources within 172 indigenous Wayuú communities in La Guajira, Colombia. Healthcare workers administered a health questionnaire and collected anthropometric measurements on all children 6 months to 5 years of age within the Wayuú households. These data were utilised to calculate the prevalence of acute malnutrition, stunting, and underweight. Of all surveyed Wayuú children, 22.9% and 18.3% met criteria for moderate and severe malnutrition, 33.4% and 28.1% met criteria for moderate and severe stunting, and 28.1% and 16.6% were moderately and severely underweight. Across all categories, malnourished children were older, less likely to have had a medical professional present at birth, less likely to have received medical care after birth, and more likely to have been born in a non-medical, community setting. The prevalence of malnutrition is much higher than national levels in Colombia. This population requires urgent assistance to address their disproportionately high rates of malnutrition. [ABSTRACT FROM AUTHOR]

Social Determination of Health (SDH)/Collective Health is a Latin American framework that sees the Marxist core concept of social class as fundamental for understanding health inequalities. In contrast to social stratification approaches, Marxist proposals seek to understand health as part of the historical transformations of capitalism's mode of production. In this article we aim to analyze the relationship between social class and health inequalities using data from the IV Oral Health National Study in Colombia. We conducted hierarchical cluster analyses to classify the population in five class positions and three living conditions clusters, which reflect how the spheres of production and social reproduction relate to social classes in Colombia. To measure oral health we use DMFT, as well as care and treatment needs indexes. Through variance analysis models we found that people from more exploited class positions and worse living conditions have more active disease and higher treatment needs. Despite technical and conceptual challenges, we conclude that a social class analytical framework can be operationalised via the interrelated spheres of production and social reproduction, which sheds light on the relationship between health inequalities and the class structure of the capitalist system. [ABSTRACT FROM AUTHOR]

In 1993, Law 100 introduced major reforms to Colombia's health system and regulated the health care industry. We analyzed the structure of the social space of Colombia's health system and the transformations that took place between 1993 and 2013. We conducted a socio-historical study using a theoretical framework based on concepts developed by Pierre Bourdieu. In addition to documentary analysis, interviews were conducted with 26 key agents. We found that private health insurance companies situated at the 'dominant' pole accumulated capital and power during the period under study, while public and private providers situated at the 'dominated' pole face serious economic challenges due to the loss of capital and power. Measures taken by the state, a major funder of the system, to regulate the market have proved to be ineffective, forcing intervention from the legal field. More than two decades after Law 100 was introduced, health remains on the political agenda and the subject of dispute. A permanent crisis in the sector prevails partly due to the contradiction that exists between protecting the right to health, and strengthening of a profit-orientated market, thus hindering the fulfillment of the principles of quality and equity. [ABSTRACT FROM AUTHOR]

Objectives:To test for differences in cardiovascular and metabolic risk (CMR) by educational attainment and physical capital. To compare CMR among black, indigenous, and mixed populations, accounting for socioeconomic status (SES). Design:We conducted multivariate analyses using cross-sectional data from a national survey of Colombian adults (n = 10,814) to examine the social patterning of CMR. In sex/gender-stratified models, a CMR index was regressed on educational attainment, physical capital, ethnicity/race, and age. Results:Women with a primary education (OR = 1.64, 95% CI: 1.25, 2.15) had higher age- and ethnicity/race-adjusted odds of CMR than women with more than secondary education. Men with a primary education (OR = 0.67, 95% CI: 0.48, 0.92) had significantly lower adjusted odds of CMR than men with more than secondary education; these associations did not remain significant after adjustments for physical capital. Men in the first (OR = 0.45, 95% CI: 0.36, 0.57) and second (OR = 0.72, 95% CI: 0.57, 0.91) physical capital tertiles had significantly lower adjusted odds of CMR than those in the highest tertile. There was not a significant patterning of CMR by ethnicity/race for women or men, or by physical capital for women. Conclusions:Findings suggest that for Colombian adults CMR is patterned by SES; these associations differ by sex/gender. [ABSTRACT FROM PUBLISHER]

Objective: To analyze sociodemographic factors, injection behavior, and the prevalence of hepatitis C and human immunodeficiency virus (HIV) among injection drug users (IDUs) in five cities of Colombia.Methods: We carried out a cross-sectional study of 1,123 people, using respondent-driven sampling (RDS). Prevalence of hepatitis C and HIV was estimated. The association between sociodemographic factors, injection behavior, and prevalence of hepatitis C and HIV syringe exchange was established, and raw and adjusted prevalence ratios were calculated.Results: Forty point three per cent of users share needles. Among IDUs, the HIV prevalence was 5.5%, and hepatitis C prevalence was 31.6%. Being male reduces the likelihood of sharing syringes. On the other hand, a secondary level of education, exchanging another part of the equipment and the increased consumption of crack are associated with syringe exchange.Conclusions: The existence of injector networks in cities of Colombia, and a lot of sharing of non-sterile and unclean injection equipment were recognized. [ABSTRACT FROM PUBLISHER]

