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[ABSTRACT]. Objectives. To (i) ascertain stakeholders’ perceptions of the contextual factors and resources necessary to successfully implement the AMORE platform, a tool that provides accessibility assessments for health care services, considering factors such travel time and traffic conditions, and (ii) identify potential barriers to and facilitators for enhancing spatial accessibility to health care services within the Colombian urban context. Methods. In this qualitative study, semi-structured interviews were conducted with a purposive sample of seven key stakeholders. The sample was drawn from individuals involved in development of policies in Colombia, service providers, and users, among others, who had expertise in the field. Interviews were conducted until saturation was reached. Results. The participants had positive views on the appearance of the AMORE platform, highlighting its user-friendly visualization. Suggestions were made about the variables used in the dashboard, the implementation of the platform, potential usage areas, and barriers and facilitators to implementation and use. Barriers included economic, political, and personnel challenges, while facilitators included creating a minimum viable product at a low cost and building interinstitutional and international cooperation. Conclusions. Innovations such as the AMORE platform have the potential to support decision-making processes across various sectors, including public policies and internal processes within private organizations, academia, and the community. However, implementing such a tool has financial, contextual and environmental challenges. The study identified key factors that were considered prerequisites for successfully implementing the AMORE platform in Colombian cities.

[RESUMEN]. Objetivos. i) Determinar las percepciones de las partes interesadas sobre los factores contextuales y los recursos necesarios para implementar con éxito la plataforma AMORE, una herramienta que proporciona evaluaciones de accesibilidad para los servicios de atención de salud, teniendo en cuenta factores como el tiempo de desplazamiento y el estado del tráfico; y ii) determinar los posibles factores que obstaculizan o favorecen las mejoras en la accesibilidad espacial a los servicios de atención de salud en el contexto urbano en Colombia. Métodos. En este estudio cualitativo, se realizaron entrevistas semiestructuradas en una muestra intencional de siete partes interesadas. La muestra se obtuvo a partir de responsables del diseño de políticas en Colombia, prestadores de servicios y usuarios, entre otras personas, con conocimientos en la materia. Las entrevistas se llevaron a cabo hasta llegar al punto de saturación. Resultados. Los participantes tenían una opinión favorable sobre el aspecto de la plataforma AMORE, de la que resaltaban su fácil visualización. Se formularon sugerencias sobre las variables utilizadas en el panel de información, la implementación de la plataforma, las posibles áreas de uso y los elementos que podrían obstaculizar o favorecer su implementación y uso. Los obstáculos incluían desafíos económicos, políticos y de personal, mientras que entre los elementos facilitadores estaban la creación de un producto mínimo viable a bajo costo y el establecimiento de lazos de cooperación interinstitucional e internacional. Conclusiones. Innovaciones como la plataforma AMORE tienen el potencial de brindar apoyo para los procesos de toma de decisiones en diversos sectores, como las políticas públicas y los procesos internos en las organizaciones privadas, el sector académico y la comunidad. Sin embargo, la implementación de una herramienta de este tipo plantea desafíos económicos, contextuales y ambientales. El estudio determinó los factores clave que se consideran requisitos previos para implementar con éxito la plataforma AMORE en las ciudades colombianas.

[RESUMO]. Objetivos. Os objetivos do estudo foram: i) avaliar as percepções das partes interessadas sobre os fatores contextuais e os recursos necessários para implementação bem-sucedida da plataforma AMORE, uma ferramenta que fornece avaliações sobre a acessibilidade dos serviços de saúde considerando fatores como tempo de deslocamento e condições de trânsito; e ii) identificar possíveis barreiras e facilitadores para melhorar a acessibilidade espacial a serviços de saúde no contexto urbano da Colômbia. Métodos. Neste estudo qualitativo, foram realizadas entrevistas semiestruturadas com uma amostra intencional de sete partes interessadas principais. A amostra foi composta por indivíduos envolvidos na elaboração de políticas na Colômbia, prestadores de serviços e usuários, entre outros, que tinham conhecimento especializado na área. As entrevistas foram realizadas até se alcançar a saturação. Resultados. Os participantes tiveram opiniões positivas sobre a aparência da plataforma AMORE, destacando a visualização fácil de usar. Foram feitas sugestões sobre as variáveis usadas no painel, a implementação da plataforma, potenciais áreas de uso e barreiras e facilitadores para sua implementação e utilização. As barreiras englobavam dificuldades econômicas, políticas e relacionadas ao pessoal. Já os facilitadores incluíam a criação de um produto mínimo viável de baixo custo e o desenvolvimento de cooperação interinstitucional e internacional. Conclusões. Inovações como a plataforma AMORE têm o potencial de apoiar processos decisórios em vários setores, incluindo políticas públicas e processos internos em organizações privadas, no meio acadêmico e na comunidade. No entanto, a implementação dessa ferramenta envolve desafios financeiros, contextuais e ambientais. O estudo identificou os principais fatores que foram considerados pré-requisitos para o sucesso da implementação da plataforma AMORE em cidades colombianas.

