The constitution of physicians' power: A theoretical framework for comparative analysis

Drawing on literatures documenting the experience of physicians in both European and American societies, a new theoretical framework for explaining variations in the professional power of physicians is provided. Most studies of professions have used professional organization as the principal explanatory variable, with state policy and the organization of civil society as secondary mediating factors. Our approach instead treats strategies of state power and forms of civil society as central features shaping the ability of the profession to exert power. Such a three-dimensional approach not only allows us to make more powerful classifications explaining contemporary differences, but also allows us to trace historical shifts and anticipate alternative futures in professional power. For example, in those societies where the state's intervention is limited and civil society is pluralistic, professional power is potentially greatest. But increasing state power does not necessarily reduce professional power. Where the state is most powerful and organizes all groups in civil society, professionals and society can be united in common struggle against the state. In response to that, it is likely that such centralized states will opt for corporatist solutions to maximize the internal differentiation of society and pit those once allied against one another, and prelude the organization of powerful autonomous interest groups.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29636/1/0000725.pd

Autopercepción del estado de salud: una aproximación al los ancianos en México

OBJECTIVE: To evaluate health status of the elderly in Mexico through their self-perception and to describe social, organizational and health-related factors. METHODS: A study was carried out on secondary data from the 2000 National Health Survey in Mexico. Multiple logistic regression models were used. The dependent variable health status was measured through self-perception. The independent variables included were: sociodemographic characteristics, risk behaviors, accidents, disease diagnosis and clinical measures. RESULTS: A total of 7,322 adults aged 60 years and older were studied, which represents 7% of the total population in that age group in Mexico. Of them, 19.8% reported poor or very poor health status. Factors found to be associated to poor health were age, female sex, having no social security, being divorced, homemaker, disabled, unemployed, tobacco consumption, having a health condition, accidents and diagnosed with chronic diseases. CONCLUSIONS: The study allowed to identifying factors that may contribute to poor health status in the elderly. These findings could be taken into account in the development of actions and health care programs for this population in Mexico.OBJETIVO: Evaluar el estado de salud de los ancianos mexicanos a través de la autopercepción y analizar los factores sociales, de salud y organizacionales asociados. MÉTODOS: Estudio de datos secundarios de la Encuesta Nacional de Salud 2000 en México. Se realizó análisis de regresión logística múltiple. La variable dependiente fue el estado de salud medido a través de la autopercepción de salud. Las variables independientes seleccionadas fueron: características sociodemográficas, hábitos de riesgo, accidentes, diagnóstico de enfermedades y mediciones clínicas. RESULTADOS: Se analizó a 7,322 adultos de 60 años y mayores, que representan al total de la población (7%) en ese grupo de edad en México. De estos, 19.8% reportó estado de salud como malo o muy malo. Los factores asociados a mala salud fueron edad, sexo femenino, no tener seguro social, ser divorciado, dedicarse al hogar, estar incapacitado, no tener trabajo, consumo de tabaco, problema de salud, accidentes y diagnóstico de enfermedades crónicas. CONCLUSIONES: El análisis de factores asociados permitió determinar elementos que influyen en mal estado de salud de ancianos. Los hallazgos podrían considerarse en la formulación de acciones y programas de atención para esa población en México

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Determinants of professional status of physicians in urban areas of Mexico.

