Expectativas del nuevo proyecto para la reforma al sistema de salud 2013

Esta investigación se desarrolla, bajo una hipótesis, la cual se busca comprobar, analizando la evidencia encontrada en documentos Teóricos investigativos de autores expertos y especialistas en el tema y en publicaciones de la prensa nacional además de las leyes que corresponden a las dos reformas de la salud la 1122 de 2007 y la 1438 de 2011. La hipótesis planteada para esta investigación es que “mientras los nuevos planteamientos para la reforma de la salud no incluyan dentro de su propuesta una solución evidente a los principales problemas encontrados en el sistema de salud actual y no establezca un control fiscal y una regulación verdadera sobre el manejo de los fondos del sistema de salud; Los principios de universalidad, eficiencia, integralidad, libre escogencia, competencia sana y calidad no serán cumplidos y por lo tanto el pueblo Colombiano no podrá ejercer su derecho a la salud como lo plantea la Constitución Política de Colombia de 1991 y la ley 100 de 1993. Para comprobar la hipótesis se han seleccionado como documentos a analizar, tres publicaciones de la prensa nacional, cuatro de autores expertos y especializados en el tema y tres documentos adicionales que corresponden a las dos reformas realizadas al sistema de salud en los años 2007 y 2011 y a la nueva propuesta radicada por el gobierno nacional a inicios de este año. Es de suma importancia conocer las apreciaciones de los autores sobre el grupo de variables que se utilizarán para desarrollar este estudio. Estas variables pertenecen a aquellas que influencian el equilibrio financiero y que adicionalmente afectan directamente a la población impactando su bienestar y su calidad de vida. Entre esas variables se destacan (i) aspectos demográficos y de la fuerza laboral, (ii) aspectos económicos como los niveles de ingreso, salarios y empleo, (iii) cobertura del sistema de salud, (iv) calidad y acceso a los servicios del sistema, (v) duplicidad del gasto (vi) flujo de los recursos del sistema de salud (problemas institucionales), (vii) Gasto en salud y estabilidad financiera y (viii) regulación financiera. El Formato utilizado para la comparación análisis y síntesis de los documentos teóricos investigativos y de las publicaciones de la prensa nacional, consta de tres cuerpos. El primero, contiene las características relacionadas con tiempo y espacio de la publicación. El segundo, hace énfasis en el contenido y en los temas y variables de interés para el desarrollo de la investigación. Y el tercero hace énfasis en el contenido y en los temas y variables de interés para el desarrollo de la investigación. Al hacer el análisis, síntesis y comparación de estos artículos se resolverán algunos interrogantes que pueden llevarnos a comprobar la hipótesis como los son:¿Cuáles han sido los principales logros en salud con el sistema actual?, ¿Cuáles han sido las principales fallas o problemas en el sistema actual de salud?, ¿Hay un buen manejo de los fondos destinados al sistema de Salud actual?, ¿La gestión financiera del Sistema de Salud Colombiano, permite que este sea un sistema de salud sostenible y perdurable para todos los colombianos?. Adicionalmente, existen otros interrogantes a destacar como lo son ¿En qué consiste la nueva reforma de Salud propuesta para el 2013?, ¿Los cambios planteados en la última propuesta para hacer una reforma al sistema de salud, realmente conducen a un avance o dejan de lado los principales problemas de la seguridad social en Colombia?, ¿La nueva propuesta para la reforma de la salud busca lograr una mejora radical en la gestión financiera del Sistema de Salud Colombiano?, ¿Cuál es la percepción de los principales autores, especialistas en el tema en cuanto a la erradicación total de los problemas más álgidos en el actual Sistema de Salud Colombiano, con la nueva propuesta para la reforma de la salud para el 2013? Este trabajo de investigación surgió debido a la radicación de una nueva propuesta para la reforma a la salud y la polémica que se ha generado alrededor de esta. Veinte años después de la aprobación de la ley 100, se han identificado logros importantes principalmente en cuanto a cobertura; lastimosamente, actualmente se han manifestado problemas financieros y de liquidez, a pesar de lo cual, vale la pena destacar que el sistema fue rentable e incluso generó excedentes financieros en su operación, durante sus primeros 10 años de funcionamiento. Ahora, según la evidencia teórica investigativa y de la prensa nacional, se determinará si la nueva propuesta para la reforma de la salud es una buena opción para el país.

