Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region

Background Cervical cancer (CC) promotion and prevention (P&P) programmes’ challenge lies in guaranteeing that follow-up strategies have a real impact on reducing CC-related mortality rates. CC P&P programme compliance and coverage rates are relevant indicators for evaluating their success a...

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Autores:
González, Alejandra
Sánchez, Ricardo
Camargo, Milena
Soto De León, Sara Cecilia
Del Río Ospina, Luisa
Mora, Luis Hernando
Ramírez, Edwin
Rodríguez, Anny Alejandra
Hurtado, Paula
Patarroyo, Manuel-Elkin
Patarroyo, Manuel-Alfonso
Tipo de recurso:
Article of investigation
Fecha de publicación:
2022
Institución:
Universidad de Ciencias Aplicadas y Ambientales U.D.C.A
Repositorio:
Repositorio Institucional UDCA
Idioma:
eng
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Acceso en línea:
https://repository.udca.edu.co/handle/11158/4461
https://repository.udca.edu.co
Palabra clave:
Neoplasias del Cuello Uterino
Citología
Medicina preventiva
Rights
openAccess
License
https://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.es
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dc.title.eng.fl_str_mv Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
title Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
spellingShingle Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
Neoplasias del Cuello Uterino
Citología
Medicina preventiva
title_short Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
title_full Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
title_fullStr Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
title_full_unstemmed Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
title_sort Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon region
dc.creator.fl_str_mv González, Alejandra
Sánchez, Ricardo
Camargo, Milena
Soto De León, Sara Cecilia
Del Río Ospina, Luisa
Mora, Luis Hernando
Ramírez, Edwin
Rodríguez, Anny Alejandra
Hurtado, Paula
Patarroyo, Manuel-Elkin
Patarroyo, Manuel-Alfonso
dc.contributor.author.none.fl_str_mv González, Alejandra
Sánchez, Ricardo
Camargo, Milena
Soto De León, Sara Cecilia
Del Río Ospina, Luisa
Mora, Luis Hernando
Ramírez, Edwin
Rodríguez, Anny Alejandra
Hurtado, Paula
Patarroyo, Manuel-Elkin
Patarroyo, Manuel-Alfonso
dc.subject.decs.none.fl_str_mv Neoplasias del Cuello Uterino
Citología
topic Neoplasias del Cuello Uterino
Citología
Medicina preventiva
dc.subject.unesco.none.fl_str_mv Medicina preventiva
description Background Cervical cancer (CC) promotion and prevention (P&P) programmes’ challenge lies in guaranteeing that follow-up strategies have a real impact on reducing CC-related mortality rates. CC P&P programme compliance and coverage rates are relevant indicators for evaluating their success and good performance; however, such indicators’ frequency rates are considerably lower among women living in rural and border areas. This study was aimed at identifying factors associated with CC screening programme attendance for women living in Colombia’s Amazon region. Methods This study (qualitative and quantitative phases) was carried out between September 2015 and November 2016; women residing in the border towns of Leticia and Puerto Nariño participated in it. The first phase (qualitative) involved interviews and focus group discussions; this led to establishing factors related to CC P&P programme attendance which were used in the quantitative phase for designing a survey for determining the strength of association in a logistic regression model. The terms attendance and compliance were considered to apply to women who had followed the 1–1–3 scheme throughout their lives, i.e. a cytology examination every 3 years after receiving two consecutive negative annual cytology results. Results Inclusion criteria were met by 309 women (≥18-year-olds having an active sexual life, having resided in the target community for at least one year); 15.2% had suitable P&P programme follow-up. Screening programme attendance was positively associated with first intercourse after becoming 20 years-old (aOR: 3.87; 1.03–9.50 95%CI; p = 0.045), frequent contraceptive use (aOR: 3.11; 1.16–8.33 95%CI; p = 0.023), awareness of the age to participate in P&P programmes (aOR: 2.69; 1.08–6.68 95%CI; p = 0.032), awareness of cytology’s usefulness in identifying cervical abnormalities (aOR: 2.43; 1.02–5.77 95%CI; p = 0.043) and considering cytology important (aOR: 2.64; 1.12–6.19 95%CI; p = 0.025). Women living in rural areas had a lower probability (aOR 0.43: 0.24–0.79 95%CI; p = 0.006) of adhering to CC P&P programmes. Conclusions This study’s findings suggested the need for including novel strategies in screening programmes which will promote CC P&P activities going beyond hospital outpatient attendance to reach the most remote or widely scattered communities, having the same guarantees regarding access, opportunity and quality. Including education-related activities and stimulating the population’s awareness regarding knowledge about CC prevention could be one of the main tools for furthering the impact of attendance at and compliance with P&P programmes.
