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OBJECTIVE: Cancer patients are among the most vulnerable populations during and after a disaster. We evaluated the impact of treatment interruption on the survival of women with gynecologic cancer in Puerto Rico following Hurricanes Irma and María. METHODS: A retrospective cohort study among a clinic-based sample of women with gynecological cancer diagnosed between January 2016 and September 2017 (n = 112) was done. Women were followed from their diagnosis until December 2019, to assess vital status. Kaplan-Meier survival curves and Cox proportional hazards models were performed. RESULTS: Mean age was 56 (± 12.3) years; corpus uteri (58.9%) was the most common gynecologic cancer. Predominant treatments were surgery (91.1%) and chemotherapy (44.6%). Overall, 75.9% were receiving treatment before the hurricanes, 16.1% experienced treatment interruptions, and 8.9% died during the follow-up period. Factors associated with treatment interruption in bivariate analysis included younger age (≤55 years), having regional/distant disease, and receiving > 1 cancer treatment (P < 0.05). Crude analysis revealed an increased risk of death among women with treatment interruption (HR: 3.88, 95% CI: 1.09-13.77), persisting after adjusting for age and cancer stage (HR: 2.49, 95% CI: 0.69-9.01). CONCLUSIONS: Findings underscore the detrimental impact of treatment interruption on cancer survival in the aftermath of hurricanes, emphasizing the need for emergency response plans for this vulnerable population.

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BACKGROUND: This paper estimates spatial inequalities of Rheumatoid Arthritis (RA) in Colombia and explores correlates of those disparities from a health system perspective. METHODS: We apply descriptive epidemiology to healthcare administrative records for estimation of crude and age-standardized prevalences, and health systems thinking for identification of barriers to effective access in RA diagnosis. RESULTS: The crude and age-standardized RA prevalence for Colombia in 2018 is estimated at 0.43% and 0.36%, respectively. In the contributory regime, the binding constraint is effective access to rheumatologists in rural and sparsely populated areas; this constraint in workforce affects service delivery, and ultimately comes from the lack of a differentiated model for effective provision of healthcare in those areas (governance). CONCLUSIONS: There are opportunities for implementation of public health policies and health system interventions that would lead to a better identification of RA patients and the subsequent more precise estimation of RA prevalence, and most importantly, to reduce exposition to risk factors and accurate diagnosis and treatment of RA patients.

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Resumen: Introducción: a diario en Colombia mueren 60 mujeres por enfermedad cardiovascular y las mujeres de raza negra tienen mayor riesgo. Según la Organización Mundial de la Salud (OMS) estas muertes son, en su mayoría, prevenibles. El cuidado como estilo de vida es una intervención del programa "Actúa con corazón de mujer" de la Sociedad Colombiana de Cardiología y Cirugía Cardiovascular (SCC) y la Fundación Colombiana del Corazón (FCC). Objetivo: formar líderes para promover la adopción de comportamientos saludables. Método: se seleccionaron municipios con población de raza negra y compromiso de las autoridades locales. 395 mujeres fueron elegidas. La percepción del riesgo se midió con un instrumento adaptado por la FCC. La intervención educativa se dividió en cuatro sesiones en cada municipio durante cinco meses. Las participantes fueron formadas en toma de presión arterial; se utilizó la automonitorización de presión arterial (AMPA) para confirmar hipertensión y se incluyeron mediciones antropométricas y fisiológicas para calcular el riesgo cardiovascular y de diabetes. Resultados: Los resultados consolidados de los instrumentos y mediciones aplicados demostraron significativos aportes en reducción de riesgo cardiovascular, en razón de una nueva percepción de los peligros y de la incorporación de comportamientos saludables. Conclusiones: las mujeres aprendieron del cuidado. 90% reportaron percepción "ideal" del riesgo, hicieron promesas y adoptaron comportamientos tomando acción frente a sus factores de riesgo y más del 50% evidenciaron cambios en las medidas antropométricas. Los resultados demuestran que estrategias de educación, especialmente con líderes comunitarias, pueden ser de gran relevancia para la salud pública.

