Reforma de la educación médica en el Perú

La reforma de la educación médica es un pilar fundamental para construir una verdadera reforma de la salud en el Perú. El autor hizo 8 años de post grado en los Estados Unidos y practicó su especialidad durante 22 años en ese país y 18 en el Perú. Este trabajo utiliza el valor de la historia en el progreso de la educación médica y la aplicación de la experiencia vivida, para ofrecer al país natal el por qué y el cómo llevar a cabo los cambios pertinentes y actualizados que beneficien a todos los Peruanos, sin distinción de raza, credo o posición socioeconómica

Reforma del sistema de salud en el Perú

La reforma de la salud ha sido mencionada políticamente en Perú por décadas. A finales del siglo XX, ya se hablaba de los sistemas de salud como el conjunto de organizaciones, instituciones y recursos encaminados a mejorar la salud de las personas. También se identificaban sus tres principales componentes, financiamiento, gestión y atención. En el año 2000, laOrganización Mundial de la Salud publicó un estudio de los sistemas de salud de 191 países, en el que Perú se encontraba en el tercio inferio

Malnutrición materno-fetal: Revisión de la bibliografía internacional y la urgencia de estudios, prevención e intervención en el Perú

Maternal-fetal malnutrition is common in Peru, but its prevention and possible intervention measures have not been investigated in Peru. We conducted a literature review on the topic to prevent and manage this serious public health problem.En el Perú, la malnutrición materno-fetal ocurre con frecuencia, pero su prevención, intervención y seguimiento no ha sido investigada en relación al conocimiento y experiencia de países emergentes. Los autores presentan una revisión actualizada de los avances científicos sobre malnutrición materno-fetal, con el fin de prevenir y manejar un empobrecido capital humano, que constituye nuestro principal y más urgente problema sanitario

Perfil das atitudes de formandos em enfermagem frente aos transtornos mentais no Brasil, Chile e Peru

This study aimed to draw a profile of nursing graduate students' attitudes towards mental disorders in three different cultures: Brazil, Chile and Peru. The opinion scale for mental disorders was applied. The results showed statistically significant differences (5%) in terms of authoritarianism, mental hygiene ideology, serial restriction and minority vision, which were favorable to Brazilian students. As to the factor interpersonal etiology, the results were favorable to Peruvians, while the results for etiology of mental strain were favorable to Chileans. There was no statistical evidence to confirm any difference in terms of benevolence. These results reveal that Brazilian students present more positive attitudes towards mental disorders, as they showed to be less authoritarian, restrictive and discriminative than the Chilean and Peruvian students. Therefore, they are more likely to develop a more therapeutic behavior towards people with mental disorders.Este estudio tuvo como objetivo delinear un perfil de actitudes de alumnos en enfermería ante trastornos mentales en tres culturas diferentes: Brasil, Chile y Perú. Para esto, los autores utilizaron la escala de opiniones respecto a la enfermedad mental. Los resultados evidenciaron diferencias estadísticamente significativas (5%) en factores como autoritarismo, ideología de higiene mental, restricción social y visión minoritaria, favorables a los estudiantes brasileños. En el factor etiología interpersonal, los resultados fueron favorables a los estudiantes peruanos y, en el factor etiología de esfuerzo mental, a los estudiantes chilenos. En el factor benevolencia, no fueron encontradas diferencias estadísticamente comprobadas. Estos resultados permitieron concluir que los alumnos brasileños presentaron actitudes más positivas ante los trastornos mentales, mostrándose menos autoritarios, restrictivos y discriminadores que los chilenos y peruanos y, por lo tanto, con mayores posibilidades de desarrollar conductas más terapéuticas ante la persona portadora de los mencionados trastornos.Este estudo teve por objetivo traçar um perfil de atitudes de formandos em enfermagem frente aos transtornos mentais em três culturas diferentes: Brasil, Chile e Peru. Para isso foi utilizada a escala de opiniões sobre a doença mental. Os resultados mostraram diferenças estatisticamente significantes no nível de 5% nos fatores autoritarismo, ideologia de higiene mental, restrição serial e visão minoritária, favoráveis aos estudantes brasileiros. No fator etiologia interpessoal, os resultados foram favoráveis aos estudantes peruanos e no fator etiologia de esforço mental, favoráveis aos chilenos. No fator benevolência não houve evidência estatística que afirmasse diferença. Esses resultados permitem concluir que os formandos brasileiros apresentaram atitudes mais positivas frente aos transtornos mentais, mostrando-se menos autoritários, restritivos e discriminadores que os chilenos e peruanos, portanto, com maiores possibilidades de desenvolverem condutas mais terapêuticas com a pessoa portadora dos transtornos referidos

Acceptability to patients, carers and clinicians of an mHealth platform for the management of Parkinson's disease (PD_Manager): study protocol for a pilot randomised controlled trial.

