Conventional agricultural practices are often contrary to human health and environmental conservation. Use of and exposure to pesticides in agricultural communities in tropical countries is a pressing public health problem and an important facet of environmental degradation. This research project was undertaken by documenting use and exposure behaviors among agricultural communities in San Cristobal, Antioquia (Colombia). The research questions were: (1) What are the primary factors associated with the use of pesticides and do those factors differ between pesticide users and agroecological adherents? (2) How do campesino pesticide users and agroecological adherents(non-pesticide users) differ in their attitudes and beliefs with regards to pesticide use and exposure? and (3) How do these factors influence campesinos‟ behaviors associated with pesticide use and exposure? I implemented qualitative and quantitative methods in this investigation. The qualitative approach was based on community participatory ethnographic research. The latter involved participant observation, interviews, and focus groups aimed at existing pesticides users and agroecological adherents. The quantitative approach used questionnaires to derive demographic information, scale-based evaluations of attitudes and beliefs, pesticides decision making, perceived confidence, and perceived control. Findings showed that the most relevant factors related to pesticide use and their categories included: a) individual: beliefs, attitudes and knowledge; b) interpersonal: family support and cultural acceptance of pesticide use; c) economic: fear of living within financially unviable constraints, market conditions and lack of economic support from the government; d) cultural: collective acceptance or tolerance of pesticide use and exposure and onset of negative reactions when stopping pesticide use; e) political: deficient regulations for controlling pesticide use control and adequate utilization of protective equipment. Pesticide users experienced the most apprehension regarding stopping pesticide use as they often believed pesticides allow them to obtain better crop yields and, therefore, higher monetary gains. Pesticide users lacked a positive attitude toward personal protectionequipment, regardless of the risks to which they may be exposed. Pesticide training was deficient in this population showing a clear need to improve safety conditions and training to reduce occupational hazards. Future studies should explore with greater detail these attitudes and beliefs so as to promote mid- to long-term public health interventions that directly address the sense of food and income insecurity found among the population of pesticides users, which blocks their transition into a non-pesticide scenario for agricultural production. Over the short-term, public health programs should continue to educate the population of pesticide users on the immediate risks of exposure. The decision making process surrounding pesticide use in the studied population was influenced by a variety of factors. Campesinos who were prone to use pesticides for their crops often exhibited diminished degrees of knowledge about adverse effects of pesticides on human health, believed pesticides are necessary for their crops, had negative attitudes about stopping pesticide use, had a strong family influence toward the use of pesticides, experienced economic fear of stopping pesticide use, cultivated flowers as their main source of income, expressed strong social acceptance of pesticide use, experienced negative community reactions when attempting to stop pesticide use, received government subsidies for pesticide use, and had never received any training on the use of required protective equipment. Campesinos who showed more proclivities towards the use of pesticides were convinced that pesticides are necessary for their crops as they guarantee substantial yields and larger specimens of the different crop varieties. They also exhibited low perceived control, low perceived confidence, and a low perception of adverse pesticide effects on human health and the natural environment. Future studies are required to fully comprehend the unique occupational health and safety needs of these campesinos. Additionally, future studies should be aimed at designing and introducing long-term, well-structured public health interventions to increase awareness about the harmfulness of pesticides on human and environmental health so as to promote a well-established behavioral change in relation to pesticides use reduction among these communities.

Tesis de Nicolás Osorio para optar al título de Doctor en Medicina, en la Facultad de Medicina de París, en 1865. A lo largo del documento, escrito en francés, Osorio analiza el comportamiento de los tumores que obstruyen el líquido cefalorraquídeo.

