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

Comprehensive primary health care and non-communicable diseases management: A case study of El Salvador

From PubMed via Jisc Publications RouterOne of today's greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders' perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.19pubpu

Estudi dels arbres monumentals de la Vall d'Àneu del Parc Natural de l'Alt Pirineu

Els arbres monumentals formen part del patrimoni natural, cultural i històric d'un país i com a tals són mereixedors de protecció. La Generalitat de Catalunya, sensible a aquest fet, ha regulat diferents figures de protecció per arbres que destaquen per algun motiu. Es tracta dels arbres monumentals, arbres d'interès comarcal i arbres d'interès local. Dels 194 arbres identificats i catalogats com a monumentals a Catalunya només 3 es troben a la comarca del Pallars Sobirà, en front dels, per exemple, 29 arbres catalogats a Osona. No hi ha cap arbre inventariat a la Vall d'Àneu, malgrat que és aquí on es troben la majoria de boscos vells amb exemplars de coníferes de grans dimensions. Cal destacar també que al Parc Natural de l'Alt Pirineu no hi trobem cap arbre catalogat com d'interès comarcal o d'interès local. Per aquest motiu s'ha cregut convenient aprofundir en l'estudi dels arbres monumentals, inventariant-ne els exemplars més destacats de la Vall d'Àneu i proposant-ne una categoria de protecció segons les seves característiques

Algunes idees sobre el model de producció a les badies del delta de l'Ebre

A continuació es presenta un petit resum dels treballs realitzats durant mes de dos anys a les badies del Fangar i dels Alfacs dins del projecte d'investigació: «Estudio ecológico de las bahias y lagunas del delta del Ebro>>

Polyunsaturated aldehydes from large phytoplankton of the Atlantic Ocean Surface (42ºN to 33ºS)

Polyunsaturated aldehydes (PUAs) are organic compounds mainly produced by diatoms, after cell wounding. These compounds are increasingly reported as teratogenic for species of grazers and deleterious for phytoplanktonic species, but there is still scarce information regarding concentration ranges and the composition of PUAs in the open ocean. In this study, we analyzed the spatial distribution and the type of aldehydes produced by the large-sized (>10 μm) phytoplankton in the Atlantic Ocean surface. Analyses were conducted on PUAs released after mechanical disruption of the phytoplankton cells, referred to here as potential PUAs (pPUAs). Results show the ubiquitous presence of pPUA in the open ocean, including upwelling areas, as well as oligotrophic gyres. Total pPUA concentrations ranged from zero to 4.18 pmol from cells in 1 L. Identified PUAs were heptadienal, octadienal and decadienal, with heptadienal being the most common (79% of total stations). PUA amount and composition across the Atlantic Ocean was mainly related to the nitrogen:phosphorus ratio, suggesting nutrient-driven mechanisms of PUA production. Extending the range of trophic conditions considered by adding data reported for productive coastal waters, we found a pattern of PUA variation in relation to trophic status

Asthma with bronchial hypersecretion : expression of mucins and toll-like receptors in sputum and blood

1) Define the clinical and inflammatory phenotype of asthma with bronchial hypersecretion of mucus. 2) Compare the type of mucin present in induced sputum (IS) of patients with and without bronchial hypersecretion. 3) Determine the expression of TLRs in IS and blood of asthmatics with and without bronchial hypersecretion. Cross-sectional study which included 43 non-smoking asthmatic patients without bronchiectasis, 19 with bronchiectasis, and 24 without bronchial hypersecretion. All patients underwent the following: IS, spirometry, fractional exhaled nitric oxide, prick test, total immunoglobulin E (IgE), and blood albumin. Analysis of mucins was determined by ELISA and expression of TLR2 and TLR4 by flow cytometry. The level of asthma control was determined by the Asthma Control Test (ACT) questionnaire and quality of life was assessed by the reduced version of the Asthma Quality of Life Questionnaire (mini-AQLQ). Asthmatics with bronchial hypersecretion were significantly older (62.6 years vs 48.5 years; p =0.02); had greater severity (persistent severe asthma 94.7% vs 29.2%; p =0.000); a higher proportion of nasal polyposis (36.8% vs 8.3%; p =0.022); less control of asthma (73.7% vs 8.3%; p =0,000); a higher proportion of asthma with negative prick test (68.4% vs 16.6%; p =0.001), and lower levels of IgE (113.4 IU/mL vs 448 IU/mL; p =0.007), compared with asthmatics without bronchial hypersecretion. Significant differences were observed neither in the expression of TLRs 2 and 4 in inflammatory cells of IS or peripheral blood, nor in the expression of mucins between both groups. Asthma patients with bronchial hypersecretion have more severe and uncontrolled disease, with poor quality of life as well as a non-allergic inflammatory phenotype. Within the mechanisms involving these differences, it does not appear that mucins and TLRs play an important role

High circulating SDF-1and MCP-1 levels and genetic variations in CXCL12, CCL2 and CCR5 : Prognostic signature of immune recovery status in treated HIV-positive patients

