Cervical cancer screening coverage in the Americas region: a synthetic analysis.

Background: The Americas region has the lowest (North America) and the second highest (Latin America and Caribbean) cervical cancer (CC) mortality worldwide. The lack of reliable data on screening coverage in the region hinders proper monitoring of the World Health Organization (WHO) CC elimination initiative. Methods: For this synthetic analysis, we searched data on CC screening coverage from official sources and national health surveys, supplemented with a formal WHO country consultation. Context data were obtained from official sources (income, health expenditure, inequality-adjusted human development index -IHDI-, universal health coverage, CC incidence/mortality). Country age-specific coverages for 2019 by screening interval were computed. Missing data were imputed through a multi-step algorithm. Beta-regression and Poisson-regression models were used to analyse associations between context variables, screening coverage, and CC mortality. Findings: We included data from 37 countries in the Americas. Data on coverage of HPV testing was scarce, and for many countries only Pap-smear coverage data was available. Overall, 78%, 34%, 60%, and 67% of women aged 25-65 years have been screened ever in their lifetime, and in the previous year, 3 years, and 5 years, respectively. By sub-region, 3-year coverage ranges from 48% (South America) to 72% (North America). Twenty-four countries showed screening coverage below 70%. Income and health system type were associated with screening coverage, but coverage was not associated with CC mortality. Interpretation: In the Americas region 35.1% and 56.8% of countries report 3-year and 5-year coverage over 70%, respectively. Inequalities remain a major challenge for screening programs in the region. The elimination campaign should reinforce the transition to HPV testing and strengthen surveillance systems. Funding: Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020.

Is it feasible to enhance quality assurance of cervical cancer screening in Latin America? A regional expert consensus.

OBJECTIVES: Cervical cancer elimination requires high-performance screening tests and high treatment rates, and thus high screening program performance is essential; however, Latin America lacks organized screening and quality assurance (QA) guidelines. We aimed to develop a core set of QA indicators suitable to the region. METHODS: We reviewed QA guidelines from countries/regions with highly organized screening programs and selected 49 indicators for screening intensity, test performance, follow-up, screening outcomes and system capacity. A regional expert consensus using the Delphi method in two rounds was implemented to identify basic indicators actionable within the regional context. The panel was integrated by recognized Latin American scientists and public health experts. They voted for the indicators blinded to each other based on feasibility and relevance. The correlation between both attributes was analyzed. RESULTS: In the first round 33 indicators reached consensus for feasibility but only 9 for relevance, without full coincidence. In the second round 9 indicators met the criteria for both (2 screening intensity, 1 test performance, 2 follow-up, 3 outcomes, 1 system capacity). A significant positive correlation was observed for test performance and outcomes indicators between the two attributes assessed (p < 0.05). CONCLUSIONS: Cervical cancer control requires realistic goals supported by proper programs and QA systems. We identified a set of indicators suitable to improve cervical cancer screening performance in Latin America. The assessment by an expert panel with a joint vision from science and public health practice represents a significant progress towards real and feasible QA guidelines for countries in the region.

Cervical cancer screening programs in Latin America: current recommendations for facing elimination challenges.

OBJECTIVE: To describe current cervical cancer screening program guidelines in Latin America. MATERIALS AND METHODS: We searched official recommendations for the general population and women living with HIV (WLHIV) by reviewing official sources from 19 countries; these data were supplemented with a consultation carried out by the WHO with the Ministries of Health. RESULTS: Screening policies vary significantly in regard to target populations, primary tests, and screening intervals. Sixteen countries have recently updated their recommendations; however, cytology remains the primary screening test for most countries. Eleven countries have introduced HPV tests, and eight countries have implemented screen-and-treat algorithms; only three countries have developed evidence-based guidelines. All countries but Costa Rica have specific recommendations for WLHIV. CONCLUSIONS: Although most countries have updated their screening policies, only a few are properly alig-ned with the WHO elimination strategy. Recommendations for WLHIV require better integration with cervical cancer screening programs.

High-risk human papillomavirus infection among women living with HIV in Latin America and the Caribbean: A systematic review and meta-analysis.

