Zeitschriftenartikel zum Thema „Discrimination – Medellín (Colombie)“

<p><strong>INTRODUCTION: </strong>We aim to understand the perception about discrimination within the LGBT population when accessing oral health services, from their perspective as well as that of the oral health professional.</p><p><strong>METHODS: </strong>A qualitative study from a phenomenological perspective was conducted by means of 37 in-depth interwiews (19 in health service providers and 18 in LGBT members). The script used in the interview included questions related to discrimination in social spaces, quality of life and its relationship with health, access to general and oral health care and proposals and strategies. Verbatim was transcripted and narrative content analysis was carried out for identifying meaning codes and after grouped through emergent categories. Atlas.Ti 6.0 software was used.</p><p><strong>RESULTS: </strong>Five categories within the participants’ discourses were identified: (1) Characteristics of LGBT population: This is a heterogeneous group (physical‚ social and cultural); (2) Quality of life (QOL), health related quality of life (HRQOL) and oral health related quality of life (OHRQOL): QOL is defined as the ability to enjoy opportunities in the human life process under equity conditions; HRQOL is related to an adequate access to health services‚ and OHRQOL as the appropriate state of the structures of the stomatognathic system; (3) Discrimination as a concept and experiences: People conceived discrimination as the act pejorative to someone because of a particular situation. Participants identified some types of discrimination in social spaces; (4) Accessibility to health services: Participants related individual and structural barriers when accessing to public health services; (5) Proposals and strategies: Interviewers suggested some educative strategies and social policies to reduce the endogenous and exogenous discrimination.</p><p><strong>CONCLUSIONS: </strong>The LGBT population is vulnerable to perceive experiences of discrimination and this situation causes a negative impact on their quality of life.</p>

SIGNIFICANCE Low vision is a public health priority disability condition. People with this condition face multiple types of discrimination in a society that is not accustomed to diversity. PURPOSE This study aimed to describe the life experience of people with low vision from an intersectional perspective in Medellín, Colombia. METHODS A qualitative ethnographic case study was conducted, considering the intersectional perspective as an analytical element to comprehend the everyday experience of people with low vision. Twenty-nine interviews were conducted with 10 participants, along with 16 participant observation exercises in their daily lives, with prior informed consent. RESULTS Participants experienced discrimination due to their visual condition, which had negative implications for the development of their life projects. Three categories emerged: Discrimination in everyday contexts: ocularcentrism, gender challenges in the lives of people with low vision, and challenges in seeking vision rehabilitation services. CONCLUSIONS The results of the study show that people experience discrimination, exclusion, and stigmatization in their daily activities, which vary according to the traditionally assigned roles of gender, social class, age, and educational level, among others. Given the complexity of the experience, it is important for health and visual rehabilitation professionals to broaden their perspective and transition toward vision rehabilitation models that address the various dimensions affected by this condition.

Background. Posttransplantation diabetes mellitus (PTDM) is a serious complication of solid organ transplantation. It is associated with major adverse cardiovascular events, which are a leading cause of morbidity and mortality in transplant patients. This study aimed to develop and validate a score to predict the risk of PTDM in kidney transplant recipients. Methods. A single-center retrospective cohort study was conducted in a tertiary care hospital in Medellín, Colombia, between 2005 and 2019. Data from 727 kidney transplant recipients were used to develop a risk prediction model. Significant predictors with competing risks were identified using time-dependent Cox proportional hazard regression models. To build the prediction model, the score for each variable was weighted using calculated regression coefficients. External validation was performed using independent data, including 198 kidney transplant recipients from Tübingen, Germany. Results. Among the 727 kidney transplant recipients, 122 developed PTDM. The predictive model was based on 5 predictors (age, gender, body mass index, tacrolimus therapy, and transient posttransplantation hyperglycemia) and exhibited good predictive performance (C-index: 0.7 [95% confidence interval, 0.65-0.76]). The risk score, which included 33 patients with PTDM, was used as a validation data set. The results showed good discrimination (C-index: 0.72 [95% confidence interval, 0.62-0.84]). The Brier score and calibration plot demonstrated an acceptable fit capability in external validation. Conclusions. We proposed and validated a prognostic model to predict the risk of PTDM, which performed well in discrimination and calibration, and is a simple score for use and implementation by means of a nomogram for routine clinical application.

