Situación de la salud en Caldas

El concepto de salud, ha sido ampliamente discutido por autores a través del tiempo. Es asi como dentro de los modelos y diversas explicaciones que han surgido con el fin de describir los múltiples componentes que podrían influir en el proceso de salud-enfermedad, se encuentran valiosos aportes como los de Leavel y Clark, Lalonde y Blurn, el concepto de «Campo de Salud» formulado por Laframboise (1974) Y David Bersh, en donde unos y otros establecen el proceso de salud-enfermedad como un proceso multicausal

Formación de médicos y enfermeras para la detección temprana del cáncer de mama en méxico

Objetivo Analizar la formación académica que reciben los estudiantes de medicina y enfermería sobre el cáncer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Métodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revisión documental. Población de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermería. Unidad de análisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y  6,3 % de enfermería se encontró información específica de contenidos sobre CaMa. La capacitación que reciben los  médicos es predominantemente desarrollada por las áreas biomédica y clínica y en menor proporción en el área socio-médica. En enfermería los temas que más se desarrollan son en áreas comunitarias, abordando contenidos de promoción de la salud y prevención de la enfermedad (estilos de vida saludable e identificación de mujeres con alto riesgo de padecer CaMa). Discusión Se encontró escasa evidencia sobre entrenamiento específico para la detección y atención del cáncer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los currículos para formar a los futuros profesionales con capacidades para trabajar en la solución de los  problemas y necesidades específicos de salud de la población particularmente en acciones de prevención primaria y secundari

Experiencias y emociones de las parteras con relación al sistema formal de salud en México

The study sought to know the experience and emotions in the practice of midwifery, in the state of Morelos, under the context of the hegemonic medical model. A qualitative study was carried out, supported by the ethnographic method, and taking as a reference to the narratives of the parties themselves through in-depth interviews. The main results of the study were that 1) the experience of the parties has led them to develop and maintain practices that have a different logic than the hegemonic allopathic medical model; 2) midwives practice a logic that considers the emotional dimension in a significant way in the care of women, with sensitivity, respect, and care; while 3) it was shown that such knowledge is delegitimized from the hegemonic logic of allopathic medicine. The study concluded that it is necessary to have a greater and better understanding of the way in which midwives work and to seek to generate spaces for dialogue with the formal health system, in order to generate inclusive policies, of recognition and respect for them, in so much so that in this way it is possible to support maternal and child health for the benefit of society.El estudio buscó conocer la experiencia y las emociones en la práctica de la partería, en el estado de Morelos, bajo el contexto del modelo médico hegemónico. Se realizó un estudio cualitativo, apoyado en el método etnográfico, y tomando como referencia las narrativas de las propias parteras mediante entrevistas en profundidad. Los principales resultados del estudio muestran que 1) la experiencia de las parteras las ha encaminado a desarrollar y mantener prácticas que tienen una lógica distinta al modelo médico alopático hegemónico; 2) las parteras cuidan de manera significativa la dimensión emocional de las mujeres en la atención al embarazo, parto y posparto, con sensibilidad y respeto; al tiempo que 3) se mostró que dichos conocimientos y prácticas son deslegitimados desde la lógica hegemónica de la medicina alopática. El estudio concluyó que es necesario tener una mayor y mejor comprensión de la forma en la que trabajan las parteras y buscar generar espacios de diálogo con el sistema formal de salud, a fin de generar políticas inclusivas, de reconocimiento y de respeto para ellas, en tanto que de esa manera es posible apoyar a la salud materno infantil en beneficio de la sociedad

Borrelia burgdorferi infection induces long-term memory-like responses in macrophages with tissue-wide consequences in the heart

