Disarming Ex-Combatants' Minds: Toward Situated Reintegration Process in Post-conflict Colombia

Emotional Competences in Adolescents Exposed to Colombian Armed Conflict During Their Childhood

Objective: Analyse the mediation role of emotional competences on behavior problems in adolescents exposed to Armed-Conflict Childhood Adversities (ACCA). Method: Families with adolescent children who studied in three schools in the municipality of Soacha, Colombia, were invited to participate in the study. One hundred and sixty-one participants were selected and pooled into three groups according to their Adverse Childhood Experiences (ACE) scores: lower-ACE (LACE), higher-ACE (HACE), and ACCA using the Adverse Childhood Experiences Questionnaire for Adolescents (ACE-QA). The Emotion Recognition Task, the Empathy for Pain Task, and the Child Behavior Checklist assessed teenagers' emotional functioning. Results: Teenagers exposed to ACCA more frequently experienced childhood adversities such as domestic violence, child abuse, and parental neglect. Moreover, these adolescents were less accurate in discriminating angry faces, reported higher control perception after social stressors, were more rigorous in punishing those who intentionally harmed others, and showed more internalizing behavior problems. In the mediational model, we found that: the control perception after social stress mediated the reduction of depressive symptoms in adolescents with ACCA history. Additionally, inaccuracy in perceiving angry faces and harsh punishment toward behaviors that intentionally harm others mediated the presence of thinking problems, anxiety, and rule-breaking behaviors. Conclusions: Colombian adolescents who experienced ACCA showed specific changes in their emotional competences, which mediate the parental report of behavioral problems. These results indicate the need for more focused interventions aimed at improving the emotional competences and mental health of adolescent victims of armed conflicts.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-024-00647-0.

Functional Connectivity Analysis of Prej udice Among Colombian Armed Conflict Former Actors

Despite institutional efforts, reconciliation among former actors of the Colombian armed conflict has yet to be achieved, with prejudice being one direct driver of this drawback. We present an EEG-based functional connectivity study applied to four groups of former actors who completed an Implicit Association Test designed to measure prejudice toward victims or combatants. We analyzed seven measures of functional connectivity calculated in six different frequency bands and two experimental conditions. In the behavioral task, we found more prejudice toward victims from the same victims and more prejudice of civilians toward combatants. For the connectivity measures, we found differences in theta band among the victims' and ex-paramilitaries' groups concerning the civilians' and ex-guerrillas' groups, and differences in the beta2 band among the victims' and ex-guerrillas' groups concerning the ex-paramilitaries' group. The results help us design more effective socio-cognitive interventions to reduce prejudice.

Undiagnosed prediabetes in Mexican adolescents under poverty in contexts affected by collective violence: A clinical comparison among health services users and hidden population

Introduction

The epidemiological pattern of prediabetes in adolescents is understudied. In Mexico, adolescents are exposed to social adversity conditions, including poverty and violence. Therefore, understanding their clinical profiles and how the social determinants of health impose barriers to access to health services is important to address detection, in those who, by their vulnerability, remain a hidden population.

Aim

This study aimed to describe undiagnosed prediabetes in Mexican adolescents under poverty in violent contexts and to compare the clinical features among health services users and hidden population.

Methods

This cross-sectional study included 371 adolescents from difficult access locations in violent contexts. Poverty, lack of health services access, and perceived vulnerability were determined in all samples. Endocrine markers (BMI, HOMA-IR, HbA1c, and cortisol) were measured in those with high violence perception.

Results

A total of 61.7% of the adolescents had a suburban grid and urban cluster residence, and 77.7-85.7% of them belonged to locations where 35-50% of their population lived below the poverty line. In total, 40-75% had a lack of 10-20% access to health services, and 18.8% had a high perceived vulnerability due to collective violence and were screened. Overall, 61.9% of respondents were newly diagnosed with prediabetes and showed the worst HbA1c (p = 0.001) compared to the health services subsample, which showed the highest BMI (p = 0.031) and insulin resistance (p = 0.025).