This study analyzed the leaf spectral response of three native timber forest species in the tropical dry forest: Diomate (Astronium graveolens Jacq.), Choibá (Dipteryx oleifera Benth.), and Algarrobo (Hymenaea courbaril L.). The study was conducted at the León Morales Soto Arboretum and Palmetum, at the Universidad Nacional de Colombia in Medellín, Antioquia, Colombia. Spectral data from the leaves were collected in situ using the portable spectroradiometer ASD FieldSpec HandHeld-2, which operates with a spectral resolution of 1 nm (resampled to 10 nm) and covers a spectral range between 325 and 1,075 nm (limited to 400-900 nm). Based on the measurements, the behavior and spectral variability of the species were evaluated. One-factor Analysis of Variance and Mann Whitney-Wilcoxon U-test were implemented in reflectance spectra to select the optimal narrow bands for species discrimination. The classification capacity of the selected narrow bands was assessed using the K-nearest neighbors’ algorithm. It was found that A. graveolens and H. courbaril exhibited spectral signatures typical of healthy vegetation, while D. oleifera showed spectral changes during the early stages of senescence. Regarding spectral separability, 23 narrow bands in the visible region and near-infrared region were identified as optimal for distinguishing the plant species. The supervised classification algorithm applied to these 23 narrow bands achieved an overall accuracy of 95.8%. In conclusion, these findings provide valuable insights into the spectral response of important tropical species and contribute to their conservation efforts by enhancing understanding of their unique spectral characteristics in diverse and heterogeneous ecosystems like tropical forests.

e12521 Background: The genomic-based 21-gene recurrence-score assay (Oncotype DX, Genomic Health)(ODx) is used to decide on the use of adjuvant chemotherapy (ACT) in luminal-type Early-Breast Cancer (LT-EBC). Patients with low RS can safely avoid ACT. Other predictive models based on standard clinical and histopathological (C&H) variables also have been developed. These include, Magee equations (ME), Predict model (PM), and Tennessee nomogram score (TNS). This study aims to establish the concordance between ODx and ME, PM and TNS models in a set of patients with EBC in Medellín, Colombia. Methods: Patients with unifocal, stage I and IIA, LT-EBC (HR+/Her2-) with results for ODx were included. For inclusion, key standard C&H variables needed to be available as to allow accurate assessment of ME, PM and TNS predictive models. ODx was used as the reference test and the predictive models as index tests. Low-risk (LR) was defined < 18 in all three ME; < 3% in the PM; and a probability calculated for LR > 90% in the TNS. A second analysis was performed in the > 50 years-old cohort (+50C), using standard and a modified criteria. In the last one, intermediate-risk (IR) patients were either excluded or grouped with high-risk scores for analysis. Concordance between the models and the ODx was evaluated using Cohen's kappa index (K). The degree of concordance was classified according to the categories established by Landis and Koch. AUROC (area under receiver operating characteristics) was estimated. Statistical analyses were performed with Stata v16. Results: 122 patients were included. Median age: 58 (IQR 49-66). Main histology was ductal carcinoma (85.2%), and median size was 15 mm (IQR 10-20). LR was adjudicated in 80.3%, 57.4%, 89.3% and 69.7% with ODx, ME, PM and TNS, respectively. Concordance between the ODx and ME and PM in the all patient population was fair, with K of 0.35 (95% CI: 0.18-0.50; p < 0.001), and 0.24 (95% CI: 0, 04 - 0.45; p < 0.001), respectively. Concordance of ODx and TNS was inferior with a K of 0.16 (95% CI: 0.03-0.34, p = 0.04). AUC for ME, PM, and TNS was 0.61 (95% CI: 0.49-0.73), 0.61 (95% CI: 0.52-0.70) and 0.59 (95% CI: 0.48-0.70), respectively. 85 patients were included in the +50C (69.7%). For one analysis, 41 patients with IR with either ME or PM were excluded. Concordance between the ME and the ODx was fair. LR in both ME and ODx was found 41/43 patients (95.5%, 95% CI 87.9-100). As for PM and TNS, the degree of concordance with ODx were low, and non-significant, respectively. Concordance between ODx LR was found in 36/37 patients with LR in all three ME, PM and TNS (97.3%, 95% CI: 90.7-100). Discrimination capacity: 79%. Conclusions: The high cost of ODx can be safely avoided in stage I/IIA luminal-type EBC and > 50 year-old with low-risk scores in all three ME, PM, and TNS.

