Settings In Colombia Research Articles

SPIRIT: Assessing Clinical Parameters Associated with Using IDegLira in Patients with Type 2 Diabetes in a Real-World Setting in Colombia.

Insulin degludec/liraglutide (IDegLira) is a fixed-ratio combination of insulin degludec (a basal insulin) and liraglutide (a glucagon-like peptide-1 receptor agonist [GLP-1RA]). This study aimed to investigate clinical outcomes in people with type 2 diabetes mellitus (T2DM) after initiating IDegLira treatment in a real-world setting in Colombia. SPIRIT is a non-interventional, single-arm, retrospective chart review study to assess clinical outcomes in people with T2DM. Participating patients were switched from a treatment regimen of basal insulin (with or without oral antidiabetics [OADs]) and started on treatment with IDegLira a minimum of 26 ± 6weeks before the data collection start date. Data were collected from the medical records of 175 patients in ten clinical centers across Colombia. Compared with baseline, there was a significant reduction in glycated hemoglobin (HbA1c) (1.3%; 95% confidence interval [CI] -1.6 to -1.0; p < 0.0001) after 26 ± 6weeks of follow-up. The mean HbA1c at baseline and at the end of the study was 9.1% and 7.8%, respectively. In addition, IDegLira significantly reduced absolute body weight by 1kg (95% CI -1.5 to -0.5; p < 0.0001), from a mean of 76.1kg at baseline to 75.1kg after follow-up. The mean IDegLira dose at the end of the study was 21.3 U, and no severe hypoglycemic events were observed during the follow-up period. In real-world practice, initiating IDegLira in patients with T2DM previously treated with basal insulin (± OAD) was associated with improved glycemic control, reduced body weight and reduced risk of hypoglycemia. ClinicalTrials.gov identifier: NCT05324462.

Decolonizing English in Higher Education: Global Englishes and TESOL as Opportunities or Barriers (SI on Global Englishes and TESOL)

AbstractEnglish is core to HE (higher education) globally, with both HE and English seen as pathways to success for students. Yet, access to English is unequal and colonial ideologies associate English with Anglophone settings. Much of the research on English in HE has focused on elite institutions and students, while the majority of the world's HE students remain comparatively under‐researched. This paper reports on a mixed‐methods study of TESOL in five linguistically and socioculturally diverse HE settings in Colombia, Mexico, Iraq, Thailand, and Vietnam. The aims were to explore the roles and perceptions of English, TESOL, and other languages in policy and practice, (including multilingualism and Global Englishes) and how these related to processes of dis/empowerment and de/colonialization of HE. We sought to uncover the extent to which TESOL and English allowed or restricted access to opportunities of empowerment for different groups of students on their way to and through HE, and how English intersected with a range of dimensions of potential marginalization or privilege, particularly socioeconomic status, ethnicity, and rurality. We present findings from students through a questionnaire (n = 1820) and interviews with students, teachers, and administrators at each of the sites (n = 150).

The Evolution of Health Benefits Packages in Colombia: Thirty Years of Successes and Failures

ABSTRACT Health benefits packages in Colombia—what is covered, by whom, and at what cost—have evolved over the past thirty years. Coverage changed from two explicit health benefits packages (with benefits linked to ability to contribute) to an implicit approach that covers, in theory, everything for everyone, excluding a narrow negative list of services and health technologies. This article explores the evolution of priority setting in Colombia during two periods of major reform. Each period had its own advantages and disadvantages associated with different institutional arrangements, processes, and methodologies. Colombia’s evolution provides several lessons for other low- and middle-income countries interested in institutionalizing evidence-based priority-setting.

