​Turismo de salud cardiovascular, la otra cara del sistema colombiano

A través de casos específicos, este reportaje radial expone las diferencias existentes en el acceso al derecho fundamental de la salud por parte de ciudadanos colombianos y extranjeros que padecen alguna cardiopatía. En él se recogen voces de pacientes locales e internacionales, expertos en turismo de salud, críticos del sistema de salud en el país, personal médico, asociaciones de defensa de usuarios y representantes de hospitales y clínicas. A través de las fuentes entrevistadas se muestra por qué Colombia se ha convertido en un destino atractivo para tratamientos y procedimientos del corazón y se analiza cuáles son las principales causas de esta diferenciación entre unos pacientes y otros.

Análisis de perdurabilidad de las Instituciones Prestadoras de Salud (IPS), especializadas en tratamiento de enfermedades de alto costo en el departamento de Antioquia, frente a las políticas de regulación de precios por medio de la Ley 1438 en Colombia

A partir de la reforma al sistema de salud, por medio de la Ley 1438 de 2011, se implementa en Colombia la política de regulación de precios de medicamentos y el ingreso al país de medicamentos biosimilares. Esta investigación analiza la perdurabilidad en las Instituciones de Prestación de Salud (IPS) especializadas en tratamiento de enfermedades del alto costo, como: Medicarte, Clínica Astorga, Clínica Vida, Helpharma, Audifarma, y Medex, para identificar finalmente, la cadena de valor en el departamento de Antioquia, buscando proponer alternativas para la toma de decisiones de tipo estratégico.

Indicadores da individualização de cuidados para o curso de licenciatura em enfermagem

RESUMO: A individualização dos cuidados de enfermagem tem sido associada a uma evolução clínica mais favorável, representando um importante parâmetro de avaliação e de desenvolvimento dos serviços de saúde. A tónica atribuída a esta problemática não só é evidenciada por diversos autores, como se enquadra nas metas de modernização do Sistema Nacional de Saúde e é destaque em vários códigos normativos da profissão nacionais e internacionais, como uma obrigação moral e deontológica. Assim, pretende-se mediante os ganhos em saúde sensíveis às intervenções de enfermagem, identificar quais indicadores do cuidado individualizado, para se efectivar a sua incorporação na formação inicial em enfermagem. Para tal efeito, construiu-se uma bateria de indicadores mediante análise de duas revisões sistemáticas da literatura, que teve por base o Modelo da Eficácia do Papel de Enfermagem, desenvolvido por Irvine et al. (1998). Para à adaptação à realidade portuguesa recorreu-se à técnica de Delphi, com duas rondas, que incluiu respectivamente, 12 e 10 peritos de enfermagem. Na análise de dados utilizou-se o nível de concordância superior ou igual a 90%, na última ronda. Na segunda fase do estudo, aplicou-se um inquérito por questionário (α de Cronbach = 0,919) para testar a sua aplicabilidade dos indicadores, a 156 enfermeiros, do mesmo hospital da área da grande Lisboa, no Serviço de Medicina e Cirurgia. Recorreu-se ao SPSS, versão 19 e realizou-se análise univariada e estatística analítica. Na bateria final de indicadores foram incorporados aqueles com ponderação positiva (≥51%). Os dados qualitativos obtidos foram submetidos a análise de conteúdo. Dos 58 indicadores iniciais, consolidaram-se 8 categorias: cuidado à pessoa em fim de vida e família, toque terapêutico, educação para a auto-gestão da saúde, cuidados de proximidade, gestão de casos, empoderamento/ literacia para a saúde, linha telefónica de apoio permanente/ tele-assistência e apoio psico-emocional, com valorização de 28 indicadores. O tempo de experiência profissional, tipo de serviço e tempo de permanência no mesmo serviço influenciou a percepção dos enfermeiros, confirmando os pressupostos de Irvine et al. (1998) e Benner (2001). A correlação total dos indicadores, no questionário, variou entre 0,248 e 0,650, para p<0,01. O facto de todas as correlações serem positivas significa que provavelmente estão associados à problemática da individualização, pelo que se sugere a sua transposição para o ensino de enfermagem. ABSTRACT: The individualization of nursing care has been associated with a more favorable clinical evolution, an important parameter for the evaluation and development of health services. The emphasis given to this problem is not only evidenced by several authors, as fits the goals of modernizing the National Health System and is featured in several normative codes of the profession nationally and internationally, as a moral and ethical obligation. Thus, it is intended by the gains in health sensitive to nursing interventions, identify indicators of individualized care and give effect to its incorporation into the initial training in nursing. For this purpose, we constructed a series of indicators by analyzing two systematic reviews of literature, which was based on the The Nursing Role Effectiveness Model developed by Irvine et al. (1998). For the adaptation to the Portuguese appealed to the Delphi technique with two rounds, which included, respectively, 10 and 12 nursing experts. In data analysis we used the level of agreement greater than or equal to 90% in the last round. In the second phase of the study, we applied a questionnaire (Cronbach's α = 0.919) to test the applicability of the indicators, the 156 nurses in the same hospital in the Greater Lisbon area, the Department of Medicine and Surgery. Done using the SPSS, version 19 and conducted a univariate analysis and analytical statistics. In the final heat of indicators were incorporated into those with positive weight (≥ 51%). Qualitative data were subjected to content analysis. Of the initial 58 indicators, eight were consolidated categories: care to the person and family life, therapeutic touch education for self-management of health care outreach, case management, empowerment / literacy to health, a telephone line permanent support / tele-assistance and psycho-emotional, with an appreciation of 28 indicators. The length of professional experience, type of service and length of stay in the same service influenced the perception of nurses, confirming the assumptions of Irvine et al. (1998) and Benner (2001). The total correlation of the indicators in the questionnaire ranged between 0.248 and 0.650, p <0.01. The fact that all correlations are positive means that are probably associated with the problem of individuation, which is suggested by its implementation in nursing education.