While there has been considerable work in medical sociology on the status of the medical profession in relation to other occupational groups, few attempts have been made to study variations in the income, prestige and power among physicians. From the status attainment research are taken three main aspects: (1) the theoretical and empirical expectations that can be applied to the case of the status attainment of a learned profession; (2) the definition of the main sets of variables in this study; and (3) the methodological approach chosen in this dissertation (the use of structural equation models--LISREL) follows the status attainment tradition, namely, the definition of causal models. The results of the dissertation show the great variation within each of the dimensions of professional status. Such a finding gives some support to the argument of the erosion of provider homogeneity. There is evidence that prestige/power and economic status share a similar pattern of determination (generation, gender and work history). However, in the economic dimension, the determinants of the internal stratification of physicians seem to parallel the determinants of the occupational and property stratification structures of social stratification in general. This leaves a complex set of implications for issues of: medical manpower policy, exploring in particular the implications of the determinants and the internal stratification of the medical profession for the state, medicine and the public, as well as the policy implications for physician management in the health system; conceptualizations of professional work, both the theoretical contribution of the findings of the dissertation to the status attainment research, as well as the theoretical contributions to the debate between the proletarianization and the medical dominance theories; and about the changing character of the medical profession, the results of this dissertation are useful to highlight a number of issues that inform about the ways in which a highly stratified medical profession can react and organize to face the introduction of changes in the health care system, and provide some insights about the paths that health care reform can follow in the case of Mexico.Ph.D.Health Services Organization and Policy and SociologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/104936/1/9624602.pdfDescription of 9624602.pdf : Restricted to UM users only

The constitution of physicians' power: A theoretical framework for comparative analysis

Drawing on literatures documenting the experience of physicians in both European and American societies, a new theoretical framework for explaining variations in the professional power of physicians is provided. Most studies of professions have used professional organization as the principal explanatory variable, with state policy and the organization of civil society as secondary mediating factors. Our approach instead treats strategies of state power and forms of civil society as central features shaping the ability of the profession to exert power. Such a three-dimensional approach not only allows us to make more powerful classifications explaining contemporary differences, but also allows us to trace historical shifts and anticipate alternative futures in professional power. For example, in those societies where the state's intervention is limited and civil society is pluralistic, professional power is potentially greatest. But increasing state power does not necessarily reduce professional power. Where the state is most powerful and organizes all groups in civil society, professionals and society can be united in common struggle against the state. In response to that, it is likely that such centralized states will opt for corporatist solutions to maximize the internal differentiation of society and pit those once allied against one another, and prelude the organization of powerful autonomous interest groups.professionalization professional power state intervention comparative analysis

Elaboración de un software fundamentado para el análisis y diseño de vigas de puentes en concreto preesforzado

