Acceso al agua potable y al saneamiento. Una visión de género para avanzar en el desarrollo

Antecedentes/Objetivos: Las desigualdades de género y los serios problemas de cambio climático, atenúan la ya difícil viabilidad de los Objetivos de Desarrollo del Milenio (ODM) para 2015, con una evolución claramente insuficiente. El acceso al agua potable y al saneamiento (A/S) son esenciales para el cumplimiento de los derechos humanos (ONU-2010) y Agua y Género es una prioridad temática de ONU-Agua (2011), pero hay pocos estudios empíricos sobre la diferencia de impacto en la salud de las mujeres./Describir la evidencia científica internacional sobre las deficiencias de acceso al A/S y su impacto en la salud pública desde la perspectiva de género. Métodos: Revisión sistemática. Medline, Scopus y Embase, 2008-2012, Inglés, francés y español. Palabras claves “drinking water”/sanitation” and “women”/gender”. Incluidos estudios empíricos originales sobre deficiencias del A/S y salud de mujeres. Excluidos socioeconómicos/sociodemográficos, técnicos medioambientales, violencia sexual, conflictos armados y catástrofes. Clasificación: 1. Tema central de dos maneras: 1.1 Problemas/factores relacionados con el déficit A/S y 1.2. Número de ODM susceptibles de ser menoscabados o comprometidos, 2. Perspectiva de género (PG): (3 parámetros: Sexo/género como variable/dimensión clave, Desigualdad y Fomento participación/aplicabilidad para equidad de género en salud/empoderamiento) 3. Tipo de estudio y 4. Lugar de procedencia: Regiones OMS. Resultados: Identificados 174. Desestimados 149. Incluidos 25. Tema Central. Problemas/factores: enfermedades (sobre todo diarreicas): 8, accesibilidad: 6, calidad: 3, trasporte de agua: 3, inseguridad/angustia: 2, consecuencias 3: (absentismo escolar: 1, mortalidad materna: 1, e infantil: 1). ODM comprometido: sustento medio ambiente: 24, igualdad de género/autonomía: 14, pobreza/hambre: 13, salud materna: 9, VIH/SIDA, paludismo y otras enfermedades: 8, mortalidad infantil: 8, enseñanza 1ª: 5. Objetivos comprometidos/estudio mediana = 3. PG Valorados 20/25 artículos, 70% cumplen 1 o más parámetros. Tipo de estudio: Trasversal: 17, cohortes: 5, casos y controles: 2, ensayo aleatorio: 1. Procedencia: África: 12, Las Américas: 4, Asia Sudoriental: 2, Europa: 2, Mediterráneo Oriental: 2 y Pacífico Oriental: 1. Conclusiones: Se han encontrado escasos estudios pero focalizan bien los problemas derivados del déficit de acceso adecuado al A/S y ponen de manifiesto relevantes y significativos problemas en la salud de las mujeres. Los ODM suelen estar comprometidos de forma conjunta y la mortalidad infantil es una consecuencia grave de diarreas. La evidencia encontrada revela el difícil progreso de las mujeres hacia un desarrollo de los pueblos en equidad

Assessment of the Association of Health with the Liberalisation of Trade in Services under the World Trade Organisation

Background: The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators – life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM) - since the WTO was established. Methods and Findings: This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995–2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995–2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: 20.358 p,0.001; MM: 20.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995–2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services. Conclusions: The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995–2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.This study was funded by the Carlos III Health Institute and the Programme for Promotion of Biomedical and Health Sciences (http://www.isciii.es/) of the Spanish Ministry of Health and Consumer Affairs (Ref. PI060295)

Gender development inequalities epidemiology in Spain (1990-2000)

