Diana Marcela Díaz-Quijano

Generation and evaluation of an indicator of the health system’s performance in maternal and reproductive health in Colombia: An ecological study

Objective To generate and evaluate an indicator of the health system’s performance in the area of maternal and reproductive health in Colombia. Materials and methods An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator’s score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. Results The factor analysis indicates that only one principal factor exists, namely coverage and utilization of maternal healthcare services (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator’s behavior was found to have an association with the unsatisfied basic needs index and women’s education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. Discussion The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

The pursuit of healthier communities through a community health medical education program

Background: Distinct periods in the community health undergraduate medical program at the University of La Sabana (Colombia) were identified in its evolution from 1999 to 2013. We describe each period and explain the succesion of changes toward improvement. Methods: An ordered review of the community health program was constructed based on the retrospective recollection, classification, and analysis of information from document archives and interviews with participants. The review of the experience reconstructs periods of the program, organizing the evolution of its learned lessons and identified changes across the development of community health projects (CHPs) and the phases followed in their implementation. Results: Two principal stages were identified, the first when students CHPs involved only schools, and the second when students worked in a broader array of community settings. Identified phases of the community health cycle leading to identifying changes across the program timeline were focus of the community–campus partnership; development of relationships among participants; health and health determinants assessment; defining project goals and objectives; devising a project activity plan; implementing and gathering results; disseminating project achievements; and building sustainability of program activities. Periods were bounded by important new characteristics introduced in the pursuit of healthier communities. Discussion: Understanding the evolution of the program revealed the key concepts and practices in setting community health apprenticeship scenarios for the various participants. Overall, trust and commitment from stakeholders requires competent facilitators able to build meaningful and sustainable collaborations that can translate the purpose of community health practice into an effective teaching–learning experience. Institutional capacity building and collaborative practice contribute to improvements in the community health program and its ability to be flexible to adapt to different contexts. Periods reflecting improvement in this schools programs over time can help others identify key elements that need to be integrated into a community health medical education program.

Colonoscopy Screening for Colorectal Cancer — Overview of the Literature

Objective: The aim of our chapter was to perform a systematic review of the clinical practice guidelines, randomized clinical trials, and prospective studies, using total colonoscopy for screening this population for colorectal cancer (CRC) and to evaluate the effectiveness of diagnosis and safety. Methods: We included clinical practice guidelines, systematic reviews, and pri‐ mary studies with more than 25 participants, and only those reporting the evaluation of colonoscopy as screening test for colorectal cancer and adenoma were included in this chapter. Analysis was performed for three outcomes: ac‐ curacy of colonoscopy as a screening test, reduction of colorectal cancer inci‐ dence and prevalence, and identification of adverse events of the procedure. Results: For screening colonoscopy, evidence was of moderate quality. The evi‐ dence results suggest tentatively an even stronger reduction in distal colorectal cancer incidence and mortality. The colonoscopy significantly reduces the mor‐ tality for CRC. These studies suggest a 17% to 30% lower risk of incident color‐ ectal cancer and 64% death from colorectal cancer after screening colonoscopy vs other screening diagnosis tests. Conclusions: Colonoscopy is a feasible and safe method for screening CRC for proximal locations in asymptomatic people; however, these findings must be in contrast with the cost of the procedure, accessibility opportunities, and com‐ plications.