Abstract: Introduction: every day in Colombia 60 women die from cardiovascular disease and black women are at higher risk. According to the World Health Organization (WHO) these deaths are preventable. Care as a lifestyle is an intervention of the "Actúa con corazón de mujer" program of the Colombian Society of Cardiology and Cardiovascular Surgery (SCC) and the Colombian Heart Foundation (FCC). Objective: Train leaders to promote the adoption of healthy behaviors. Method: Municipalities with a black population were selected with the commitment of the local authorities. 395 women were elected. Risk perception was measured with an instrument adapted by the FCC. The educational intervention was divided into four sessions in each municipality for five months. Participants were trained in blood pressure measurement, blood pressure self-monitoring (AMPA) was used to confirm hypertension, and anthropometric and physiological measurements were included to calculate cardiovascular and diabetes risk. Results: The consolidated results of the instruments and measurements applied showed significant contributions in reducing cardiovascular risk, due to a new perception of the dangers and the incorporation of healthy behaviors Conclusions: the women learned about care. 90% reported "ideal" perception of risk, made promises and adopted behaviors taking action against their risk factors and more than 50% showed changes in anthropometric measurements. The results show that education strategies, especially with community leaders, can be of great relevance for public health.

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BACKGROUND: In September 2017, hurricanes Irma and Maria affected Puerto Rico (PR) and the US Virgin Islands (USVI), causing major disruptions in basic services and health care. This study documented the stressors and experiences of patients with gynecologic cancer receiving oncology care in PR following these hurricanes. METHODS: We conducted 4 focus groups (December 2018-April 2019) among women aged ≥21 years from PR who were diagnosed with gynecological cancer between September 2016 and September 2018 (n = 24). Using the same eligibility criteria, we also interviewed patients from the USVI (n = 2) who were treated in PR. We also conducted key-informant interviews with oncology care providers and administrators (n = 23) serving gynecologic cancer patients in PR. Discussions were audio-recorded, transcribed verbatim, and coded to identify emergent themes using a constant comparison method. RESULTS: Analyses of focus group discussions and interviews allowed us to identify the following emergent themes: 1) disruptions in oncology care were common; 2) communication between oncology providers and patients was challenging before and after the hurricanes hit; 3) patient resilience was key to resume care; and 4) local communities provided much-needed social support and resources. CONCLUSIONS: This study provides firsthand information about the disruptions in oncology care experienced by and the resiliency of women with gynecologic cancer following hurricanes Irma and Maria. Our findings underscore the need to incorporate oncology care in the preparedness and response plans of communities, health systems, and government agencies to maintain adequate care for cancer patients during and after disasters such as hurricanes.

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BACKGROUND: Hurricanes are the immediate ways that people experience climate impacts in the Caribbean. These events affect socio-ecological systems and lead to major disruptions in the healthcare system, having effects on health outcomes. In September 2017, Puerto Rico (PR) and the United States Virgin Islands (USVI) experienced one of the most catastrophic hurricane seasons in recent history (Hurricane Irma was a Category 5 and Hurricane María was a Category 4 when they hit PR). OBJECTIVE: This study examines environmental stressors experienced by women with gynecologic (GYN) cancers from PR and USVI who received oncologic cancer care in PR, in the aftermath of the hurricanes. METHODS: A descriptive qualitative study design was used to obtain rich information for understanding the context, barriers, knowledge, perspectives, risks, vulnerabilities, and attitudes associated to these hurricanes. We performed focus groups among GYN cancer patients (n = 24) and key-informant interviews (n = 21) among health-care providers and administrators. Interviews were conducted from December 2018-April 2019. RESULTS: Environmental health stressors such as lack of water, heat and uncomfortable temperatures, air pollution (air quality), noise pollution, mosquitos, and rats ranked in the top concerns among cancer patients and key-informants. CONCLUSIONS: These findings are relevant to cancer patients, decision-makers, and health providers facing extreme events and disasters in the Caribbean. Identifying environmental secondary stressors and the most relevant cascading effects is useful for decision-makers so that they may address and mitigate the effects of hurricanes on public health and cancer care.

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OBJECTIVE: Anal cancer screening has been recommended for women with lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation recipients. This study described and compared knowledge, attitudes, and experiences related to anal cancer and anal cancer screening between women at high risk for anal cancer and their counterparts. METHODS: This is a cross-sectional study within colposcopy and gynecology oncology clinics in Puerto Rico; 278 women 21 years or older and with prior diagnosis of gynecological neoplasia completed an interviewer-administered questionnaire. Women were categorized according to their medical history as being high risk or non-high risk for anal cancer. The high-risk group included women with a history of lower genital tract neoplasia, lupus, Crohn disease, HIV, and/or organ transplantation. RESULTS: Overall, 40.7% of the study population were at high risk for developing anal cancer. History of anal cancer screening was low among high-risk and non-high-risk women (11.5% vs 5.6%, p > .05). Less than 1% of all women reported to have had a high-resolution anoscopy. Most women (87.6%) had little knowledge about anal Pap test but were willing to have one if their doctors recommended it (96.5%). No major differences in knowledge, attitudes, or screening history were observed between high-risk and non-high-risk women. CONCLUSIONS: Although experts do not recommend routine anal cancer screening for the general population, they do recommend it for women within certain high-risk groups. Study findings highlight the importance of increasing education and awareness of anal cancer among high-risk patients and physicians, to promote better preventive methods, achieve early detection, and improve disease outcomes.