Uretero-uretero anastomosis: una alternativa para pacientes con patología asociada a doble sistema colector

Introducción El doble sistema colector es la alteración renal más frecuente y presenta una incidencia 1/500 individuos. Hay varias opciones de tratamiento para el uréter con reflujo o severamente dilatado cuando se asocia a un sistema duplicado, entre ellas la uretero-uretero anastomosis. El objetivo es dar a conocer nuestra experiencia en la realización de este procedimiento para pacientes pediátricos. Materiales y métodos: Se presenta una serie de casos entre Enero 2010 y Abril 2014, se revisaron 214 historias clínicas de pacientes con doble sistema colector y patologías asociadas; 10 fueron sometidos a uretero-uretero anastomosis. El Seguimiento posopertorio fue de 12 meses promedio. Resultados: Se incluyeron 10 pacientes. El 70% fueron género femenino, la edad promedio al momento de la cirugía fue 5 años . Todos cursaban con infección urinaria y 10% presentaban incontinencia urinaria. En el postoperatorio, en 40% se encontró uréter ectópico, 30% ureterocele intravesical y 30% reflujo vesicoureteral al sistema inferior. Se realizaron siete anastomosis del sistema superior al inferior y tres del inferior al superior, todos por una incisión de 2cm a nivel inguinal y fueron derivados con catéter doble J sin complicaciones postoperatorias. Al tiempo de seguimiento la totalidad de los pacientes se encontraron sin profilaxis antibiótica, con dilatación resuelta, sin infecciones urinarias ni incontinencia. Conclusión: La uretero-uretero anastomosis es una alternativa fiable, segura y con mínima morbilidad para el tratamiento de pacientes con patología asociada a doble sistema colector. Estudios adicionales, con mayor número de pacientes y seguimiento serán necesarios para ver evolución a largo plazo.

A study on the phylogeny and the ecology of ammonia-oxidizing bacteria using a new molecular marker based on the gene amoB

