The role of social movements in strengthening health systems: The experience of the National Health Forum in El Salvador (2009–2018)

From Crossref via Jisc Publications RouterNicole Vidal - ORCID 0000-0001-6159-2757 https://orcid.org/0000-0001-6159-2757Pol de Vos - ORCID 0000-0002-1672-6469 https://orcid.org/0000-0002-1672-6469In 2009, the newly elected FMLN government of El Salvador launched a comprehensive health reform, which gave the National Health Forum (NHF) a key role in developing community participation. This study aims to examine and analyze the content and impact of this social movement during the study period 2009–2018. The context was analyzed through relevant documents, which helped identify key stakeholders. Semi-structured interviews took place at 3 levels of decision making: the political level, the health professionals, and the community. Data were analyzed using a qualitative methodology. Participation is carried by a structure created by the Ministry of Health, the National Health Forum. The NHF developed 3 strategies: (1) leadership building in the communities through the strengthening of social, political, and economic skills, where they developed social accountability mechanisms at all decision-making levels of the health system; (2) the strategy carried by the sectoral working groups, where they responded to prioritized needs identified by the community; and (3) advocacy for human rights-based policies. The NHF, and its role in the strengthening of the National Public Health System, provides strong evidence of community participation strategies and co-governance with the health system within the social determinants of health scope.Funder: Health Services and Delivery Research Programme; FundRef: 10.13039/501100002001; Grant(s): 16/136/10050pubpub

Community and health staff perceptions on non-communicable disease management in El Salvador’s health system: A qualitative study

From Springer Nature via Jisc Publications RouterHistory: received 2019-10-01, accepted 2020-04-23, registration 2020-04-23, online 2020-05-27, epub 2020-05-27, collection 2020-12Funder: Public Health Research Programme; doi: http://dx.doi.org/10.13039/501100001921; Grant(s): Programme 16/136/100Dataset available in eData: https://eresearch.qmu.ac.uk/handle/20.500.12289/9699Background: Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders’ perceptions about the management of NCDs along the pathways of care in this health system. Methods: During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data. Results: This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management. Conclusions: The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach – including long-term follow-up – with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.This study was supported by the NIHR Research Unit on Health in Situations of Fragility (RUHF), through the NIHR Global Health Research Programme 16/136/10020pubpu

Myomectomy complicated by thrombotic microangiopathy

[spa] Presentamos a una paciente que fue intervenida de miomectomía laparoscópica que desarrolló anemia hemolítica microangiopática grave en el post operatorio, desembocando en fallo renal, insuficiencia respiratoria aguda parcial y trombocitopenia. Reisamos los diferentes tipos de microangiopatía trompetica, la dificultad de llegar al diagnóstico y los posibles tratamientos.[eng] We present a patient who underwent a laparotomy myomectomy that developed severe microangiopathic hemolytic anemia post-operatively, leading to acute renal failure, acute partial respiratory failure and thrombocytopenia. We discuss the different types of MAT, the difficulty of reaching the diagnose and the possible treatment

La vaca de l’Albera: necessitat d’un programa de conservació i expansió

La raça de l’Albera és una població bovina autòctona localitzada en el massís de l’Albera (Alt Empordà, Girona, Catalunya), ben adaptada i capaç d’aprofitar els recursos alimentaris de la zona. Són animals rústics, de petit format i que viuen en llibertat tot l’any. S’enquadra en el tronc cantàbric, encara que tradicionalment s’hagin descrit dues varietats: la Negra i la Fagina. Les femelles s’usen com a reposició del ramat i els vedells mascles són engreixats tot i el seu limitat potencial carnisser. L’edat al primer part de les vaques és entre els 3 i 4 anys. L’últim cens d’animals adults amb morfotip Albera ha classificant la població de raça en perill d’extinció d’acord amb la FAO. Per aquest motiu s’està realitzant un programa formal de conservació que inclou la conservació in situ, ex situ i in vitro.The Alberes cattle breed is an autochthonous bovine population located in the Alberes Massif (Alt Empordà,Girona, Catalunya), well adapted to the zone in which it mainly makes use of forest resources. Cows are small sized and rustic, living under a semi-feral management system with minimal human contact. This breed clusters within the Cantabrian trunk, although traditionally two coat colour varieties have been described, Black and Fawn varieties. All of the females are used for replacement and the males are destined for fattening despite their low meat potential. The age at first calving ranges between three and four years. The last census of adult animals considered as an Endangered Breed according to the FAO classification. This dramatic situation allows to start a formal conservation programme with the combination of in situ, ex situ and in vitro practices