The app for the System for Observing Play and Recreation in Communities (iSOPARC®) was developed to enhance System for Observing Play and Recreation in Communities data collection and management. The study aim was to examine the usability and inter-rater reliability of iSOPARC®. Trained observers collected data in 16 park areas in two Latin America cities (Curitiba, Brazil; Bogotá, Colombia) using both the original System for Observing Play and Recreation in Communities (mechanical counter) and new iSOPARC® (electronic counter) methods. A total of 8,707 park users (3,958 females and 4,749 males) were observed. Reliabilities among observers were determined using the intraclass correlation coefficient and relative overall agreement (%) in three ways: (a) mechanical versus mechanical, (b) mechanical versus electronic, and (c) electronic versus electronic. When both used mechanical counters comparisons overall agreement was over 78% (intraclass correlation coefficient  = .982;p < .001) for variables in all analysis. When one used a mechanical counter and the other used electronic (iSOPARC®) comparisons overall agreement was higher for age (84%;p < .001) than for physical activity (83%;p < .001) variables and average intraclass correlation coefficient was .965. Using both used iSOPARC® comparisons overall agreement was 81% to physical activity and 83% to age group. Results suggest iSOPARC® can be used reliably for examining variables previously validated in System for Observing Play and Recreation in Communities. [ABSTRACT FROM PUBLISHER]

Background: Heroin production in Colombia has increased dramatically in recent decades, and some studies point to an increase in local heroin use since the mid-1990s. Despite this rapid increase, little is known about the effects of these activities on heroin injection within Colombia. One of the biggest concerns surrounding heroin injection is the potential spread of HIV through drug user networks. Objectives: This article examines injection risk behaviors among heroin injectors in the Colombian cities of Medellín and Pereira to explore the implications for possible increased HIV transmission within this group. Methods: A cross-sectional study used respondent-driving sampling to recruit a sample of 540 people who inject drugs (PWID) over 18 years of age (Medellín: n = 242, Pereira: n = 298). Structured interviews with each participant were conducted using the World Health Organization Drug Injection Study Phase II Survey. An HIV test was also administered. Results: Information regarding the socio-demographics, injection drug use, HIV risk and transmission behaviors, injection risk management, and HIV knowledge and prevalence of participants are reported. The study identified many young, newly initiated injectors who engage in risky injection practices. The study also found that HIV prevalence is fairly low among participants (2.7%). Conclusions/Importance: Findings indicate a potential risk for the spread of HIV among PWID in Colombia given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Colombia has a possibly time-limited opportunity to prevent an HIV epidemic by implementing harm reduction interventions among young, newly initiated PWID. [ABSTRACT FROM AUTHOR]

Obesity-associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. Sixty-seven bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12 months post-operatively. The structured clinical interview for the DSM-IV Axis I disorders assessed major depressive disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12 months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g. older age) that may modify cognitive changes following surgery. [ABSTRACT FROM AUTHOR]

Aim: To examine what demographics and clinical factors are associated with the provision of assistive technology (AT) devices in a low-income country. Method: Retrospective cross-sectional exploratory study design including 15 of the 20 localities across Bogotá D.C., Colombia, a city with 6 776 009 inhabitants. Results: The type of AT device provided was significantly dependent ( p < 0.001) on the client's diagnosis, impairment, age, and socio-economic strata, whether the client has a care giver, the geographical zone in which the client lives, the year of the AT provision, and the total number of AT delivered. In contrast, the client's gender ( p > 0.05) and the client's affiliated type of healthcare service had no effect. In addition to that, the client's age, the client's socio-economic strata, the number of AT devices provided to the client, and the diagnostic type were the factors with the strongest level of association with the type of AT device provided. Conclusions: Our research showed that the provision of AT in Bogotá D.C. prioritizes both people who are at the highest levels of vulnerability, and as many people as possible with the budget. That is, the low socio-economic strata, younger and older people, and the provision of at least one AT device. [ABSTRACT FROM AUTHOR]

Objective: To assess health-related quality of life (HRQoL) of individuals with traumatic brain injury (TBI) in Barranquilla, Colombia. Participants/methods: Thirty-one individuals with TBI and 61 healthy controls completed the SF-36, a self-report HRQoL measure composed of eight component areas: physical health problems, pain, role limitations due to physical problems or due to emotional problems, emotional well-being, social functioning, energy/fatigue and general health perceptions. Results: The samples were statistically similar with respect to age, gender and education and statistically different with respect to depression, SES, social support and cognition. Compared to healthy controls, individuals with TBI had significantly lower means on all SF-36 sub-scales. However, after adjusting for depression, SES, social support and cognitive performance, significant differences remained on three of the SF-36 sub-scales. Specifically, individuals with TBI had lower adjusted means on Role-Physical ( p-value < 0.005), Role-Emotional ( p-value < 0.005) and Bodily Pain ( p-value < 0.05). Conclusion: Even after controlling for depression, SES, social support and cognitive performance, individuals with TBI living in Barranquilla Colombia report having poorer quality of life across various domains, including Role-Physical, Role-Emotional and Bodily Pain. These findings suggest the need for rehabilitation health professionals to develop and implement culturally-appropriate interventions to improve quality of life in Colombian individuals with TBI. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of self-generation on learning and memory in Spanish-speaking individuals with traumatic brain injury (TBI). Method: Thirty Spanish-speaking individuals with moderate-to-severe TBI and 31 healthy controls were recruited to read 32 individual sentences and required to remember the last word in each sentence. Target words were presented both in a self-generated and provided condition for each participant. Recall and recognition of the words were examined immediately, after 30 minutes and after 1 week. Results: Findings indicated that both healthy controls and individuals with TBI showed significantly better recall and recognition for words in the generated condition than words that had been provided to them at immediate, 30-minute and 1-week time intervals. Conclusion: The self-generation technique effectively improves learning and memory in Spanish-speaking individuals with TBI. Results should encourage researchers and clinicians to use the principles of cognitive psychology to adapt (as opposed to simply translate) cognitive rehabilitation protocols for use in Spanish-speaking populations with neurological conditions. [ABSTRACT FROM AUTHOR]