Conclusion

There is a prediabetes hidden population living in violent contexts under poverty. These social determinants promote poor outcomes in perceived vulnerability and endocrine response and represent barriers to access to health services.

Supporting healthcare workers caring for ex-combatants: incentives among Colombian providers with FARC ex-combatants

With the Peace Agreement between Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised healthcare to 13,000 'reincorporating' FARC ex-combatants. Shortages of healthcare workers in reincorporation camps means this promise is in danger of going unfulfilled. More information is needed to determine incentives, disincentives, and recruitment of healthcare providers to address this shortage. Semi-structured interviews were conducted with healthcare providers across FARC reincorporation camps, and a multidisciplinary team conducted analysis in NVivo12 using a team-based coding method. Twenty-four healthcare professionals from 15 camps participated, of which 75% were female. Incentives to work with FARC included improved clinical skills, professional advancement, increased comfort with FARC, and contributing to the peace process. Disincentives included poor living conditions, lack of support, biases, familial commitments, and sacrificing career opportunities. Three-fourths of the sample recommended working with FARC, and 92% reported a shortage of healthcare workers. Recruitment strategies included improved resources and specialised career development for healthcare workers, facilitating interactions between FARC and healthcare professionals outside clinical scenarios, and integrating medicine for vulnerable populations into health education. This study shows the impact that working with FARC ex-combatants can have on healthcare providers and tangible suggestions for increasing provider participation to address the healthcare worker shortage.

The Dynamics of Implicit Intergroup Biases of Victims and Ex-combatants in Post-conflict Scenarios

Strong group identities arise in intergroup conflict scenarios and perpetuate sectarian violence even in post-conflict scenarios. In particular, out-group negative implicit associations are predictors of decreased intergroup forgiveness, as well as increased distrust and aggression against the out-group. Thus, the presence of implicit intergroup (i.e., ex-combatants and victims) biases seems to be a relevant factor in post-conflict scenarios. Here, we aimed to explore whether negative biases toward the out-group are boosted by (a) previous exposure to conflict violence or (b) identification with an armed violent group. One hundred and twenty-eight participants, 65 ex-combatants from Colombian guerrillas and 63 victims of the armed conflict, were assessed with a modified version of the implicit association test (IAT). Our results revealed that the victim group showed a significant negative bias against ex-combatants. However, no bias toward the out-group (i.e., victims) or in-group favoritism was observed in the ex-combatant group. Similarly, we found that IAT scores were not associated with sociodemographical variables (i.e., sex, years of education, or type of dwelling), the levels of combat exposure, victimization armed-conflict-related experiences, or child abuse antecedents. Our results showed an unexpected lack of in-group bias in ex-combatants, potentially triggered by the effect of current demobilization and reintegration processes. Thus, negative associations with the out-group will persist in the framework of societal condemnation of the out-group. In contrast, these negative biases will tend to be abolished when entering in conflict with larger societal reintegration processes. The results reinforce the idea that reintegration may benefit from interventions at the societal level, including all actors of the conflict. In addition, our findings highlight the importance of implementing victim interventions aimed at reducing stigma and revengeful actions in spaces of collective disarmament.

Uncovering social-contextual and individual mental health factors associated with violence via computational inference

The identification of human violence determinants has sparked multiple questions from different academic fields. Innovative methodological assessments of the weight and interaction of multiple determinants are still required. Here, we examine multiple features potentially associated with confessed acts of violence in ex-members of illegal armed groups in Colombia (N = 26,349) through deep learning and feature-derived machine learning. We assessed 162 social-contextual and individual mental health potential predictors of historical data regarding consequentialist, appetitive, retaliative, and reactive domains of violence. Deep learning yields high accuracy using the full set of determinants. Progressive feature elimination revealed that contextual factors were more important than individual factors. Combined social network adversities, membership identification, and normalization of violence were among the more accurate social-contextual factors. To a lesser extent the best individual factors were personality traits (borderline, paranoid, and antisocial) and psychiatric symptoms. The results provide a population-based computational classification regarding historical assessments of violence in vulnerable populations.