Background: qSOFA is a score to identify patients with suspected infection and risk of complications. Its criteria are similar to those evaluated in prognostic scores for pneumonia (CRB-65 - CURB-65), but it is not clear which is best for predicting mortality and admission to the ICU. Objective: validate and compare three scores (CURB-65, CRB-65 and qSOFA) to determine the best tool to identify emergency department patients with pneumonia who are at increased risk of mortality or intensive care unit (ICU) admission. Methods: Secondary analysis of three prospective cohorts of patients hospitalized with diagnosis of pneumonia in five hospitals in Medellin (Colombia). Validation and comparison of the score´s accuracies were performed by means of discrimination and calibration measures. Results: Cohorts 1, 2 and 3 included 158, 745 and 207 patients, with mortality rates of 32.3%, 17.2% and 18.4%, and admission to ICU was required for 52.5%, 43.5% and 25.6%, respectively. The best AUC-ROC for mortality was for CURB-65 in cohort 3 (AUC-ROC=0.67). The calibration was adequate (p>0.05) for the three scores. Conclusions: None of these scores proved to be an appropriate predictor for mortality and admission to the ICU. It is probable that the local context have modified their performance. It is necessary to validate the old ones and probably to develop new predictive models of prognosis for CAP in each country.

OBJECTIVEDiagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection.METHODSA cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants. Their CSF was studied for suspicion of infection and a bivariate analysis was performed between the dependent variable (confirmed/probable NM) and the identified independent variables. Those variables with a p value ≤ 0.2 were fitted in a multiple logistic regression analysis with the same dependent variable. After determining the best model according to its discrimination and calibration, the β coefficient for each selected dichotomized variable obtained from the logistic regression model was used to construct the score for the prediction rule.RESULTSAmong 320 patients recruited for the study, 154 had confirmed or probable NM. Using bivariate analysis, 15 variables had statistical associations with the outcome: aneurysmal subarachnoid hemorrhage (aSAH), traumatic brain injury, CSF leak, positioning of external ventricular drains (EVDs), daily CSF draining via EVDs, intraventricular hemorrhage, neurological deterioration, age ≥ 50 years, surgical duration ≥ 220 minutes, blood loss during surgery ≥ 200 ml, C-reactive protein (CRP) ≥ 6 mg/dl, CSF/serum glucose ratio ≤ 0.4 mmol/L, CSF lactate ≥ 4 mmol/L, CSF leukocytes ≥ 250 cells, and CSF polymorphonuclear (PMN) neutrophils ≥ 50%. The multivariate analysis fitted a final model with 6 variables for the prediction rule (aSAH diagnosis: 1 point; CRP ≥ 6 mg/dl: 1 point; CSF/serum glucose ratio ≤ 0.4 mmol/L: 1 point; CSF leak: 1.5 points; CSF PMN neutrophils ≥ 50%: 1.5 points; and CSF lactate ≥ 4 mmol/L: 4 points) with good calibration (Hosmer-Lemeshow goodness of fit = 0.71) and discrimination (area under the receiver operating characteristic curve = 0.94).CONCLUSIONSThe prediction rule for diagnosing NM improves the diagnostic accuracy in neurosurgical patients with suspicion of infection. A score ≥ 6 points suggests a high probability of neuroinfection, for which antibiotic treatment should be considered. An independent validation of the rule in a different group of patients is warranted.