L'agricultura i la industrialització han causat un augment significatiu del nombre d'ambients rics en amoni. La presència de compostos nitrogenats redueix la qualitat de l'aigua, causant problemes de toxicitat, deteriorant el medi ambient i fins i tot afectant la salut humana. En conseqüència, la nitrificació s'ha convertit en un procés global que afecta al cicle del nitrogen a la biosfera. Els bacteris oxidadors d'amoni (AOB) són els responsables de l'oxidació de l'amoni a nitrit, i juguen un paper essencial en el cicle del nitrogen. Els primers oxidadors d'amoni foren aïllats a finals del segle XIX, però la lentitud del seu creixement i les dificultats per cultivar-los feren que fins als anys 80, amb els primers estudis emprant el gen 16SrDNA, no s'assolís un coneixement complert d'aquest grup bacterià. Actualment les bases de dades contenen multitud d'entrades amb seqüències corresponents a AOB. L'objectiu d'aquest treball era trobar, desenvolupar i avaluar eines útils i fiables per a l'estudi dels AOB en mostres ambientals. En aquest treball primer descrivim la utilització de la hibridació in situ amb fluorescència (FISH), mitjançant l'aplicació de sondes amb diana en el 16SrRNA dels AOB. La FISH ens va permetre detectar i recomptar aquest grup bacterià; no obstant, aquest mètode no permetia la detecció de noves seqüències, pel que es necessitava una nova eina. Amb aquesta intenció vam aplicar la seqüència de la sonda Nso1225 en una PCR. El fet d'amplificar específicament un fragment del 16SrDNA dels AOB va suposar el desenvolupament d'una nova eina molecular que permetia detectar la presència i diversitat d'aquests bacteris en ambients naturals. Malgrat tot, algunes seqüències pertanyents a bacteris no oxidadors d'amoni del subgrup β dels proteobacteris, eren també obtingudes amb aquesta tècnica. Així mateix, un dels inconvenients de l'ús del 16SrDNA com a marcador és la impossibilitat de detectar simultàniament els AOB que pertanyen als subgrups β i γ dels proteobacteris. El gen amoA, que codifica per la subunitat A de l'enzim amoni monooxigenasa (AMO), era aleshores àmpliament utilitzat com a marcador per a la detecció dels AOB. En aquest treball també descrivim la utilització d'aquest marcador en mostres procedents d'un reactor SBR. Aquest marcador ens va permetre identificar seqüències de AOB en la mostra, però la necessitat de detectar amoA mitjançant clonatge fa que l'ús d'aquest marcador requereixi massa temps per a la seva utilització com a eina en estudis d'ecologia microbiana amb moltes mostres. Per altra banda, alguns autors han assenyalat l'obtenció de seqüències de no AOB en utilitzar amoA en un protocol de PCR-DGGE. Amb la finalitat d'obtenir una eina ràpida i rigorosa per detectar i identificar els AOB, vam desenvolupar un joc nou d'oligonucleòtids amb diana en el gen amoB, que codifica per a la subunitat transmembrana de l'enzim AMO. Aquest gen ha demostrat ser un bon marcador molecular pels AOB, oferint, sense tenir en compte afiliacions filogenètiques, una elevada especificitat, sensibilitat i fiabilitat. En aquest treball també presentem una anàlisi de RT-PCR basada en la detecció del gen amoB per a la quantificació del gènere Nitrosococcus. El nou joc d'oligonucleòtids dissenyat permet una enumeració altament específica i sensible de tots els γ-Nitrosococcus coneguts. Finalment, vam realitzar un estudi poligènic, comparant i avaluant els marcadors amoA, amoB i 16SrDNA, i vàrem construir un arbre filogenètic combinat. Com a resultat concloem que amoB és un marcador adequat per a la detecció i identificació dels AOB en mostres ambientals, proporcionant alhora agrupacions consistents en fer inferències filogenètiques. Per altra banda, la seqüència sencera del gen 16S rDNA és indicada com a marcador en estudis amb finalitats taxonòmiques i filogenètiques en treballar amb cultius purs de AOB.

Speciation in fig wasps

There are over 700 species of fig trees in the tropics and several thousand species of fig wasps are associated with their syconia (inflorescences). These wasps comprise a monophyletic family of fig pollinators and several diverse lineages of non-pollinating wasps. The pollinator larvae gall fig flowers, while larvae of non-pollinating species either initiate their own galls or parasitise the galls of other wasps. A single fig species has 1-4 pollinator species and also hosts up to 30 non-pollinating wasp species. Most wasps show a high degree of host plant specificity and are known from only a single fig species. However, in some cases wasps may be shared across closely related fig species. There is impressive morphological coevolution between figs and fig wasps and this, combined with a high degree of partner specificity, led to the expectation that figs and pollinators have cospeciated extensively. Comparison of deep phylogenies supports long-term codivergence of figs and pollinators, but also suggests that some host shifts have occurred. Phylogenies of more closely related species do not match perfectly and may even be incongruent, suggesting significant roles for processes other than strict cospeciation. Combined with recent evidence on host specificity patterns, this suggests that pollinator wasps may often speciate by host shifts between closely related figs, or by duplication (the wasp speciates but the fig doesn't). The frequencies and biological details of these different modes of speciation invite further study. Far less is known about speciation in non-pollinating fig wasps. Some lineages have probably coevolved with figs and pollinators for most of the evolutionary history of the symbiosis, while others appear to be more recent colonisers. Many species appear to be highly host plant specific, but those that lay eggs through the fig wall without entering the syconium (the majority of species) may be subject to fewer constraints on host-shifting than pollinators. There is evidence for substantial host shifting in at least one gens, but also evidence for ecological speciation on the same host plant by niche shifts in other cases. Finally, recent work has begun to address the issue of “community phylogeny” and provided evidence for long-term co-divergence of multiple pollinating and non-pollinating wasp lineages with their host figs.