Healthcare access barriers for FARC ex-combatants in Colombia: qualitative perspectives from healthcare providers and FARC health promoters

Background

Following the 2016 Peace Agreement with the Fuerzas Armadas Revolucionarias de Colombia (FARC), Colombia promised to reincorporate more than 13,000 guerrilla fighters into its healthcare system. Despite a subsidized healthcare insurance program and the establishment of 24 Espacios Territoriales de Capacitación y Reincorporación (ETCRs—Territorial Spaces for Training and Reintegration) to facilitate this transition, data has shown that FARC ex-combatants access care at disproportionately lower rates, and face barriers to healthcare services.

Methods

Semi-structured interviews were conducted with FARC health promoters and healthcare providers working in ETCRs to determine healthcare access barriers for FARC ex-combatants. Analysis was completed with a qualitative team-based coding method and barriers were categorized according to Julio Frenk’s Domains of Healthcare Access framework.

Results

Among 32 participants, 25 were healthcare providers and 7 self-identified as FARC health promoters. The sample was majority female (71.9%) and worked with the FARC for an average of 12 months in hospital, health center, medical brigade, and ETCR settings. Our sample had experiences with FARC across 16 ETCRs in 13 Departments of Colombia. Participants identified a total of 141 healthcare access barriers affecting FARC ex-combatants, which affected healthcare needs, desires, seeking, initiation and continuation. Significant barriers were related to a lack of resources in rural areas, limited knowledge of the Colombian health system, the health insurance program, perceived stigma, and transition process from the FARC health system.

Conclusions

FARC ex-combatants face significant healthcare access barriers, some of which are unique from other low-resource populations in Colombia. Potential solutions to these barriers included health insurance provider partnerships with health centers close to ETCRs, and training and contracting FARC health promoters to be primary healthcare providers in ETCRs. Future studies are needed to quantify the healthcare barriers affecting FARC ex-combatants, in order to implement targeted interventions to improve healthcare access.

Transformaciones ocupacionales en la implementación del Acuerdo de Paz en un espacio territorial de capacitación y reincorporación para excombatientes: un estudio de caso

En noviembre de 2016 se firmó el Acuerdo Final para la Terminación del Conflicto y la Construcción de una Paz Estable y Duradera entre las Fuerzas Armadas Revolucionarias de Colombia - Ejército del Pueblo (FARC-EP) y el Gobierno Nacional de Colombia. Esto posibilitó a los integrantes de este grupo insurgente el tránsito a la vida civil y a la legalidad. El objetivo del estudio fue conocer cómo son y cómo se dan las transformaciones y reconfiguraciones ocupacionales y comunicativas de los excombatientes de las FARC-EP en su tránsito a la participación en la vida civil y política. Se recogieron narrativas de un grupo de excombatientes de las FARC-EP ubicados en un espacio territorial de capacitación y reincorporación, a través de observación participante, cartografía social y entrevistas. El análisis revela los retos de asumir la vida civil frente a nuevas interacciones, significados y formas de ocuparse en dos escenarios: la reconfiguración personal (identidad, cambios de rol, ajuste de rutinas, prácticas cotidianas y nuevos aprendizajes ocupacionales) y la reconfiguración social (expectativas de participación y reconocimiento, tensiones, reconciliaciones con su entorno y participación política). Se concluye que las transformaciones para la construcción de paz deben basarse en principios de justicia e inclusión social.

Current trends and future perspectives for medical education in Colombia

Colombia is the second largest country in South America. In this article, we provide an overview of medical education in Colombia, including a description of existing public and private medical schools and available undergraduate and postgraduate programs. Medical education in Colombia has evolved through time, following international trends. In addition to 61 undergraduate medical programs, there are 529 postgraduate clinical, 30 PhD, and 131 Master programs in health sciences in Colombia. We identify current challenges and highlight future perspectives for medical education in Colombia.