Influence of Positive Thinking Ideology on Physician Representations of Cancer.

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

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

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

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

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

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

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

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

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

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

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

Perfil de investigaciones en malaria asociada al embarazo: revisión sistemática 1925-2018 / Research profile in pregnancy-associated malaria: systematic review 1925-2018 / Perfil das pesquisas sobre malária associada à gravidez: Revisão sistemática 1925-2018

Resumen Objetivo: Describir el perfil de publicaciones en malaria asociada al embarazo en el ámbito mundial, con base en los países, tipos y años de estudio, 1925-2018. Metodología: Revisión sistemática de la literatura, mediante el seguimiento de la guía prisma y garantizando la reproducibilidad del protocolo de selección y extracción de variables. Se aplicaron doce estrategias de búsqueda en PubMed, Science Direct, SciELO y Google Scholar. Se realizó síntesis cualitativa mediante frecuencias para el país, año de estudio y tipología de investigación. Resultados: Se tamizaron 3362 publicaciones, de las cuales 617 cumplieron el protocolo. El 81,5 % fueron de África, 9,9 % de Asia y 5,3 % de América. La mayor proporción de publicaciones fue posterior al 2009. El 65,8 % fueron estudios observacionales; el 22,0 %, ensayos clínicos, y los estudios cualitativos, de evaluación económica o evaluación de programas y políticas, fueron menores al 5 %. No se hallaron estudios de pruebas diagnósticas, evaluación de programas o investigaciones cualitativas en América. Conclusión: El perfil de publicaciones evidencia el predominio de la investigación epidemiológica tradicional-positivista y su concentración en África, lo que implica retos para las agendas sanitarias y de investigación en salud pública, pero con mayor necesidad en América.

Abstract Objective: To describe the profile of publications on pregnancy-associated malaria worldwide, based on countries, types and years of study, 1925-2018. Methodology: Systematic review of the literature, by monitoring the PRISMA guide and guaranteeing the reproducibility of the variable selection and extraction protocol. Twelve search strategies were applied in PubMed, Science Direct, SciELO and Google Scholar. Qualitative synthesis was performed using frequencies for the country, year of study and type of research. Results: 3362 publications were screened, of which 617 complied with the protocol. 81.5% were from Africa, 9.9% from Asia and 5.3% from America. The highest proportion of publications was after 2009. 65.8% were observational studies; 22.0%, clinical trials, while qualitative studies, economic evaluation studies or evaluation studies of programs and policies accounted for less than 5%. No studies of diagnostic tests, evaluation of programs or qualitative research were found in America. Conclusion: The profile of publications shows the predominance of traditional-positivist epidemiological research and its concentration in Africa, which implies challenges for health and research agendas in public health, but with greater need in America.

Resumo Objetivo: Descrever o perfil das publicações sobre malária associada à gravidez no âmbito mundial, com base nos países, tipos e anos de estudo, 1925-2018. Metodologia: Revisão sistemática da literatura através do seguimento da recomendação PRISMA e garantindo a reprodutibilidade do protocolo de seleção e extração de variáveis. Foram aplicadas doce estratégias de busca em PubMed, Science Direct, SciELO e Google Scholar. Foi realizada síntese qualitativa através de frequências para o país, ano do estudo e tipologia de pesquisa. Resultados: Foram escolhidas 3362 publicações, das quais 617 cumpriram o protocolo. Um total de 81,5% foi da África, 9,9% da Ásia e 5,3% da América. O maior número proporcional de publicações foi posterior a 2009. Os estudos observacionais registraram 65,8%; os ensaios clínicos 22,0% e os estudos qualitativos, de avaliação econômica ou avaliação de programas e políticas registrados foram menores a 5%. Não foram encontrados estudos de testes diagnósticos, avaliação de programas ou pesquisas qualitativas na América. Conclusão: O perfil das publicações evidencia a predominância da pesquisa epidemiológica positivista tradicional e sua concentração na África, o que representa desafios para as agendas de saúde e de pesquisa em saúde pública, mas com uma necessidade maior na América.