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Resumen El objetivo de este artículo es analizar las políticas públicas e intervenciones (PPI) a nivel nacional vigentes a 2022 para la prevención del exceso de peso (sobrepeso y obesidad) en población adulta de México, desde una perspectiva interseccional. Se realizó un análisis documental de las estrategias para prevenir el exceso de peso en México en la adultez. Los documentos fueron analizados aplicando una metodología para el análisis de políticas basado en la interseccionalidad. Un total de 9 PPI fueron analizadas. En el diseño de las mismas operan alcances variables para visibilizar una perspectiva interseccional. En la definición del problema identificamos dos tendencias principales: una tendencia reduccionista y una tendencia holística. Ambas se combinan de manera variable en las PPI, evidenciando contradicciones internas en su diseño. La mayoría de las PPI señalan pocos ejes de desigualdad social, y como aditivos más que interseccionales. Las PPI consideran las desigualdades sociales mayormente en la definición del problema y, en mucho menor medida, en las soluciones y en los procesos de consulta y negociación. La consideración de la naturaleza interseccional de la problemática del exceso de peso en las PPI es importante para abordar la epidémica desigualdad del exceso de peso.

Abstract The scope of this article is to analyze public policies and interventions (PPI) prevailing in 2022 at the national level for the prevention of excess weight (overweight and obesity) in the adult population of Mexico, from an intersectional perspective. We performed documental analysis of PPI to prevent excess weight in Mexico in adulthood by applying a methodology for policy analysis based on intersectionality (Intersectionality-Based Policy Analysis Framework). A total of nine PPI were analyzed. The extent to which the PPI design considers an intersectional perspective is heterogeneous in the documents analyzed. In the definition of the problem, we identified two main tendencies, namely reductionist and holistic. Both are combined in a variable way in the PPI, revealing internal contradictions in their design. Most PPI consider relatively few cases of social inequality, and as an additive rather than an intersectional consideration. Overall, the PPI consider social inequalities predominantly in the definition of the problem and, to a far lesser extent, in the proposed solutions and in the consultation and negotiation processes. The consideration of the intersectional nature of the problem of excess weight in PPI is important to address the unequal epidemic of excess weight.

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COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.

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[This corrects the article DOI: 10.1371/journal.pone.0238401.].

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The coronavirus disease 2019 (COVID-19) pandemic is hitting the world's most vulnerable people hardest, primarily the communities living in slums in the Global South. Lockdown, handwashing and social distancing are impossible privileges for many urban dwellers - measures which make structural inequities more visible, exacerbating racial, gender and class differences. There are many social determinants of health to explain these inequalities that trigger a high prevalence of infectious and chronic diseases. In Medellín (Colombia), it is a challenge to cope with this crisis, especially when the resources and aid provided by the government and institutions are limited. Yet, an organized social response is happening in some communes and slums, with high community participation, as a potentially effective key to control the pandemic. Once the emergency is over, communities in slums will have to face the social and economic reactivation, and effectively react to the multiple social and psychological consequences, new waves of COVID-19 or other pandemics.

