Factores Laborales y Sociodemográficos Asociados a Riesgos Psicosociales en el Ambiente Laboral del Personal Médico Asistencial de la Microred Metropolitana de la Red de Salud Tacna, 2019

Objetivo: Determinar los factores laborales y sociodemográficos asociados a riesgos psicosociales en el ambiente laboral del personal médico asistencial de la Micro Red Metropolitana de la Red de Salud Tacna, 2019. Material y método: Estudio observacional de cohorte transversal de diseño analítico y de un nivel de investigación relacional, Se trabajó con un total de 32 médicos de la Micro red Metropolitana de la Red de Salud de Tacna. El análisis del dato se hace a través del sistema informático de ISTAS 21 que consolida la data on-line definiendo las dimensiones a ser analizadas. Se midió la exposición a riesgo psicosocial mediante la evaluación de “prevalencia de exposición”. Resultados: La muestra intencional de los médicos que accedieron al estudio de la Micro Red en conjunto estuvo conformada por el 46.9% de varones y el 53.1% de sexo de mujeres. Respecto a la edad, el 31.3%, tenía entre 30 a 39 años. Según el estado civil, el 68.8% tenía la condición de casado. Respecto al número de hijos, el 37.5% tiene dos hijos. Las dimensiones mejor representadas son trabajo activo y posibilidad de desarrollo, y apoyo social y calidad de liderazgo, pero las más desfavorables son exigencias psicológicas, inseguridad, doble presencia y estima (p< 0.05). Conclusiones: Las dimensiones que necesitarían intervención son exigencias psicológicas, inseguridad, doble presencia y estima.Tesi

Impact of supragingival therapy on subgingival microbial profile in smokers versus non-smokers with severe chronic periodontitis

The aim of this study was to assess subgingival microbiological changes in smokers versus non-smokers presenting severe chronic periodontitis after supragingival periodontal therapy (ST).Non-smokers (n=10) and smokers (n=10) presenting at least nine teeth with probing pocket depth (PPD) (&#x2265;5 mm), bleeding on probing (BoP), and no history of periodontal treatment in the last 6 months were selected. Clinical parameters assessed were plaque index (PI), BoP, PPD, relative gingival margin position (rGMP) and relative clinical attachment level (rCAL). Subgingival biofilm was collected before and 21 days after ST. DNA was extracted and the 16S rRNA gene was amplified with the universal primer pair, 27F and 1492R. Amplified genes were cloned, sequenced, and identified by comparison with known 16S rRNA sequences. Statistical analysis was performed by Student&#x0027;s t and Chi-Square tests (&#x03B1;=5%).Clinically, ST promoted a significant reduction in PI and PPD, and gain of rCAL for both groups, with no significant intergroup difference. Microbiologically, at baseline, data analysis demonstrated that smokers harbored a higher proportion of Porphyromonas endodontalis, Bacteroidetes sp., Fusobacterium sp. and Tannerella forsythia and a lower number of cultivated phylotypes (p&#60;0.05). Furthermore, non-smokers featured significant reductions in key phylotypes associated with periodontitis, whereas smokers presented more modest changes.Within the limits of the present study, ST promoted comparable clinical improvements in smokers and non-smokers with severe chronic periodontitis. However, in smokers, ST only slightly affected the subgingival biofilm biodiversity, as compared with non-smokers

Definition and Classification of Generic Drugs Across the World.

Our aim was to systematically identify and compare how generic medications, as defined by the US Food and Drug Administration (FDA), World Health Organization (WHO), and European Medicines Agency (EMA), are classified and defined by regulatory agencies around the world. We focused on emerging markets and selected the most populated countries in each of the WHO regions: Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia, and Western Pacific. A structured review of published literature was performed through December 2013. Direct information from regulatory agencies and Ministries of Health for each country was extracted. Additionally, key informant interviews were performed for validation. Of the 21 countries selected, approximately half provided an official country-level definition for generic pharmaceuticals. The others did not have any definition or referred to the WHO. Only two-thirds of the countries had specific requirements for generic pharmaceuticals, often associated with clinical interchangeability. Most countries with requirements mention bioequivalence, but few required bioavailability studies explicitly. Over 30% of the countries had other terms associated with generics in their definitions and processes. In countries with generic drug policies, there is reference to patent and/or data protection during the drug registration process. Several countries do not mention good manufacturing practices as part of the evaluation process. Countries in Africa and Eastern Mediterranean regions appear to have a less developed regulatory framework. In summary, there is significant variability in the definition and classification of generic drugs in emerging markets. Standardization of the definitions is necessary to make international comparisons viable

Definition and Classification of Generic Drugs Across the World.

