Spatial variations in cervical cancer prevention in Colombia: Geographical differences and associated socio-demographic factors.

We examined spatial variations in the frequencies of women who had not heard of human papillomavirus vaccination (NHrd-Vac) and who had not had Pap testing (NHd-Pap) among Colombian administrative divisions (departments), before and after considering differences in socio-demographic factors. Following global and local tests for clustering, Bayesian Poisson hierarchical models identified department factors associated with NHrd-Vac and NHd-Pap, as well as the extent of the spatially structured and unstructured heterogeneity. Models of spatial variations for both outcomes included the department percentage of women with subsidised health insurance. The relative risks of NHrd-Vac and NHd-Pap were highest in several departments adjacent to the Colombian border. Our finding that the risk of not having adequate access to cervical cancer (CC) prevention programmes in Colombia was location-dependent, could be used to focus resources for CC prevention programmes.

The role of socio-demographic factors in premature cervical cancer mortality in Colombia.

BACKGROUND: While cervical cancer (CC) is an important cause of premature mortality in Colombia, the impact of socio-demographic factors on CC mortality in young women is not well understood. The primary objective of this study was to identify differences in CC mortality among Colombian women aged 20-49 years associated with education, type of health insurance, urban or rural and region of residence, and to determine whether differences in mortality associated with education or insurance varied by age. METHODS: Cervical cancer deaths for 2005-2013 and risk factors were obtained from the National Administrative Department of Statistics. Populations at risk were calculated from age-stratified population projections and the 2010 National and Demographic Health Survey. Negative binomial regression models, stratified by age, were used to examine associations between socio-demographic factors and mortality rates and whether the effects of education and health insurance varied by age. Multiple imputation was used to examine the importance of missing data. RESULTS: Differences of CC mortality were identified among women with limited to no education compared to highly educated women, with the largest disparity in the youngest age group (IRR 26.8, 95 % CI 6.65-108). Differences in mortality associated with health insurance also varied based on age group. Women with contributory and special health insurance had lower mortality rates than women with subsidised or no health insurance, except in the youngest age group. No differences were observed between women with subsidised and those with no insurance in any age group. Mortality rates were high among women who resided in urban areas and in the Atlantic, Central, Pacific, and Amazon-Orinoquía regions of Colombia. Missing values in the mortality database did not impact the findings from this study. CONCLUSIONS: Limited education was most strongly associated with premature CC mortality in the youngest women. Subsidised insurance did not appear to provide significant protection against CC mortality when compared to not having insurance, suggesting the need to examine diagnostic and treatment services available under the subsidised insurance plan. Our results could be used to target interventions to optimise the impact of resources to prevent premature mortality due to CC in Colombia.

Inequities in cervical cancer screening among Colombian women: a multilevel analysis of a nationwide survey.

OBJECTIVES: To identify factors associated with whether women in Colombia have had a Pap test, evaluate differences in risk factors between rural and urban residence, and evaluate the contextual effect of the lack of education on having ever had a Pap test. METHOD: Data used were from the 2010 Colombian National Demographic and Health Survey; 40,392 women reported whether they have had a Pap test. A multilevel mixed logistic regression model was developed with random intercepts to account for clustering by neighbourhood and municipality. The model evaluated whether having a rural/urban area of residence modified the effect of identified risk factors and if the prevalence of no education at the neighbourhood level acted as a contextual effect. RESULTS: Most women (87.3%) reported having at least one Pap test. Women from lower socioeconomic quintiles (p=0.002), who were unemployed (p<0.001), and whose final health decisions depended on others (p<0.001) were less likely to have had a Pap test. Women with children were more likely to have had the test (p<0.001), and the effects of education (p=0.03), type of health insurance (p=0.01), age (p<0.001), and region (p<0.001) varied with having a rural/urban area of residence. Women living in rural areas (specifically younger ones, with no health insurance, living in the Atlantic and Amazon-Orinoquía regions, and with no education) were less likely to have had a Pap test when compared to those living in urban areas. Furthermore, women living in a neighbourhood with a higher prevalence of no education were less likely to have ever had a Pap test (p=0.005). CONCLUSIONS: In Colombia, the probability of having had a Pap test is associated with personal attributes, area of residence, and prevalence of no education in the neighbourhood. Efforts to improve access to cervical cancer screening should focus on disadvantaged women with limited education, low socioeconomic status, and no health insurance or subsidised insurance, especially those in rural/isolated areas.

Effect of rider experience and evaluator expertise on subjective grading of lameness in sound and unsound sports horses under saddle.

The primary objective of this study was to investigate whether rider experience influences the assessment and grading of lameness in horses based on under-saddle gait analysis. Thirteen adult sports horses in active training were included in the study. After a baseline lameness and neurologic examination by the principal investigators, horses were videotaped while being ridden by an experienced and a less experienced rider. A 3-minute video was made for each horse and rider and 26 videos were randomly ordered and compiled on a DVD. Veterinarians with different levels of experience in evaluating lameness and veterinary students viewed the DVD and assigned a lameness score to each horse/rider combination. In a model accounting for the expertise of the evaluator, there was no difference in overall lameness scores between experienced and less experienced riders. This result was consistent for both sound and unsound horses. The overall lameness scores reported by specialists and students, however, differed significantly. The lameness score reported by the study participants while the horse was ridden was significantly associated with the subjective baseline lameness assessment reported by the principal investigators for the same limb when the horse was not under saddle. Additional work is necessary to determine whether riders with even lower skill levels would further alter the balance and motion pattern of the horse and have more influence on subjective grading of lameness.

L'objectif principal de la présente étude était d'examiner si l'expérience du cavalier influence l'évaluation et la gradation de la boiterie chez des chevaux basées sur l'analyse de la démarche sous-selle. Treize chevaux sportifs adultes en entraînement actif ont été inclus dans l'étude. Suite à un examen neurologique et de boiterie de base par les chercheurs principaux, les chevaux ont été filmés alors qu'ils étaient montés par un cavalier d'expérience et un cavalier moins expérimenté. Une vidéo de 3 minutes a été réalisée pour chaque combinaison cheval/cavalier et les 26 vidéos ont été compilées de manière aléatoire sur un DVD. Des vétérinaires ayant différents niveaux d'expérience à évaluer les boiteries et des étudiants vétérinaires ont visualisé le DVD et donné un pointage à chaque combinaison cheval/cavalier. Dans un modèle tenant compte de l'expérience de l'évaluateur, il n'y avait aucune différence dans les pointages globaux entre un cavalier expérimenté et un moins expérimenté. Ce résultat était constant autant pour les chevaux solides que fragiles. Toutefois, les pointages globaux de boiterie notés par les spécialistes et les étudiants étaient significativement différents. Le pointage de boiterie rapporté par les participants à l'étude alors que le cheval était conduit était significativement associé avec l'évaluation subjective de base rapportée par les chercheurs principaux pour le même membre lorsque le cheval n'était pas sous-selle. Des études additionnelles sont nécessaires afin de déterminer si des cavaliers avec encore moins d'expérience influenceraient encore plus l'équilibre et le patron de mouvement du cheval et aurait plus d'influence sur la gradation subjective de la boiterie.(Traduit par Docteur Serge Messier).