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Introduction: Urinary tract infection (UTI) is the most common medical complication during pregnancy and is associated with adverse maternal and perinatal outcomes. Objectives: To determine the prevalence of UTI in socially vulnerable pregnant women in Bucaramanga, Colombia, and to characterize these cases. Also, to identify the factors associated with the development of this complication and the antibiotic resistance profile of the microorganisms causing the infection. Materials and methods: Secondary analysis of the data obtained in a main study conducted on 838 pregnant women treated by the public healthcare network of Bucaramanga. The prevalence of UTI was estimated considering the number of pregnant women with a urine culture report (n=648). A descriptive analysis of the sample characteristics and a bivariate analysis were performed to evaluate the differences in the diagnosis of UTI. Finally, factors associated with UTI were estimated using a binomial logistic regression model. Results: The prevalence of UTI during pregnancy was 14.51% (n=94). For each year that maternal age increased, a 6% reduction in the prevalence of UTI (PR: 0.94 95% CI: 0.90-0.98, p<0.001) was observed. Moreover, an association was found between having a history of UTI and developing this complication during pregnancy (PR: 3.6 95% CI: 1.81-7.08, p= 0.005). The most common pathogens isolated were E. Coli (75.53%) and Klebsiella spp (17.02%). Conclusion: About 15% of the participants had UTI, so it is necessary to implement health education strategies aimed at socially vulnerable pregnant women, mainly the youngest and those with a history of UTI, to reduce its occurrence and possible consequences for maternal-fetal health. Furthermore, the data reported herein may help develop public policies to improve prevention and care of UTI in this population.

In several parts of the world, women are subjected to disrespectful and offensive treatment during childbirth. Humanized obstetrics or humanized childbirth has emerged as a response to this situation, and it refers to a model of comprehensive care for labor and childbirth that focuses on the respect and dignity of the woman. This study was aimed at estimating the prevalence and factors associated with humanized childbirth, as perceived by women in six major cities in Colombia. An analytical, multicenter, representative cross-sectional study was conducted in a random sample of six Colombian cities, including the country’s capital. We included 1294 women who were over 14 years of age and who had an institution-assisted vaginal childbirth resulting in a live birth in 2018. The prevalence of humanized childbirth in the sample of participating cities was 32.9% (95% confidence interval, 30.4–35.5). The city of residence of the pregnant woman, the presence of health problems during pregnancy, attendance at an antenatal course, the sex of the attending professional, and the association between the involvement of an obstetrician–gynecologist and the occurrence of a humanized childbirth were examined. These results indicate the need to monitor compliance with existing regulations to ensure dignified, respectful, and humane care that prioritizes women.

To assess the association of social determinants on the performance of health systems around the world. A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010. Health determinants with a significant association on child mortality(<1year): higher access to water (βa Quartile 4(Q4) vs Quartile 1(Q1) = -6,14; 95%CI: -11,63 to -0,73), sanitation systems, (Q4 vs Q1 = -25,58; 95%CI: -31,91 to -19,25), % measles vaccination coverage (Q4 vs Q1 = -7.35; 95%CI: -10,18 to -4,52), % of births attended by a healthcare professional (Q4 vs Q1 = -7,91; 95%CI: -11,36 to -4,52) and a % of the total health expenditure (Q3 vs Q1 = -2,85; 95%CI: -4,93 to -0,7). Ethnic fragmentation (Q4 vs Q1 = 9,93; 95%CI: -0.03 to 19.89) had a marginal effect. For child mortality<5 years, an association was found for these variables and democratization (not free vs free = 11,23; 95%CI: -0,82 to 23,29), out-of-pocket expenditure (Q1 vs Q4 = 17,71; 95%CI: 5,86 to 29,56). For MMR (Maternal mortality ratio), % of access to water for all the quartiles, % of access to sanitation systems, (Q3 vs Q1 = -171,15; 95%CI: -281,29 to -61), birth attention by a healthcare professional (Q4 vs Q1 = -231,23; 95%CI: -349,32 to -113,15), and having corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133). Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results.