Systematic review of qualitative studies about malaria in Colombia.

INTRODUCTION: The research about malaria in Colombia has centered mainly on the biomedical (clinical, parasitological, epidemiological and entomological) field, with little focus on qualitative research. PURPOSE: Analyzing social categories related to malaria in Colombia, based on qualitative studies published among scientific literature. METHODS: Systematic review following Cochrane and PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) recommendations. An ex-ante protocol was applied, comprehensive and reproducible for the search, screening, and extraction of information. Methodological quality was evaluated through SRQR (Standards for Reporting Qualitative Research). RESULTS: 10 studies complied with the protocol; these studies interviewed 500 infected or exposed subjects, program administrators, health professionals, and indigenous people. 40 categories were identified, which account for social-economical, cultural and ecological determiners of malaria; insights and ways to understand the disease at an individual level; malaria consequences, and medical attention, disease control and elimination actions. CONCLUSION: A wide variety of populations and subjects was considered. They show similar qualitative evidence on structural determiners, family-individual effects, and ways to understand malaria. Motivations to participate in disease interventions are less known, and they constitute the central axis for subsequent studies aimed to improve community engagement in disease control and elimination initiatives.

Conocimientos, actitudes y prácticas (CAP) sobre sostenibilidad en estudiantes de una universidad pública colombiana / Knowledge, attitudes, and practices (KAP) in sustainability among students of a colombian university

RESUMEN La educación para el desarrollo sostenible tiene el propósito de generar cambios en los conocimientos, las actitudes y las prácticas de las personas, para promover transiciones hacia la sostenibilidad. Los estudios de Conocimientos Actitudes y Prácticas (CAP) pueden ser una herramienta útil, oportuna y pertinente, para valorar los logros de la educación con orientación ambiental. Este estudio analizó el perfil de CAP sobre Sostenibilidad y sus factores asociados en estudiantes de una universidad pública colombiana, mediante un estudio descriptivo transversal, de 356 estudiantes universitarios. Se encontró que la dimensión con los puntajes más altos fue la de Actitudes, seguida por los Conocimientos y el más bajo para las Prácticas, y asociaciones con el sexo, la edad y el programa de formación al que pertenecen los estudiantes.

ABSTRACT The education for sustainable development aims at generating changes in people's knowledge, attitudes, and practices in order to promote transitions towards sustainability. Studies on Knowledge, Attitudes, and Practices (KAP) may become useful, timely and pertinent tools to assess the accomplishments of environmentally-oriented education. This study analyzed the profile of KAP in Sustainability, together with its associated factors, among students at a public Colombian university by means of a cross-sectional descriptive study which included 356 subjects. It found that attitudes dimension showed the highest scores, followed in decreasing order by knowledge and practices, as well as associations with gender, age, and the undergraduate program the students belong to.

[Social determination and determinants of malaria: a systematic review, 1980-2018Determinação social e determinantes sociais da malária: revisão sistemática, 1980-2018]. / Determinación y determinantes sociales de la malaria: revisión sistemática, 1980-2018.

OBJECTIVE: Describe how the 'social determination of health' approach has been applied in malaria studies around the world. METHODS: Systematic review of original studies published from 1980 to 2018. Six search strategies were used in ten multidisciplinary databases, and in libraries and repositories of seven universities in Brazil, Colombia, Ecuador, and Peru. PRISMA guidelines were followed, methodological quality was evaluated according to STROBE criteria, and a qualitative summary of the results was conducted. RESULTS: Ten studies published from 1984 to 2017 met pre-established inclusion and exclusion criteria; 33 social determinants of malaria were identified. Of individual determinants, greater malaria risk was found in adults, people who are often outdoors at night, and people who do not take preventive measures; intermediate determinants were dwellings with poor physical and sanitary infrastructure, overcrowded, located in forested areas, and containing animals. Regarding socioeconomic determinants, the people at greatest risk were involved in agro-forestry activities, migrants, and those with low income and a low educational level. Malaria caused high economic losses and led to poverty and educational delay. CONCLUSION: No studies were found that used Latin American social medicine approaches or that applied the World Health Organization's hierarchical and multilevel analysis for individual, intermediate, and structural determinants. No progress has been made in the analysis of social categories-territory, social class, gender, ethnic group, macroeconomic policies-or other socioeconomic characteristics that determine risk of illness or death from malaria.

