Evolución del conocimiento del sistema de salud, derechos en salud, de la política de participación y de las experiencias de participación de los usuarios del Sistema General de Seguridad Social en Salud de Colombia : una comparación entre 2000 y 2010 /

Antecedentes A fines de los años ochenta e inicios de los noventa, bajo la influencia de organismos multilaterales como el Banco Mundial y el Fondo Monetario Internacional numerosos países empezaron reformas a los sistemas de salud basadas en modelos de mercados, a las que Colombia no escapó. Así se crea en 1993 el Sistema General de Seguridad Social en Salud (SGSSS). En 1994, se formula una comprehensiva política de participación en salud que establece la participación en la gestión, la planeación y la evaluación en varios niveles: desde la información hasta la toma de decisiones y a través de diferentes mecanismos de participación: participación ciudadana (basada en mecanismos de mercado, participación comunitaria y la participación dentro de las instituciones de salud. El conocimiento de los usuarios acerca del sistema de salud, de sus derechos en salud y de la política de participación los fortalece para una efectiva interacción con el sistema: para participar en varios aspectos del sistema de salud, para tomar decisiones informadas en salud, así como para acceder a los servicios de salud y exigir sus derechos, entre otros. Objetivo Analizar la evolución del conocimiento del SGSSS, de los derechos en salud así como el conocimiento y utilización de los mecanismos de participación de los usuarios de los servicios de salud en dos municipios de Colombia y los factores asociados, entre 2000 y el 2010. Métodos Se realizó un estudio descriptivo comparando estudios transversales basados en dos encuestas a usuarios del SGSSS de Colombia, la primera en el 2000 y la segunda en 2010. Se tomaron como áreas de estudio los municipios de Tuluá (zona urbana) y Palmira (zona rural). En ambas encuestas se hizo muestreo probabilístico multietápico, con una muestra final: en la primera encuesta de 1497 usuarios y en la segunda, 1405. Se estimaron modelos de regresión logística para comparar, los cambios en los niveles de conocimientos acerca del SGSSS, de la norma para participar y los derechos, tomando primero los dos años juntos (el 2000 como referencia) y luego uno por cada año para determinar los factores asociados con esos conocimientos. Se estimaron modelos de regresión logística para comparar los cambios en los niveles de conocimientos de los mecanismos de participación y su utilización, tomando los dos años juntos (el 2000 como referencia), y luego uno por cada año para determinar los factores asociados con el conocimiento y la utilización de los mecanismos de participación. Todos los datos fueron analizados con el SPSS v17 Resultados Si en el año 2000 el conocimiento del SGSSS, el conocimiento de los mecanismos de participación y su utilización eran limitados, en 2010 éste disminuyó significativamente, exceptuado el conocimiento con relación a las aseguradoras (EPS) y proveedores (IPS), que se incrementó un poco. En contraste, los resultados muestran que más del 90% de los entrevistados en ambas encuestas se percibían portadores de derechos en salud. Los mecanismos más conocidos y utilizados fueron los de mercado. Tener nivel socioeconómico y estudios superiores y vivir en el área urbana se asoció consistentemente a niveles de conocimiento alto del SGSSS. Tener nivel socioeconómico y estudios superiores y vivir en aérea rural, se asoció al conocimiento y utilización de los mecanismos de participación. Con relación a la actuación institucional, se observa que en el año 2000 menos del 5% refirió haber sido invitado o notificado por alguna institución o autoridad de salud. En el año 2010 esta proporción bajo, observándose que menos del 1.5% dijo haber sido invitado o notificado. Discusión y conclusiones Los usuarios más desventajados tienen bajas probabilidades de conocer el SGSSS, la política de participación, de conocer y usar los mecanismos de participación que los demás; lo que representa una barrera para tomar decisiones informadas en salud, para fortalecerse en el ejercicio de sus derechos en salud. Para revertir esta situación, se necesita una intervención decidida de las instituciones de salud y del gobierno en reducir las inequidades socialesBackground During the late 1980s and 1990s, and under the influence of multilateral organizations like the World Bank and the International Monetary Fund, numerous nations undertook reforms based on market models in their social sectors, including healthcare; Colombia was not removed from this. Thus, in 1993 the General System of Social Security in Health (Sistema General de Seguridad Social en Salud - SGSSS). In 1994, a comprehensive policy for social participation in health was also formulated, which established participation in management, planning, and evaluation at various levels: from information to decision making and through different types of health participation: citizen participation (based on a market approach), community participation and participation within healthcare institutions. Users' awareness of the healthcare system, of their rights to healthcare and awareness of the policy participation, empowers them for effective interaction with health services: for participating in various aspects of the healthcare system; for making informed health decisions; as well as for accessing services and hence, it is one of the fundamental conditions for users to exercise their right to healthcare- among others. Objective To analyze the evolution of awareness of the SGSSS, of rights in health, as well as the awareness and use of the participation mechanisms of health service users in two municipalities in Colombia and associated factors, between 2000 and 2010. Methods A descriptive study was conducted comparing cross-sectional studies based on two surveys of users of the SGSSS in Colombia, the first in 2000, and the second in 2010. The municipalities of Tuluá (urban area) and Palmira (rural area) were taken as study areas. A multistage probability sampling was carried out in both surveys, with a final sample: in the first survey, of 1497 users, and 1405 in the second. Logistic regression models were estimated to compare, on one hand, changes in the levels of awareness of the SGSSS, the standard for participation and rights, taking first the two years together (2000 as a reference and adjusted by the explanatory variables), and then one for each year to determine the factors associated with these levels of knowledge. Moreover, the logistic regression models were estimated to compare changes in the levels of awareness of the participation mechanisms and their use, taking the two years together (2000 as reference and adjusted by explicative variables), and then one for each year to determine the factors associated with the levels of awareness and use of the participation mechanisms. All data were analyzed with the SPSS v17. Results Users' awareness of the healthcare system, awareness and utilization of the mechanisms in 2000 was limited, and in 2010, it diminished significantly, with the exception of that relating to health insurers and providers. In contrast, results show that more than 90% of users in both surveys perceive themselves as bearers of healthcare rights. In both surveys, living in an urban area, having a higher education, and belonging to a higher socioeconomic status is consistently associated with a higher level of awareness of the SGSSS. Living in rural area, having a higher education, and belonging to a higher socioeconomic status are consistently associated with a higher level of awareness and use of the participation mechanisms. With respect to institutional performance, it is observed that in the year 2000 less than 5% stated having been invited to or notified by any institution or health authority. In the year 2010 this proportion decreased, observing that less than 1.5% said they had been invited or notified. Conclusions The most underprivileged users have lower odds of being knowledgeable of the SGSSS, the social participation norms and participation mechanisms than the others, which represents a barrier for making informed decisions and the enforcement and exercise of their rights to health. In order to reverse this situation, a decisive intervention of health institutions and government is necessary to reduce social inequities