Geological context and human exposures to element mixtures in mining and agricultural settings in Colombia

Anthropogenic and natural sources contribute to chemical mixtures in air, water, and soil, posing potential risks to the environment and human health. To understand the interplay between element profiles in the human body, geographical location, and associated economic activities, we carried out an observational analytic cross-sectional study. The study recruited 199 participants from three municipalities, two of which had gold-mining as their primary economic activity, while the other was dedicated to agricultural and other local activities not related to mining. The concentrations of a total of 30 elements in human hair samples and 21 elements in environmental soil samples were measured using various spectrometry techniques. Unsupervised clustering analysis using Self-Organizing Maps was applied to human hair samples to analyze element concentrations. Distinct clusters of individuals were identified based on their hair element profiles, which were mapped to geographical location and economic activities. While higher levels of heavy metals (Ag, As, Hg, and Pb) were observed in individuals engaged in mining activities in certain clusters, individuals in agricultural areas show higher concentrations of elements found in pesticides (Ba and Sr). However, the elemental composition of hair is influenced not only by the anthropogenic activities but also by the inherent geological context where people live. Our findings highlight the significance of accounting for environmental factors when evaluating human health risks, as the intricate mixture of elements can yield valuable insights for targeted health interventions.

Liquidity constraints in free post-secondary education: Evidence from Colombia

This paper provides evidence of the importance of liquidity constraints in a tuition-free post-secondary education setting in Colombia. We exploit exogenous variation in the relative cost of tuition-free vocational education from a nationwide cash transfer program. We show that eligibility for a USD 136 grant every other month increases enrollment by up to 12 percentage points. We also show that men with larger returns to education are more affected by the availability of grants, which is consistent with the presence of liquidity constraints. However, we do not find the same for women. This paper highlights the importance of non-tuition costs and discusses whether individuals under-invest in their human capital when free education is available.

Adherence to guidelines on the use of amoxicillin for treatment of ambulatory pneumonia in children younger than 5 years, Colombia, 2017-2019.

To determine the level of adherence to clinical guidelines in prescribing amoxicillin to children younger than 5 years with pneumonia in outpatient settings in Colombia from 2017 to 2019, and assess the factors associated with adherence. This was a cross-sectional study of secondary data from the Colombian Integrated Social Protection Information System database. Adherence was defined as prescription of oral amoxicillin for bacterial and unspecified pneumonia and non-prescription for viral pneumonia. Variables examined included: age (< 1 year, 1-4 years) of child; sex; cause of pneumonia (bacterial, viral, unspecified); region (Andean, Amazonian, Pacific, Caribbean, Insular, Orinoquian); and payment mechanism (without prior authorization, capitation, direct payment, pay per case, pay for event). Of 215 925 cases of community-acquired pneumonia reported during 2017-2019, 64.8% were from the Andean region, 73.9% were bacterial pneumonia and 1.8% were viral pneumonia. Adherence to guidelines was observed in 5.8% of cases: this was highest for children diagnosed with viral (86.0%) compared with bacterial (2.0%) pneumonia. For children diagnosed with bacterial pneumonia, 9.4% were prescribed any antibiotic. A greater proportion of children covered by capitated payments (22.3%) were given treatment consistent with the guidelines compared with payment for event (1.3%). In this first study from Colombia, adherence to guidelines for outpatient treatment of children with bacterial pneumonia was low and was better for viral pneumonia. Further qualitative studies are needed to explore the reasons for this lack of adherence and why bacterial pneumonia was the most commonly reported etiology.

Management of unexpected placenta accreta spectrum cases in resource-poor settings

On a global scale, cases of placenta accreta spectrum are often just identified during cesarean delivery because they are missed during antenatal care screening. Routine operating teams not trained in the management of placenta accreta spectrum are faced with difficult surgical situations and have to make decisions that may define the clinical outcomes. Although there are general recommendations for the intraoperative management of placenta accreta spectrum, no studies have described the clinical reality of unexpected placenta accreta spectrum cases in resource-poor settings. This study aimed to describe the maternal outcomes of previously undiagnosed placenta accreta spectrum managed in resource-poor settings in Colombia and Indonesia. This was a retrospective case series of women with histologically confirmed placenta accreta spectrum treated in 2 placenta accreta spectrum centers after referral from remote resource-poor hospitals. Clinical outcomes were analyzed according to the initial type of management: (1) no cesarean delivery; (2) placenta left in situ after cesarean delivery; (3) partial removal of the placenta after cesarean delivery; and (4) post-cesarean hysterectomy. In addition, we evaluated the use of telemedicine by comparing the outcomes of women in hospitals that used the support of the placenta accreta spectrum center during the initial surgery. A total of 29 women who were initially managed in Colombia (n=2) and Indonesia (n=27) were included. The lowest volume of blood loss and the lowest frequency of complications were in women who underwent deferred cesarean delivery (n=5; 17.2%) and in those who had a delayed placental delivery (n=5; 20.7%). Five maternal deaths (14%) occurred in the group that did not receive telehelp, and 4 women died of irreversible shock because of uncontrolled bleeding. Previously undiagnosed placenta accreta spectrum in resource-poor hospitals was associated with a high risk of maternal mortality. Open-close abdominal surgery or leaving the placenta in situ seem to be the best choices for unexpected placenta accreta spectrum management in resource-poor settings. Telemedicine with a placenta accreta spectrum center may improve prognosis.