LEVINAS: OTRA FUENTE DE PENSAMIENTO PARA OTRO MODO DE EDUCAR. Pedro Ortega Ruiz, Universidad de Murcia (España). Artículo de reflexión generativa. El autor aborda en este trabajo la dimensión ética del ser humano, su ser relacional que le vincula al otro y le hace responsable de él. La ética es el hábitat de los humanos, su universo simbólico. Somos seres relacionales volcados al otro, a los demás. Es el otro quien nos constituye en seres humanos cuando respondemos de él. Pero el ser humano es un ser histórico, vive en una circunstancia que le condiciona y le define. Prescindir de la circunstancia es diluir al hombre en una idea universal, abstracta, irreconocible en la experiencia. El autor aboga por “otra fuente” de pensamiento que aborde la realidad del hombre en su totalidad. Propone otra antropología y otra ética, inspiradas en Levinas, que permitan otro modelo educativo, que hagan de la experiencia del educando el punto de partida y de llegada de la acción educativa. Antropología y ética van de la mano. Todo cambio de modelo educativo conlleva, necesariamente, un cambio en los principios teóricos que lo sustentan. EDUCATION IN LATIN AMERICA, WHAT COULD WE DO?. Celso Rodríguez Echenique, Centre for Scientific and Technological Research Alberto Masferrer Salvadorian University, El Salvador, Central America. Artículo de reflexión generativa. Education has had different trends throughout history. The teaching-learning process has been modified through generations. Each region or country had its own characteristics that differentiated them. With the socio-economic approach of globalization, these regional characteristics have been lost. After World War II, the so-called modernity in Western countries has tried to unify criteria and equalize learning methods with the aim of reducing the knowledge and technology gap that exists among the most developed countries and those that are still developing. For our Latin American subcontinent, which despite its cultural diversity shares common histories and traditions, trying to adapt our teaching methods to those devel oped in the countries of the northern hemisphere could be considered a hegemonic imposition or a neo-colonization. Our ethnic and cultural diversity needs its own methods that help educate current and new generations in principles of solidarity, inclusion, fraternal understanding, and respect among all. It is urgent to know how to teach by educating, and influencing the formation of constructive learning so that the educable subject contributes to the construction of better worlds. Teaching-learning methods without discrimination, with the desire to grow in the community, to have upright citizens, and to achieve the self-development that our countries need. A development with everyone and for the good of all. COMMUNICATION SKILLS IN THE TRAINING OF HEALTH PROFESSIONALS. Eliecer González Valdéz, Víctor Daniel Pérez Collado, University of Medical Sciences Sancti Spiritus. Cuba. Artículo de investigación. The improvement of pedagogical practices in the training of health professionals constitutes a challenge in the Cuban university. However, methodological inconsistencies are evident for the development of professional pedagogical skills related to communication, which is why reflections are offered on the need to promote the development of communication skills in students aimed at greater integrality as health professionals. APORTES DE LA PEDAGOGÍA, LA DIDÁCTICA Y LAS TIC EN LA FORMACIÓN PROFESIONAL DE INGENIEROS. José Ricardo Velasco Méndez, Universidad de Tijuana, Tijuana, México. Artículo producto de una investigación doctoral desarrollada en torno a las concepciones que sobre la práctica poseen los docentes de la universidad Pascual Bravo de Medellín, Colombia, donde el problema de estudio fue centrado en la pedagogía y la didáctica como pilares fundamentales de la docencia, con el fin de interpretar sus implicaciones dentro del proceso formativo de los estudiantes de ingeniería. Para ello, se estableció como unidades categoriales: La pedagogía, la didáctica y las TIC; desde donde se desplegó una revisión minuciosa en torno el estado del arte de estos constructos, que permitió articular el presupuesto teórico-filosófico necesario para el desarrollo del estudio. Así, el proceso de trabajo se enmarcó en el paradigma interpretativo, enfoque cualitativo, a través de la hermenéutica como diseño. En cuanto la muestra, se seleccionó de forma intencional 35 ingenieros con funciones docentes pertenecientes a la institución mencionada, con quienes se conformó un grupo focal mediante la entrevista colectiva y también se les aplicó una encuesta tipo cuestionario, todo lo cual fue analizado por medio de la triangulación. En general, los resultados destacan en gran medida la importancia de la pedagogía y la didáctica con enfoque crítico en la formación de ingenieros, pero al mismo tiempo, fue posible evidenciar falencias en cuanto recursos tecnológicos, necesidad de referentes educativos, diatribas en cuanto facilitador y profesional de la docencia, todo ello como derivación epistémica propia de la investigación. EL LIDERAZGO ESCOLAR EN EL SISTEMA EDUCATIVO ESPAÑOL E ITALIANO Artículo de investigación a cargo de la académica Anna Maria Nicolosi, Instituto de Enseñanza Superior “Corinaldesi-Padovano” – Italia. Pone de relieve que no obstante los múltiples estudios internacionales adelantados sobre el liderazgo escolar, falta mucho por saber acerca de cómo los directores emplean a diario su tiempo, y de la gran variabilidad de las actividades que llevan a término. El objetivo de este estudio es examinar en qué medida las prácticas y estilos de liderazgo de seis directores escolares de España e Italia coinciden o difieren en aspectos relevantes de su práctica profesional. La investigación recurre al método mixto y, en el marco de seis estudios de casos, administra