Caracterización clínica y genética de la miocardiopatía restrictiva idiopática

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 22-04-2016Esta tesis tiene embargado el acceso al texto completo hasta el 22-10-201

Reverse logistics systems for waste generated throughout vehicles life-cycle

Waste produced during the service life of automobiles has received much less attention than end-of-life vehicles themselves. In this paper, we deal with the set up of a reverse logistics system for the collection and treatment of use-phase residues. First, the type of waste arising during vehicles? service life is characterized. Data were collected in collaboration with SIGRAUTO, the product stewardship organization in charge of vehicles? recovery in Spain. Next, three organizational models are proposed. The three alternatives are benchmarked and assessed from a double organizational and operational perspective for the particular case of the Madrid region in Spai

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Producción CientíficaEstudio de los yacimientos de empleo ligados a la distribución comercial y el abastecimiento en general en el mundo rural, el transporte colectivo y a la demanda, el turismo cultural y la puesta en valor del patrimonio y las telecomunicaciones como elemento dinamizador de la economía regional. Incluye un análisis sobre la formación de la mano de obra.Geografí

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[EN] Introduction: Today’s society is aware that healthy aging favors quality of life in the future, even more so as life expectancy increases in populations such as Europe. As in countries such as Japan, it is necessary for institutions to provide social services to support the elderly, with the aim of achieving an optimal quality of life for these people. The aim of this study is to analyze the different types of social services and activities that certain institutions provide to the elderly in order to find areas for improvement or to propose relationships between them that will benefit both users and institutions. Methods: Official data from Junta de Castilla y León (Spain) on social services for the elderly in the 9 provinces of the autonomous community of Castilla y León from 2007 to 2021 were analysed using multivariate statistical techniques. Results: Throughout the period under analysis, there is an association between the number of places in public and private non-profit residential centers for the elderly and the number of places in day-care centers or the number of students in the Inter-University Experience Programme. The variables associated with the telecare programme are related to the number of people under guardianship. On the other hand, three well-differentiated clusters of provinces of Castilla y León were observed. Discussion: Our findings have implications for the quality of life of the elderly, as the differences in social services in the areas analysed have a direct impact on the health of the elderly

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The aim of this study is to analyse the relationship between democratic quality and excess mortality produced in the year 2020 before COVID-19 vaccinations were generalised. Using cross-sectional data from 80 countries on five continents, multiple linear regression models between excess mortality, the general democracy index and its disaggregation into five categories: electoral process and pluralism, government functioning, political participation, political culture and civil liberties were estimated. The analysis also considered, public health spending per capita, overweight inhabitants, the average temperature of the country, population over 65 years of age, The KOF Globalisation Index, and the Gross National Income per capita as control variables. It was possible to establish a strong inverse association between excess mortality per million inhabitants and the general democracy index and four of its five categories. There was a particularly strong relationship between excess mortality and the political culture dimension (−326.50, p < 0.001). The results suggest that the higher the democratic quality of the political institutions of a State and particularly of their political culture the more improved the response and management of the pandemic was in preventing deaths and protecting their citizens more effectively. Conversely, countries with lower democracy index values have higher excess mortality. Quality democratic political institutions provide more effective public health policies in the face of the COVID-19 pandemic.Unit of Excellence in Inequality, Human Rights, and Sustainability of the University of Granada (DEHUSO

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A gender perspective was used to analyze whether and how education, unemployment, and per capita public health expenditure were associated with perceived health among the Spanish population between the years 2014 and 2017. Using multilevel methodologies (looking at year, individual, and region) and linear and logistic specifications, we analyzed longitudinal microdata files from the Survey on Living Conditions. The results suggest that women with lower educational levels tend to report worse health than their more educated counterparts. On the other hand, women’s bad health was not associated with unemployment, unlike men’s. Regional per capita public health expenditure was not associated with perceived health in either men or womenthe Health Department of the Regional Andalusian Government (2017–2019) under Grant PI-0457-2016