Adapting DIALOG+ in a School Setting-A Tool to Support Well-being and Resilience in Adolescents Living in Postconflict Areas During the COVID-19 Pandemic: Protocol for a Cluster Randomized Exploratory Study.

Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in low- and middle-Income countries, where scarcity of resources exacerbates the problem that has been further compounded by the global COVID-19 pandemic. Thus, special attention should be paid to the development of interventions that target this population. Our research aims to adapt an existing patient-centered digital intervention called DIALOG+ from a clinical setting to an educational setting using stakeholders' (teachers' and students') perspectives. We aim to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for the identification and mobilization of personal and social resources to mitigate the impact of social difficulties and to promote mental well-being. We will conduct an exploratory mixed methods study in public schools of postconflict areas in Tolima, Colombia. The study consists of 3 phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires on the basis of data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomized trial with teachers and school counselors to assess the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in school settings. Adolescents' data about mental health symptoms and wellness will be collected before and after DIALOG+ implementation. During this phase, teachers or counselors who were part of the intervention group will share their opinions through the think-aloud method. Lastly, the consolidation phase will consist of 2 focus groups with teachers and students to discuss their experiences and to understand acceptability. Study recruitment was completed in March 2022, and follow-up is anticipated to last through November 2022. This exploratory study will evaluate the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in postconflict school settings in Colombia. The use of this technology-supported tool aims to support interactions between teachers or counselors and students and to provide an effective student-centered communication guide. This is an innovative approach in both the school and the postconflict contexts that could help improve the mental health and wellness of adolescents in vulnerable zones in Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access. ISRCTN Registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374?q=ISRCTN14396374. DERR1-10.2196/40286.

Management of Unexpected Placenta Accreta Spectrum Cases in Resource Poor Settings in Colombia and Indonesia: Potential Role for Telemedicine

Management of Unexpected Placenta Accreta Spectrum Cases in Resource Poor Settings in Colombia and Indonesia: Potential Role for Telemedicine

Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities.

Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000–2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf’s circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.

Impact of COVID-19 on Maternal Mental Health in a Fragile and Conflict-Affected Setting: A Longitudinal Case-Control Study in Tumaco, Colombia

Background: The effects of the COVID-19 pandemic on mental health have been understudied among vulnerable and marginalized populations, particularly in fragile and conflict-affected settings. We analyzed changes in mental health and parenting stress among caregivers, many of whom are Internally Displaced Persons (IDPs), in a conflict-affected setting in Colombia.Method: We used longitudinal data from a psychosocial support program in which 1,374 caregivers with children aged 2-5 were randomly assigned to treatment and control groups across four sequential cohorts. At end-line, two cohorts were assessed prior to the pandemic, while two cohorts were assessed two to five weeks into the national lockdown. We estimated the impact of COVID-19 by comparing end-line outcomes between pre and post-pandemic cohorts using lagged-dependent variable models.Findings: Results showed that the likelihood of reporting symptoms above the risk threshold increased by 14 percentage points for anxiety (95% CI 0·100 – 0·174), five percentage points for depression (0·005 – 0·091), and ten percentage points for parental stress (0·046 – 0·146). Impact was stronger for Internally Displaced Persons (IDPs), and participants with lower educationor with pre-existing mental health conditions. Impact was also higher for those reporting food insecurity, job loss, or illness of a relative.Interpretation: Mental health significantly worsened due to COVID-19. Considering the vulnerability and preexisting mental health conditions of this population, the estimated effects are substantial. Policies in fragile and conflict-affected settings targeting IDPs and other vulnerable people will be important to mitigate further mental health and socioeconomic problems.Trial Registration: The trial was registered at the Clinical Trials Registry #NCT03502252 and at the Social Science Registry #2868, while the amendment for the phone survey was registered in the latter registry on April 20, 2020.Funding Statement: Saving Brains – Grand Challenges Canada; Fundación Éxito; Fundación FEMSA; United Way Colombia.Declaration of Interests: Dr. Moya reports grants from Saving Brains - Grand Challenges Canada, Fundación Exito, Fundación Femsa, and United Way Colombia, which supported implementation and impact evaluation of the Semillas de Apego program in Tumaco, Colombia. All other authors have nothing to declare. Ethics Approval Statement: Study procedures were approved by the Universidad de los Andes’s Ethics Committee (Protocol 786, 2017).