entrevistas, cuestionarios y grupos focales. FACTORES CULTURALES DEL “AUTISMO”. Artículo de investigación a cargo de Dominique Demelenne, Université Saint-Louis-Bruselles, Bélgica ; Viviana Sofía Sánchez Bobadilla, IP Grupo de Investigaciónn (ITEDEPREVEN), Paraguay. Plantea algunas reflexiones sobre el autismo desde una perspectiva cultural en como la forma de entender las diversas maneras de comunicación e interacción que se dan en los diferentes espacios de relacionamiento, ya sea en el ámbito social, educativo o familiar. Las personas o grupos socioculturales tienen la posibilidad de utilizar una diversidad de lenguajes para construir sus modos particulares de convivir, a pesar de que nuestros procesos de socialización y comunicación suelen solo privilegiar algunos. Adoptar una perspectiva cultural nos permite indagar las representaciones sociales, creencias o cosmovisiones que se transmiten a través de estas diferentes formas de lenguaje. Es reconocer que todos de acuerdo a nuestras sensibilidades podemos tener diferentes formas de ver y entender el mundo. Aceptar que las personas con autismo tienen formas diferentes de ver el mundo y buscar a entenderlas nos permite construir otro tipo de relacionamiento, donde el “problema” ya no es de buscar como integrarlos en nuestro mundo, sino buscar formas de convivir en armonía desde diferentes mundos. Las conclusiones manifiestan la importancia de comprender desde las representaciones del mundo y los diferentes modos del lenguaje para llegar al reconocimiento de las diferencias y a partir de allí a una verdadera convivencia. Una propuesta educativa integral se construye a través de intervenciones biológicas, culturales y sociales basadas en una comprensión que debe producirse en un marco relacional aceptado por los afectados y sus familiares. ¿MÁS ALLÁ DE LA EDUCACIÓN BASADA EN LA CONCIENCIA? Agustín de la Herrán Gascón, Universidad Autónoma de Madrid. Artículo de reflexión generativa. Ofrece razones incluyan y vayan más allá de la educación basada en la conciencia. Se intenta dar respuesta al objetivo desde un ensayo desarrollado desde el enfoque radical e inclusivo de la educación. La contribución se detiene en cuatro contenidos: esta breve introducción, el enfoque radical e inclusivo de la educación, algunas teorías sobre la conciencia y algunas conclusiones más allá de la educación basada en la conciencia. DIAGNÓSTICO DE DISCAPACIDAD INTELECTUAL. UNA PROPUESTA DE AUTOMATIZACIÓN. Artículo de investigación. Jimpikit Cunambe Lida Gabriela; Aguilar Paladines Washington Eduardo; Naranjo Sánchez Bertha Alice, Universidad Politécnica Salesiana, Guayaquil, Ecuador. Una realidad de índole social que demanda atención es la necesidad que tienen algunas organizaciones que trabajan con personas con discapacidad intelectual de estar informados del estado cognitivo de sus pacientes. El presente trabajo describe la propuesta de un sistema de detección de discapacidad intelectual en base a un modelo de evaluación de discapacidades para apoyar con eficiencia la gestión técnica y administrativa de las asociaciones y federaciones de personas con discapacidad. Bajo un enfoque descriptivo se presenta la metodología de desarrollo del sistema, la arquitectura tecnológica, las interfaces de las pruebas psicológicas incluidas en la propuesta, así como la evaluación de la productividad al usar dicho sistema. Como resultado se obtuvo que sta propuesta de automatización del diagnóstico de discapacidad intelectual ayuda a agilizar y facilitar los procesos administrativos y técnicos con una notable mejora en los tiempos de los procesos incurridos. ESTILOS DE APRENDIZAJE EN LA UNIVERSIDAD NACIONAL AGRARIA DE LA SELVA, PERIODO ACADÉMICO 2021. Macklean Reátegui Guerra, Carmela Pajuelo Maguiña, Universidad Nacional Agraria de la Selva. Artículo de investigación. Refiere generalidades del proyecto relativo a identificar los estilos de aprendizaje predominante en la Universidad Nacional Agraria de la Selva, periodo académico 2021. Se utilizó el método de observación indirecta, nivel descriptivo, el tipo básico; cuya población fueron 2781 estudiantes y con una muestra de 338 de la Universidad Nacional Agraria de la Selva, periodo académico 2021. Se utilizó como instrumento de evaluación al cuestionario CHAEA de Catalina. M. Alonso, Domingo J. Gallego y Peter Honey. Se encontró que un 27.5% de estudiantes presenta estilo pragmático - reflexivo; por otro lado, tenemos a un 26.7% con estilo pragmático y un 17.8% con estilo de aprendizaje teórico- pragmático. Los resultados por facultades muestran que los estudiantes de las Facultades de Agronomía; Ciencias económicas y administrativas; Ciencias contables; y Recursos Naturales Renovables son: pragmático; reflexivo – pragmático y teórico – pragmático; de la Facultad de Ingeniería en Industrias alimentarias, es: pragmático; de las Facultades de Ingeniería en informática y sistemas; mecánica eléctrica son: reflexivo – pragmático y pragmático; y de la Facultad de Zootecnia, son: pragmático y reflexivo –pragmático. El estilo predominante en los estudiantes de la Universidad Nacional Agraria de la Selva es el pragmático. ENSEÑANZA DE LA HISTORIA DE LA MÚSICA: PROCEDIMIENTOS EN EL ISA HASTA EL 2015. Nairin Rodríguez Duverger, María del Rosario Hernández Iznaga, Yamira Rodríguez Núñez. Universidad de las Artes, La Habana, Cuba. La disciplina Historia de Música es fundamental en los programas de estudio para la formación de músicos profesionales. Este artículo esboza los aspectos más significativos de la enseñanza de la Historia de la Música de manera general. Su importancia para los estudiantes de música, objetivos y contenidos. Además, se realiza un acercamiento a la estructura de los programas en el ISA hasta el 2015. Asimismo, re establece una relación de los profesores que han impartido la asignatura y sus metodologías en la etapa mencionada.