Our aim was to systematically identify and compare how generic medications, as defined by the US Food and Drug Administration (FDA), World Health Organization (WHO), and European Medicines Agency (EMA), are classified and defined by regulatory agencies around the world. We focused on emerging markets and selected the most populated countries in each of the WHO regions: Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia, and Western Pacific. A structured review of published literature was performed through December 2013. Direct information from regulatory agencies and Ministries of Health for each country was extracted. Additionally, key informant interviews were performed for validation. Of the 21 countries selected, approximately half provided an official country-level definition for generic pharmaceuticals. The others did not have any definition or referred to the WHO. Only two-thirds of the countries had specific requirements for generic pharmaceuticals, often associated with clinical interchangeability. Most countries with requirements mention bioequivalence, but few required bioavailability studies explicitly. Over 30% of the countries had other terms associated with generics in their definitions and processes. In countries with generic drug policies, there is reference to patent and/or data protection during the drug registration process. Several countries do not mention good manufacturing practices as part of the evaluation process. Countries in Africa and Eastern Mediterranean regions appear to have a less developed regulatory framework. In summary, there is significant variability in the definition and classification of generic drugs in emerging markets. Standardization of the definitions is necessary to make international comparisons viable

Extracting low-cost signals of quality control in community pharmacies: a simulated client study in Bogotá

Objetivos: determinar si existe una diferenciación en la calidad del servicio entre las farmacias comunitarias en Bogotá. Métodos: Utilizamos la metodología de cliente simulado (N = 298) para evaluar si las farmacias comunitarias de Bogotá cumplen con las reglas de prescripción relacionadas con los medicamentos anticonceptivos. Los clientes simulados solicitaron una marca específica de píldoras anticonceptivas para su hermana menor. Resultados: el uno por ciento del personal de la farmacia pidió una receta cuando se solicitaron las píldoras. El cinco por ciento del personal hizo preguntas adicionales que indican conocimiento o interés en la correcta entrega de las píldoras (por ejemplo, la edad de la hermana o si las píldoras se recetaron para el acné). No encontramos diferencias por nivel socioeconómico o tipo de propiedad de la farmacia (empresa grande versus independiente). Las farmacias independientes tenían menos probabilidades de retratar un diploma de su químico, y la probabilidad de que su personal usara batas blancas también era menor. Conclusiones: la diferenciación de calidad de las farmacias comunitarias de Bogotá parece estar relacionada con señales simples asociadas con una imagen profesional, pero no con procedimientos reales que garanticen la seguridad de los consumidores.Objectives: Determine whether there is differentiation on service quality accross community pharmacies in Bogota. Methods: We use the simulated client methodology (N=298) to assess whether Bogota's community pharmacies comply with prescription rules related to contraceptive medications. Simulated clients requested a specific brand of contraceptive pills for their young sister. Results: One per cent of the staff at the pharmacy asked for a prescription when the pills were requested. Five per cent of the staff made additional questions that signal knowledge or interest in correct delivery of pills (e.g., the sister's age or if the pills were prescribed for acne). We do not find differences by socio-economic level or type of ownership of the pharmacy (large firm versus independent). Independent pharmacies were less likely to portray a diploma of their chemist, and the likelihood that their staff wore white coats was also lower. Conclusions: Bogota's community pharmacies differentiation on quality appears to be related to simple signals associated with a professional image, but not with actual procedures that guarantee the safety of consumers

Does price-cap regulation work for increasing access to contraceptives? Aggregate- and pharmacy-level evidence from Colombia