Out-of-pocket expenditure for hypertension care: a population-based study in low-income urban Medellin, Colombia

ABSTRACT Background Hypertension requires life-long medical care, which may cause economic burden and even lead to catastrophic health expenditure. Objective To estimate the extent of out-of-pocket expenditure for hypertension care at a population level and its impact on households’ budgets in a low-income urban setting in Colombia. Methods We conducted a cross-sectional survey in Santa Cruz, a commune in the city of Medellin. In 410 randomly selected households with a hypertensive adult, we estimated annual basic household expenditure and hypertension-attributable out-of-pocket expenditure. For socioeconomic stratification, we categorised households according to basic expenditure quintiles. Catastrophic hypertension-attributable expenditure was defined as out-of-pocket expenditure above 10% of total household expenditure. Results The average annual basic household expenditure was US dollars at purchasing power parity (USD-PPP) $12,255.59. The average annual hypertension-attributable out-of-pocket expenditure was USD-PPP $147.75 (95% CI 120.93–174.52). It was incurred by 73.9% (95% CI 69.4%-78.1%) of patients, and consisted mainly of direct non-medical expenses (76.7%), predominantly for dietary requirements prescribed as non-pharmacological treatment and for transport to attend health care consultations. Medical out-of-pocket expenditure (23.3%) was for the most part incurred for pharmacological treatment. Hypertension-attributable out-of-pocket expenditure represented on average 1.6% (95% CI 1.3%-1.9%) of the total annual basic household expenditure. Eight households (2.0%; 95% CI 1.0%-3.8%) had catastrophic health expenditure; six of them belonged to the two lowest expenditure quintiles. Payments related to dietary requirements and transport to consultations were critical determinants of their catastrophic expenditure. Conclusions Out-of-pocket expenditure for hypertension care is moderate on average, but frequent, and mainly made up of direct non-medical expenses. Catastrophic health expenditure is uncommon and affects primarily households in the bottom socioeconomic quintiles. Financial protection should be strengthened by covering the costs of chronic diseases-related dietary requirements and transport to health services in the most deprived households. Abbreviations NCDs: Non-communicable diseases; LMICs: Low and middle-income countries; WHO: World Health Organization; HTN: hypertension; CVDs: Cardiovascular diseases; OOPE: out-of-pocket expenditure; USD-PPP: US dollars at purchasing power parity; CI: Confidence interval

Understanding knowledge creation processes among rural communities in post-conflict settings in Colombia

The purpose of this research was to identify how the knowledge creation process (KCP) takes place among Suyusama, an organization that carries out specific extension functions and advisory services, and the rural communities in Nariño, Colombia. Specifically, the study determined how new knowledge was created, disseminated, and materialized into products, services or systems. Colombia, as a country emerging from conflict, faces considerable challenges to improve rural livelihoods in its agricultural sector. To gain productivity and food security within a sustainable management of natural resources requires a conceptual framework for planning and implementing programs to strengthen agricultural extension and advisory systems. Grounded Theory Methodology was employed in order to create theory from the systematic analysis of data, obtained from field observations and in-depth interviews with members of the local community organizations. The result was a theoretical explanation of the KCP that occurs from the autonomous work of the community with the accompaniment of a mentor organization in a multicultural and diverse meeting scenario, where the dialogue of knowledge and cooperation is promoted by integrating traditional and contemporary knowledge. This work is also an academic contribution to exemplify the distinction between tacit and explicit knowledge and the interorganizational ontological dimension in which a knowledge -creation spiral takes place in a rural context.