Objective: To assess the leadership styles of the assistance Nursing professionals and their associated sociodemographic and professional factors. Materials and methods: An analytical and cross-sectional study. The sample comprised 75 Nursing professionals and 170 Nursing assistants selected for convenience. The Multifactorial Leadership Questionnaire was applied to assess leadership and the organizational result variables. Results: The predominant leadership styles were as follows: transformational (mean of 3.43) and transactional (3.40), which presented high correlation rates with satisfaction, efficacy and additional effort. The leadership style least perceived by the staff was corrective/avoidance (2.10). In transformational leadership, behavioral influence and inspirational motivation presented better scores in the leaders’ self-perception. Age, marital status and having children evidenced statistically significant differences with the transformational and transactional leadership styles; work experience was significant with transactional leadership. Conclusions: In their work, Nursing professionals denote encouraging practices that are inherent to transformational leadership, which is related to changes in the organizational culture, leads to motivating and inspiring the subordinates to transcend the routines and increases their satisfaction and commitment to their duties, thus being an important factor in health institutions.

–Palabras clave: atención primaria de la salud, evaluación de servicios de salud, RE-AIM –Keywords: primary health care, evaluation of health care services, RE-AIM. –Palavras-chave: Atenção primária à saúde, Avaliação de serviços de saúde, RE-AIM

Objetivo: comprender los significados de la maternidad para las gestantes, con el fin de orientar la promoción de la salud materno- infantil. Materiales y métodos: investigación cualitativa, con sustento teórico en el interaccionismo simbólico y el método de la teoría fundamentada. Previo consentimiento informado se realizaron entrevistas en profundidad a 18 gestantes mayores de 14 años, de diferentes estratos socioeconómicos, residentes en Bucaramanga (Colombia). También se observaron sus interacciones con otras gestantes y con personal de salud en las instituciones donde reciben atención prenatal. La información fue analizada paralelamente con su recolección mediante codificación abierta y categorización basada en el método de comparación constante y muestreo teórico, hasta lograr la saturación de las categorías. Los resultados se validaron en grupos focales con gestantes. Resultados: emergieron categorías que dan cuenta de la maternidad como proceso, con preocupación, responsabilidad, adaptación/acomodación y como una experiencia positiva. Como categoría central surgió la maternidad como proceso transformador con experiencias positivas y construcción de vínculos. Discusión: para las gestantes, la maternidad tiene distintos significados y matices, principalmente desde sus componentes socioculturales, aspectos que se deben tener en cuenta para orientar la promoción de la salud materno-infantil y el cuidado materno. Conclusiones: la maternidad es un proceso complejo y de transformación personal que ayuda a las gestantes a formar vínculos con su hijo, con la pareja y con los familiares que la apoyan. Durante esta experimentan sentimientos encontrados de alegría y satisfacción, junto con preocupación y angustia por los retos que implica la maternidad. Entender este proceso orienta el quehacer de los profesionales de la salud hacia una atención prenatal armonizada con las expectativas de la gestante.

Introduction: It is necessary to know the educational needs of pregnant women after the Covid-19 pandemic. Objectives: To know the educational needs of pregnant women and their preferred mans to receive that education. Method: Descriptive study through virtual survey with purposive sampling and snowball call towards pregnant women who had their deliveries during the pandemic, as well as healthcare workers dedicated to prenatal and delivery care. Educational needs, types of content and the preferred way to receive it were found out. Results: A total of 144 women participated, 34 (23.61%) pregnant and 110 (76.39%) mothers, between 17-34 years old. They stated that they needed education on prenatal/delivery care: 113 (78.47%), breastfeeding: 109 (75.69%), baby care: 108 (75.00%) maternity and Covid-19): 90 (62.50%), prevention of Covid-19 transmission to the baby, 85 (59.03%) and mental health: 79 (54.86%). They would prefer videos 114 (54.86%), by WhatsApp: 106 (73.61%) and email 82 (56.94%). Conclusions: Pregnant women, mothers need education on pregnancy care, but also on Covid-19 prevention. They suggest videos through social networks.