Fundamento: El género es un determinante de la salud importante para las Políticas de Salud Pública. Este estudio describe los cambios en las desigualdades del desarrollo de género en España y sus Comunidades Autónomas (CCAA) en la década 1990 y 2000. Métodos: Estudio ecológico del Índice de Desarrollo Humano (IDH) y el Índice de Desarrollo de Género (IDG) y sus componentes por sexo (educación, ingresos y esperanza de vida al nacer). Resultados: El IDG de España ha crecido en un 5,05% en los años 90. Pero, mientras que en 1990 el 51,5% de la población estaba ubicada por encima del IDG promedio español en 2000 disminuyó al 46,3%. Asturias: 3,37%, Cantabria: 3,68% e Islas Baleares: 3,71% son las de menor crecimiento; Madrid: 6,46% y Extremadura: 6,75% las de mayor. Todas las CCAA. tienen un valor de IDG menor que de IDH. Ambos sexos tuvieron un crecimiento promedio similar en la esperanza de vida (Hombres: 5% y Mujeres: 4%) manteniéndose las diferencias, aunque se detectan variaciones según CCAA. En educación, las mujeres mejoraron el doble que los hombres (Hombres: 3% y Mujeres: 6%), siendo Cataluña, Aragón, Madrid, Baleares y Galicia las de mayor igualdad. Pese a que las mujeres mejoraron el triple que los hombres en el índice de ingresos (Hombres: 3% y Mujeres: 9%), las diferencias persisten a favor de los hombres. Conclusiones: Las desigualdades en el desarrollo de género disminuyeron en los 90 en España, aunque la mejora de la educación, ingresos y esperanza de vida se produjo sólo en algunas CCAA, persistiendo diferencias interregionales.Background: Gender is an important health determinant for public health policies. This study describes the changes in gender development inequalities in Spain and its autonomous regions from 1990 to 2000. Methods: An ecological study using the Human Development Index (HDI) and the Gender Development Index (GDI) was done. IDG both men and women was analysed according to indexes of education, income and life expectancy at birth. Results: Although the GDI has had an increase of 5,05% in the 90´s, 51,5% of the population was located above the global GDI of Spain in 1990, moreover this number decreased to 46,3% in 2000. Gender inequalities have been reduced both at national and regional levels. The regions with the lowest increase were Asturias (3.37%), Cantabria (3.68%) and Baleares Islands (3.71%). The regions with the highest increase were Madrid (6,46%) and Extremadura (6,75%). All the autonomous regions showed a number of GDI lower than the value of HDI. Both sexes achieved similar increase in life expectancy (Men: 5% and Women: 4%). An unequal variation was detected according to the autonomous region (Basque Country; Men: 7% and Women: 3%; Madrid; Men:8% and Women:5%). Women have improved their educational level in comparison to men (Men: 3% and Women: 6%). In the 90s, men obtained more income than women, but women improved their situation three times more than men. Conclusions: Inequalities in Human Development analysed by gender have been reduced in the 90s in Spain. However, the improvement of education, income and life expectancy occurred only in some autonomous regions. This situation shows the differences among Spanish autonomous regions.Observatorio de Salud de las Mujeres; Ministerio de Sanidad y Consumo de España; Fundación Bancaja y Universidad de Alicante

Quality and Applicability: Two Necessary Requirements in Instruments That Measure Creative Potential, for Use in the Classroom

Creativity is a growing demand in today’s world. Education for creativity takes hierarchy, as well as the search for ways to evaluate its promotion. This paper presents partial results of a research project aimed at the study of the promotion of creative qualities in science education. The CREA test was used as an instrument to evaluate the creativity of students. The results allow us to propose limitations of this test as a tool for a global measure of creativity. The conventional analysis could measure one of the creative qualities: fluidity. The assessment of other creative qualities could benefit from a modified analysis. Some modifications like test time, could improve the measure of flexibility and elaboration. The applicability of the CREA test may not be accompanied by quality to the extent of creative potential

Preclinical Test of Dacomitinib, an Irreversible EGFR Inhibitor, Confirms Its Effectiveness for Glioblastoma.

Glioblastomas (GBM) are devastating tumors in which there has been little clinical improvement in the last decades. New molecularly directed therapies are under development. EGFR is one of the most promising targets, as this receptor is mutated and/or overexpressed in nearly half of the GBMs. However, the results obtained with first-generation tyrosine-kinase inhibitors have been disappointing with no clear predictive markers of tumor response. Here, we have tested the antitumoral efficacy of a second-generation inhibitor, dacomitinib (PF299804, Pfizer), that binds in an irreversible way to the receptor. Our results confirm that dacomitinib has an effect on cell viability, self-renewal, and proliferation in EGFR-amplified ± EGFRvIII GBM cells. Moreover, systemic administration of dacomitinib strongly impaired the in vivo tumor growth rate of these EGFR-amplified cell lines, with a decrease in the expression of stem cell-related markers. However, continuous administration of the compound was required to maintain the antitumor effect. The data presented here confirm that dacomitinib clearly affects receptor signaling in vivo and that its strong antitumoral effect is independent of the presence of mutant receptor isoforms although it could be affected by the PTEN status (as it is less effective in a PTEN-deleted GBM line). Dacomitinib is being tested in second line for EGFR-amplified GBMs. We hope that our results could help to select retrospectively molecular determinants of this response and to implement future trials with dacomitinib (alone or in combination with other inhibitors) in newly diagnosed GBMs.This work was supported by grants from the Fundación Mutua-madrileña (FMM2011/89) to J.M. Sepúlveda and from Ministerio de Economía y Competitividad, Fondo de Investigación Sanitaria (FIS): PI12/00775 to P. Sánchez-Gómez and PI13/01258 to A. Hernández-Laín, and from Ministerio de Economía y Competitividad, Red Temática de Investigación Cooperativa en Cancer (RTICC) (RD12/0036/0027) to J.M. Sepúlveda, P. Sánchez-Gómez, A. Pérez-Núñez and A. Hernández-Laín.S