OBJETIVO: Descrever como foi aplicado o enfoque da determinação social da saúde nos estudos de malária no mundo. MÉTODOS: Uma revisão sistemática de estudos originais publicados entre 1980 e 2018 foi conduzida com o uso de seis estratégias de busca em 10 bases de dados multidisciplinares e em bibliotecas e repositórios de sete universidades do Brasil, Colômbia, Equador e Peru. O estudo se baseou nos critérios da recomendação PRISMA e a qualidade metodológica foi avaliada segundo os critérios da iniciativa STROBE. Foi realizada uma síntese qualitativa dos resultados. RESULTADOS: Dez estudos publicados entre 1984 e 2017 preencheram os critérios de inclusão e exclusão predefinidos. Foram identificados 33 determinantes sociais da malária. Com relação aos determinantes individuais, foi observado maior risco da malária em adultos, pessoas com hábitos noturnos e que não aderem a práticas preventivas. Os determinantes intermediários foram moradias com infraestruturas física e sanitária precárias, com aglomeração de pessoas, localizadas em áreas de mata e com a presença de animais. E, quanto aos determinantes socioeconômicos, houve maior risco da doença entre os indivíduos que se dedicam a atividades agroflorestais, migrantes e pessoas com baixa escolaridade e baixa renda. A malária causou grande prejuízo econômico, gerando pobreza e atraso educacional. CONCLUSÃO: Não foram encontrados estudos com enfoques da medicina social latino-americana nem estudos contendo análises com modelo hierárquico e multinível para os determinantes individuais, intermediários e estruturais de acordo com a definição da Organização Mundial da Saúde. Não foi possível aprofundar a análise das categorias sociais (território, classe social, gênero, etnia e políticas macroeconômicas) ou outras características socioeconômicas que determinam o risco de ter a doença ou morrer de malária.

Determinación y determinantes sociales de la malaria: revisión sistemática, 1980-2018

[RESUMEN]. Objetivo. Describir cómo se ha aplicado el enfoque de la determinación social de la salud en los estudios sobre malaria en el mundo. Métodos. Revisión sistemática de los estudios originales publicados entre 1980 y 2018. Se emplearon seis estrategias de búsqueda en diez bases de datos multidisciplinarias, y en las bibliotecas y los repositorios de siete universidades de Brasil, Colombia, Ecuador y Perú. Se siguió la guía PRISMA; la calidad metodológica se evaluó según los criterios de STROBE y se realizó la síntesis cualitativa de los resultados. Resultados. Diez estudios publicados entre 1984 y 2017 cumplieron con los criterios de inclusión y exclusión preestablecidos; se identificaron 33 determinantes sociales de la malaria. De los determinantes individuales se halló mayor riesgo de malaria en adultos, personas con hábitos nocturnos y sin prácticas preventivas; de los intermedios, fueron las viviendas con mala infraestructura física y sanitaria, hacinamiento, ubicadas en áreas boscosas y con animales. De los socioeconómicos, el mayor riesgo correspondió a personas con actividades agroforestales, migrantes, y con bajos ingresos y escolaridad. La malaria ocasionó elevadas pérdidas económicas y generó pobreza y retardo educativo. Conclusión. No se hallaron estudios con los enfoques de la Medicina Social Latinoamericana ni que aplicaran el análisis jerárquico y multinivel para los determinantes individuales, intermedios y estructurales, de la Organización Mundial de la Salud. No se ha logrado avanzar en el análisis de categorías sociales —territorio, clase social, género, etnia, políticas macroeconómicas— u otras características socioeconómicas que determinan el riesgo de enfermar o morir de malaria.