Nature protection in Greece: an appraisal of the factors shaping integrative conservation and policy effectiveness

The proliferation of designated areas following the implementation of Natura 2000 in Greece has initiated changes in the protected area design and conservation policy making aiming at delivering action for biodiversity and integrative planning on a wider landscape. Following the sustainability concept, an integrative approach cannot realistically take place simply by extending the protected area and designations. The paper addresses public involvement and inter-sectoral coordination as major procedural elements of integrative management and evaluates the nature and strength of their negative or positive influences on the fulfillment of an integrative vision of nature conservation. A review of the history of protected areas and administration developments in Greece provide useful input in the research. The analysis has shown that the selected network of Natura 2000 sites has been superimposed upon the existing system and resulted in duplication of administrative effort and related legislation. As a result the overall picture of protected areas in the country appears complex, confusing and fragmented. Major failures to integrated conservation perspective can be traced to structural causes rooted in politico-economic power structures of mainstream policy and in a rather limited political commitment to conservation. It is concluded that greater realisation. of integrated conservation in Greece necessitates policy reforms related mainly to sectoral legal frameworks to promote environmentalism as well as an increased effort by the managing authorities to facilitate a broader framework of public dialogue and give local communities incentives to sustainably benefit from protected areas. (C) 2006 Elsevier Ltd. All rights reserved.

Expression of FoxC, FoxF, FoxL1, and FoxQ1 genes in the dogfish scyliorhinus canicula defines ancient and derived roles for fox genes in vertebrate development

In the human genome, members of the FoxC, FoxF, FoxL1, and FoxQ1 gene families are found in two paralagous clusters. Here we characterize all four gene families in the dogfish Seyliorhinus canicula, a member of the cartilaginous fish lineage that diverged before the radiation of osteichthyan vertebrates. We identify two FoxC genes, two FoxF genes, and single FoxQ1 and FoxL1 genes, demonstrating cluster duplication preceded the radiation of gnathostomes. The expression of all six genes was analyzed by in situ hybridization. The results show conserved expression of FoxL1, FoxF, and FoxC genes in different compartments of the mesoderm and of FoxQ1 in pharyngeal endoderm and its derivatives, confirming these as ancient sites of Fox gene expression, and also illustrate multiple cases of lineage-specific expression domains. Comparison to invertebrate chordates shows that the majority of conserved vertebrate expression domains mark tissues that are part of the primitive chordate body plan.

The Fox genes of Branchiostoma floridae

The Fox genes are united by encoding a fork head domain, a deoxyribonucleic acid (DNA)-binding domain of the winged-helix type that marks these genes as encoding transcription factors. Vertebrate Fox genes are classified into 23 subclasses named from FoxA to FoxS. We have surveyed the genome of the amphioxus Branchiostoma floridae, identifying 32 distinct Fox genes representing 21 of these 23 subclasses. The missing subclasses, FoxR and FoxS, are specific to vertebrates, and in addition, B. floridae has one further group, FoxAB, that is not found in vertebrates. Hence, we conclude B. floridae has maintained a high level of Fox gene diversity. Expressed sequence tag and complementary DNA sequence data support the expression of 23 genes. Several linkages between B. floridae Fox genes were noted, including some that have evolved relatively recently via tandem duplication in the amphioxus lineage and others that are more ancient.