ABSTRACT Objective: To understand the vulnerabilities to which Venezuelan immigrants living in Brazil and Colombia are exposed, from the perspective of Intervention Bioethics. Method: Qualitative study, carried out through a semi-structured interview, with 15 immigrants living in Brasília-Brazil and 20 in Medellín-Colombia, analyzed by the IRAMUTEQ software, in the Descending Hierarchical Classification and Similitude Analysis modalities. Results: The first thematic axis dealt with the reasons for immigrating, above all, difficulties in accessing food and health services. The second axis revealed the trajectory of the migration process, especially the adversities faced before arriving in the countries. The third axis highlighted the challenges of integration in the destination countries, with emphasis on the processes of exclusion and discrimination faced. Conclusion: It was observed that both Brazil and Colombia need, as proposed by Bioethics of Intervention, to develop policies to reduce the vulnerabilities of immigrants to guarantee a dignified life without discrimination against them.

Abstract The current study examines the extent to which perceptual factors may account for the emergence of assibilated variants of the alveopalatal approximant /j/ in two geographically remote varieties of Spanish. Participants from Medellin, Colombia and Santiago, Dominican Republic completed a discrimination task and a matched guise. Both tasks presented listeners with stimuli containing affricate [ʤ] and approximant [j] allophones of /j/. Participants were more accurate when discriminating between sound pairs that included the affricate allophone, suggesting that the presence of (af)frication is a salient acoustic cue upon which judgments are reliably made. Therefore, we argue that the emergence of assibilated variants ([ʤ], [ʒ]) can be explained in part by more prominent acoustic cuing and thus greater perceptual salience. Evidence of the relationship between these findings and a possible sound change in progress is observed in the association of social characteristics with [ʤ] and [j].

Abstract Background People living a trans-life require access to equitable healthcare services, policies and research that address their needs. However, trans people have experienced different forms of violence, discrimination, stigma, and unfair access barriers when dealing with healthcare providers. Therefore, adapting sexual and reproductive health services with the purpose of providing more equitable, inclusive and discrimination-free healthcare services is an urgent need. The article presents an example of how operative research can be used in order to adjust sexual and reproductive healthcare services to trans people’s needs, identities and circumstances. Methods This is a qualitative study written from a constructivist perspective, and it is based on the voices and experiences of trans people in four major cities in Colombia. The research used a combination of focus groups of discussion (n = 6) and in-depth interviews with trans people (n = 13) in Barranquilla, Bogota, Cali and Medellin. This research had two specific objectives: i) identifying the main sexual and reproductive health needs of people living a trans-life; and ii) generating new evidence in order to guide the adaptation of sexual and reproductive health services centered to trans people’s needs, identities, and circumstances. Qualitative data codification and analysis was using NVivo. Results Once access barriers to sexual and reproductive health services, unmet sexual and reproductive health needs were identified, the research helped define strategies to adapt sexual and reproductive health services to the needs, identities, and circumstances of people living a trans-life in Colombia. Amongst the main barriers found were healthcare costs, lack of insurance, stigmatization, discrimination and abuse by health care providers. Perhaps among the most notable sexual and reproductive health needs presented were trans-specific services such as sensitive assistance for the transition process, endocrinology appointments, and sex reaffirmation surgeries. Conclusions The evidence obtained from this research allowed Profamilia, a Colombian healthcare provider, to adapt the sexual and reproductive health services it provides to people living a trans-life in Colombia. Furthermore, it was possible for Profamilia to design and implement an inclusive sexual and reproductive health program that specifically addresses trans people’s needs, identities, and circumstances.

