La filosofía y la práctica del Taiji Quan en la vida diaria

Después de señalar que la filosofía taoísta es básicamente una filosofía práctica, se abordan someramente algunos aspectos del Taiji Quan, arte marcial que busca la armonización del ser

Los medicamentos esenciales en México: el caso de los medicamentos genéricos

México no desarrolla sus políticas de salud de manera aislada. En el año 2011 la Organización mundial de la Salud (OMS), a través de su directora Margaret Chan, expresó que: “Los países podrían ahorrarse alrededor de un 60% de gastos farmacéuticos si en lugar de medicamentos originales comprasen productos genéricos” . La Constitución Política de los Estados Unidos Mexicanos contempla el derecho a la salud en su artículo 4o y la premisa principal de este artículo se ha mantenido constante desde su primera publicación en 1917. En el año de 1997 cuando los medicamentos genéricos fueron distribuidos en el mercado mexicano no existía una norma técnica que describiera las pruebas y los procedimientos a los que debía someterse un medicamento para ser considerado genérico. Dichas pruebas fueron establecidas en la NOM-177-SSA1-1998 Que establece las pruebas y procedimientos para demostrar que un medicamento es intercambiable. Requisitos a que deben sujetarse los terceros autorizados, que entró en vigor hasta 1999. Este capítulo revisa la historia e impacto de los medicamentos esenciales y los medicamentos genéricos en nuestro país

Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches

CITATION: Langlois, E. V., et al. 2016. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches. Health Research Policy and Systems, 14:20, doi:10.1186/s12961-016-0089-0.The original publication is available at http://health-policy-systems.biomedcentral.comENGLISH SUMMARY : Background: There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings. Methods: The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals’ abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a ‘buddying’ process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design. Results: In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge. Conclusions: The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems.http://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0089-0Publisher's versio

Embedded implementation research determinants in Latin American health systems

OBJECTIVE: To assess the determinants of embedded implementation research (EIR) conduct in seven Latin American and Caribbean countries. METHODS: This qualitative interpretative study conducted and analyzed 14 semi-structured interviews based on a grounded theory approach using Atlas-ti© 7.5.7. We grouped the conditions appointed by interviewees as determinants of EIR conduct into six domains. RESULTS: The participation of high-level engaged decision makers as research co-producers is an important EIR determinant that fosters research use. Nevertheless, EIR faces challenges such as dealing with key personnel changes and fluctuating political contexts. CONCLUSIONS: Despite its limitations, EIR is effective in creating a sense of ownership of research results among implementers, which helps bridge the gap between research and decision-making in health syste

Historia de la regulación de los medicamentos genéricos en México: 1977 a la fecha

Esta es una revisión del desarrollo histórico de la legislación en materia de medicamentos genéricos en México, con especial énfasis en la evolución del Cuadro Básico de Medicamentos desde 1975 hasta la actualidad y en la Norma Oficial Mexicana 177 versiones 1998 y 2013. Se discute también el impacto que tienen estos insumos para la salud en la economía nacional, puesto que México está considerado como el primer exportador de medicamentos en América Latina. Se revisa el uso de la prueba in vitro de disolución como una herramienta necesaria tanto en la fase de investigación y desarrollo, como en la de la producción industrial de medicamentos. Asimismo, se revisa el sistema de clasificación biofarmacéutica, un modelo que puede ser usado como guía para definir una prueba de intercambiabilidad. Los medicamentos genéricos son un insumo de especial importancia para el Estado mexicano porque son un elemento clave para abatir el gasto en salud pública

Subculturas en adolescentes de Ciudad Nezahualcóyotl: prácticas de riesgo para la salud

Los adolescentes en la búsqueda de identidad, aceptación y construcción de su imaginario, transitan a través de un mundo lleno de construcciones sociales hechas por otros coetáneos, que moldearan su inclusión social dentro de estos grupos o subgrupos, en ese sentido las aglomeraciones adolescentes tiene una identidad, llena de códigos, símbolos, conductas y reglas, que en muchos de los casos son estigmatizadas sin haberse estudiado, por lo cual el conocer los tipos más comunes de grupos o subgrupos y su relación con las conductas de riesgo para la salud, es adentrarnos al fenómeno social que vive, el adolescente de Ciudad Nezahualcóyotl.Introducción: La adolescencia es un fenómeno psicológico que se ve determinado por la pubertad, pero no se reduce a ella, aquí radican aspectos socioculturales que en la búsqueda de una identidad se ven inmersos en fenómenos de: prácticas, códigos, símbolos, valores, que instauran en ocasiones conductas de riesgo. Materiales y métodos: Es un estudio transversal analítico, de 1,139 adolescentes entrevistados en Ciudad Nezahualcóyotl, a través de instrumento de medición que aportó información sobre las variables de determinación social para la salud asociando a la subcultura. Las variables de determinación social fueron: la subcultura, rango de edad en las subculturas, género, estado civil, consumo de drogas, ocupación de los adolescentes, arrestos policiacos. Resultados: Se encontró que las “subculturas” más destacadas en Ciudad Nezahualcóyotl son: reguetoneros 36.4%, fresas 24.1%, skate 9%, punk 5.9%, metalero 4.5%, B-Boy 4.3%, raperos 4%, reggae 3.3, dark 3%, cholos 2.3% y góticos 2%; en todas las subculturas existe el consumo de drogas legales e ilegales como práctica de asociación juvenil, además existe un alto índice de práctica sexual, baja utilización de métodos de planificación familiar y servicios de salud. Las subculturas reguetonero, fresa y cholo se encontró correlación directa con embarazo adolescente y número de hijos. Conclusiones: No se pretende estigmatizar a las subculturas, ni señalar que grupos tiene menos prácticas de riesgo, el adentrarnos en estas subculturas es conocer como profesionales de la salud, que la adolescencia es una etapa de transición en busca de una identidad, en la cual convergen prácticas de riesgo para la salud, en las cuales podríamos incidir para estilos de vida saludables