Origin and evolution of 3'UTR of flaviviruses: long direct repeats as a basis for the formation of secondary structures and their significance for virus transmission

The 3' untranslated regions (3'UTRs) of flaviviruses are reviewed and analyzed in relation to short sequences conserved as direct repeats (DRs). Previously, alignments of the 3'UTRs have been constructed for three of the four recognized flavivirus groups, namely mosquito-borne, tick-borne, and nonclassified flaviviruses (MBFV, TBFV, and NCFV, respectively). This revealed (1) six long repeat sequences (LRSs) in the 3'UTR and open-reading frame (ORF) of the TBFV, (2) duplication of the 3'UTR of the NCFV by intramolecular recombination, and (3) the possibility of a common origin for all DRs within the MBFV. We have now extended this analysis and review it in the context of all previous published analyses. This has been achieved by constructing a robust alignment between all flaviviruses using the published DRs and secondary RNA structures as "anchors" to reveal additional homologies along the 3'UTR. This approach identified nucleotide regions within the MBFV, NKV (no-known vector viruses), and NCFV 3'UTRs that are homologous to different LRSs in the TBFV 3'UTR and ORF. The analysis revealed that some of the DRs and secondary RNA structures described individually within each flavivirus group share common evolutionary origins. The 3'UTR of flaviviruses, and possibly the ORF, therefore probably evolved through multiple duplication of an RNA domain, homologous to the LRS previously identified only in the TBFV. The short DRs in all virus groups appear to represent the evolutionary remnants of these domains rather than resulting from new duplications. The relevance of these flavivirus DRs to evolution, diversity, 3'UTR enhancer function, and virus transmission is reviewed.

Origin and evolution of flavivirus 5'UTRs and panhandles: trans-terminal duplications?

Flavivirus replication is mediated by interactions between complementary ssRNA sequences of the 5'- and 3'-termini that form dsRNA cyclisation stems or panhandles, varying in length, sequence and specific location in the mosquito-borne, tick-borne, non-vectored and non-classified flaviviruses. In this manuscript we manually aligned the flavivirus 5'UTRs and adjacent capsid genes and revealed significantly more homology than has hitherto been identified. Analysis of the alignments revealed that the panhandles represent evolutionary remnants of a long cyclisation domain that probably emerged through duplication of one of the UTR termini.

Chromosomal mapping of ANTP class homeobox genes in amphioxus: piecing together ancestral genomes

Homeobox genes encode DNA-binding proteins, many of which are implicated in the control of embryonic development. Evolutionarily, most homeobox genes fall into two related clades: the ANTP and the PRD classes. Some genes in ANTP class, notably Hox, ParaHox, and NK genes, have an intriguing arrangement into physical clusters. To investigate the evolutionary history of these gene clusters, we examined homeobox gene chromosomal locations in the cephalochordate amphioxus, Branchiostoma floridae. We deduce that 22 amphioxus ANTP class homeobox genes localize in just three chromosomes. One contains the Hox cluster plus AmphiEn, AmphiMnx, and AmphiDll. The ParaHox cluster resides in another chromosome, whereas a third chromosome contains the NK type homeobox genes, including AmphiMsx and ArnphiTlx. By comparative analysis we infer that clustering of ANTP class homeobox genes evolved just once, during a series of extensive cis-duplication events of genes early in animal evolution. A trans-duplication event occurred later to yield the Hox and ParaHox gene clusters on different chromosomes. The results obtained have implications for understanding the origin of homeobox gene clustering, the diversification of the ANTP class of homeobox genes, and the evolution of animal genomes.

Amphioxus type I keratin cDNA and the evolution of intermediate filament genes

We report the cloning of an intermediate filament (IF) cDNA from the cephalochordate amphioxus that encodes a protein assignable to the type I keratin group. This is the first type I keratin reported from an invertebrate. Molecular phylogenetic analyses reveal that amphioxus also possesses a type II keratin, and that the genes encoding short-rod IF proteins underwent different patterns of duplication in vertebrates and their closest relatives, the cephalochordates. Extensive IF gene duplication and divergence may have facilitated the origin of new specialised cell types in vertebrates.