Many low- and middle-income countries are experiencing a rapid increase of overweight and obesity rates. Nonetheless, there are some concerns not only about the pace of the increase in overweight and obesity, but also about inequalities in their distribution across social groups. The main aims of this thesis were to: i) examine socioeconomic differences in overweight and obesity over the last decades among women of childbearing age in low- and middle- income countries; ii) determine the contribution of reproductive variables (e.g., parity, age at first birth, breastfeeding) to socioeconomic inequalities in overweight and obesity in low- and middle-income countries; and iii) assess the impact of recently adopted poverty reduction policies, namely conditional cash transfer programs (CCT) on determinants of child health and children´s nutritional status. Overall, the prevalence of overweight and obesity among women has increased in most low- and middle-income countries across all educational groups and occupational classes in the last two decade. Nonetheless, overweight and obesity trends have rapidly increased among less educated and lower occupational classes especially in North Africa/West and Central Asia (NWA), Sub-Saharan (SS) and Latin America and the Caribbean (LAC) region. For example, women working in agriculture and production sector had an annual increase in the prevalence of overweight/obesity ranged from 2.8% in LAC region to 3.7% in the SS region. In addition, women with lower age at first birth, high parity, and shorter duration of breastfeeding had an increased odds of overweight. Nonetheless, those reproductive factors did not play a key role in explaining differences in overweight by socioeconomic status and related trends. Finally, the CCT Familias en Accion was associated with significant higher BMI z-scores among children beneficiaries of this program; BMI-for-age z-scores (β=0.14, 95%CI 0.00, 0.27, p <0.05). These results suggest that in future years, the unequal distribution of body weight between and within societies likely contributes to perpetuate poverty and poor health as in high-income countries. In addition, poverty reduction policies such as CCT programs in a middle- income country such as Colombia have not been very successful in preventing overweight and obesity. Therefore, additional efforts specifically focused on preventing an increase in inequalities in overweight and obesity are needed, targeting mothers and children from low income households.