[ABSTRACT]. Objective. Describe how the ‘social determination of health’ approach has been applied in malaria studies around the world. Methods. Systematic review of original studies published from 1980 to 2018. Six search strategies were used in ten multidisciplinary databases, and in libraries and repositories of seven universities in Brazil, Colombia, Ecuador, and Peru. PRISMA guidelines were followed, methodological quality was evaluated according to STROBE criteria, and a qualitative summary of the results was conducted. Results. Ten studies published from 1984 to 2017 met pre-established inclusion and exclusion criteria; 33 social determinants of malaria were identified. Of individual determinants, greater malaria risk was found in adults, people who are often outdoors at night, and people who do not take preventive measures; intermediate determinants were dwellings with poor physical and sanitary infrastructure, overcrowded, located in forested areas, and containing animals. Regarding socioeconomic determinants, the people at greatest risk were involved in agro-forestry activities, migrants, and those with low income and a low educational level. Malaria caused high economic losses and led to poverty and educational delay. Conclusion. No studies were found that used Latin American social medicine approaches or that applied the World Health Organization’s hierarchical and multilevel analysis for individual, intermediate, and structural determinants. No progress has been made in the analysis of social categories—territory, social class, gender, ethnic group, macroeconomic policies—or other socioeconomic characteristics that determine risk of illness or death from malaria.

[RESUMO]. Objetivo. Descrever como foi aplicado o enfoque da determinação social da saúde nos estudos de malária no mundo. Métodos. Uma revisão sistemática de estudos originais publicados entre 1980 e 2018 foi conduzida com o uso de seis estratégias de busca em 10 bases de dados multidisciplinares e em bibliotecas e repositórios de sete universidades do Brasil, Colômbia, Equador e Peru. O estudo se baseou nos critérios da recomendação PRISMA e a qualidade metodológica foi avaliada segundo os critérios da iniciativa STROBE. Foi realizada uma síntese qualitativa dos resultados. Resultados. Dez estudos publicados entre 1984 e 2017 preencheram os critérios de inclusão e exclusão predefinidos. Foram identificados 33 determinantes sociais da malária. Com relação aos determinantes individuais, foi observado maior risco da malária em adultos, pessoas com hábitos noturnos e que não aderem a práticas preventivas. Os determinantes intermediários foram moradias com infraestruturas física e sanitária precárias, com aglomeração de pessoas, localizadas em áreas de mata e com a presença de animais. E, quanto aos determinantes socioeconômicos, houve maior risco da doença entre os indivíduos que se dedicam a atividades agroflorestais, migrantes e pessoas com baixa escolaridade e baixa renda. A malária causou grande prejuízo econômico, gerando pobreza e atraso educacional. Conclusão. Não foram encontrados estudos com enfoques da medicina social latino-americana nem estudos contendo análises com modelo hierárquico e multinível para os determinantes individuais, intermediários e estruturais de acordo com a definição da Organização Mundial da Saúde. Não foi possível aprofundar a análise das categorias sociais (território, classe social, gênero, etnia e políticas macroeconômicas) ou outras características socioeconômicas que determinam o risco de ter a doença ou morrer de malária.

Análisis de sostenibilidad de la política de control de malaria del municipio de El Bagre, Colombia / Sustainability Analysis of the Malaria Control Policy in the Municipality of El Bagre, Colombia / Análise de sustentabilidade da política de controle de malária do município de El Bagre, Colombia

El objetivo de esta investigación fue analizar la sostenibilidad de la política de control de malaria en el municipio de El Bagre durante el año 2011. Se llevó a cabo un estudio de diseño mixto de modelo dominante CUAL-cuan, de carácter exploratorio. Se hicieron catorce entrevistas y una revisión documental, para identificar procesos sociales y ecológicos involucrados con la malaria, y también para describir y analizar la política de control de esta enfermedad. Se encontró que la minería, las migraciones, las prácticas y creencias culturales, el conflicto armado y las variaciones climáticas se relacionaban con la dinámica de la enfermedad y, asimismo, que la estructura de la política de control da cuenta de escasa capacidad de los actores para adaptar las acciones de control a estos procesos socioecológicos de la región. La política de control mostró ser efectiva aunque, bajo los supuestos del modelo, es escasamente sostenible.