Appropriateness of colonoscopy requests according to EPAGE-II in the Spanish region of Catalonia

Background: In a context of increasing demand and pressure on the public health expenditure, appropriateness of colonoscopy indications is a topic of discussion. The objective of this study is to evaluate the appropriateness of colonoscopy requests performed in a primary care (PC) setting in Catalonia. Methods: Cross-sectional descriptive study. Out-patients >14 years of age, referred by their reference physicians from PC or hospital care settings to the endoscopy units in their reference hospitals, to undergo a colonoscopy. Evaluation of the appropriateness of 1440 colonoscopy requests issued from January to July 2011, according to the EPAGE-II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). Results: The most frequent indications of diagnostic suspicion requests were: rectal bleeding (37.46 %), abdominal pain (26.54 %), and anaemia study (16.78 %). The most frequent indications of disease follow-up were adenomas (58.1 %), and CRC (31.16 %). Colonoscopy was appropriate in 73.68 % of the cases, uncertain in 16.57 %, and inappropriate in 9.74 %. In multivariate analysis, performed colonoscopies reached an OR of 9.9 (CI 95 % 1.16-84.08) for qualifying as appropriate for colorectal cancer (CRC) diagnosis, 1.49 (CI 95 % 1.1-2.02) when requested by a general practitioner, and 1.09 (CI 95 % 1.07-1.1) when performed on women. Conclusions: Appropriateness of colonoscopy requests in our setting shows a suitable situation in accordance with recognized standards. General practitioners contribute positively to this appropriateness level. It is necessary to provide physicians with simple and updated guidelines, which stress recommendations for avoiding colonoscopy requests in the most prevalent conditions in PC

A cross-sectional study of the appropriateness of colonoscopy requests in the Spanish region of Catalonia

Introduction: Colonoscopies are being requested with increasing frequency in the last few years, as they are used both as a diagnostic and therapeutic procedure in several gastrointestinal diseases. Our purpose is to describe the appropriateness of colonoscopy requests issued both from primary care centres and from hospitals, according to the EPAGE II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). Methods and analysis: Cross-sectional study. Colonoscopy requests issued since January 2011 and received at the endoscopy units of all six reference hospitals serving the primary care centres of the South Metropolitan and Central Catalonia districts will be collected (total=1500 requests). Variables to be collected include gender, date of birth, origin of the request and reference hospital, priority of the procedure, type of clinician requesting the procedure, date and indication of request, abdominal examination performed, anal inspection examination performed, date of last colonoscopy if applicable, diagnosis and date of diagnosis. Using the available information and the EPAGE II website, colonoscopy requests will be assigned as an appropriateness score. The association between the variables collected and the EPAGE II scores will be assessed using a Student's t test and a χ(2) test. A multilevel logistic model will be generated on the factors associated with the appropriateness of the requests. Ethics and dissemination: Colonoscopy is a costly procedure and not free from complications. In order to increase cost effectiveness, reduce waiting lists and optimise resources, it is necessary to use tools such as the EPAGE II guidelines, which establish criteria to assess the appropriateness of colonoscopies. The purpose of this study is to describe the current situation and to discuss whether current clinical practice is appropriate. The results of the study will be published in the next few years. In consideration of the ethical principles and methods of the research study, approval was granted for the project

Caracterización del sistema de producción de arroz criollo en La Mojana, en Colombia