Antecedentes: Los topes de precios mediante precios de referencia internacionales se utilizan ampliamente en todo el mundo, pero no tan comúnmente en los mercados over-the-counter (OTC). Estudiamos este tipo de regulación para el caso de los anticonceptivos orales en Colombia, que es un mercado OTC de facto. Objetivos: Se pretende establecer si la regulación desencadenó una respuesta competitiva dentro y a través de las categorías de productos (ingredientes activos farmacéuticos). También estudiamos si los productos regulados dirigidos a clientes de alto nivel socioeconómico se distribuyen ahora en farmacias de barrios de bajo nivel socioeconómico. Métodos: En primer lugar, utilizamos un modelo de panel lineal de efectos fijos para estimar el cambio en los precios y las cantidades asociadas a la nueva regulación para los productos regulados y no regulados utilizando datos administrativos a nivel de mayorista, según tres niveles de precios. Segundo, realizamos un estudio de auditoría con 213 farmacias comunitarias en la ciudad de Bogotá, Colombia. Visitamos las farmacias en dos ocasiones, antes y después de la introducción del tope de precios, recogiendo información sobre los precios y la disponibilidad de seis marcas seleccionadas. Hallazgos: El análisis a nivel mayorista revela una reducción de precios en productos regulados, y en los no regulados pero con un ingrediente activo regulado. Las cantidades comercializadas aumentan para los mismos tipos de productos, pero sólo para los de las categorías más caras. Además, las cantidades comercializadas de productos no regulados disminuyen. Aunque esta reducción de precios también se transmite a las farmacias, la disponibilidad de los anticonceptivos de gama alta y media incluidos en nuestro estudio de auditoría también disminuye. Proporcionamos pruebas sugestivas de que la reducción de la disponibilidad de los mismos fue mayor en las zonas de baja condición socioeconómica. Conclusiones: Las reglamentaciones sobre límites de precios que podrían parecer tan eficaces para reducir los precios y ampliar el acceso a nivel agregado podrían ocultar pautas de almacenamiento que afectan negativamente a la disponibilidad del producto para el consumidor final.Background: Price caps through international reference pricing are widely used around the World, but not so commonly in over-the-counter markets (OTC). We study this type of regulation for the case of oral contraceptives in Colombia, which is a de facto OTC market. Objectives: We aim to establish whether the regulation triggered a competitive response within and across product categories (active pharmaceutical ingredients). We also study whether regulated products targeted to customers from high socio-economic status are now distributed in pharmacies from low socio-economic neighborhoods. Methods: First, we use a fixed effects linear panel model to estimate the change in prices and quantities associated with the new regulation for regulated and non-regulated products using administrative data at the wholesale level, according to three price tiers. Second, we conducted an audit study with 213 community pharmacies in the city of Bogotá, Colombia. We visited pharmacies twice, before and after the introduction of the price cap, collecting information on prices and availability of six selected brands. Findings: The wholesale-level analysis reveals a price reduction in regulated and non-regulated products with a regulated active ingredient. Traded quantities increase for the same product types, but only for those in the most expensive categories. Besides, the traded quantities of non-regulated products decrease. Although this price reduction is also transmitted to community pharmacies, the availability of the high-end and mid-range contraceptives included in our audit study decreases as well. We provide suggestive evidence that reduction in the availability of was larger in areas of low socio-economic status. Conclusions: Price cap regulations that might look as effective in lowering prices and expanding access at the aggregate level could conceal stocking patterns that negatively affect the product availability for the final consumer

Extracting low-cost signals of perceived quality control in community pharmacies: a simulated client study of contraceptive dispensing in Bogotá