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BACKGROUND: Social epidemiologic research in relation to the health impacts of precarious employment has grown markedly during the past decade. While the multidimensional nature of precarious employment has long been acknowledged theoretically, empirical studies have mostly focused on one-dimensional approach only (based either on employment temporariness or perceived job insecurity). This study compares the use of a multidimensional employment precariousness scale (EPRES) with traditional one-dimensional approaches in relation to distinct health outcomes and across various socio-demographic characteristics. METHODS: We used a subsample of formal salaried workers (n = 3521) from the first Chilean employment and working conditions survey (2009-2010). Multilevel modified Poisson regressions with fixed effects (individuals nested within regions) and survey weights were conducted to estimate the association between general health, mental health and occupational injuries and distinct precarious employment exposures (temporary employment, perceived job insecurity, and the multidimensional EPRES scale). We assessed the presence of effect measure modification according to sex, age, educational level, and occupational class (manual/non-manual). RESULTS: Compared to one-dimensional approaches to precarious employment, the multidimensional EPRES scale captured a larger picture of potential health effects and differences across subgroups of workers. Patterns of effect measure that modification were consistent with the expectations that groups in greater disadvantage (women, older individuals, less educated and manual workers) were more vulnerable to poor employment conditions. CONCLUSIONS: Multidimensional measures of precarious employment better capture its association with a breath of health outcomes, being necessary tools for research in order to strengthen the evidence base for policy making in the protection of workers' health.

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This study aims to assess the accuracy of temporary employment as indicator or proxy measure of precarious employment. Using sensitivity and specificity analysis, we compared type of contract (temporary versus permanent) with the Chilean version of the multidimensional Employment Precariousness Scale. Temporary employment exhibited very low sensitivity (<30%) (specificity >90%), resulting in roughly 38% of false negative results. Different EPRES-Ch cut-off scores produced similar results. The main implication of these findings is that the public health relevance of precarious employment is being underestimated both in terms of prevalence and of its association with health, making it critical that valid multidimensional measures of precarious employment be implemented.

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Objective: Our objective was to quantitatively describe the research on HIV infection carried out in Colombia. Materials and methods: A bibliometric review of all studies that included people infected or affected by HIV between January 1, 1983, and August 31, 2018, was performed. Results: 587 studies were identified. Most were descriptive studies. There are a lower number of studies in the fields of prevention, education and public health. Most of the published studies were carried out in 3 departments. 72% were published in Q3, Q4 or unclassified journals. Discussion: The research performed has given priority to the description of figures and is not enough to understand and know how to treat factors like late diagnosis, the stigma and the prevention of the disease. Conclusion: There does not seem to be a national strategy to define the research needs. There is a low dissemination of the results and a low cover of the research in the country.

Objetivo: Describir cuantitativamente la investigación sobre infección por VIH realizada en Colombia. Materiales y métodos: Se realizó una revisión bibliométrica de estudios que incluyeran personas infectadas o afectadas por el VIH entre el 1 de enero de 1983 y el 31 de agosto de 2018. Resultados: Se identificaron 587 estudios. La mayoría fueron descriptivos. Hay un menor número en los campos de prevención, educación y salud pública. La mayoría se llevaron a cabo en 3 departamentos. El 72% se publicaron en Q3, Q4 o revistas no clasificadas. Discusión: La investigación realizada ha dado prioridad a la descripción de las cifras y no es suficiente para comprender y saber cómo tratar factores como el diagnóstico tardío, el estigma y la prevención de la enfermedad. Conclusión: No parece haber una estrategia nacional para definir las necesidades de investigación. Hay una baja difusión de los resultados y una baja cobertura de la investigación en el país.

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BACKGROUND: In Ecuador, there are inequalities in the completeness and quality of the mortality registry between men and women and among geographical areas. Consequently, using cause of death statistics leads to several difficulties. Our aim was to analyze geographical inequalities in mortality due to some of the main specific causes of death in the provinces of Ecuador (2001-2016) after correction for the deficiencies found in the mortality registry. METHODS: This ecologic study used mortality data from 2001 to 2016 for the 22 provinces of Ecuador at the beginning of the study period. We assessed completeness using death distribution methods for the intercensal period 2001-2010. We assessed quality by estimating the percentage of garbage codes for the entire study period. We corrected mortality using completeness as a correction factor and applying a garbage code redistribution protocol. We estimated age-standardized mortality ratios in the provinces of Ecuador for men and women, before and after applying the correction methods. RESULTS: We found substantial changes in the number of deaths due to the selected causes after garbage code redistribution and correction for completeness. These changes corresponded to the deficiencies in completeness and quality found in the study areas and the manner in which garbage codes were redistributed to each of the studied causes. We observed changes in the geographical patterns of mortality due to specific causes. CONCLUSIONS: Correcting deficiencies in the mortality registry resulted not only in changes in the number of deaths but also in the geographical patterns of mortality in Ecuador.

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OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013-2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.

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