Feasibility and Reliability of Physical Fitness Tests among Colombian Preschool Children.

The aim of the study was to assess the feasibility and reliability of physical fitness field tests used in the “Fuprecol kids” study among Colombian preschool children aged 3–5 years. A total of 90 preschoolers aged 3–5 years participated in the study. Weight, height, waist circumference, cardiorespiratory fitness (CRF), musculoskeletal fitness (handgrip strength and standing broad jump), speed–agility (4 × 10 m shuttle run), and flexibility (sit and reach test) components were tested twice (two weeks apart). The feasibility of the tests (preschoolers able to complete the test) ranged from 96% in the CRF test to 100% in the musculoskeletal fitness, speed–agility, and flexibility tests. Overall, the %TEMs were 0.625% for the weight, 0.378% for the height, 1.035% for the body mass index, and 0.547% for the waist circumference. In addition, all tests were substantial reliable, for CRF (in stages and laps, concordance correlation coefficient = 0.944 and 0.941, respectively) in both sexes and flexibility (concordance correlation coefficient = 0.949) in girls. There were no significant differences in fitness test–retest mean differences in the boys (p > 0.05), except in CRF (laps p = 0.017). In girls, there were differences in CRF (stages (p = 0.017) and laps (p = 0.013)), and flexibility (p = 0.002) variables. The results from this study indicate that the “Fuprecol kids” battery of tests, administered by physical education teachers, was reliable and feasible for measuring components of physical fitness in preschoolers in a school setting in Colombia.

Clinical and electrophysiological characteristics of Guillain-Barré syndrome in Colombia.

Despite the wide literature describing the features of Guillain-Barré syndrome (GBS) in different populations worldwide, Colombian data are very scarce. We aim to characterize patients with GBS in a general hospital setting in Colombia. We conducted a retrospective chart review of GBS cases managed at the Hospital Universitario Fundación Santa Fe de Bogotá, from 2011 to 2016. Twenty-three patients were included. The most commonly reported symptoms were paresthesias (65%), pain (61%), proximal (22%) and distal (74%) limb weakness, and facial palsy (30%). 9% of patients had Fisher syndrome and 21% had other variants: Bickerstaff, pharyngeal-cervical-brachial pattern, and facial diplegia. There was a predominance of the demyelinating form (70%), with only 22% of patients presenting with the axonal variants. Our results are concordant with previous studies in Colombia.

Adaptation and Application of the Measuring Early Learning Quality and Outcomes (MELQO) Framework to Early Childhood Education Settings in Colombia

Abstract. In Colombia, the national law De Cero a Siempre (DCAS) provides a framework for holistic and integrated early childhood development and education for all children. Against the backdrop of the United Nations’ Sustainable Development Goals and the DCAS policy objectives, Colombia set out to apply a comprehensive measure to track the quality of early childhood education programs that would inform pedagogical, programmatic, and policy strategies. Our study describes the process whereby key stakeholders selected, adapted, validated, and applied the Measuring Early Learning Quality and Outcomes (MELQO) framework to characterize the quality of early childhood education at scale in the country. We describe the phases that led to the application of the different instrument modules, and the key enablers and challenges to the process. The paper includes implications for policy, practice, and research in Colombia and discusses lessons learned with relevance to the Latin American and global contexts.

Cycles of action and reflection as the basis of transformative innovation

Purpose This paper aims at explaining the design process of a learning model targeting potential entrepreneurs with no technical or business expertise aiming to develop sustainable business models in deprived areas. The case that the paper explores focuses on experiential learning and learning in adulthood to design a learning model that considers context and socio-demographic characteristics, makes clear the interconnections between sustainability principles, entrepreneurship rationale and design methodologies and includes actions and processes of reflection and contextual interaction. Design/methodology/approach Following a recursive argument, the paper applies design research methodology (DRM) to systematically design the “transformative innovation model” that Product Co Creation Centers (PC3) from the University of Twente (The Netherlands) has developed. Findings Building on Kolb’s cycle of experiential learning, the result of applying DRM is a learning cycle of confrontation, observation, practice and application. The proposed learning model is applied to a specific setting in Colombia, allowing to verify and validate whether the learning model leads to the expected outcomes. It is argued that an interdisciplinary approach, a focus on feedback loops and the consideration of the context are important elements for addressing and transforming complex problems related to sustainable development from the bottom-up. Originality/value This paper contributes to academic research in management emphasizing a solution-finding approach based on a prescription-driven research process, informed by design science research.