Abstract Background Diseases transmitted by invasive Aedes aegypti and Aedes albopictus mosquitoes are public health issues in the tropics and subtropics. Understanding the ecology of mosquito vectors is essential for the development of effective disease mitigation programs and will allow for accurate predictions of vector occurrence and abundance. Studies that examine mosquito population dynamics are typically focused on female presence or total adult captures without discriminating the temporal and spatial distribution of both sexes. Methods We collected immature and adult mosquitoes bimonthly for 2 years (2018–2019) in the Medellín Botanical Garden. Collection sites differed in proximity to buildings and nearby vegetation, and were classified by their overhead vegetation cover. We used linear mixed models (LMMs) and Spatial Analysis by Distance Indices (SADIE) to assess the spatial distribution of Ae. aegypti and Ae. albopictus. Using our Ae. albopictus captures exclusively, we assessed (1) the spatial and temporal distribution of males and females using SADIE and a generalized linear mixed model (GLMM), (2) the relationship between climatic variables/vegetation coverage and adult captures using GLMMs and LMMs, and (3) the correlation of male and female size in relation to climatic variables and vegetation coverage using LMMs. Results Spatial analysis showed that Ae. aegypti and Ae. albopictus were distributed at different locations within the surveilled area. However, Ae. albopictus was the predominant species in the park during the study period. Adult Ae. albopictus captures were positively correlated with precipitation and relative humidity, and inversely correlated with temperature and wind speed. Moreover, we observed a spatial misalignment of Ae. albopictus males and females—the majority of males were located in the high vegetation coverage sites, while females were more evenly distributed. We observed significant associations of the size of our adult Ae. albopictus captures with precipitation, temperature, and wind speed for both sexes and found that overhead vegetation cover influenced male size, but observed no effect on female size. Conclusions Our work elucidates the differential dynamics of Ae. albopictus males and females, which is pivotal to develop accurate surveillance and the successful establishment of vector control programs based on the disruption of insect reproduction. Graphic Abstract

Introduction: women and trans people who have engaged in sex work are triply vulnerable since they are victims of discrimination due to their employment status, their gender, and the risks that this work entails. This situation impacts their health situation. This study aimed to know the perceptions about health (physical, mental, and oral) of four women who work in prostitution in Medellin, based on their life experiences and those related to their social context. Methods: qualitative research with an ethnographic approach was conducted to analyze the situations mentioned. Four women participated, two Venezuelans and two Colombians, and semi-structured interviews were conducted. Qualitative content analysis was performed, which allowed the generation of four categories (mental health, oral health, general health, and quality of life). Results: her discourses made it possible to elucidate the connection between the living conditions and the health situation. The lack of job opportunities, a migratory process of profound economic and social changes, and a Colombia with inequities and barriers to access to health and social services are determining processes of a general and singular order of the precarious conditions of oral health and general. Conclusions: the participating population is in a situation of social and health vulnerability, which shows the need for public policies and strategies based on the social reality that contribute to generating equity in health.

Abstract Background The Racing and Crowded Thoughts Questionnaire (RCTQ-13) is the most widely used specific scale for the measurement of racing thoughts, but there is currently no Spanish version that allow the evaluation in Spanish-speaking patients. The objective of this study is to translate, adapt, and validate the RCTQ-13 in a Colombian population with affective disorders. Methods The questionnaire was translated and back-translated, and corrections were implemented following a pilot test to improve comprehensibility. We included patients with Bipolar I Disorder and with Major depressive disorder seen in three centers in the city of Medellín, Colombia. We evaluate structural validity with confirmatory factor analysis, internal consistency, and test-retest reliability. Construct validity was also assessed with the comparison between euthymic, maniac, and depressive episodes and the correlation with worry, rumination, and mania scales. Responsiveness was measured 1 month after the first evaluation. Based on item response theory (IRT), we also estimated item difficulty, discrimination, and fit using a generalized partial credit model. Results Two hundred fifty subjects were included. Confirmatory factor analysis revealed that the three-factor structure of the scale was appropriate. Internal consistency was adequate for the entire scale (Cronbach’s alpha = 0.95, 95% CI: 0.94-0.96) and for each factor. Test-retest reliability was good (intraclass correlation coefficient = 0.82, 95%IC: 0.70-0.88). For construct validity, we observed differences between patients with different types of affective episodes, a moderate positive correlation with the Penn State Worry Scale (r = 0.55) and the Ruminative Response Scale (r = 0.42), and a low negative correlation with the Young Mania Rating Scale (r = − 0.10). Responsiveness was proved to be adequate. Under IRT, the response thresholds for the response options are organized for all items. The infit was adequate for all items and the outfit was acceptable. Conclusions The Spanish version of the RCTQ-13 is a reliable, valid, and responsive scale and can be used for the clinical assessment of the construct of racing and crowded thoughts in patients with the spectrum of affective disorders in whom this experience can be expressed with different nuances. Further research is needed to expand the relationship with rumination and worry.