Administração em saúde : da prestação à avaliação de resultados

A área da “política e administração da saúde”, tem merecido um interesse crescente nas últimas décadas. Provavelmente em consequência do substancial aumento das despesas de saúde que tem ocorrido em todo o mundo mas, também porque se tem verificado uma sensível melhoria da situação de saúde das populações, o que faz com que, “policy makers”, académicos, analistas do setor e “media” tragam as questões de saúde para as primeiras páginas, valorizando-as e tentando melhorar a compreensão sobre o muito complexo processo de prestação em saúde.Não se trata no entanto de uma melhoria que usualmente seja quantificada, ocorrendo até que, se são frequentes, as tentativas de medir os custos e a produção da saúde, setor que tem uma importante dimensão económica, o mesmo não se verifica em relação aos seus resultados (o impacto que os cuidados tiveram na saúde das populações) e ainda menos em relação aos chamados “ganhos em saúde”, afinal o objectivo maior dos sistemas de saúde.Assim, entre a subida das despesas e a melhoria dos resultados, há uma falta de relacionamento que torna difícil fazer um balanço, pelo que é urgente adotar modelos de avaliação da prestação e dos seus resultados que sejam explícitos e ajudem a validar a efetividade da prestação e dos resultados obtidos. O presente trabalho pretende ser um contributo para clarificar esta questão e procurar um indicador corrente que possa ser utilizado para objetivar os “ganhos em saúde” e que, por ser quantificável, possa permitir a definição de medidas de efetividade dos resultados obtidos e de avaliação da performance dos sistemas de saúde.Não será mais uma medida de medição da produção (outputs) mas que pode resolver muitos problemas de há longos anos, e dar suporte ao confronto recursos/resultados e permitindo avaliar a performance de sistemas de saúde, com consistência face aos seus objectivos e fiabilidade, sendo capaz de detetar as mudanças e de mostrar as diferenças.