BACKGROUND: Parkinson's disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_Manager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_Manager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_Manager for clinical decision making and the acceptability of the system in clinical practice. METHODS/DESIGN: This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson's disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson's diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_Manager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_Manager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_Manager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_Manager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework. DISCUSSION: Information gathered will inform further development of the PD_Manager system and a larger effectiveness trial. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17396879 . Registered on 15 March 2017

Anthropogenic geomorphic change as a potential generator of renewable geologic resources in the humid Pampa of Argentina

The nature and amount of sediments in various lakes, intermittent swampy areas and river sectors in the humid Pampa (Buenos Aires Province, Argentina) were analysed. The aim was to determine whether recent sediments in such environments could serve as an alternative resource to the brick industry, for minimising the current, high environmental impact of soil mining. Sediment sequences were obtained, and the thicknesses of the upper sediment layers, corresponding to the suballuvial (approx. 1400-700 years BP) and alluvial (approx. 250 years BP to present) were determined. Sediment samples were collected and analysed for grain size and Atterberg limits. Suitable sediments were then selected to determine the optimal brick materials and their technical properties. Similarly, control bricks were prepared with ceramic pastes of local industries. The results show that the quality of the former is similar or superior to that of the latter. The initial estimates of the available resource indicate a long-term supply for the industry. Estimates of the current sedimentation rates indicate that resource renewal might occur at a rate comparable to current consumption. The sedimentation rates have increased significantly in the past two centuries - more so in the past few decades (the Anthropocene?) - with increasing human modification of geomorphic processes. If the results presented here are confirmed, a highly sustainable model can be implemented in the brick industry.Fil: Forte, Luis María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Geomorfología y Suelos; Argentina. Universidad de Cantabria; EspañaFil: Hurtado, Martín H.. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Geomorfología y Suelos; Argentina. Universidad de Cantabria; EspañaFil: Dangvas, Nauris V.. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Geomorfología y Suelos; ArgentinaFil: Couyoupetrou, Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Giménez, Jorge E.. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Geomorfología y Suelos; ArgentinaFil: Da Silva, Mario Marcelo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Instituto de Geomorfología y Suelos; ArgentinaFil: Bruschi, Viola María. Universidad de Cantabria; EspañaFil: Cendrero Uceda, Antonio. Universidad Nacional de La Plata; Argentina. Universidad de Cantabria; Españ

Proliferating Cell Nuclear Antigen (PCNA) Interactions in Solution Studied by NMR

PCNA is an essential factor for DNA replication and repair. It forms a ring shaped structure of 86 kDa by the symmetric association of three identical protomers. The ring encircles the DNA and acts as a docking platform for other proteins, most of them containing the PCNA Interaction Protein sequence (PIP-box). We have used NMR to characterize the interactions of PCNA with several other proteins and fragments in solution. The binding of the PIP-box peptide of the cell cycle inhibitor p21 to PCNA is consistent with the crystal structure of the complex. A shorter p21 peptide binds with reduced affinity but retains most of the molecular recognition determinants. However the binding of the corresponding peptide of the tumor suppressor ING1 is extremely weak, indicating that slight deviations from the consensus PIP-box sequence dramatically reduce the affinity for PCNA, in contrast with a proposed less stringent PIP-box sequence requirement. We could not detect any binding between PCNA and the MCL-1 or the CDK2 protein, reported to interact with PCNA in biochemical assays. This suggests that they do not bind directly to PCNA, or they do but very weakly, with additional unidentified factors stabilizing the interactions in the cell. Backbone dynamics measurements show three PCNA regions with high relative flexibility, including the interdomain connector loop (IDCL) and the C-terminus, both of them involved in the interaction with the PIP-box. Our work provides the basis for high resolution studies of direct ligand binding to PCNA in solution.This work was supported by the Spanish Ministry of Economic Affairs and Competitiveness (www.mineco.gob.es)grants CTQ2011-28680 to FJB and BIO2009-13265-CO2-01 to IL, and by the grant BIPEDD-CM (P-BIO-0214-2006) from Comunidad Autónoma de Madrid (www.madrid.org) to RCO. ADB was supported by a Juan de la Cierva contract from the Spanish Ministry of Economic Affairs and Competitiveness