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Patients with cancer are among the most vulnerable populations in the aftermath of a disaster. They are at higher risk of medical complications and death due to the collapse of or disruptions in the health care system, the community infrastructure, and the complexity of cancer care. The United Nations' Sendai Framework for Disaster Reduction states that people with life-threatening and chronic diseases should be considered in disaster plans to manage their risks. With extreme weather or disasters becoming more intense and frequent and with the high burden of cancer in the United States and its territories, it is important to develop region-specific plans to mitigate the impact of these events on the cancer patient population. After Hurricanes Irma and Maria hit Puerto Rico and the U.S. Virgin Islands in 2017, the need to develop and implement such plans for patients with cancer was evident. We describe ongoing efforts and opportunities for disseminating and implementing emergency response plans to maintain adequate cancer care for patients during and after disasters. While plans for patients with cancer should be housed within the emergency support function infrastructure of each jurisdiction, the Centers for Disease Control and Prevention's Comprehensive Cancer Control Plans provide excellent community-centered mechanisms to support these efforts.

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Resumen: El absceso epidural es una complicación rara que puede ser causa de una elevada morbimortalidad, por ello es fundamental el diagnóstico y tratamiento oportunos. Nuestra paciente desarrolló un absceso posterior a un bloqueo epidural para una cesárea, la técnica anestésica se realizó en condiciones de asepsia y antisepsia, y se retiró el catéter al terminar la cirugía; fue dada de alta a las 48 horas. Reingresa a los nueve días por presentar fiebre, dolor en miembro pélvico izquierdo y dehiscencia de herida quirúrgica. La resonancia magnética mostró un absceso epidural en L3-L4. Se realizó laminectomía y el cultivo mostró Escherichia coli, fue manejada con antibióticos intravenosos durante cuatro semanas y se dio de alta sin secuelas neurológicas.

Abstract. Spinal epidural abscess is a rare complication, it can be cause a high morbimortality and the prompt diagnosis and treatment is essential. Our patient present an abscess after epidural block for caesarean section, the anesthetic procedure was in aseptic technique and the catheter was withdrawn after surgery, the patient was discharged after 48 hours. She was readmitted nine days later with fever, left leg pain and wound surgery infection. The magnetic resonance showed a spinal epidural abscess in L3-L4. Underwent laminectomy cultured showed Escherichia coli, she was at hospital by intravenous antibiotic treatment for 4 weeks and she was discharged without neurologic sequelae.

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PURPOSE OF REVIEW: Research suggests that periodontal tissue might serve as a reservoir for oral human papillomavirus (HPV) infection, while another hypothesis is that chronic inflammation of the tissue might perpetuate an infection with oral HPV infection. In this narrative review, we summarize the evidence related to a potential association between oral HPV infection and periodontitis. RECENT FINDINGS: Twelve articles were identified, and their key findings summarized. Studies vary in sample size, study population, study design, and methods for assessment of oral HPV and periodontitis. Although results are conflicting and still inconclusive, various studies have found an association between oral HPV infection and periodontitis, which is supported by biological plausibility. SUMMARY: Future longitudinal studies should further evaluate this association, using clinical definitions of oral HPV infection and periodontitis, and focusing on high-risk populations for oral HPV infection. Studying this association is important since periodontitis might help identify at-risk individuals for oral HPV infection and potentially HPV-related oropharyngeal cancers.

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The shift of the Noncommunicable Diseases (NCDs) epidemic, including cardiovascular disease, from developed to Low and Middle Income Countries (LMIC), creates new challenges in contexts where there is poor information on healthcare costs. Clearly this information is essential for planning, and its relevance is even more valuable as a driver for prevention and control of NCDs. This paper begins to address that handicap by estimating the healthcare cost of Cardiovascular Disease (Coronary Heart Disease and Stroke) in Colombia, using a person-based approach. Results show that the annual healthcare cost of a person with Coronary Heart Disease is between INT$ 4,277 and INT$ 4,846, while the cost for a person with Stroke varies between INT$5,816 and INT$6,616. The expansion of the NCDs epidemic combined with such high costs threatens the financial sustainability of health systems; primary prevention and policies targeting structural and intermediate determinants of health are a promising way to make health systems financially sustainable.

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