Lyme carditis is an extracutaneous manifestation of Lyme disease characterized by episodes of atrioventricular block of varying degrees and additional, less reported cardiomyopathies. The molecular changes associated with the response to Borrelia burgdorferi over the course of infection are poorly understood. Here, we identify broad transcriptomic and proteomic changes in the heart during infection that reveal a profound down-regulation of mitochondrial components. We also describe the long-term functional modulation of macrophages exposed to live bacteria, characterized by an augmented glycolytic output, increased spirochetal binding and internalization, and reduced inflammatory responses. In vitro, glycolysis inhibition reduces the production of tumor necrosis factor (TNF) by memory macrophages, whereas in vivo, it produces the reversion of the memory phenotype, the recovery of tissue mitochondrial components, and decreased inflammation and spirochetal burdens. These results show that B. burgdorferi induces long-term, memory-like responses in macrophages with tissue-wide consequences that are amenable to be manipulated in vivo.Supported by grants from the Spanish Ministry of Science, Innovation and Universities (MCIU) co-financed with FEDER funds (SAF2015-65327-R and RTI2018-096494-B-100 to JA; BFU2016-76872-R to EB, AGL2017-86757-R to LA, SAF2017-87301-R to MLMC, SAF2015-64111-R to AP, SAF2015-73549-JIN to HR), Instituto de Salud Carlos III (PIE13/0004 to AP), the Basque Government Department of Health (2015111117 to LA), the Basque Foundation for Innovation and Health Research (BIOEF), through the EiTB Maratoia grant BIO15/CA/016/BS to MLMC, the regional Government of Andalusia co-funded by CEC and FEDER funds (Proyectos de Excelencia P12-CTS-2232) and Fundación Domingo Martínez (to AP). LA is supported by the Ramon y Cajal program (RYC-2013-13666). DB, MMR and TMM are recipients of MCIU FPI fellowships. ACG and AP are recipients of fellowships form the Basque Government. APC is a recipient of a fellowship from the University of the Basque Country. We thank the MCIU for the Severo Ochoa Excellence accreditation (SEV-2016-0644), the Basque Department of Industry, Tourism and Trade (Etortek and Elkartek programs), the Innovation Technology Department of the Bizkaia Province and the CIBERehd network. DB and JA are supported by a grant from the Jesús de Gangoiti Barrera Foundation

CIBERER : Spanish national network for research on rare diseases: A highly productive collaborative initiative

Altres ajuts: Instituto de Salud Carlos III (ISCIII); Ministerio de Ciencia e Innovación.CIBER (Center for Biomedical Network Research; Centro de Investigación Biomédica En Red) is a public national consortium created in 2006 under the umbrella of the Spanish National Institute of Health Carlos III (ISCIII). This innovative research structure comprises 11 different specific areas dedicated to the main public health priorities in the National Health System. CIBERER, the thematic area of CIBER focused on rare diseases (RDs) currently consists of 75 research groups belonging to universities, research centers, and hospitals of the entire country. CIBERER's mission is to be a center prioritizing and favoring collaboration and cooperation between biomedical and clinical research groups, with special emphasis on the aspects of genetic, molecular, biochemical, and cellular research of RDs. This research is the basis for providing new tools for the diagnosis and therapy of low-prevalence diseases, in line with the International Rare Diseases Research Consortium (IRDiRC) objectives, thus favoring translational research between the scientific environment of the laboratory and the clinical setting of health centers. In this article, we intend to review CIBERER's 15-year journey and summarize the main results obtained in terms of internationalization, scientific production, contributions toward the discovery of new therapies and novel genes associated to diseases, cooperation with patients' associations and many other topics related to RD research

Situación de la salud en Caldas

El concepto de salud, ha sido ampliamente discutido por autores a través del tiempo. Es asi como dentro de los modelos y diversas explicaciones que han surgido con el fin de describir los múltiples componentes que podrían influir en el proceso de salud-enfermedad, se encuentran valiosos aportes como los de Leavel y Clark, Lalonde y Blurn, el concepto de «Campo de Salud» formulado por Laframboise (1974) Y David Bersh, en donde unos y otros establecen el proceso de salud-enfermedad como un proceso multicausal

Barreras de acceso al diagnóstico temprano del cáncer de mama en el Distrito Federal y en Oaxaca Access barriers in early diagnosis of breast cancer in the Federal District and Oaxaca

OBJETIVO: Identificar las barreras sociales, culturales y de los servicios de salud que impiden el acceso oportuno a la detección temprana del cáncer de mama en el DF y en Oaxaca. MATERIAL Y MÉTODOS: Estudio exploratorio transversal de corte cualitativo realizado en 2008 en mujeres mayores de 25 años sin la afección, mujeres diagnosticadas y sus parejas varones y directores de programas de cáncer de mama de diversas instituciones. Se recogió información mediante grupos focales y entrevistas, que se grabaron y transcribieron previo consentimiento informado. RESULTADOS: La exploración inicial permitió identificar barreras de acceso a los servicios en: a) disponibilidad de información para la población general; b) entrenamiento de los médicos generales y ginecólogos de primer contacto; y c) temores de la pareja y familia. CONCLUSIONES: Las barreras identificadas en los tres niveles muestran notorias deficiencias en la difusión de información tanto a la población en general como a los proveedores de servicios de salud.OBJECTIVE: To identify social, cultural and health service barriers that prevent timely access to early detection of breast cancer in two regions: Mexico City Federal District and the state of Oaxaca. MATERIAL AND METHODS: An exploratory cross-sectional qualitative study was carried out in 2008 among women under 25 years of age without pathology, with pathological diagnosis, their male partners and managers of several public and private institutions. Information was collected by focus groups and through interviews that were recorded and transcribed after having received informed consent. RESULTS: Initial exploration allowed the identification of access barriers in three main areas: a) the availability of information for the general population, b) training of first-contact general practitioners and gynecologists, and c) fears among couples and families. CONCLUSIONS: Barriers in the three levels identified are relevant as they reveal important deficiencies in the dissemination of information both to the general population and to health providers