Different Ipsi-and Contralateral Glial Responses to Anti- VEGF and Triamcinolone Intravitreal Injections in Rats

Citation: Di Pierdomenico J, García-Ayuso D, Jiménez-López M, AgudoBarriuso M, Vidal-Sanz M, VillegasPérez MP. Different ipsi-and contralateral glial responses to anti-VEGF and triamcinolone intravitreal injections in rats. Invest Ophthalmol Vis Sci. 2016;57:3533-3544. DOI:10.1167/iovs.16-19618 PURPOSE. To investigate the glial response of the rat retina to single or repeated intravitreal injections (IVI). METHODS. Albino Sprague-Dawley rats received one or three (one every 7 days) IVI of anti-rat VEGF (5 lL; 0.015 lg/lL), triamcinolone (2.5 or 5 lL; 40 lg/lL; Trigón Depot), bevacizumab (5 lL; 25 lg/lL; Avastin), or their vehicles (PBS and balanced salt solution) and were processed 7 days after the last injection. Retinas were dissected as whole mounts and incubated with antibodies against: Iba1 (Ionized Calcium-Binding Adapter Molecule 1) to label retinal microglia, GFAP (Glial Fibrillary Acidic Protein) to label macroglial cells, and vimentin to label Müller cells. The retinas were examined with fluorescence and confocal microscopy, and the numbers of microglial cells in the inner retinal layers were quantified using a semiautomatic method. RESULTS. All the injected substances caused an important micro-and macroglial response locally at the injection site and all throughout the injected retina that was exacerbated by repeated injections. The microglial response was also observed but was milder in the contralateral noninjected eyes. The IVI of the humanized antibody bevacizumab caused a very strong microglial reaction in the ipsilateral retina. Two types of macroglial response were observed: astrocyte hypertrophy and Müller end-foot hypertrophy. While astrocyte hypertrophy was widespread throughout the injected retina, Müller end-foot hypertrophy was localized and more extensive with triamcinolone use or after repeated injections. CONCLUSIONS. Intravitreal injections cause micro-and macroglial responses that vary depending on the injected agent but increase with repeated injections. This inflammatory glial response may influence the effects of the injected substances on the retina

Analysis of factors affecting the variability of a quantitative suspension bead array assay measuring IgG to multiple Plasmodium antigens

Reducing variability of quantitative suspension array assays is key for multi-center and large sero-epidemiological studies. To maximize precision and robustness of an in-house IgG multiplex assay, we analyzed the effect of several conditions on variability to find the best combination. The following assay conditions were studied through a fractional factorial design: antigen-bead coupling (stock vs. several), sample predilution (stock vs. daily), temperature of incubation of sample with antigen-bead (22°C vs. 37°C), plate washing (manual vs. automatic) and operator expertise (expert vs. apprentice). IgG levels against seven P. falciparum antigens with heterogeneous immunogenicities were measured in test samples, in a positive control and in blanks. We assessed the variability and MFI quantification range associated to each combination of conditions, and their interactions, and evaluated the minimum number of samples and blank replicates to achieve good replicability. Results showed that antigen immunogenicity and sample seroreactivity defined the optimal dilution to assess the effect of assay conditions on variability. We found that a unique antigen-bead coupling, samples prediluted daily, incubation at 22°C, and automatic washing, had lower variability. However, variability increased when performing several couplings and incubating at 22°C vs. 37°C. In addition, no effect of temperature was seen with a unique coupling. The expertise of the operator had no effect on assay variability but reduced the MFI quantification range. Finally, differences between sample replicates were minimal, and two blanks were sufficient to capture assay variability, as suggested by the constant Intraclass Correlation Coefficient of three and two blanks. To conclude, a single coupling was the variable that most consistently reduced assay variability, being clearly advisable. In addition, we suggest having more sample dilutions instead of replicates to increase the likelihood of sample MFIs falling in the linear part of the antigen-specific curve, thus increasing precision