Introduction: Individuals with cleft lip and palate often face persistent challenges related to speech and hearing disorders, impacting various aspects of their lives. These challenges can lead to additional mental health issues such as attention-deficit/hyperactivity disorder, anxiety, and depression, as well as heightened psychosocial challenges, including appearance-related issues, bullying, workplace discrimination, and impaired social interactions. Children and adolescents with these disorders commonly experience loneliness, peer rejection, and challenges in forming friendships, particularly during adolescence, while voice disorders can diminish the quality of life in older individuals. Case description: This case study focuses on a 17-year-old male with unilateral cleft lip and palate undergoing treatment in Medellin, Colombia, aiming to provide insights into the intricate psychosocial challenges linked to speech and hearing difficulties in individuals with cleft conditions. Discussion and Evaluation: Clinical evaluations identified significant challenges concerning speech difficulties and self-perception, influenced by the patient’s cleft condition, which impacts his self-esteem, confidence, and social skills development. The interconnectedness between speech and hearing challenges underscores the necessity for comprehensive care to address the multifaceted psychosocial aspects experienced by individuals with cleft conditions. Conclusions: This case study used as an example, indicates that speech difficulties and psychosocial challenges related to cleft conditions are experienced from childhood and may persist into adulthood. These challenges can have profound effects on various aspects of life, including school, social interactions, family dynamics, and even romantic relationships. Consequently, the lack of confidence, social isolation, and limited social skills may delay patients from reaching their fullest potential.

We must stir up a new springtime of holiness... No more violence, terrorism, or drug trafficking. No more torture or other forms of abuse... No more exploitation of the weak, race discrimination or poor slums. Never again. These are intolerable evils. This is our cry: Life with dignity for all, for all who have been conceived in their mother's womb, for street children, for indigenous people and... for those who suffer any kind of marginalization Pope John Paul II, January 23, 1999, Mexico City, Mexico. Pope John Paul II came to Mexico and the United States in January 1999 to preach about the evils of rampant world capitalism (Tamayo 1999). This rekindled popular interest in"the preferential option for the poor," as expressed a generation earlier within the Catholic Church under the auspices of the 1968 Latin American Bishop's Conference held in Medellín, Colombia (Lernoux 1989). For many, this movement towards the preferential option for the poor had been operational under the moniker of Liberation Theology (Gutiérrez 1988). Originally, however, this "preferential option for the poor," or the drive towards social justice, was rebuffed when Pope John Paul II first became leader of the Roman Catholic Church in 1978. Strikingly, the Pope's message to the Liberation Theologians within the Nicaraguan Church was pointed, upon his Nicaraguan visit in March 1983, when he wagged his finger at Reverend (and Minister of Culture) Ernesto Cardenal for mixing political and religious service (Kirk 1992). More importantly for social movements within Latin America, the opposition of the Pope to social justice within a framework of social action through politics stunted the vitality of the Catholic Church in serving and expressing a preferential option for the poor.

Successive measurements of global disease burden have documented that lower respiratory tract infections, including pneumonia, are among the top 10 causes of disability-adjusted life-years, and in 2019, pneumonia was the fourth cause of mortality for all ages. In Colombia, acute respiratory infections are the leading cause of mortality within the group of infectious diseases, 52.3% of the total reported between 2005 and 2019. Notably, the COVID-19 epidemic increased the impact of respiratory tract infections on the global disease burden, with estimates of 18 million excess deaths from January 2020 to December 2021 worldwide. The assessment of an adult with pneumonia or suspected pneumonia demands the identification of the likelihood of death and hospitalization. Several scales have been constructed to estimate this probability to improve the predictive capacity of clinical evaluation. Among these scales, the CRB-65 and the CURB-65 standout, being the first recommended for use with clinical criteria and the second when laboratory data such as urea nitrogen are available. Additionally, for an individual with sepsis, there have been developed to predict mortality, such as SOFA (Sequential Organ Failure Assessment) and, more recently, the qSOFA(quick SOFA), which has an accurate prediction of mortality in this population. Hincapié C et al. assessed the CURB-65, CRB-65 and SOFA scales to predict mortality and admission to the intensive care unit in adults with pneumonia in three cohorts of patients admitted in three medium- and high-complexity hospitals in the city of Medellin-Colombia. The study included 1110 patients with suspected pneumonia identified in the emergency department and followed up until discharge and death. The authors found that the highest discrimination capacity, measured by the ROC curve, for the outcome hospitalization in an intensive care unit was 0.61, 0.58, and 0.59 for the CURB-65, CRB-65, and SOFA, respectively. About mortality, the ROC found was 0.66, 0.63, and 0.63 for CURB-65, CRB65, and SOFA, respectively. The calibration was appropriate, that is, the ability to predict mortality and admission to the intensive care unit e for the three scales. Some readers have expressed their disagreement with the possible limited use of the scales, particularly the CURB-65 and the CRB-65, in the evaluation of an adult patient with pneumonia expressed by the authors.