Indigenous communities in Colombia are facing a critical health situation; alternative health care models based on the vision of the communities themselves are needed. The objective of this research was to create a health care model that decreases health inequities for the Indigenous Awá population of Nariño, Colombia. This study was guided by the paradigm of community-based participatory action research; the process was carried out in 2015 and 2016. The proposed Intercultural Health Care Model is essentially based on health promotion, disease prevention, community empowerment, social participation in health, decentralized health care and coordination between the two medicines (traditional and allopathic). Strategies such as those reported herein, with concerted efforts rather than imposition, maintain human rights and respect for the sovereignty and autonomy of Indigenous people.

Objetivo: Describir los conocimientos y las prácticas sobre infección respiratoria aguda por parte de cuidadores de menores de 5 años, de las comunas más pobladas y pobres de Bucaramanga, Colombia, y su asociación con variables sociodemográficas y del contexto. Metodología: Estudio de corte. Se realizó muestreo secuencial de cuidadores de menores de 5 años de edad, usuarios de centros de salud de primer nivel de atención de las comunas más pobres de la capital de Santander. Se realizó entrevista sobre conocimientos y prácticas de prevención y control de infección respiratoria aguda. Se calificaron como adecuados o no, usando lineamientos de la Organización Mundial de la Salud. Se compararon con base en el grupo de mayor prevalencia de conocimientos y prácticas adecuados, y se exploraron asociaciones con las variables sociodemográficas. Resultados: Participaron 403 cuidadores, 92,6 % mujeres, 45,9 % mayores de 24 años. En total, 236 tenían conocimiento adecuado y 286 reportaron prácticas adecuadas de prevención. El análisis multivariado mostró que cuidadores con 25 años o más, y escolaridad de 5 o más años, tienen mayor prevalencia de conocimientos y prácticas adecuados. Conclusión: La edad y el nivel educativo de los cuidadores están asociados a prácticas adecuadas de prevención y control de la infección respiratoria aguda. Estos hallazgos orientan a focalizar la educación en cuidadores jóvenes con baja educación, recomendaciones contempladas en la ruta de promoción de la salud del Modelo de Atención Integral en Salud en Colombia.

BackgroundThe liquidation of health promoting entities (Entidades Promotoras de Salud (EPS)) in Colombia and the forced transfer of millions of enrollees to solvent insurers have raised concerns about the financial sustainability of the health insurance system. This study examines the impact of these uncompensated mass transfers on key financial indicators of receiving EPS.MethodsA multitemporal ecological study and a difference-in-differences (DiD) model were conducted using national administrative data. Nine continuously operating EPS that received enrollees from liquidated entities were included. Key financial indicators analysed included operating margin, capitation payment unit (Unidad de Pago por Capitación (UPC)) sufficiency, medical loss ratio, per capita medical cost and enrolment volume. Linear mixed-effects and fixed-effects DiD models were applied.FindingsAverage operating margins decreased from 3.2% (2017) to –0.59% (2024). In mixed-effects models, UPC sufficiency was the strongest positive correlate of margin (β=0.28, 95% CI 0.14 to 0.41), while per capita medical cost (β=−0.43, 95% CI −0.66 to −0.21) and enrollee transfers (β=−0.014, 95% CI −0.027 to −0.002) were negatively associated. DiD estimates show that mass transfers reduced operating margins by 1.2 percentage points (95% CI −1.5 to −0.9), with the strongest effects in the first 2 years and consistent results across sensitivity analyses.InterpretationUncompensated mass enrollee transfers from liquidated EPS have a significant negative impact on the financial sustainability of receiving insurers. Regulatory reforms, including risk-adjusted premium adjustments and interinsurer compensation mechanisms, are urgently needed.