We determine whether community pharmacies in Bogotá produce differential quality signals, and if they are related to an objective quality measure: the compliance with prescription rules. In this quantitative descriptive study, we use the simulated client methodology (N=298) to assess whether Bogota’s community pharmacies comply with prescription rules related to contraceptive medications. We find that one per cent of the staff at the pharmacy asked for a prescription when the pills were requested. Five per cent of the staff asked additional questions that signal knowledge or interest in the correct delivery of pills. We do not find differences by socio-economic level or type of pharmacy ownership (i.e., large firm versus independent) regarding the request of prescriptions or further questions about the pills. Concerning the aesthetic signals of quality, independent pharmacies were less likely to display a diploma of their chemist, and the likelihood that their staff wore white coats was also lower. We conclude that Bogota’s community pharmacies differentiation is based on simple signals associated with a professional image, but not with actual procedures that guarantee the safety of consumers. En este artículo determinamos si las farmacias en Bogotá producen señales diferenciales de calidad, y si están relacionadas con una medida de calidad objetiva: el cumplimiento de las reglas de prescripción. En este estudio descriptivo cuantitativo, utilizamos la metodología de clientes simulados (N = 298) para evaluar si las farmacias de Bogotá cumplen con las reglas de prescripción relacionadas con los medicamentos anticonceptivos. Encontramos que el uno por ciento del personal de la farmacia pidió una receta cuando se solicitaron las píldoras. El cinco por ciento del personal formuló preguntas adicionales que indican conocimiento o interés en la correcta administración de las píldoras. No encontramos diferencias por nivel socioeconómico o tipo de propiedad de la farmacia (es decir, empresa grande versus independiente) con respecto a la solicitud de recetas o preguntas adicionales sobre las píldoras. En cuanto a las señales estéticas de calidad, las farmacias independientes tenían menos probabilidades de mostrar un diploma de su químico y la probabilidad de que su personal vistiera batas blancas también era menor. Concluimos que la diferenciación de las farmacias comunitarias de Bogotá se basa en simples señales asociadas a una imagen profesional, pero no a procedimientos reales que garanticen la seguridad de los consumidores. Dans cet article, nous déterminons si les pharmacies de Bogota produisent des signaux de qualité différentiels, et s’ils sont liés à une mesure de qualité objective : le respect des règles de prescription. Dans cette étude descriptive quantitative, nous avons utilisé la méthodologie des clients simulés (N = 298) pour évaluer si les pharmacies de Bogota respectent les règles de prescription liées aux médicaments contraceptifs. Nous avons constaté qu’un pour cent du personnel de la pharmacie a demandé une ordonnance lorsque les pilules ont été commandées. Cinq pour cent des membres du personnel ont posé des questions supplémentaires indiquant la connaissance ou l’intérêt dans la bonne administration des pilules. Nous n’avons trouvé aucune différence selon le statut socioéconomique ou le type de propriété de la pharmacie (c.-à-d. grande entreprise par rapport à l’entreprise indépendante) en ce qui concerne les demandes d’ordonnance ou des questions supplémentaires sur les pilules. En ce qui concerne les indices de qualité esthétique, les pharmacies indépendantes étaient moins susceptibles de montrer un diplôme de leur chimiste et leur personnel était moins susceptible de porter des blouses blanches. Nous concluons que la différenciation des pharmacies communautaires à Bogota est basée sur des signaux simples associés à une image professionnelle, mais pas avec des procédures réelles qui garantissent la sécurité des consommateurs.

Covid-19 consecuencias y desafíos en la economía colombiana. Una mirada desde las universidades

Este capítulo da una perspectiva que mezcla la economía, la sociología y la psicología. A lo cual también encontraremos la sección 1, presentaremos los detalles del estudio; en la 2, los principales resultados frente a la afectación laboral; en la 3, sobre bienestar y salud mental; y en la 4, acerca de las percepciones sobre el futuro. En la sección 5 discutiremos una medición asociada a economía del comportamiento, una medida sobre altruismo. Finalmente, damos los mensajes clave en las conclusiones

Higher pharmaceutical public expenditure after direct price control: improved access or induced demand? The Colombian case

Abstract Background High pharmaceutical expenditure is one of the main concerns for policymakers worldwide. In Colombia, a middle-income country, outpatient prescription represents over 10% of total health expenditure in the mandatory benefits package (POS), and close to 90% in the complementary government fund (No POS). In order to control expenditure, since 2011, the Ministry of Health introduced price caps on inpatient drugs reimbursements by active ingredient. By 2013, more than 400 different products, covering 80% of public pharmaceutical expenditure were controlled. This paper investigates the effects of the Colombian policy efforts to control expenditure by controlling prices. Methods Using SISMED data, the official database for prices and quantities sold in the domestic market, we estimate a Laspeyres price index for 90 relevant markets in the period 2011–2015, and, then, we estimate real pharmaceutical expenditure. Results Results show that, after direct price controls were enacted, price inflation decreased almost − 43%, but real pharmaceutical expenditure almost doubled due mainly to an increase in units sold. Such disproportionate increase in units sold maybe attributable to better access to drugs due to lower prices, and/or to an increase in marketing efforts by the pharmaceutical industry to maintain profits. Conclusions We conclude that pricing interventions should be implemented along with a strong market monitoring to prevent market distortions such as inappropriate and unnecessary drug use