The underlying mechanisms of incomplete immune reconstitution in treated HIV-positive patients are very complex and may be multifactorial, but perturbation of chemokine secretion could play a key role in CD4 T-cell turnover. We evaluated the circulating baseline and 48-week follow-up concentrations of SDF-1/CXCL12, fractalkine/CX3CL1, MCP-1/CCL2, MIP-α/CCL3, MIP-β/CCL4 and RANTES/CCL5, and we estimated their association with CXCL12, CX3CR1, CCR2, CCL5 and CCR5 single nucleotide polymorphisms (SNPs) to investigate multiple chemokine-chemokine receptor signatures associated with immune dysregulation preceding poor immune recovery. The circulating concentrations and gene expression patterns of SDF-1/CXCL12 (CXCL12 rs1801157) and MCP-1/CCL2 (CCR2 rs1799864_814) were associated with immune recovery status. CCR2 rs1799864_814 and CCR5 rs333_814 (Δ32) determine the baseline plasma RANTES and MIP-α concentrations, respectively, in participants with poor immune response. SDF-1/CXCL12 and MCP-1/CCL2 could be considered prognostic markers of immune failure despite suppressive antiretroviral therapy. The strong linkage disequilibrium (LD) between CCR2 rs1799864_814 and CCR5 rs1800024 indicated that the alleles of each gene are inherited together more often than would be expected by chance. This work was supported by Fondo de Investigacion Sanitaria and SPANISH AIDS Research Network (ISCIII-FEDER); AGAUR and Gilead Fellowship. FV and YMP are supported by grants from the Programa de Intensificación (ISCIII) and Servicio Andaluz de Salud, respectively. JVG,EY and LR are supported by the Instituto de Salud Carlos III (ISCIII). AR is supported by Departament de Salut, Generalitat de Catalunya and by the Instituto de Salud Carlos III (ISCIII)

Dataset on the RETRO-BMC cruise onboard the R/V Hespérides, April 2017, Brazil-Malvinas Confluence

This dataset, gathered during the RETRO-BMC cruise, reports multiple-scale measurements at the Confluence of the Brazil and Malvinas Currents. The cruise was carried out between 8 and 28 April 2017 onboard R/V Hespérides, departing from Ushuaia and arriving to Santos. Along its track, the vessel recorded near-surface temperature and salinity, as well as the horizontal flow from 20 m down to about 800 m. A total of 33 hydrographic stations were completed in a region off the Patagonian Shelf, within 41.2°S-35.9°S and out to 53.0°W. At each station, a multiparametric probe and velocity sensors were deployed inside the frame of a rosette used to collect water samples at selected depths; these samples were later used for several water analyses, including inorganic nutrient concentrations. Microstructure measurements were carried out in 11 of these hydrographic stations. In addition, two high-resolution three-dimensional surveys were conducted with an instrumented undulating vehicle between 40.6°S-39.0°S and 55.6°W-53.8°W. Lastly, eight high-frequency vertical profilers were deployed in the region and five position-transmitting drifters were launched. These data allow the description of the Confluence from the regional scale to the microscale, and provide a view of the variability of the frontal region on time scales from days to weeks

Efficacy of extended infusion of β-lactam antibiotics for the treatment of febrile neutropenia in haematologic patients : Protocol for a randomised, multicentre, open-label, superiority clinical trial (BEATLE)

Altres ajuts: The BEATLE study is a non-commercial, investigator-driven clinical trial funded by the Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0005; RD16/0016/0010) The Spanish Clinical Research Network (SCReN) provides clinical trial data monitoring and oversees pharmacovigilance (PT17/0017/0010).Background: Febrile neutropaenia (FN) is a very common complication in patients with haematological malignancies and is associated with considerable morbidity and mortality. Broad-spectrum antipseudomonal β-lactam antibiotics (BLA) are routinely used for the treatment of cancer patients with FN. However, the clinical efficacy of BLA may be diminished in these patients because they present with pathophysiological variations that compromise the pharmacokinetic (PK) parameters of these antibiotics. Optimised administration of BLA in prolonged infusions has demonstrated better clinical outcomes in critically ill patients. However, there is a paucity of data on the usefulness of this strategy in patients with FN. The aim of this study is to test the hypothesis that the administration of BLA would be clinically more effective by extended infusion (EI) than by intermittent infusion (II) in haematological patients with FN. Methods: A randomised, multicentre, open-label, superiority clinical trial will be performed. Patients with haematological malignancies undergoing chemotherapy or haematopoietic stem-cell transplant and who have FN and receive empirical antibiotic therapy with cefepime, piperacillin-tazobactam or meropenem will be randomised (1:1) to receive the antibiotic by EI (during half the time of the dosing interval) in the study group, or by II (30 min) in the control group. The primary endpoint will be clinical efficacy, defined as defervescence without modifying the antibiotic treatment administered within the first 5 days of therapy. The primary endpoint will be analysed in the intention-to-treat population. The secondary endpoints will be pharmacokinetic/pharmacodynamic (PK/PD) target achievement, bacteraemia clearance, decrease in C-reactive protein, overall (30-day) case-fatality rate, adverse events and development of a population PK model of the BLA studied. Discussion: Data on the usefulness of BLA administration in patients with FN are scant. Only three clinical studies addressing this issue have been published thus far, with contradictory results. Moreover, these studies had some methodological flaws that limit the interpretation of their findings. If this randomised, multicentre, phase IV, open-label, superiority clinical trial validates the hypothesis that the administration of BLA is clinically more effective by EI than by II in haematological patients with FN, then the daily routine management of these high-risk patients could be changed to improve their outcomes. Trial registration: European Clinical Trials Database: EudraCT 2018-001476-37. ClinicalTrials.gov, ID: NCT04233996