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2022-02-14T13:08:58Z
dc.date.available.none.fl_str_mv 2022-02-14T13:08:58Z
dc.date.issued.none.fl_str_mv 2022
dc.type.spa.fl_str_mv Artículo de revista
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dc.identifier.citation.spa.fl_str_mv González, A., Sánchez, R., Camargo, M., Soto-De León, S. C., Río-Ospina, L. D., Mora, L. H., . . . Patarroyo, M. A. (2022). Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s amazon region. PLoS ONE, 17(1 1) doi:10.1371/journal.pone.0262069
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dc.identifier.instname.spa.fl_str_mv Universidad de Ciencias Aplicadas y Ambientales
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identifier_str_mv González, A., Sánchez, R., Camargo, M., Soto-De León, S. C., Río-Ospina, L. D., Mora, L. H., . . . Patarroyo, M. A. (2022). Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s amazon region. PLoS ONE, 17(1 1) doi:10.1371/journal.pone.0262069
doi:10.1371/journal.pone.0262069
Universidad de Ciencias Aplicadas y Ambientales
UDCA
url https://repository.udca.edu.co/handle/11158/4461
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spelling González, AlejandraSánchez, RicardoCamargo, MilenaSoto De León, Sara CeciliaDel Río Ospina, LuisaMora, Luis HernandoRamírez, EdwinRodríguez, Anny AlejandraHurtado, PaulaPatarroyo, Manuel-ElkinPatarroyo, Manuel-Alfonso2022-02-14T13:08:58Z2022-02-14T13:08:58Z2022González, A., Sánchez, R., Camargo, M., Soto-De León, S. C., Río-Ospina, L. D., Mora, L. H., . . . Patarroyo, M. A. (2022). Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s amazon region. PLoS ONE, 17(1 1) doi:10.1371/journal.pone.0262069https://repository.udca.edu.co/handle/11158/4461doi:10.1371/journal.pone.0262069Universidad de Ciencias Aplicadas y AmbientalesUDCAhttps://repository.udca.edu.coBackground Cervical cancer (CC) promotion and prevention (P&P) programmes’ challenge lies in guaranteeing that follow-up strategies have a real impact on reducing CC-related mortality rates. CC P&P programme compliance and coverage rates are relevant indicators for evaluating their success and good performance; however, such indicators’ frequency rates are considerably lower among women living in rural and border areas. This study was aimed at identifying factors associated with CC screening programme attendance for women living in Colombia’s Amazon region. Methods This study (qualitative and quantitative phases) was carried out between September 2015 and November 2016; women residing in the border towns of Leticia and Puerto Nariño participated in it. The first phase (qualitative) involved interviews and focus group discussions; this led to establishing factors related to CC P&P programme attendance which were used in the quantitative phase for designing a survey for determining the strength of association in a logistic regression model. The terms attendance and compliance were considered to apply to women who had followed the 1–1–3 scheme throughout their lives, i.e. a cytology examination every 3 years after receiving two consecutive negative annual cytology results. Results Inclusion criteria were met by 309 women (≥18-year-olds having an active sexual life, having resided in the target community for at least one year); 15.2% had suitable P&P programme follow-up. Screening programme attendance was positively associated with first intercourse after becoming 20 years-old (aOR: 3.87; 1.03–9.50 95%CI; p = 0.045), frequent contraceptive use (aOR: 3.11; 1.16–8.33 95%CI; p = 0.023), awareness of the age to participate in P&P programmes (aOR: 2.69; 1.08–6.68 95%CI; p = 0.032), awareness of cytology’s usefulness in identifying cervical abnormalities (aOR: 2.43; 1.02–5.77 95%CI; p = 0.043) and considering cytology important (aOR: 2.64; 1.12–6.19 95%CI; p = 0.025). Women living in rural areas had a lower probability (aOR 0.43: 0.24–0.79 95%CI; p = 0.006) of adhering to CC P&P programmes. Conclusions This study’s findings suggested the need for including novel strategies in screening programmes which will promote CC P&P activities going beyond hospital outpatient attendance to reach the most remote or widely scattered communities, having the same guarantees regarding access, opportunity and quality. Including education-related activities and stimulating