The objective of this research was to analyze the sustainability of the malaria control policy in the municipality of El Bagre, during 2011. We performed a mixed-design study with a dominant model QUAL^quan, of exploratory character. We carried out fourteen interviews and a review of the documentation to identify social and ecological processes involved with malaria, and also to describe and analyze the control policy for this illness. We found that mining, migrations, cultural practices and beliefs, the armed conflict and climate variations are related with the dynamic of the illness. Likewise, we found that the structure of the control policy accounts for the limited capacity of the actors to adapt the control actions to the socio-ecological processes of the region. The control policy showed to be effective, although, under the assumptions of the model, it is barely sustainable.

O objetivo desta pesquisa foi analisar a sustentabilidade da política de controle de malária no município de El Bagre durante o ano 2011. Efetuou-se estudo de desenho misto de modelo dominante QUAL-quan, de caráter exploratorio. Foram feitas quatorze entrevistas e uma revisao documental, para identificar processos sociais e ecológicos envolvidos na malária, mesmo para descrever e analisar a política de controle desta doenca. Encontrou-se que a mineracao, migra-coes, práticas e crencas culturais, o conflito armado e as variacoes climáticas relacionavam-se com a dinámica da doenca e, do mesmo modo, que a estrutura da política de controle mostra escassa capacidade dos atores para adaptar as acoes de controle a esses processos socioecológicos da regiao. A política de controle mostrou ser efetiva embora, sob os supostos do modelo, escassamente sustentável.

Concepts associated with health from the perspective of sustainable development / Conceptos asociados a la salud desde la perspectiva del desarrollo sostenible

The concept of health is a social construction defined by the historical-cultural contexts of societies. At the moment, this context is characterized by global challenges such as climate change, energy crisis, the north-south divide, and poverty, among others. In view of these challenges, sustainable development has emerged as a proposal to cope with these drawbacks of the Western development model. In this sense, it is plausible to suppose, in accordance with a new global scenario of sustainable development, that a new conception of health is also emerging. For that reason, this paper aims at identifying this renewed concept of health, together with related concepts which are mentioned in the official documents on sustainable development originated in the world summits. Despite the fact that the concepts of health and sustainable development have been understood as being equivalent, none of the aforementioned official documents has provided societies with an explicit concept of health. It was verified that the concept of health has been associated with that of need satisfaction and preservation of ecosystems, whereas the construct of illness is associated with the concepts of poverty and high consumption levels. Finally, it is concluded that health is an intermediate goal of sustainable development and not an end in itself.(AU)

Concepts associated with health from the perspective of sustainable development

The concept of health is a social construction defined by the historical-cultural contexts of societies. At the moment, this context is characterized by global challenges such as climate change, energy crisis, the north-south divide, and poverty, among others. In view of these challenges, sustainable development has emerged as a proposal to cope with these drawbacks of the Western development model. In this sense, it is plausible to suppose, in accordance with a new global scenario of sustainable development, that a new conception of health is also emerging. For that reason, this paper aims at identifying this renewed concept of health, together with related concepts which are mentioned in the official documents on sustainable development originated in the world summits. Despite the fact that the concepts of health and sustainable development have been understood as being equivalent, none of the aforementioned official documents has provided societies with an explicit concept of health. It was verified that the concept of health has been associated with that of need satisfaction and preservation of ecosystems, whereas the construct of illness is associated with the concepts of poverty and high consumption levels. Finally, it is concluded that health is an intermediate goal of sustainable development and not an end in itself.

[Paradigms in the analysis of public health policies: limitations and challenges]. / Paradigmas en el análisis de políticas públicas de salud: limitaciones y desafíos.

Research on health policies is considered essential to ensure the effectiveness and efficiency of public policies. Analyses of public health policies have various objectives, including helping to solve the problems for which the policy was originated. That objective faces two large obstacles: (1) the ambiguity and heterogeneity of the models applied for the analysis of public policies, conditions that hinder the selection of analytical methods and the assessment of the scope of the objective; and (2) the traditional methodological approaches that limit the capacity of analyses to help solve the problems detected. This paper reviews the epistemology of the predominant models of public health policy analysis in order to assess their scope and limitations. It concludes that the development of new conceptual approaches could improve the quality of research on public policies and their ability to favorably impact decisions.