Con la elaboración del software fundamentado en el análisis y diseño de vigas para puentes en concreto presforzado (Conpress- 2004) tiene como objeto principal brindar una herramienta metodología a los programas de pregrado de ingeniería civil de la corporación universitaria de la costa, cuc y otras universidades, que agilice las largas tareas de calculo obteniendo resultados seguros en los diseños que se planteen en su ejercicio profesional. Los autores quieren con esta publicación satisfacer el anhelo sentido de poseer una guía de diseño, brindándole al lector la información eficaz y de gran utilidad sobre diseño de vigas para puentes en concreto presforzado, teniendo como referencia la utilización del software que contempla los diferentes estados de carga al cual puede estar sometido el puente durante su vida útil. El desarrollo del software se basa en conceptos teóricos – prácticos relacionados con el entorno de programación de visual- Basic 6.0 y las teorías de diseño de concreto presforzado, como estrategia para cumplir con el diseño planteado. La investigación se clasifica como cuasiexperimental debido a la simulación de los procesos en que se desarrollo la metodología, mediante la fusión de la ingeniería civil y la ingeniería de sistemas. Esta investigación esta encaminada por procesos descriptivos y métodos deductivos en la cual la forma como se desarrolla la aplicación de una teoría general del concreto presforzado mediante la sistematización que conlleva a resultados óptimos y eficaces en el análisis y diseño de vigas para puentes. Los resultados están apoyados en diseños reales comparados mediante el software, estos cálculos son efectuados manualmente y luego sometidos a procesos sistemáticos, brindándole a la ingeniería de puentes beneficios al utilizarlos como solución a los problemas por falta de herramientas permitiendo una inversión de tiempo y costo menor. Por otro lado los costos en la adquisición es una de las principales ventajas del software en comparación de los existentes en el mercado y como característica principal la fase de utilización para el usuario debido a su idioma en español, la interfase, botones, cuadros de diálogos y botones de opción permite una mejor manipulación para los estudiantes e ingenieros civiles. Haciendo énfasis, el concreto presforzado es una técnica en la construcción de hormigón armado que satisface los requerimientos de las estructuras modernas. La economía estética y la utilización de materiales de alta calidad hace de esta una excelente alternativa para el diseñador. Las teorías y conceptos que fundamentan la construcción de concreto presforzado con la elaboración del software para el análisis y diseño de vigas para puentes en concreto presforzado causa alternativa a los problemas de diseño estructurales de hoy día brindando una excelente solución. Todo lo anterior hace del software un instrumento confiable, competitivo y funcional para el análisis y diseño de vigas para puentes de concreto presforzado.INTRODUCCION 14 -- CONCEPTOS BÁSICOS 16 – INTRODUCCION 16 -- LA IDEA DEL PRESFUERZO 17 -- COMPORTAMIENTO DEL CONCRETO PRESFORZADO BAJO CARGAS SUPERPUERTAS 19 -- PRESFORZADO PARCIAL 21 -- MODALIDAD DEL PRESFUERZO 22 – Pretensado 22 – Postensado 23 -- CAMBIO EN LA FUERZA EN EL PRESFUERZO 24 – MATERIALES 24 -- Concreto de alta resistencia 25 -- Acero de refuerzo 31 -- Acero de preesfuerzo 33 -- CARGAS PARA PUENTES 37 – GENERALIDADES 37 -- CARGA MUERTA 37 -- CARGA VIVA (L) 38 -- El camión estándar 38 -- Línea de carga 41 -- Línea de la carga equivalente (AASTHO) 42 -- Reducción de intensidad de carga viva (AASHTO) 44 -- CARGA VIVA ADOPTADA POR EL MINISTERIO DE OBRAS PUBLICAS Y TRANSPORTE DE COLOMBIA 45 -- LOCALIZACION DE LA CARGA VIVA PARA PRODUCIR MAXIMO MOMENTO Y MAXIMO ESFUERZO POR VIA DE CIRCULACION 47 -- Línea de carga 47 – Camiones 48 -- PERDIDA PARCIAL DE LA FUERZA DE PRESFUERZO 58 – INTRODUCCION 58 -- ESTIMACIONES GLOBALES DE LAS PERDIDAS 60 -- ESTIMACION DETALLADA DE LAS PERDIDAS 63 -- DESLIZAMIENTO DEL ANCLAJE 63 -- ACORTAMIENTO ELASTICO DEL CONCRETO 64 -- PERDIDAS DE PRESFORZADO DEBIDA A LA FRICCION EN VIGAS POSTENSADAS 67 -- FLUJO PLASTICO DEL CONCRETO 71 -- CONTRACCION DEL CONCRETO 72 -- RELAJAMIENTO DEL ACERO 73 -- ANALISIS POR FLEXION 76 – GENERALIDADES 76 – NOTACION 77 -- PERDIDA PARCIAL DE LA FUERZA PRETENSORA 78 -- ESFUERZOS ELASTICO EN FLEXION EN VIGAS NO AGRIETADAS (COMPORTAMIENTO EN EL RANGO ELASTICO) 78 -- Esfuerzos elásticos 81 -- ESFUERZO PERMISIBLE DE FLEXION 84 -- CARGA DE AGRIETAMIENTO 88 -- Momento de agrietamiento 90 -- RESISTENCIA A LA FLEXION 91 -- ANALISIS A FLEXION DE VIGAS COMPUESTAS 105 -- TIPO DE CONSTRUCCION COMPUESTAS 105 -- ESTADO DE LAS CARGAS 106 -- PROPIEDADES DE LA SECCION Y ESFUERZO ELASTICO DE FLEXION 108 -- RESISTENCIA A LA FLEXION 113 – CORTANTE 113 -- Criterio de diseño por cortante del ACI 114 -- Longitud de desarrollo de los torones de presfuerzo 117 -- DISEÑO DE VIGAS 118 -- BASE DEL DISEÑO 118 -- DISEÑO BASADO EN LA RESISTENCIA ÚLTIMA 120 -- DISEÑO DE UNA VIGA COMPUESTA BASADO EN LOS REQUISITOS DE RESISTENCIA 121 -- LENGUAJE DE PROGRAMACION 132 -- REQUERIMIENTO PARA LA INSTALACION DEL LENGUAJE VISUAL BASIC 6.0 133 -- CONCEPTO DE HARDWARE 134 -- REQUERIMIENTO DEL HARDWARE Y DEL SISTEMA 135 – RESULTDADOS 136 – CONCLUSION 137 – BIBLIOGRAFIA 138Ingeniero(a) CivilPregrad