the population’s awareness regarding knowledge about CC prevention could be one of the main tools for furthering the impact of attendance at and compliance with P&P programmes.Incluye referencias bibliográficasapplication/pdfenghttps://creativecommons.org/licenses/by-nc-sa/4.0/legalcode.eshttps://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)http://purl.org/coar/access_right/c_abf2https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262069Cervical cancer screening programme attendance and compliance predictors regarding Colombia’s Amazon regionArtículo de revistahttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionTexthttp://purl.org/redcol/resource_type/ARThttp://purl.org/coar/version/c_970fb48d4fbd8a85Neoplasias del Cuello UterinoCitologíaMedicina preventivaN/A(Ene., 2022) Artículo Número e02620692211117PLoS ONEAmazonía colombianaPublicationORIGINALjournal.pone.0262069.pdfjournal.pone.0262069.pdfapplication/pdf1491231https://repository.udca.edu.co/bitstreams/a1430931-e238-4315-bb49-607c371d963c/download9497f4b97fdd0cca8d8858d1bced4af7MD51LICENSElicense.txtlicense.txttext/plain; charset=utf-814775https://repository.udca.edu.co/bitstreams/969094fc-67be-4d17-add8-b56bb626c10f/downloadf661acf14bedbf9f5d13897a0387e751MD52TEXTjournal.pone.0262069.pdf.txtjournal.pone.0262069.pdf.txtExtracted texttext/plain75884https://repository.udca.edu.co/bitstreams/3b8d8f30-dae8-4892-8b0a-1e3ff88c2cff/downloadfb4d4e4425da9d6d66db788486c0694bMD53THUMBNAILjournal.pone.0262069.pdf.jpgjournal.pone.0262069.pdf.jpgGenerated Thumbnailimage/jpeg15615https://repository.udca.edu.co/bitstreams/90101df7-58cd-437e-b058-eb4279effb7e/downloadfd40d98b95004d91dccf8f8145533a25MD5411158/4461oai:repository.udca.edu.co:11158/44612024-05-09 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en las Obras Colectivas;
b.	Distribuir copias o fonogramas de las Obras, exhibirlas públicamente, ejecutarlas públicamente y/o ponerlas a disposición pública, incluyéndolas como incorporadas en Obras Colectivas, según corresponda;
c.	Distribuir copias de las Obras Derivadas que se generen, exhibirlas públicamente, ejecutarlas públicamente y/o ponerlas a disposición pública.
Los derechos mencionados anteriormente pueden ser ejercidos en todos los medios y formatos, actualmente conocidos o que se inventen en el futuro. Los derechos antes mencionados incluyen el derecho a realizar dichas modificaciones en la medida que sean técnicamente necesarias para ejercer los derechos en otro medio o formatos, pero de otra manera usted no está autorizado para realizar obras derivadas.Todos los derechos no otorgados expresamente por el Licenciante quedan por este medio reservados, incluyendo pero sin limitarse a aquellos que se mencionan en las secciones 4(d) y 4(e).
4. Restricciones.
La licencia otorgada en la anterior Sección 3 está expresamente sujeta y limitada por las siguientes restricciones:
a.	Usted puede distribuir, exhibir públicamente, ejecutar públicamente, o poner a disposición pública la Obra sólo bajo las condiciones de esta Licencia, y Usted debe incluir una copia de esta licencia o del Identificador Universal de Recursos de la misma con cada copia de la Obra que distribuya, exhiba públicamente, ejecute públicamente o ponga a disposición pública. No es posible ofrecer o imponer ninguna condición sobre la Obra que altere o limite las condiciones de esta Licencia o el ejercicio de los derechos de los destinatarios otorgados en este documento. No es posible sublicenciar la Obra. Usted debe mantener intactos todos los avisos que hagan referencia a esta Licencia y a la cláusula de limitación de garantías. Usted no puede distribuir, exhibir públicamente, ejecutar públicamente, o poner a disposición pública la Obra con alguna medida tecnológica que controle el acceso o la utilización de ella de una forma que sea inconsistente con las condiciones de esta Licencia. Lo anterior se aplica a la Obra incorporada a una Obra Colectiva, pero esto no exige que la Obra Colectiva aparte de la obra misma quede sujeta a las condiciones de esta Licencia. Si Usted crea una Obra Colectiva, previo aviso de cualquier Licenciante debe, en la medida de lo posible, eliminar de la Obra Colectiva cualquier referencia a dicho Licenciante o al Autor Original, según lo solicitado por el Licenciante y conforme lo exige la cláusula 4(c).
