ResumenObjetivo. Caracterizar el diagnóstico y tratamiento de mujeres con cáncer de mama en Bogotá, Colombia; establecer la demora de pacientes en la asistencia a consulta y los factores relacionados. Material y Métodos. A través de una aproximación censal se identificaron 1 106 mujeres con cáncer de mama. La recolección de información se hizo mediante entrevistas y revisión de historias clínicas. Se consideró demora de la paciente el tiempo entre la percepción del síntoma y la primera consulta. Resultados. Más de 80% de las mujeres consultaron por síntomas; la mayoría eran estados avanzados. Los factores que se relacionaron con la demora fueron una mayor edad, no tener afiliación al sistema de salud y la enfermedad avanzada. Una mayor educación se relacionó con menor demora. Discusión. Las mujeres no reconocen los síntomas del cáncer de mama; es necesario diseñar estrategias de comunicación y educación para estimular el reconocimiento de los síntomas y la oportunidad de consulta.

The FACT-G scale measures a four-factor construct. Results indicate that the FACT-G scale is an instrument that performs consistently over time, with evidence of responsiveness. The finding of misfitting items in two subscales ("Social-family well-being", and "Emotional well-being") imposes caution in interpreting the scores of these domains.

BackgroundThe design of new healthcare schemes which involve using molecular HPV screening means that both persistence and clearance data regarding the most prevalent types of HR-HPV occurring in cities in Colombia must be ascertained.MethodsThis study involved 219 HPV positive women in all of whom 6 types of HR-HPV had been molecularly identified and quantified; they were followed-up for 2 years. The Kaplan-Meier survival function was used for calculating the time taken for the clearance of each type of HPV. The role of a group of independent variables concerning the time taken until clearance was evaluated using a Cox proportional-hazards regression model or parametric (log-logistic) methods when necessary. Regarding viral load, the Wilcoxon rank-sum test was used for measuring the difference of medians for viral load for each type, according to the state of infection (cleared or persistent). The Kruskal-Wallis test was used for evaluating the change in the women’s colposcopy findings at the start of follow-up and at the end of it (whether due to clearance or the end of the follow-up period).ResultsIt was found that HPV-18 and HPV-31 types had the lowest probability of becoming cleared (1.76 and 2.75 per 100 patients/month rate, respectively). Women from Colombian cities other than Bogotá had a greater probability of being cleared if they had HPV-16 (HR 2.58: 1.51–4.4 95% CI) or HPV-58 (1.79 time ratio: 1.33-2.39 95% CI) infection. Regarding viral load, HPV-45-infected women having 1 × 106 to 9.99 × 109 viral copies had better clearance compared to those having greater viral loads (1.61 time ratio: 1.01-2.57 95% CI). Lower HPV-31 viral load values were associated with this type’s persistence and changes in colposcopy findings for HPV-16 gave the worst prognosis in women having low absolute load values.ConclusionsHPV infection clearance in this study was related to factors such as infection type, viral load and the characteristics of the cities from which the women came. Low viral load values would indicate viral persistence and a worse prognosis regarding a change in colposcopy findings.

♦ BACKGROUND: Peritonitis is the most important complication of peritoneal dialysis (PD), and early peritonitis rate is predictive of the subsequent course on PD. Our aim was to calculate the early peritonitis rate and to identify characteristics and predisposing factors in a large nationwide PD provider network in Colombia. ♦ METHODS: This was a historical observational cohort study of all adult patients starting PD between January 1, 2012, and December 31, 2013, in 49 renal facilities in the Renal Therapy Services in Colombia. We studied the peritonitis rate in the first 90 days of treatment, its causative micro-organisms, its predictors and its variation with time on PD and between individual facilities. ♦ RESULTS: A total of 3,525 patients initiated PD, with 176 episodes of peritonitis during 752 patient-years of follow-up for a rate of 0.23 episodes per patient year equivalent to 1 every 52 months. In 41 of 49 units, the rate was better than 1 per 33 months, and in 45, it was better than 1 per 24 months. Peritonitis rates did not differ with age, ethnicity, socioeconomic status, or PD modality. We identified high incidence risk periods at 2 to 5 weeks after initiation of PD and again at 10 to 12 weeks. ♦ CONCLUSION: An excellent peritonitis rate was achieved across a large nationwide network. This occurred in the context of high nationwide PD utilization and despite high rates of socioeconomic deprivation. We propose that a key factor in achieving this was a standardized approach to management of patients.

Objective: To assess cost-effectiveness of conventional cytology and HPV DNA testing for cervical-cancer screening in Colombia. Material and Methods: The National Cancer Institute of Colombia (NCIC) in 2007 developed a Markov model on the natural history of cervical cancer; no screening, conventional cytology, and HPV DNA testing were compared. Only direct costs were used. Outcomes comprise cervical cancer mortality, years of life saved, and lifetime costs. Discounted incremental cost-effectiveness ratios were estimated and sensitivity analyses were conducted for key parameters. Results: Depending on the screening strategy a 69-81% mortality reduction might be expected. The HPV DNA testing every five years is a cost-effective strategy (Incremental Cost-Effectiveness Ratio (ICER): USD$44/YLS) if the cost per test is under USD$31. The effectiveness was sensitive to coverage and primarily to follow-up. Conclusions: HPV DNA testing is a cost-effective alternative for screening in Colombia. Not only high coverage but high follow-up rates are critical for successful screening programs.