Resumo: Neste estudo analisam-se o câncer de colo uterino como problema social e as contribuições da enfermagem na realização de testes para detectá-lo precocemente. Metodologicamente se fundamenta na epidemiologia descritiva e na revisão sistemática. Os resultados são apresentados na forma de artigos. No primeiro, Câncer de colo do útero: um problema social mundial, é analisado o câncer de colo de útero como problema social. Estudo transversal, com dados populacionais coletados na base de dados Globocan-2008. Foram utilizados dados das Taxas de Incidência e das Taxas de Mortalidade por 100.000 mulheres e percentuais de risco acumulado de incidência e mortalidade antes dos 75 anos pela doença nas regiões desenvolvidas e em desenvolvimento do mundo. Na análise são aplicadas as classificações da Organização das Nações Unidas (ONU) de desenvolvimento dos países ou regiões com base em projeções sociais e demográficas e os níveis de classificação das Taxas de Incidência e de Mortalidade do International Agency for Research on Cancer (IARC). O segundo artigo, Câncer de colo do útero: mortalidade em Santa Catarina – Brasil, 2000 a 2009, foi desenvolvido com base nos dados dos óbitos de mulheres por câncer de colo do útero, inclusive os de porção não especificada, ocorridos em Santa Catarina no período de 2000 a 2009, obtidos no Sistema de Informação de Mortalidade (SIM) do Ministério da Saúde e do Instituto Brasileiro de Geografia e Estatística (IBGE). Observou-se que as taxas de mortalidade mais elevadas incidiram em mulheres a partir dos trinta anos e que o câncer de colo uterino ainda não foi controlado. No terceiro artigo, A enfermagem na detecção precoce do câncer de colo uterino: revisão sistemática, são analisadas as contribuições da Enfermagem para a título e resumo foram pré-selecionados 174, os quais foram lidos integralmente, resultando na seleção de 10 artigos. O pessoal de enfermagem atuou como participante em nove pesquisas e como pesquisador em três pesquisas. A maioria dos artigos foi classificada com o nível de evidência 3B segundo a classificação Oxford; somente um obteve nível 4. Há contribuição de Enfermagem na realização de exames para detecção precoce do câncer de colo uterino, apesar do nível de evidência com que foram classificados os artigos. Conclui-se que o impacto da doença nas mulheres, nas suas famílias e nas sociedades demanda modificações no quadro das iniquidades sociais com adoção de estratégias intersetoriais que também facilitem o acesso aos serviços de saúde. O cuidado de enfermagem é uma estratégia para atender a responsabilidade social com as mulheres, as famílias e as sociedades e contribuir na detecção precoce da doença, favorecendo a qualidade de vida de milhares de mulheres. Resumen: En este estudio se analizan el cáncer de cuello uterino como problema social y las contribuciones de la enfermería en la realización de pruebas para detectarlo precozmente. Metodológicamente se fundamenta en la epidemiologia descriptiva y en la revisión sistemática. Los resultados son presentados en la forma de artículos. En el primer, El cáncer de cuello de útero: un problema social mundial, es analizado el cáncer de cuello de útero como problema social. Estudio transversal, con datos poblacionales recolectados en la base de datos Globocan-2008. Fueron utilizados datos de las Tasas de Incidencia y de las Tasas de Mortalidad por 100.000 mujeres y porcentajes de riesgo acumulado de incidencia y mortalidad antes de los 75 años por cáncer de cuello uterino en las regiones desarrolladas y en desarrollo. En el análisis son aplicadas las clasificaciones de la Organización de las Naciones Unidas (ONU) de desarrollo de los países o regiones con base en proyecciones sociales y demográficas y los niveles de clasificación de las Tasas de Incidencia y de Mortalidad de la International Agency for Research on Cancer (IARC). El segundo artículo, Cáncer de cuello de útero: mortalidad en Santa Catarina – Brasil, 2000 a 2009, fue desarrollado con base en los datos de las muertes de mujeres por cáncer de cuello de útero, inclusive los de porción no específica, ocurridos en Santa Catarina en el período de 2000 a 2009, obtenidos en el Sistema de Información de Mortalidad (SIM) del Ministerio de Salud y del Instituto Brasileiro de Geografía y Estadística (IBGE). Se observó que las tasas de mortalidad elevadas incidieron en mujeres a partir de los treinta años y que el cáncer de cuello uterino todavía no fue controlado. En el tercer artículo, Contribuciones de la enfermería en la detección precoz del cáncer de cuello de útero: revisión sistemática, son analizadas las contribuciones de la enfermería para la detección precoz de esa neoplasia. Revisión sistemática con artículos recuperados en el año de 2010 en las bases de datos MEDLINE, Cochrane, CINHAHL y LILACS. De los 3091 artículos identificados, después de la lectura del título y resumen fueron preseleccionados 174, los cuales fueron leídos integralmente, resultando en la selección de 10 artículos. El personal de enfermería actuó como participante en nueve investigaciones y como investigador en tres investigaciones. El nivel de evidencia 3B, en la clasificación Oxford, ocurrió en la mayoría de los artículos; solamente uno obtuvo nivel 4. Hay contribuciones de enfermería en la realización de exámenes para detección precoz del cáncer de cuello uterino, a pesar del nivel de evidencia en el que fueron clasificados los artículos. Se concluye que el impacto de la enfermedad en las mujeres, en las familias y en las sociedades demanda modificaciones en el cuadro de las inequidades sociales con adopción de estrategias intersectoriales que también faciliten el acceso a los servicios de salud. El cuidado de enfermería es una estrategia para atender la responsabilidad social con las mujeres, las familias y las sociedades y contribuir en la detección precoz de la enfermad, favoreciendo la calidad de vida de millares de mujeres. Abstract: In this study cervix cancer is analyzed as a social problem and the contribution of nursing in applying screening tests for the early detection of cervical cancer. Methodology is based on descriptive epidemiology and a systematic review. The results were presented like articles. In the first article, Cervical cancer: a social problem, and analyzing cervical cancer as a social problem. Cross sectional Study, with population data collected using the Globocan-2008 databases. Data from incidence and mortality rates per 100.000 women, and accumulated risk rates of cervical cancer incidence and mortality before the age of 75 in developed and developing regions of the world were used. In the analysis, the United Nations Organization classifications of countries or regions development based on social and demographic projections and the levels of classification of the incidence and mortality rates of the International Agency for Research on Cancer (IARC) are applied. The second article, Cervical Cancer: Mortality in Santa Catarina – Brazil, 2000 to 2009, obtained from the Information Mortality System (SIM) of the Ministry of Health and the Brazilian Institute of Geography and Statistics (IBGE). It was observed that the Mortality rate was higher in women in their early thirties and in whom the cervical cancer was not yet controlled. In the third article, Contributions of Nursing in the early detection of cervical cancer: systematic review. The contributions of nursing for the early detection of the disease were analyzed. Systematic review with articles recovered in the year of 2010 from MEDLINE, Cochrane, CINAHL and LILACS databases. After reading the titles and abstracts of the articles, from 3091 identified, 174 were pre-selected and read exhaustively resulting in the selection of 10 articles. The nursing staff participated in nine of the researches and in three of them they participated as researchers. Most of the articles had a level of evidence 3B, in the Oxford classification; only one of them had a level 4. There are also nursing contributions in the application of tests for the early detection of cervical cancer despite the level of evidence in which the articles were classified. It is concluded that the impact of the disease in women, their families and the society demand modifications in the role of social inequities with the adoption of inter-sector strategies that also facilitate the access to health services. Nursing care is a strategy to attend the social responsibility with women, their families and the society and contribute in the early detection of diseases, favoring the quality of life of millions of women.