Investment in preventing and preparing for biological emergencies and disasters: social and economic costs of disasters versus costs of surveillance and response preparedness

Biological emergencies such as the appearance of an exotic transboundary or emerging disease can become disasters. The question that faces Veterinary Services in developing countries is how to balance resources dedicated to active insurance measures, such as border control, surveillance, working with the governments of developing countries, and investing in improving veterinary knowledge and tools, with passive measures, such as contingency funds and vaccine banks. There is strong evidence that the animal health situation in developed countries has improved and is relatively stable. In addition, through trade with other countries, developing countries are becoming part of the international animal health system, the status of which is improving, though with occasional setbacks. However, despite these improvements, the risk of a possible biological disaster still remains, and has increased in recent times because of the threat of bioterrorism. This paper suggests that a model that combines decision tree analysis with epidemiology is required to identify critical points in food chains that should be strengthened to reduce the risk of emergencies and prevent emergencies from becoming disasters.

Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness

Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and Subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Final report on research project PS2010, proof of concept of automated mapping of weeds in arable fields

Many weeds occur in patches but farmers frequently spray whole fields to control the weeds in these patches. Given a geo-referenced weed map, technology exists to confine spraying to these patches. Adoption of patch spraying by arable farmers has, however, been negligible partly due to the difficulty of constructing weed maps. Building on previous DEFRA and HGCA projects, this proposal aims to develop and evaluate a machine vision system to automate the weed mapping process. The project thereby addresses the principal technical stumbling block to widespread adoption of site specific weed management (SSWM). The accuracy of weed identification by machine vision based on a single field survey may be inadequate to create herbicide application maps. We therefore propose to test the hypothesis that sufficiently accurate weed maps can be constructed by integrating information from geo-referenced images captured automatically at different times of the year during normal field activities. Accuracy of identification will also be increased by utilising a priori knowledge of weeds present in fields. To prove this concept, images will be captured from arable fields on two farms and processed offline to identify and map the weeds, focussing especially on black-grass, wild oats, barren brome, couch grass and cleavers. As advocated by Lutman et al. (2002), the approach uncouples the weed mapping and treatment processes and builds on the observation that patches of these weeds are quite stable in arable fields. There are three main aspects to the project. 1) Machine vision hardware. Hardware component parts of the system are one or more cameras connected to a single board computer (Concurrent Solutions LLC) and interfaced with an accurate Global Positioning System (GPS) supplied by Patchwork Technology. The camera(s) will take separate measurements for each of the three primary colours of visible light (red, green and blue) in each pixel. The basic proof of concept can be achieved in principle using a single camera system, but in practice systems with more than one camera may need to be installed so that larger fractions of each field can be photographed. Hardware will be reviewed regularly during the project in response to feedback from other work packages and updated as required. 2) Image capture and weed identification software. The machine vision system will be attached to toolbars of farm machinery so that images can be collected during different field operations. Images will be captured at different ground speeds, in different directions and at different crop growth stages as well as in different crop backgrounds. Having captured geo-referenced images in the field, image analysis software will be developed to identify weed species by Murray State and Reading Universities with advice from The Arable Group. A wide range of pattern recognition and in particular Bayesian Networks will be used to advance the state of the art in machine vision-based weed identification and mapping. Weed identification algorithms used by others are inadequate for this project as we intend to collect and correlate images collected at different growth stages. Plants grown for this purpose by Herbiseed will be used in the first instance. In addition, our image capture and analysis system will include plant characteristics such as leaf shape, size, vein structure, colour and textural pattern, some of which are not detectable by other machine vision systems or are omitted by their algorithms. Using such a list of features observable using our machine vision system, we will determine those that can be used to distinguish weed species of interest. 3) Weed mapping. Geo-referenced maps of weeds in arable fields (Reading University and Syngenta) will be produced with advice from The Arable Group and Patchwork Technology. Natural infestations will be mapped in the fields but we will also introduce specimen plants in pots to facilitate more rigorous system evaluation and testing. Manual weed maps of the same fields will be generated by Reading University, Syngenta and Peter Lutman so that the accuracy of automated mapping can be assessed. The principal hypothesis and concept to be tested is that by combining maps from several surveys, a weed map with acceptable accuracy for endusers can be produced. If the concept is proved and can be commercialised, systems could be retrofitted at low cost onto existing farm machinery. The outputs of the weed mapping software would then link with the precision farming options already built into many commercial sprayers, allowing their use for targeted, site-specific herbicide applications. Immediate economic benefits would, therefore, arise directly from reducing herbicide costs. SSWM will also reduce the overall pesticide load on the crop and so may reduce pesticide residues in food and drinking water, and reduce adverse impacts of pesticides on non-target species and beneficials. Farmers may even choose to leave unsprayed some non-injurious, environmentally-beneficial, low density weed infestations. These benefits fit very well with the anticipated legislation emerging in the new EU Thematic Strategy for Pesticides which will encourage more targeted use of pesticides and greater uptake of Integrated Crop (Pest) Management approaches, and also with the requirements of the Water Framework Directive to reduce levels of pesticides in water bodies. The greater precision of weed management offered by SSWM is therefore a key element in preparing arable farming systems for the future, where policy makers and consumers want to minimise pesticide use and the carbon footprint of farming while maintaining food production and security. The mapping technology could also be used on organic farms to identify areas of fields needing mechanical weed control thereby reducing both carbon footprints and also damage to crops by, for example, spring tines. Objective i. To develop a prototype machine vision system for automated image capture during agricultural field operations; ii. To prove the concept that images captured by the machine vision system over a series of field operations can be processed to identify and geo-reference specific weeds in the field; iii. To generate weed maps from the geo-referenced, weed plants/patches identified in objective (ii).