Antibody responses to α-Gal in African children vary with age and site and are associated with malaria protection

Naturally-acquired antibody responses to malaria parasites are not only directed to protein antigens but also to carbohydrates on the surface of Plasmodium protozoa. Immunoglobulin M responses to α-galactose (α-Gal) (Galα1-3Galβ1-4GlcNAc-R)-containing glycoconjugates have been associated with protection from P. falciparum infection and, as a result, these molecules are under consideration as vaccine targets; however there are limited field studies in endemic populations. We assessed a wide breadth of isotype and subclass antibody response to α-Gal in children from Mozambique (South East Africa) and Ghana (West Africa) by quantitative suspension array technology. We showed that anti-α-Gal IgM, IgG and IgG1–4 levels vary mainly depending on the age of the child, and also differ in magnitude in the two sites. At an individual level, the intensity of malaria exposure to P. falciparum and maternally-transferred antibodies affected the magnitude of α-Gal responses. There was evidence for a possible protective role of anti-α-Gal IgG3 and IgG4 antibodies. However, the most consistent findings were that the magnitude of IgM responses to α-Gal was associated with protection against clinical malaria over a one-year follow up period, especially in the first months of life, while IgG levels correlated with malaria risk

Assembling the dead, gathering the living: Radiocarbon dating and bayesian modelling for copper age valencina de la concepcioón (Seville, Spain)

The great site of Valencina de la Concepción, near Seville in the lower Guadalquivir valley of southwest Spain, is presented in the context of debate about the nature of Copper Age society in southern Iberia as a whole. Many aspects of the layout, use, character and development of Valencina remain unclear, just as there are major unresolved questions about the kind of society represented there and in southern Iberia, from the late fourth to the late third millennium cal BC. This paper discusses 178 radiocarbon dates, from 17 excavated sectors within the c. 450 ha site, making it the best dated in later Iberian prehistory as a whole. Dates are modelled in a Bayesian statistical framework. The resulting formal date estimates provide the basis for both a new epistemological approach to the site and a much more detailed narrative of its development than previously available. Beginning in the 32nd century cal BC, a long-lasting tradition of simple, mainly collective and often successive burial was established at the site. Mud-vaulted tholoi appear to belong to the 29th or 28th centuries cal BC; large stone-vaulted tholoi such as La Pastora appear to date later in the sequence. There is plenty of evidence for a wide range of other activity, but no clear sign of permanent, large-scale residence or public buildings or spaces. Results in general support a model of increasingly competitive but ultimately unstable social relations, through various phases of emergence, social competition, display and hierarchisation, and eventual decline, over a period of c. 900 years.Acknowledgements Thanks are due to: the Archaeology Museum of Seville and especially Ana Navarro Ortega (director) and Juan Ignacio Vallejo (curator) for their assistance when sampling; Isabel Santana Falcón for the photo of El Algarrobillo; Penny Bickle, Seren Griffiths and Jessica Smyth for help with sample selection and collection; and Marta Cintas-Peña for help with final editing. The 32 dates obtained by the University of Seville were funded by the research project ‘A Comparative Analysis of Socioeconomic Dynamics in Late Prehistory in the Central South of the Iberian Peninsula (4th–2nd millennia BC): the South-West’ (Spanish Ministry of Science and Innovation), led by Leonardo García Sanjuán (2009–2012). The work of other dating laboratories is gratefully acknowledged. We would also like to thank Professor Marcela Frangipane for her kind advice regarding the chronology of the spear heads found in Arslantepe (Turkey). The Times of Their Lives (www.totl.eu) has been supported by an Advanced Investigator Grant (295412) from the European Research Council, led by Alasdair Whittle and Alex Bayliss

La didáctica de la literatura hispanoamericana a través del cine

Memoria ID-068. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2018-2019