b.	Usted no puede ejercer ninguno de los derechos que le han sido otorgados en la Sección 3 precedente de modo que estén principalmente destinados o directamente dirigidos a conseguir un provecho comercial o una compensación monetaria privada. El intercambio de la Obra por otras obras protegidas por derechos de autor, ya sea a través de un sistema para compartir archivos digitales (digital file-sharing) o de cualquier otra manera no será considerado como estar destinado principalmente o dirigido directamente a conseguir un provecho comercial o una compensación monetaria privada, siempre que no se realice un pago mediante una compensación monetaria en relación con el intercambio de obras protegidas por el derecho de autor.
c.	Si usted distribuye, exhibe públicamente, ejecuta públicamente o ejecuta públicamente en forma digital la Obra o cualquier Obra Derivada u Obra Colectiva, Usted debe mantener intacta toda la información de derecho de autor de la Obra y proporcionar, de forma razonable según el medio o manera que Usted esté utilizando: (i) el nombre del Autor Original si está provisto (o seudónimo, si fuere aplicable), y/o (ii) el nombre de la parte o las partes que el Autor Original y/o el Licenciante hubieren designado para la atribución (v.g., un instituto patrocinador, editorial, publicación) en la información de los derechos de autor del Licenciante, términos de servicios o de otras formas razonables; el título de la Obra si está provisto; en la medida de lo razonablemente factible y, si está provisto, el Identificador Uniforme de Recursos (Uniform Resource Identifier) que el Licenciante especifica para ser asociado con la Obra, salvo que tal URI no se refiera a la nota sobre los derechos de autor o a la información sobre el licenciamiento de la Obra; y en el caso de una Obra Derivada, atribuir el crédito identificando el uso de la Obra en la Obra Derivada (v.g., "Traducción Francesa de la Obra del Autor Original," o "Guión Cinematográfico basado en la Obra original del Autor Original"). Tal crédito puede ser implementado de cualquier forma razonable; en el caso, sin embargo, de Obras Derivadas u Obras Colectivas, tal crédito aparecerá, como mínimo, donde aparece el crédito de cualquier otro autor comparable y de una manera, al menos, tan destacada como el crédito de otro autor comparable.
d.	Para evitar toda confusión, el Licenciante aclara que, cuando la obra es una composición musical:
i.	Regalías por interpretación y ejecución bajo licencias generales. El Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública o la ejecución pública digital de la obra y de recolectar, sea individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), las regalías por la ejecución pública o por la ejecución pública digital de la obra (por ejemplo Webcast) licenciada bajo licencias generales, si la interpretación o ejecución de la obra está primordialmente orientada por o dirigida a la obtención de una ventaja comercial o una compensación monetaria privada.
ii.	Regalías por Fonogramas. El Licenciante se reserva el derecho exclusivo de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, SAYCO), una agencia de derechos musicales o algún agente designado, las regalías por cualquier fonograma que Usted cree a partir de la obra (“versión cover”) y distribuya, en los términos del régimen de derechos de autor, si la creación o distribución de esa versión cover está primordialmente destinada o dirigida a obtener una ventaja comercial o una compensación monetaria privada.
e.	Gestión de Derechos de Autor sobre Interpretaciones y Ejecuciones Digitales (WebCasting). Para evitar toda confusión, el Licenciante aclara que, cuando la obra sea un fonograma, el Licenciante se reserva el derecho exclusivo de autorizar la ejecución pública digital de la obra (por ejemplo, webcast) y de recolectar, individualmente o a través de una sociedad de gestión colectiva de derechos de autor y derechos conexos (por ejemplo, Acinpro), las regalías por la ejecución pública digital de la obra (por ejemplo, webcast), sujeta a las disposiciones aplicables del régimen de Derecho de Autor, si esta ejecución pública digital está primordialmente dirigida a obtener una ventaja comercial o una compensación monetaria privada.