Physical activity promotion (PAP) has reached policy agendas worldwide due to the social and economic burden that non-communicable diseases have generated. Colombia is one of the countries that have taken the challenge of promoting healthy lifestyles in order to reduce this burden and in addition, take advantage of other benefits that promoting this healthy lifestyle brings. Although some research has been done on the field, no studies related to the local government contribution were found. The local government plays a crucial role in PAP, considering that it has a great influence on the physical and social environment of a city and consequently in the individual behavior of its citizens. Additionally, it has a great responsibility concerning public health, social and economic development and environmental sustainability, aspects that are related to PAP. The present research, aims to provide a general overview on the current state of PAP in the Municipal Sport Authorities (MSAs) of one department of Colombia. In this sense, it is important to highlight that the sport sector has had a major role in PAP in the country and the department. Hence, structured interviews were conducted among heads of the MSAs of the 14 municipalities of the department and development plans were analyzed. Using this data, two main aspects were studied in order to achieve the research aim: the current PAP interventions and the conditions to promote physical activity (PA) in the department. Results indicate that the current PAP interventions have both strengths and weaknesses. Among the most important aspects, it was noticed that PAP in Risaralda has neglected important environmental determinants for PA behavior. PAP has been oriented from an “anthropic” perspective (targeting the individual). However, this seems to have had a positive effect on PA levels in the department. Concerning the conditions to promote PA, there are important findings related to the knowledge and skills of policy-makers and the management process used to develop the interventions. Some of the weaknesses found in the interventions might be related to the conditions to develop them. Recommendations to MSAs and for further research are given.

Las Actividades Integradoras del Aprendizaje por Sistemas -AIAS-, son una estrategia educativa fundamentada en el Aprendizaje Basado en Problemas -ABP-. Esta técnica se centra en el aprendiz, promueve el trabajo en pequeños grupos, utiliza casos clínicos como" detonadores" (triggers), con el propósito de promover en los estudiantes habilidades para la resolución de problemas, mediante la aplicación de conocimientos. Las AIAS son un espacio generador de sentido, de reflexión y del manejo de la incertidumbre. El rol del facilitador favorece el 'andamiaje', un concepto muy utilizado en educación, con base en la visión constructivista de Vygotsky y el concepto de Zona de Desarrollo Próximo -ZDP-, que se conoce como la distancia que existe entre lo que el estudiante puede resolver por sí solo, y lo que podría realizar con ayuda o guía de un adulto o persona más capacitada, para encontrar su nivel de desarrollo potencial.

Este texto muestra cómo el riesgo se ha convertido en un tema popular en las últimas décadas y cómo este proceso afecta el campo de la promoción de la salud, incluidas las cuestiones relacionadas con el estilo de vida, genética y contextos socioculturales. Además de discutir los aspectos técnicos, metodológicos y teóricos, llama la atención sobre publicidad asociada con la percepción de las amenazas constantes y la aversión obsesiva a todos los riesgos. Aunque -por supuesto- no hacen apología de la exposición desmedida a las amenazas reconocidas para la salud y la vida, adopta una actitud crítica hacia el generador de comportamiento "riesgofóbico" ansiedad e inseguridad.