Strategic Environmental Assessment for development programs and sustainability transition in the Colombian post-conflict context

This article offers a critical analysis of the applicability and relevance of strategic environmental assessment (SEA) in the post-conflict period in Colombia as a means to support societal sustainability transition and avoid the depletion of natural resources and the emergence of new conflicts. Colombia, emerging from decades of war between the Colombian government and the FARC-EP (Revolutionary Armed Forces of Colombia), is experiencing an urgent need to allocate financial resources to large-scale projects with the aim of supporting post-conflict development activities, potentially resulting in rapid and hyper-development conditions and causing severe environmental impacts. Theoretically, SEA can be seen as one way to assist the Colombian government in their strategic decision-making and planning. However, the use of SEA will be bound by the post-conflict conditions and the more general institutional setting in Colombia. This article is focused on identifying the opportunities and challenges arising from the post-conflict context and the SEA action arena in Colombia. By doing this, the article provides a better understanding of institutional processes and resources in Colombia and contributes to the limited scholarly literature that is available on the application of SEA in post-conflict contexts, including research on the institutional capacity involved.

Naval Medicine's Involvement in Global Health: The Participation of Women's Healthcare Providers in Continuing Promise 2017.

This is a retrospective review of information collected during operation Continuing Promise 2017 from the Wayuu population in Colombia, South America. Team objective was to present an overview of women's health care needs in an isolated underserved population of Colombia by a humanitarian mission of health care providers from the U.S. Navy. We analyzed demographics, contraceptive selection, presenting complaint, diagnosis, and disposition of those female patients presenting for care. The acute care clinics of this mission saw patients for 10 full clinic days in each of the countries of Guatemala, Honduras, and Colombia. In the Wayuu clinic of Colombia, 356 patients were seen in the acute care women's clinic. These women averaged 36 years of age with an age range of 9-77 years of age and a gravidity of 3 ± 3.3 and a range of 0-18. Of the women less than the age of 50, not permanently sterilized, 186/220 (84.5%) were not using any form of contraception. The most common chief complaints were vaginal discharge and pelvic pain and the most common final diagnosis was bacterial vaginosis. The two most common secondary diagnoses of the pregnant women were urinary tract infection and anemia. Other significant diagnoses included uterine cancer, preterm labor, and fetal posterior urethral valve syndrome. A majority of Wayuu women presenting to an acute clinic setting in Colombia, South America were in their mid-thirties having had three pregnancies and the majority were not using any form of contraception. The most common diagnoses were straightforward diagnoses such as vaginal infections, urinary tract infections, and abnormal uterine bleeding. Our findings suggest a need for access to routine gynecologic care, general hygiene education, and increased availability of birth control among the Wayuu population.

Effects of Indirect Exposure to Homicide Events on Children’s Mental Health: Evidence from Urban Settings in Colombia

Exposure to neighborhood violence is an important risk factor for the social and emotional development of children and youth. Previous work recognizes that violence may affect children indirectly via secondhand exposure; yet, few studies have aimed to identify and quantify these effects, especially in settings like Colombia where youth is chronically exposed to violence. To address this gap in the literature, this article implements an empirical strategy where geographically specific and time-stamped data are leveraged to identify the effect of indirect exposure to homicides on fifth grade children's social and emotional outcomes. Sample participants (N = 5801) represent the fifth-grade population of boys and girls (50.7%) in two major urban areas in the country (Mage = 11.01, SD = 0.75). We hypothesize that the effects of exposure to neighborhood violence on children's social and emotional skills will be consistent and negative. The findings indicate a consistent negative effect of indirect exposure to homicides on children's emotional functioning (i.e., emotional regulation and empathy), as well as on the prevalence of avoidance behaviors. However, contrary to theoretical expectations, the results do not support effects on children's levels of aggressive behavior, nor on the beliefs and attitudes that justify the use of aggression in interpersonal relationships. The findings are discussed in light of predictions from social cognitive models and their implications for developmentally and trauma-informed interventions for youth.