Paradigmas en el análisis de políticas públicas de salud: limitaciones y desafíos / Paradigms in the analysis of public health policies: limitations and challenges

La investigación en políticas de salud se considera esencial para asegurar la efectividad y eficiencia de las políticas públicas. Los análisis de políticas públicas de salud (APPS) obedecen a diferentes propósitos; entre ellos, contribuir a resolver aquellos problemas que originaron la política. Tal propósito enfrenta dos grandes obstáculos: 1) la polisemia y heterogeneidad de los modelos aplicados al análisis de políticas públicas, condiciones que dificultan la selección de los métodos de análisis y la valoración de sus alcances; y 2) los enfoques metodológicos tradicionales que limitan la capacidad de los análisis para contribuir a resolver los problemas detectados. En este ensayo se revisan los fundamentos epistemológicos de los modelos predominantes en APPS con el fin de valorar sus alcances y limitaciones. Se concluye que el desarrollo de nuevas perspectivas conceptuales podría mejorar la calidad de la investigación en políticas públicas y su capacidad para incidir favorablemente en las decisiones.

Research on health policies is considered essential to ensure the effectiveness and efficiency of public policies. Analyses of public health policies have various objectives, including helping to solve the problems for which the policy was originated. That objective faces two large obstacles: (1) the ambiguity and heterogeneity of the models applied for the analysis of public policies, conditions that hinder the selection of analytical methods and the assessment of the scope of the objective; and (2) the traditional methodological approaches that limit the capacity of analyses to help solve the problems detected. This paper reviews the epistemology of the predominant models of public health policy analysis in order to assess their scope and limitations. It concludes that the development of new conceptual approaches could improve the quality of research on public policies and their ability to favorably impact decisions.

Sentidos de la práctica en el Proyecto Interinstitucional por una Infancia Saludable (PRISA) / Meaning of the academic practices implemented in PRISA (Proyecto Interinstitucional por una Infancia Saludable)

La presente sistematización se realizó en el marco del Proyecto Interinstitucional por una Infancia Saludable (PRISA), proyecto interinstitucional de prácticas académicas en el que participaron seis facultades del área de la salud de la Universidad de Antioquia. La sistematización partió de un proceso reflexivo y continúo con un riguroso transcurso metodológico a través del cual se encontró el sentido a las voces de los actores participantes en PRISA y en la sistematización. El proceso de reflexión e indagación conllevó al establecimiento de los objetivos de la sistematización y a la definición de las técnicas de investigación más propicias para interactuar con los actores de PRISA y encontrar el sentido a sus vivencias. Se establecieron los siguientes objetivos; entre otros: a) indagar por el concepto de Práctica Social y académica de las unidades académicas que participaron en PRISA. b) indagar por el sentido de las prácticas académicas para los actores participantes en PRISA. Entre los hallazgos de la sistematización se evidencia que PRISA constituyó un escenario de vivencias y de aprendizajes, de esta manera el concepto instrumental e instructivo de la práctica se transformó, porque profesores, estudiantes y comunidad le dieron otros sentidos a la misma, generando acciones pedagógicas y sociales que, en la búsqueda de otros significados, configuraron nuevos propósitos y motivaciones que trascendieron lo propuesto institucionalmente; instaurándose nuevas relaciones e intersubjetividades y, por lo tanto, generando aprendizajes desde la práctica.

It was systematization method applied to the project for a healthy childhood-PRISA-academic practices that involved six health programs from the University of Antioquia. The systematization begun with a reflexive process involving a systematic and continue accurate methodological processes that allowed us to find the meaning of actor’s experiences working in PRISA and participating in the systematization method. The process led us to establish the objectives of the systematization and the definition of investigative techniques more appropriate for the actors of PRISA in order to find the meaning of their experiences. The following objectives were proposed: a) to investigate the concept of academic practice and social academic units that are applied by people working in PRISA. b) To investigate actor’s academic practice outcomes working in PRISA. We found with the systematization method that PRISA was a place for learning experiences. The concept of instrumental and instructive practice was essential, for teachers, students and community who found meaning for this practice, this experience made they to take pedagogical and social actions, to search for other meanings, creating new purposes and motivations that may go beyond the institutional proposals, establishing new relationships and therefore generating knowledge for themselves.