We carried out a systematic review to summarize available data regarding prevalence of high-risk human papillomavirus (HR-HPV) among women living with HIV (WLHIV) in Latin America and the Caribbean (LAC). A literature search in PubMed and LILACS was conducted and supplemented with cross-referencing and grey literature. The primary outcome was prevalence of HR-HPV by age as a major determinant of HPV infection. Pooled prevalence and weighted averages were obtained. A random effects meta-analysis conducted for HPV- and HIV-associated factors. In total, 6157 women from 19 cross-sectional studies were included. Weighted prevalence of HR-HPV in WLHIV was 51.0% (95% CI 42.8-59.1, I2 = 97.4%) with a bimodal trend by age. No association between antiretroviral therapy and HR-HPV prevalence was observed, but low CD4 cell count was associated (PR 1.64, 95% CI 1.07-2.52). Although not significant, a higher HR-HPV prevalence was observed with Hybrid Capture 2 versus PCR. The high prevalence of HR-HPV among WLHIV in LAC underlines the need for improved cervical cancer prevention and early detection in this vulnerable population. Moreover, the high prevalence across age groups, and particularly in young women, deserves careful consideration for defining target populations of HPV-based screening and HPV immunization programs.

Cancer Research in the Time of COVID-19: A Colombian Narrative.

Cancer research is deficient in Colombia and efforts and resources diverted due to the COVID-19 pandemic could worsen the situation. We explore the impact of the pandemic on cancer research funding, output, and conduct. We sought information at national level and used the experience of an academic reference center to contrast the impact at institutional level. We searched databases and official documents of national governmental institutions, trial registries, hospital registries, and the Web of Science. We interviewed principal investigators (PIs) to retrieve information on the conduct of cancer research. A decline in resource availability and new proposals was observed at the national level with a shift to COVID-19 related research. However, at institutional level there was no decline in the number of cancer research proposals. The predominance of observational studies as opposed to the preponderance of clinical trials and basic science in high-income countries may be related to the lower impact at institutional level. Nevertheless, we found difficulties similar to previous reports for conducting research during the pandemic. PIs reported long recovery times and a great impact on research other than clinical trials, such as observational and qualitative studies. No significant impact on research output was observed. Alternatives to ensure research continuity such as telemedicine and remote data collection have scarcely been implemented given limited access and low technology literacy. In this middle-income setting the situation shows a notable dependency of international collaborations to develop research on COVID-19 and cancer and to overcome challenges for cancer research during the pandemic.

Perspectivas de pacientes y profesionales en torno al uso de medicinas alternativas y complementarias para el cuidado del cáncer: un estudio exploratorio / Perception of Alternative and Complementary Medicine for Cancer Care among Patients and Health Professionals: An Exploratory Study

Introducción: el uso de medicinas alternativas y complementarias (MAC) por pacientes oncológicos es una práctica extendida, generalmente por fuera del tratamiento principal. La falta de entendimiento entre percepciones de pacientes y profesionales puede derivar en problemas de comunicación con repercusión negativa en el cuidado. Objetivo: indagar por coincidencias y divergencias en la percepción de pacientes y profesionales frente al uso de MAC en el paciente oncológico. Métodos: estudio exploratorio con análisis interpretativo fenomenológico mediante grupos focales, usando dominios prestablecidos. Se realizó codificación manual independiente y, posteriormente, se agruparon los códigos para su interpretación. El agrupamiento fue triangulado con el equipo de investigación para generar categorías definitivas. Resultados: surgieron dos categorías: conceptualización y vivencia frente a MAC. Cada categoría incluye subcategorías similares (p. ej., denominaciones, uso de MAC) y diferenciales (p. ej. valoración, fundamentación), entre los dos grupos. La conceptualización reconoce cómo los participantes caracterizan la MAC y la vivencia identifica la forma y vías como se relacionan con la MAC. Conclusiones: pacientes y profesionales comparten inquietudes frente al uso de MAC, pero existen diferencias en lenguaje y expectativas frente a su uso. Para los pacientes el consejo médico es relevante pero no definitivo y la evidencia científica solo es relevante para los profesionales.