Complex history of a chromosomal paralogy region: insights from amphioxus aromatic amino acid hydroxylase genes and insulin-related genes

Aromatic amino acid hydroxylase (AAAH) genes and insulin-like genes form part of an extensive paralogy region shared by human chromosomes 11 and 12, thought to have arisen by tetraploidy in early vertebrate evolution. Cloning of a complementary DNA (cDNA) for an amphioxus (Branchiostoma floridae) hydroxylase gene (AmphiPAH) allowed us to investigate the ancestry of the human chromosome 11/12 paralogy region. Molecular phylogenetic evidence reveals that AmphiPAH is orthologous to vertebrate phenylalanine (PAH) genes; the implication is that all three vertebrate AAAH genes arose early in metazoan evolution, predating vertebrates. In contrast, our phylogenetic analysis of amphioxus and vertebrate insulin-related gene sequences is consistent with duplication of these genes during early chordate ancestry. The conclusion is that two tightly linked gene families on human chromosomes 11 and 12 were not duplicated coincidentally. We rationalize this paradox by invoking gene loss in the AAAH gene family and conclude that paralogous genes shared by paralogous chromosomes need not have identical evolutionary histories.

Divergent evolutionary pattern of starch biosynthetic pathway genes in grasses and dicots

Starch is the most widespread and abundant storage carbohydrate in crops and its production is critical to both crop yield and quality. As regards the starch content in the seeds of crop plants, there are distinct difference between grasses (Poaceae) and dicots. However, few studies have described the evolutionary pattern of genes in the starch biosynthetic pathway in these two groups of plants. In this study, therefore, an attempt was made to compare the evolutionary rate, gene duplication and selective pattern of the key genes involved in this pathway between the two groups, using five grasses and five dicots as materials. The results showed (i) distinct differences in patterns of gene duplication and loss between grasses and dicots; duplication in grasses mainly occurred prior to the divergence of grasses, whereas duplication mostly occurred in individual species within the dicots; there is less gene loss in grasses than in dicots; (ii) a considerably higher evolutionary rate in grasses than in dicots in most gene families analyzed; (iii) evidence of a different selective pattern between grasses and dicots; positive selection may have occurred asymmetrically in grasses in some gene families, e.g. AGPase small subunit. Therefore, we deduced that gene duplication contributes to, and a higher evolutionary rate is associated with, the higher starch content in grasses. In addition, two novel aspects of the evolution of the starch biosynthetic pathway were observed.

Genome dynamics explain the evolution of flowering time CCT domain gene families in the Poaceae

Numerous CCT domain genes are known to control flowering in plants. They belong to the CONSTANS-like (COL) and PREUDORESPONSE REGULATOR (PRR) gene families, which in addition to a CCT domain possess B-box or response-regulator domains, respectively. Ghd7 is the most recently identified COL gene to have a proven role in the control of flowering time in the Poaceae. However, as it lacks B-box domains, its inclusion within the COL gene family, technically, is incorrect. Here, we show Ghd7 belongs to a larger family of previously uncharacterized Poaceae genes which possess just a single CCT domain, termed here CCT MOTIF FAMILY (CMF) genes. We molecularly describe the CMF (and related COL and PRR) gene families in four sequenced Poaceae species, as well as in the draft genome assembly of barley (Hordeum vulgare). Genetic mapping of the ten barley CMF genes identified, as well as twelve previously unmapped HvCOL and HvPRR genes, finds the majority map to colinear positions relative to their Poaceae orthologues. Combined inter-/intra-species comparative and phylogenetic analysis of CMF, COL and PRR gene families indicates they evolved prior to the monocot/dicot divergence ~200 mya, with Poaceae CMF evolution described as the interplay between whole genome duplication in the ancestral cereal, and subsequent clade-specific mutation, deletion and duplication events. Given the proven role of CMF genes in the modulation of cereals flowering, the molecular, phylogenetic and comparative analysis of the Poaceae CMF, COL and PRR gene families presented here provides the foundation from which functional investigation can be undertaken.

Segmental chromosomal duplications harbouring group IV CONSTANS-like genes in cereals

Comparative mapping is an important component of map-based cloning in large-genome cereal species. We describe evidence of a segmental chromosomal duplication harbouring CONSTANS-like genes in barley that predates the divergence of the Oryzoideae (rice) and Pooideae (brachypodium, barley, wheat) clades, and discuss the implications of such events for comparative mapping and QTL cloning in temperate cereal crops.