Accesibilidad a la citología cervical en Medellín, Colombia en 2006 / Access to cervical cytology in Medellín, Colombia during 2006

Fundamento: en países en desarrollo no se han logradosuficientes avances en reducción de la carga de la enfermedadpor cáncer cervical, por lo que es importante mejorar la cobertura,condiciones de acceso y efectividad de los programas detamizaje. El objetivo de este trabajo es analizar el acceso realde mujeres usuarias del tamizaje citológico ofrecido por laSecretaría de Salud de Medellín (Colombia).Métodos: se analizaron 1.519 registros de mujeres, provenientesde un estudio transversal realizado en un área urbanade Medellín (Colombia). Se realizó un análisis descriptivo y seestimó un modelo de regresión logística para explicar la prácticade citología reciente (aquélla realizada hace máximo 36meses, previos a la aplicación de la encuesta).Resultados: El 68,7% de las mujeres se habían practicadouna citología recientemente, el 17,2% tenía citologías previaspero no recientes, y el 14,2% era la primera vez que acudíaal servicio. La probabilidad de haberse realizado unacitología reciente es mayor para mujeres con más edad, antecedentefamiliar de cáncer cervical, antecedente personal deinfecciones de transmisión sexual, mujeres con algún grado deeducación y las que se encuentran en unión estable o están (oestuvieron) casadas.Conclusiones: hay indicios de que la demanda por la citologíaestá concentrada, con una buena frecuencia para unnúmero limitado de mujeres, mientras otras no la practican odejan de hacerlo(AU)

Background: The burden of illness of cervical cancer hasnot decreased enough in developing countries. For that reasonis important to improve coverage, access and effectiveness ofcervical cancer screening programs. The objective of this paperis to analyze women's access to the cervical cytologyprogramme of the Secretary of Health of Medellín (Colombia).Methods: An analysis was made of 1.519 records of womenfrom a cross-sectional study conducted in an urban area ofMedellín (Colombia). Descriptive analysis was conducted and aLogit model was estimated for analysing recent cervical cytology(cytology performed less than 36 months prior to the survey).Results: 68,7% of women had a recent cytology, 17,2%did not have recent cytology and 14,2% of women attended forthe first time to the service. The probability of having a recentcytology increased with age, women with family history ofcervical cancer, women with personal history of sexuallytransmitted infections, women with some education andwomen who are (or were) married or in a stable union.Conclusions: The demand for cytology appears to beconcentrated; a limited number of women assist frequentlywhile others don’t practice it or stop assisting(AU)

[Access to cervical cytology in Medellín, Colombia during 2006]. / Accesibilidad a la citología cervical en Medellín, Colombia en 2006.

BACKGROUND: The burden of illness of cervical cancer has not decreased enough in developing countries. For that reason is important to improve coverage, access and effectiveness of cervical cancer screening programs. The objective of this paper is to analyze women's access to the cervical cytology programme of the Secretary of Health of Medellín (Colombia). METHODS: An analysis was made of 1,519 records of women from a cross-sectional study conducted in an urban area of Medellin (Colombia). Descriptive analysis was conducted and a Logit model was estimated for analysing recent cervical cytology (cytology performed less than 36 months prior to the survey). RESULTS: 68.7% of women had a recent cytology, 17.2% did not have recent cytology and 14.2% of women attended for the first time to the service. The probability of having a recent cytology increased with age, women with family history of cervical cancer, women with personal history of sexually transmitted infections, women with some education and women who are (or were) married or in a stable union. CONCLUSIONS: The demand for cytology appears to be concentrated; a limited number of women assist frequently while others don't practice it or stop assisting.