Internationalized regimes: a second dimension of regime hybridity

Traditional approaches have conceptualized political regimes almost exclusively with reference to domestic-level political factors. However, many current and historical political regimes have entailed a major role for international actors, and in some cases the external influence has been so great that regimes have become internationalized. This article explores the concept of internationalized regimes and argues that they should be seen as a distinct form of hybrid regime type that demonstrates a distinct dimension of hybridity. Until now, regime hybridity has been conceived of along a single dimension of domestic politics: the level of competitiveness. Yet, some regimes are characterised by a different type of hybridity, in which domestic and international authority are found together within a single political system. The article explores the dynamics of internationalized regimes within three settings, those of international occupation, international administration and informal empire.

Characteristics of tropical cyclones in high-resolution models in the present climate

The global characteristics of tropical cyclones (TCs) simulated by several climate models are analyzed and compared with observations. The global climate models were forced by the same sea surface temperature (SST) fields in two types of experiments, using climatological SST and interannually varying SST. TC tracks and intensities are derived from each model's output fields by the group who ran that model, using their own preferred tracking scheme; the study considers the combination of model and tracking scheme as a single modeling system, and compares the properties derived from the different systems. Overall, the observed geographic distribution of global TC frequency was reasonably well reproduced. As expected, with the exception of one model, intensities of the simulated TC were lower than in observations, to a degree that varies considerably across models.

Exploring strategies for coupled 4D-Var data assimilation using an idealised atmosphere-ocean model

Operational forecasting centres are currently developing data assimilation systems for coupled atmosphere-ocean models. Strongly coupled assimilation, in which a single assimilation system is applied to a coupled model, presents significant technical and scientific challenges. Hence weakly coupled assimilation systems are being developed as a first step, in which the coupled model is used to compare the current state estimate with observations, but corrections to the atmosphere and ocean initial conditions are then calculated independently. In this paper we provide a comprehensive description of the different coupled assimilation methodologies in the context of four dimensional variational assimilation (4D-Var) and use an idealised framework to assess the expected benefits of moving towards coupled data assimilation. We implement an incremental 4D-Var system within an idealised single column atmosphere-ocean model. The system has the capability to run both strongly and weakly coupled assimilations as well as uncoupled atmosphere or ocean only assimilations, thus allowing a systematic comparison of the different strategies for treating the coupled data assimilation problem. We present results from a series of identical twin experiments devised to investigate the behaviour and sensitivities of the different approaches. Overall, our study demonstrates the potential benefits that may be expected from coupled data assimilation. When compared to uncoupled initialisation, coupled assimilation is able to produce more balanced initial analysis fields, thus reducing initialisation shock and its impact on the subsequent forecast. Single observation experiments demonstrate how coupled assimilation systems are able to pass information between the atmosphere and ocean and therefore use near-surface data to greater effect. We show that much of this benefit may also be gained from a weakly coupled assimilation system, but that this can be sensitive to the parameters used in the assimilation.