5. Representaciones, Garantías y Limitaciones de Responsabilidad.
A MENOS QUE LAS PARTES LO ACORDARAN DE OTRA FORMA POR ESCRITO, EL LICENCIANTE OFRECE LA OBRA (EN EL ESTADO EN EL QUE SE ENCUENTRA) “TAL CUAL”, SIN BRINDAR GARANTÍAS DE CLASE ALGUNA RESPECTO DE LA OBRA, YA SEA EXPRESA, IMPLÍCITA, LEGAL O CUALQUIERA OTRA, INCLUYENDO, SIN LIMITARSE A ELLAS, GARANTÍAS DE TITULARIDAD, COMERCIABILIDAD, ADAPTABILIDAD O ADECUACIÓN A PROPÓSITO DETERMINADO, AUSENCIA DE INFRACCIÓN, DE AUSENCIA DE DEFECTOS LATENTES O DE OTRO TIPO, O LA PRESENCIA O AUSENCIA DE ERRORES, SEAN O NO DESCUBRIBLES (PUEDAN O NO SER ESTOS DESCUBIERTOS). ALGUNAS JURISDICCIONES NO PERMITEN LA EXCLUSIÓN DE GARANTÍAS IMPLÍCITAS, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.
6. Limitación de responsabilidad.
A MENOS QUE LO EXIJA EXPRESAMENTE LA LEY APLICABLE, EL LICENCIANTE NO SERÁ RESPONSABLE ANTE USTED POR DAÑO ALGUNO, SEA POR RESPONSABILIDAD EXTRACONTRACTUAL, PRECONTRACTUAL O CONTRACTUAL, OBJETIVA O SUBJETIVA, SE TRATE DE DAÑOS MORALES O PATRIMONIALES, DIRECTOS O INDIRECTOS, PREVISTOS O IMPREVISTOS PRODUCIDOS POR EL USO DE ESTA LICENCIA O DE LA OBRA, AUN CUANDO EL LICENCIANTE HAYA SIDO ADVERTIDO DE LA POSIBILIDAD DE DICHOS DAÑOS. ALGUNAS LEYES NO PERMITEN LA EXCLUSIÓN DE CIERTA RESPONSABILIDAD, EN CUYO CASO ESTA EXCLUSIÓN PUEDE NO APLICARSE A USTED.
7. Término.
a.	Esta Licencia y los derechos otorgados en virtud de ella terminarán automáticamente si Usted infringe alguna condición establecida en ella. Sin embargo, los individuos o entidades que han recibido Obras Derivadas o Colectivas de Usted de conformidad con esta Licencia, no verán terminadas sus licencias, siempre que estos individuos o entidades sigan cumpliendo íntegramente las condiciones de estas licencias. Las Secciones 1, 2, 5, 6, 7, y 8 subsistirán a cualquier terminación de esta Licencia.
b.	Sujeta a las condiciones y términos anteriores, la licencia otorgada aquí es perpetua (durante el período de vigencia de los derechos de autor de la obra). No obstante lo anterior, el Licenciante se reserva el derecho a publicar y/o estrenar la Obra bajo condiciones de licencia diferentes o a dejar de distribuirla en los términos de esta Licencia en cualquier momento; en el entendido, sin embargo, que esa elección no servirá para revocar esta licencia o que deba ser otorgada , bajo los términos de esta licencia), y esta licencia continuará en pleno vigor y efecto a menos que sea terminada como se expresa atrás. La Licencia revocada continuará siendo plenamente vigente y efectiva si no se le da término en las condiciones indicadas anteriormente.
8. Varios.
a.	Cada vez que Usted distribuya o ponga a disposición pública la Obra o una Obra Colectiva, el Licenciante ofrecerá al destinatario una licencia en los mismos términos y condiciones que la licencia otorgada a Usted bajo esta Licencia.
b.	Si alguna disposición de esta Licencia resulta invalidada o no exigible, según la legislación vigente, esto no afectará ni la validez ni la aplicabilidad del resto de condiciones de esta Licencia y, sin acción adicional por parte de los sujetos de este acuerdo, aquélla se entenderá reformada lo mínimo necesario para hacer que dicha disposición sea válida y exigible.
c.	Ningún término o disposición de esta Licencia se estimará renunciada y ninguna violación de ella será consentida a menos que esa renuncia o consentimiento sea otorgado por escrito y firmado por la parte que renuncie o consienta.
d.	Esta Licencia refleja el acuerdo pleno entre las partes respecto a la Obra aquí licenciada. No hay arreglos, acuerdos o declaraciones respecto a la Obra que no estén especificados en este documento. El Licenciante no se verá limitado por ninguna disposición adicional que pueda surgir en alguna comunicación emanada de Usted. Esta Licencia no puede ser modificada sin el consentimiento mutuo por escrito del Licenciante y Usted.