El Fondo de Protección contra Gastos Catastróficos: tendencia, evolución y operación Fund for Protection against Catastrophic Expenses

OBJETIVO. Documentar los procesos operativos y de gestión del Fondo de Protección contra Gastos Catastróficos (FPGC), evolución y distribución del gasto y explorar semejanza entre padecimientos cubiertos y perfil epidemiológico. MATERIAL Y MÉTODOS. Estudio mixto, de naturaleza gerencial, que incluyó entrevistas semiestructuradas, revisión de bases de datos de la Comisión Nacional de Protección Social en Salud (CNPSS), egresos hospitalarios y mortalidad. RESULTADOS. El 52% de los estados tardan el doble del tiempo establecido para notificar y validar los casos. De 2004 a 2009 el FPGC pasó de 6 a 49 intervenciones, equivalente a un incremento nominal y real del gasto de 2 306.4 y 1 659.3%, respectivamente. La intervención priorizada fue VIH/SIDA con 39.3%; el Distrito Federal obtuvo la mayor proporción del gasto (25.1%). Algunas de las principales causas de mortalidad son cubiertas por el FPGC. CONCLUSIONES. La revisión de los criterios de inclusión de enfermedades y la adecuación del fondo para atender la demanda creciente es impostergable.<br>OBJECTIVE. To document the status of operational and managerial processes of the Fund for Protection against Catastrophic Expenses (FPGC), as well as to describe its evolution, and to explore the relationship between covered diseases and the Mexican health profile. MATERIAL AND METHODS. This is a joint management study, which included a qualitative and a quantitative phase. We conducted semi-structured interviews with key informants. We also analyzed the records of CNPSS, the hospital discharge and mortality data bases. RESULTS. Fifty two percent of the states take twice as long to report and validate the cases. From 2004-2009 the FPGC increased its coverage from 6 to 49 interventions, that means a spending increase of 2 306.4% in nominal terms and 1 659.3% in real terms. The HIV/AIDS was the intervention prioritized with 39.3% and Mexico City had the highest proportion of expenditure (25.1%). A few diseases included in the health profile are covered by the FPGC. CONCLUSIONS. The review of the inclusion criteria of diseases is urgent, so as to cover diseases of epidemiological importance

Gender-related beliefs and attitudes about tobacco use and smoking cessation in Mexico

Background. While overall trends in tobacco use among men are declining, tobacco use continues to rise significantly among women in developing countries. This study aimed to explore the gender-related beliefs and attitudes about tobacco use and smoking cessation in Mexico, one of the top five Latin America countries with the highest prevalence of tobacco consumption. Materials and Methods. This study was conducted using an explanatory qualitative methods design. Semi-structured interviews were conducted with 14 adults smokers (8 women & 6 men) who visited primary healthcare clinics in Mexico City. Two researchers independently coded the interviews and applied the final codes upon consensus. Inter-rater reliability was assessed for four groups of codewords (92% agreement), based on an ecological model on socio-cultural factors. Findings. Initiation to smoking in women begins out of curiosity, and in men by imitation. Also, women start using tobacco at an older age compared to men. During maintenance of smoking, women report experiencing loneliness and anxiety about multiple responsibilities, e.g. women reveal that they feel guilty when they smoke due to their maternal role as caregivers. Additionally, some women report that smoking is a symbol of freedom, recalling the media messages associated with promoting tobacco products. Among men, the results show that they smoke for pleasure and to socialize, and consider that women smoke to imitate men and feel powerful. Regarding cessation, women are ambivalent about quitting smoking or not, and men mention not needing professional support. For organizational barriers, women mention the cost of treatment and men, the distance to clinics. Conclusion. Smoking cessation interventions should be proposed from an approach that involves changes in social norms, seeking a more equitable relationship between men and women. Therefore, there must be broad engagement from different sectors and not just at the health sector level