Effects of ITO based back contacts on Cu(In,Ga)Se2 thin films, solar cells, and mini-modules relevant for semi-transparent building integrated photovoltaics

This study presents the results of the development of semi-transparent Cu(In,Ga)Se2 (CIGSe) mini-modules for the application in building integrated photovoltaics (BIPV). Applying in-situ X-ray diffraction in real-time during CIGSe growth we find that the bulk of indium-tin-oxide (ITO), acting as the transparent back contact, is chemically stable in CIGSe processing. CIGSe layers grown on reactively sputtered ITO (Ar/O2 flux ratio = 60:1) or on ITO annealed in ambient air have a pro-portionally higher (220/204) orientation compared to CIGSe layers grown on as fabricated ITO sputtered solely by Ar. However, independent from the fabrication and annealing state of the ITO back contact, after CIGSe deposition at high substrate temperatures >= 600 degrees C accumulation of Ga at the CIGSe/ITO back contact interface combined with reduced solar cell efficiency is observed. This Ga accumulation visible in elemental depth profiles is attributed to the formation of gallium -oxide (GaOx). Applying a very thin (approximate to 10-30 nm) functional molybdenum layer in between CIGSe and the ITO back contact inhibits the formation of GaOx. Based on this Mo/ITO back contact configuration semi-transparent 10 x 10 cm2 mini-modules with 14 cells interconnected in series have been fabricated. Module parameters resulted in a fill factor of 63% and >12% in efficiency. The solar active coverage of the modules amounts to approximate to 70%, and the average visible transmittance (in the range 380-780 nm) of the transparent sections was 27.6% (9.6% for the total area of the device). Optimisation of the Mo/ITO contact allows increasing this transparency to values > 50%. Long-term outdoor testing of a semi-transparent module prototype reveals no degradation in electric output power for 3 months, demonstrating the device stability under changing climatic conditions

Perspectives on the methods of a large systematic mapping of maternal health interventions.

BACKGROUND: Mapping studies describe a broad body of literature, and differ from classical systematic reviews, which assess more narrowly-defined questions and evaluate the quality of the studies included in the review. While the steps involved in mapping studies have been described previously, a detailed qualitative account of the methodology could inform the design of future mapping studies. OBJECTIVES: Describe the perspectives of a large research team on the methods used and collaborative experiences in a study that mapped the literature published on maternal health interventions in low- and middle-income countries (2292 full text articles included, after screening 35,048 titles and abstracts in duplicate). METHODS: Fifteen members of the mapping team, drawn from eight countries, provided their experiences and perspectives of the study in response to a list of questions and probes. The responses were collated and analysed thematically following a grounded theory approach. RESULTS: The objectives of the mapping evolved over time, posing difficulties in ensuring a uniform understanding of the purpose of the mapping among the team members. Ambiguity of some study variables and modifications in data extraction codes were the main threats to the quality of data extraction. The desire for obtaining detailed information on a few topics needed to be weighed against the benefits of collecting more superficial data on a wider range of topics. Team members acquired skills in systematic review methodology and software, and a broad knowledge of maternal health literature. Participation in analysis and dissemination was lower than during the screening of articles for eligibility and data coding. Though all respondents believed the workload involved was high, study outputs were viewed as novel and important contributions to evidence. Overall, most believed there was a favourable balance between the amount of work done and the project's outputs. CONCLUSIONS: A large mapping of literature is feasible with a committed team aiming to build their research capacity, and with a limited, simplified set of data extraction codes. In the team's view, the balance between the time spent on the review, and the outputs and skills acquired was favourable. Assessments of the value of a mapping need, however, to take into account the limitations inherent in such exercises, especially the exclusion of grey literature and of assessments of the quality of the studies identified

Mapping of research on maternal health interventions in low- and middle-income countries: a review of 2292 publications between 2000 and 2012.

BACKGROUND: Progress in achieving maternal health goals and the rates of reductions in deaths from individual conditions have varied over time and across countries. Assessing whether research priorities in maternal health align with the main causes of mortality, and those factors responsible for inequitable health outcomes, such as health system performance, may help direct future research. The study thus investigated whether the research done in low- and middle-income countries (LMICs) matched the principal causes of maternal deaths in these settings. METHODS: Systematic mapping was done of maternal health interventional research in LMICs from 2000 to 2012. Articles were included on health systems strengthening, health promotion; and on five tracer conditions (haemorrhage, hypertension, malaria, HIV and other sexually transmitted infections (STIs)). Following review of 35,078 titles and abstracts in duplicate, data were extracted from 2292 full-text publications. RESULTS: Over time, the number of publications rose several-fold, especially in 2004-2007, and the range of methods used broadened considerably. More than half the studies were done in sub-Saharan Africa (55.4 %), mostly addressing HIV and malaria. This region had low numbers of publications per hypertension and haemorrhage deaths, though South Asia had even fewer. The proportion of studies set in East Asia Pacific dropped steadily over the period, and in Latin America from 2008 to 2012. By 2008-2012, 39.1 % of articles included health systems components and 30.2 % health promotion. Only 5.4 % of studies assessed maternal STI interventions, diminishing with time. More than a third of haemorrhage research included health systems or health promotion components, double that of HIV research. CONCLUSION: Several mismatches were noted between research publications, and the burden and causes of maternal deaths. This is especially true for South Asia; haemorrhage and hypertension in sub-Saharan Africa; and for STIs worldwide. The large rise in research outputs and range of methods employed indicates a major expansion in the number of researchers and their skills. This bodes well for maternal health if variations in research priorities across settings and topics are corrected