Association of genetic variants in the adiponectin encoding gene (ADIPOQ) with type 2 diabetes in Japanese Brazilians

Aim: The objective of this study is to assess the contribution of ADIPOQ variants to type 2 diabetes in Japanese Brazilians. Methods: We genotyped 200 patients with diabetes mellitus (100 male and 100 female, aged 55.0 years [47.5-64.0 years]) and 200 control subjects with normal glucose tolerant (NGT) (72 male and 128 female, aged 52.0 years [43.5-64.5 years]). Results: Whereas each polymorphism studied (T45G, G276T, and A349G) was not significantly associated with type 2 diabetes mellitus, the haplotype GGA was overrepresented in our diabetic population (9.3% against 3.1% in NGT individuals, P=.0003). Also, this haplotype was associated with decreased levels of adiponectin. We also identified three mutations in exon 3: I164T, R221S, and H241P, but, owing to the low frequencies of them, associations with type 2 diabetes could not be evaluated. The subjects carrying the R221S mutation had plasma adiponectin levels lower than those without the mutation (2.10 mu g/ml [1.35-2.55 mu g/ml] vs. 6.68 mu g/ml [3.90-11.23 mu g/ml], P=.015). Similarly, the I164T mutation carriers had mean plasma adiponectin levels lower than those noncarriers (3.73 mu g/ml [3.10-4.35 mu g/ml] vs. 6.68 mu g/ml [3.90-11.23 mu g/ml]), but this difference was not significant (P=.17). Conclusions: We identified in the ADIPOQ gene a risk haplotype for type 2 diabetes in the Japanese Brazilian population. (C) 2010 Elsevier Inc. All rights reserved.

Active Transport of Glutamate in Leishmania (Leishmania) amazonensis

Leishmania spp. are the causative agents of leishmaniasis, a complex of diseases with a broad spectrum of clinical manifestations. Leishmania (Leishmania) amazonensis is a main etiological agent of diffuse cutaneous leishmaniasis. Leishmania spp., as other trypanosomatids, possess a metabolism based significantly on the consumption of amino acids. However, the transport of amino acids in these organisms remains poorly understood with few exceptions. Glutamate transport is an important biological process in many organisms. In the present work, the transport of glutamate is characterized. This process is performed by a single kinetic system (K-m=0.59 +/- 0.04 mM, V-max=0.123 +/- 0.003 nmol/min per 20 x 10(6) cells) showing an energy of activation of 52.38 +/- 4.7 kJ/mol and was shown to be partially inhibited by analogues, such as glutamine, aspartate, alpha-ketoglutarate and oxaloacetate, methionine, and alanine. The transport activity was sensitive to the extracellular concentration of H+ but not to Na+ or K+. However, unlike other amino acid transporters presently characterized, the treatment with specific ionophores confirmed the participation of a K+, and not H+ membrane gradient in the transport process.

Taking advantage of contextualized interactions while users watch TV

While watching TV, viewers use the remote control to turn the TV set on and off, change channel and volume, to adjust the image and audio settings, etc. Worldwide, research institutes collect information about audience measurement, which can also be used to provide personalization and recommendation services, among others. The interactive digital TV offers viewers the opportunity to interact with interactive applications associated with the broadcast program. Interactive TV infrastructure supports the capture of the user-TV interaction at fine-grained levels. In this paper we propose the capture of all the user interaction with a TV remote control-including short term and instant interactions: we argue that the corresponding captured information can be used to create content pervasively and automatically, and that this content can be used by a wide variety of services, such as audience measurement, personalization and recommendation services. The capture of fine grained data about instant and interval-based interactions also allows the underlying infrastructure to offer services at the same scale, such as annotation services and adaptative applications. We present the main modules of an infrastructure for TV-based services, along with a detailed example of a document used to record the user-remote control interaction. Our approach is evaluated by means of a proof-of-concept prototype which uses the Brazilian Digital TV System, the Ginga-NCL middleware.

Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.