Autopercepción del estado de salud: una aproximación al los ancianos en México

OBJETIVO: Evaluar el estado de salud de los ancianos mexicanos a través de la autopercepción y analizar los factores sociales, de salud y organizacionales asociados. MÉTODOS: Estudio de datos secundarios de la Encuesta Nacional de Salud 2000 en México. Se realizó análisis de regresión logística múltiple. La variable dependiente fue el estado de salud medido a través de la autopercepción de salud. Las variables independientes seleccionadas fueron: características sociodemográficas, hábitos de riesgo, accidentes, diagnóstico de enfermedades y mediciones clínicas. RESULTADOS: Se analizó a 7,322 adultos de 60 años y mayores, que representan al total de la población (7%) en ese grupo de edad en México. De estos, 19.8% reportó estado de salud como malo o muy malo. Los factores asociados a mala salud fueron edad, sexo femenino, no tener seguro social, ser divorciado, dedicarse al hogar, estar incapacitado, no tener trabajo, consumo de tabaco, problema de salud, accidentes y diagnóstico de enfermedades crónicas. CONCLUSIONES: El análisis de factores asociados permitió determinar elementos que influyen en mal estado de salud de ancianos. Los hallazgos podrían considerarse en la formulación de acciones y programas de atención para esa población en México

Comparative estimates of crude coverage of the Mexican immunization program: Findings from a national survey

The purpose of the study is to provide estimates for immunization coverage, considering single-dose and schemes (three or five vaccines), by comparing self-report method to immunization cards, while also assessing the timeliness of immunization in Mexico, with reference to Mexican Immunization Program guidelines.Data on immunization was obtained from the Mexican Immunization Survey conducted in 2017 that aimed to assess crude (card-based) coverage at the regional level. Timely immunization was defined with reference to National Immunization Program guidelines, and immunization coverage was defined as a three or five vaccine scheme, based on previous national reports of immunization coverage. Immunization coverage estimates account for sample weights from the complex survey design. We used weighted immunization coverage estimates to assess the extent to which immunization cards and self-reporting concurred.It was found that most Mexican children are not receiving their full vaccine schedule in a timely manner. Concerning children under twelve months of age, the coverage targets for National Immunization of 95 % was not reached for either vaccine, and only 2.94 % (95 % CI 0.92–9.01) who had been receiving a three-vaccine scheme were considered as fully immunized in a timely manner. In contrast, coverage increased to 33.94 % (95 % CI 26.99–41.66), when untimely immunizations were taken into account, and the 95 % target was reached for five vaccines. Likewise, there is little correlation between self-report and immunization cards but rates show more concurrence, when only considering the proportion of true positives.In conclusion it was find that children at a local level are vaccinated in an incomplete and untimely manner. In order to improve immunization systems, a nominal registry of administered doses is thus of paramount importance. There is a need to address underlying health inequalities, as well as the factors associated with these, resulting in improved chances of a disease-free childhood and healthy life