Educación basada en competencias para estudiantes de medicina sobre la prevención y detección temprana del cáncer / Competency-based education for medical students on prevention and early detection of cancer

La presente revisión analiza los aspectos necesarios para la formación de médicos en prevención y detección temprana del cáncer, profundizando en la educación basada en competencias, dada la importancia de este modelo a la hora de diseñar planes de estudio para la formación médica; además, se habla acerca del impacto que genera el fortalecimiento de las habilidades de los médicos en la materia. A lo largo del texto se describen aspectos, tanto en el contexto colombiano como a nivel internacional, con respecto al sistema de educación actual, las falencias encontradas en los planes de estudio de las carreras de medicina, la definición de competencias y la relevancia de este modelo para el entrenamiento de médicos sobre las estrategias de prevención primaria y secundaria del cáncer. Se hace evidente la necesidad de evaluar los contenidos curriculares en materia de prevención y detección temprana del cáncer, resaltando la importancia de la intervención médica a la hora de desarrollar acciones para la prevención y cribado de los principales tipos de cáncer; es necesaria la implementación de planes educativos que faciliten el desarrollo de habilidades en los profesionales y permitan superar los desafíos actuales de la atención médica en esta área

A literature review is presented that analyses the necessary aspects for medical education about cancer prevention and its early detection, placing an emphasis on the competency-based education model and the impact generated through the improvement of medical skills in this area. A description is also presented on the aspects related to the current educational system in Colombia, the flaws found in different medical programs about this subject, the definition of competency-based education, and the relevance of this model when it comes to training physicians on the primary and secondary prevention strategies for cancer. The present review shows the need to evaluate the curriculum contents on cancer prevention and early detection, highlighting the importance of medical interventions when developing prevention and screening strategies for the main cancer types. The need to implement education plans that help to develop competencies in the professionals that will enable them to overcome the current challenges of medical care in this area

Síndrome Infantil de Muerte Súbita: nuevos conceptos y una misma solución / New concepts but the same solution regarding sudden infant death syndrome

El Síndrome Infantil de Muerte Súbita (SIMS) es la primera causa de muerte en niños entre un mes y un año de vida. Se define como la muerte inesperada de un infante menor de un año, en la que se ha realizado un análisis completo de la muerte y no se encuentra una causa aparente. A nivel mundial las campañas de sueño seguro han demostrado reducción de la mortalidad infantil, sin embargo, aún existe desconocimiento de las recomendaciones preventivas dentro los profesionales de la salud y los padres, lo cual pone en riesgo a un alto número de lactantes. Se han encontrado múltiples asociaciones con factores que aumentan el riesgo para desarrollar SIMS, algunos asociados a la madre o el entorno y otros propios del infante. Debido al gran impacto que genera la reducción de factores de riesgo extrínsecos, dentro de los cuales dormir en decúbito prono o decúbito lateral es el de mayor asociación, sumado a la promoción de factores protectores como la lactancia materna, es importante que las recomendaciones preventivas se instauren desde el periodo prenatal. Este artículo presenta un recuento de la evidencia actual acerca de los factores de riesgo modificables y las prácticas de "sueño seguro", con el fin último de prevenir muertes por SIMS.

Sudden infant death syndrome (SIDS) is the main cause of death in one month to one year-old children. This syndrome is defined as being the unexpected death of an infant under one year of age, where there has been a complete investigation and there has not been an apparent cause of death. Campaigns aimed at preventing this syndrome have revealed an important reduction in infant mortality worldwide; however, many healthcare workers and parents are still ignorant about preventative measures aimed at providing a safe sleeping environment for infants. Due to the great impact of external risk factor prevention, the prone or lateral sleeping position is the most important factor associated with SIDS occurring. Protective measures like breastfeeding play an important role; preventative recommendations must be promoted during prenatal counselling. This article reviews current evidence concerning modifiable risk factors regarding SIDS and "safe sleep" practice aimed at preventing SIDS-related deaths.