La Mojana is a subregion with landscapes dominated by large bodies of water, interconnected by a network of pipes and swamps. One of the productive systems of greater social importance is that of Creole rice, to which small producers of the peasant economy are dedicated. Given that socio-economic and technical aspects of this system are unknown, a characterization of the system was carried out using the structured survey method that captured social, technical, and economic aspects. The sampling method used was non-probabilistic and the data were analyzed using descriptive statistics, with measures of central tendency and dispersion. The results showed that Creole rice farmers have been engaged in this productive activity for more than 40 years, in small areas of land on the farm. Part of the production is commercialized in local markets and another part is used to feed the family nucleus, which makes it of great importance in food security. Despite the existence of a supply of improved varieties, with higher yields, a good part of the farmers prefers this type of rice for their food because they attribute a better culinary and nutritional quality to it. At least 46 varieties are used for manually planting, with very low inputs of chemical origin. The main technological limitations of the system were identified and the costs and yields were determined, which allowed calculating a unit cost of US $0.40 kg-1. The main risk faced by this productive system is the loss of ancestral seeds, which is why the conservation, purification, and scaling of the creole varieties is proposed, to return them to the community and thus contribute to food security.La Mojana, es una subregión con paisajes dominados por grandes cuerpos de agua, interconectados por una red de caños y ciénagas. Uno de los sistemas productivos de mayor importancia social es el arroz criollo, al cual se dedican pequeños productores de economía campesina. Dado a que se desconocen aspectos socioeconómicos y técnicos de este sistema, se realizó una caracterización del sistema mediante el método de encuestas estructuradas que captaron aspectos sociales, técnicos y económicos. El método de muestreo usado fue el no probabilístico y los datos se analizaron mediante estadística descriptiva, con medidas de tendencia central y dispersión. Los resultados mostraron que los agricultores de arroz criollo llevan más de 40 años dedicados a esta actividad productiva, en pequeñas áreas de terreno de la finca. Parte de la producción es comercializada en los mercados locales y otra parte es usada para la alimentación del núcleo familiar, por lo que tiene gran importancia en la seguridad alimentaria. A pesar de existir oferta de variedades mejoradas, de mayor rendimiento, buena parte de los agricultores prefieren para su alimentación este tipo de arroz debido a que le atribuyen una mejor calidad culinaria y nutricional. Se identificaron al menos 46 variedades utilizadas para la siembra, la cual se realiza de forma manual con muy baja entrada de insumos de origen químico. Se identificaron las principales limitantes tecnológicas del sistema y se determinaron los costos y rendimientos, lo cual permitió calcular un costo unitario de US$0,40 kg-1. El principal riesgo que enfrenta este sistema productivo es la pérdida de semillas ancestrales, por lo que se propone la conservación, purificación y escalamiento de las variedades criollas, para devolverlas a la comunidad y así contribuir a la seguridad alimentaria de la población de pequeños productores vinculados a este sistema.&nbsp

Propuesta de un plan de mejora y un plan de trazabilidad para la panificadora Gabriel.

Planes de trazabilidad y mejora, que contemplan aspectos que forman parte de un planear - hacer - verificar y actuar, donde el objetivo de los dos se establece para obtener el más alto grado de calidad en la obtención de un producto final. Se aplica con eficacia en todo su proceso desdés el inicio, durante y fin del proceso el cual debe estar monitoreado por medio de registros que asegure cada etapa. Este proyecto se aplica al caso de contaminación de bacteria Ecoli en el producto pastel de moka; desde su ficha técnica, flujo grama del proceso, diagrama de flujo y materias primas que se requieren en su elaboración ,también puntualiza la metodología de la trazabilidad por medio de formatos dispuestos en cada etapa del proceso, cuenta con un plan de mejora y plan de acción para las no conformidades halladas en la inspección sanitaria realizada por los organismos de control, buscando el cumplimiento de la legislación alimentaria.Plans for traceability and improvement, which contemplate aspects that are part of a plan - do - verify and act, where the objective of the two is established to obtain the highest degree of quality in obtaining a final product. It is applied effectively throughout the process from the start, during and end of the process which must be monitored by means of records that ensure each stage. This project applies to the case of contamination of Ecoli bacteria in the moka cake product; from its technical sheet, flow of the process, flow diagram and raw materials that are required in its preparation, also points out the methodology of traceability by means of formats arranged in each stage of the process, has an improvement plan and plan of action for non-conformities found in the sanitary inspection carried out by the control bodies, seeking compliance with food legislation

Reflexiones de la psicología contemporánea.

En este libro encuentran reflexiones sobre diferentes temas que emergen de la psicología actual, la invitación es a evaluar con realismo cada situación de la vida, y con la mayor objetividad posible, dimensionar los aprendizajes, cuya visualización es necesaria para la enseñanza. Es así que el texto empodera al lector para un pensamiento crítico, necesario para la construcción de conocimientos, puesto que hay muchos libros con estos temas, pero como este ninguno. También aborda problemas de investigación desde la psicología en diferentes contextos, teniendo en cuenta los ejes como el conflicto, violencia, TIC en el aprendizaje, psicoterapia, comunidad y abuso sexual, los cuales generan aportes al estudio de la salud mental, así mismo, explica la complejidad del ser humano y de su comportamiento