Das Krankenhaus als Schlüsselakteur im Gesundheitswesen muss heutzutage die Herausforderungen des Marktes und Wettbewerbes annehmen, dafür soll es eine Wettbewerbsstrategie folgen. Die zunehmenden Umweltprobleme mit der einhergehenden sozialen Ungerechtigkeit und Armut haben die Notwendigkeit erweckt, Unternehmen stärker in die Verantwortlichkeit ihres Handelns einzubinden. Krankenhäuser sind wichtiger Arbeitgeber, bedeutender Verbraucher von Ressourcen, und damit auch größere Erzeuger von Emissionen und Abfälle. Die vorliegende Arbeit soll klären, welche Wettbewerbsvorteile durch Nachhaltigkeitsmanagement in kolumbianischen Krankenhäusern aufgebaut und gehalten werden können. In der Einführung dieser Masterarbeit wird das kolumbianische Gesundheitssystem kurz vorgestellt sowie das externe Umfeld der Krankenhäuser erläutert, um eine allgemeine Strategie zu empfehlen. Im Anschluss wird der Einfluss von Nachhaltigkeitsmaßnahmen auf Wettbewerbsvorteile analysiert. Das kolumbianische System für soziale Sicherheit im Gesundheitswesen fördert die Qualität der Dienstleistung und Patientenorientierung als Grundlagen für die Wahl der Gesundheitseinrichtung bei Patienten. Neben den Ergebnissen der Analyse des Makroumfelds wird die Schlussfolgerung gezogen, dass eine Differenzierungsstrategie, die auf Qualität und Patientenorientierung basiert ist, das Konzept der Lebensqualität durch Wohlbefinden, Vitalität und Gesundheit in ihrer Struktur als Basis immer enthalten sollte. Der positive Einfluss von Nachhaltigkeitsmaßnahmen auf Wettbewerbsvorteile wird durch Ursache-Wirkungsbeziehungen dargestellt. Entlang der gesamten Wertschöpfungskette ist dann ihre Anwendung aufgezeigt. Einige der in der Masterarbeit identifizierten Maßnahmen sind: Risikoanalyse, Biosicherheit, Weiterbildung, Ethikkodex, effizientere Technologie, nachhaltige Beschaffung, Corporate Citizenship, u.a. Am Ende der Masterarbeit kommt der Autor zu dem Entschluss, sowohl Investitionen in Qualität als auch eine Rationalisierung von Kosten durch die Anwendung von Öko- und Sozioeffizienz in einer Weise durchzuführen, dass die Qualität der Dienstleistungen nicht belastet wird. Durch diesen Lösungsvorschlag kann das Krankenhaus attraktive Preise mit Krankenkasse handeln und gleichzeitig die Treue der Patienten behalten.

Pregnancy during adolescence is a worldwide public health concern. In developing countries, 14 million adolescents give birth each year, which accounts for 90% of all worldwide pregnancies. The proportion of adolescent women aged 10-19 whom have been pregnant in Mitú, Colombia is of approximately 25%, in comparison to 19.5% at the national level. This report aims to review the effectiveness and identifying best practice of adolescent pregnancy interventions in low and middle income countries and use formative research to make specific recommendations for policy and practice to prevent adolescent pregnancy in Mitú, Colombia. EMBASE, Medline, CINHAL, Cochrane library, GLOBAL HEALTH, ADOLEC, Popline, LILACS and REPRODUCTIVE HEALTH LIBRARY were searched to identify studies examining adolescent pregnancy prevention interventions in developing countries. GOOGLE was searched to identify grey literature. Five semi-structured interviews were also conducted with key service providers in the field of Adolescent Sexual and Reproductive Health in Mitú to explore the needs of the region in regards to adolescent pregnancy prevention and the barriers and facilitators for programme implementation. The literature review found that adolescent pregnancy prevention interventions in developing countries had a positive impact on the knowledge of pregnancy prevention and may contribute to the delay of sexual initiation. However, impact on the use of contraceptive methods and reduction of adolescent pregnancy inconclusive. Interviews revealed key societal, familial and individual factors that were viewed to be linked to adolescent pregnancy in Mitú. Relationships between military personnel and young women appeared to be an important factor in high teenage pregnancy rates. Barriers for the adequate implementation and continuation of programmes included lack of political commitment, lack of financial, human and material resources and lack of inter-institutional collaboration, the high rate of staff turnover and the lack of monitoring programmes. Only few facilitators were mentioned that consisted mainly in the willing of both adolescent and military to collaborate in the implementation of adolescent pregnancy prevention interventions. In conclusion, evidence suggests that adolescent pregnancy prevention strategies are effective in increasing knowledge of pregnancy and might delay sexual initiation in low and middle-income countries. Features of effective programmes were identified and discussed and are important in designing and developing new strategies. However, cultural, environmental and social barriers need to be addressed through political commitment and inter-institutional collaboration in order to develop effective interventions for pregnancy prevention in Mitú.

Zanahoria-Daucus carota