Relationship between reduction of urban PM2.5 and mental health of middle-aged and elderly people after China's Air Pollution Prevention and Control Action Plan / 环境与职业医学

Background Epidemiological evidence indicates an association of particulate matter with depression and cognitive performance. From 2013 to 2017, China implemented the Air Pollution Prevention and Control Action Plan to reduce particulate matter concentration. There are few studies on the relationship between the decrease of particulate matter concentration and the improvement of mental health in middle-aged and elderly people. Objective To analyze the relationship between the decrease of city-level particulate matter concentration and the improvement of depression and cognitive function in the middle-aged and elderly population after the implementation of the Air Pollution Prevention and Control Action Plan. Methods Using the China Health and Retirement Longitudinal Study (CHARLS) data in 2011 and 2018, this study applied longitudinal data clustering technology to group cities based on the actual response of each city to the policy (the dynamic change trajectory of PM2.5 in each city during the study period); the higher the degree of response, the greater the reduction of PM2.5 concentration in the city. We assigned participants to three groups with different degrees of response to the policy, including low-response group A as the control group, medium-response intervention group B, and high-response intervention group C. A difference-in-differences (DID) model was used to estimate the influence of PM2.5 decline on the depression and cognitive function among middle-aged and elderly people in China by considering potential individual and city-level time-varying confounders. Depression was measured using the 10-item Center for the Epidemiological Studies of Depression Scale (CES-D10) (10 questions, total score range 0-30) with higher score representing higher severity of depression. Cognitive function was evaluated with reference to the international cognitive function test questionnaire for the middle-aged and the elderly which was further categorized into two dimensions of memory and cognitive status and included 31 questions with a score range of 0-31; the higher the score, the better the cognitive function. Samples with relatively complete outcomes were selected for analysis, including 10729 people in depression analysis and 4510 people in cognitive analysis. Results The longitudinal clustering results indicated that the urban groups with the highest decline of PM2.5 concentrations (high-response group C) had the highest baseline PM2.5 concentrations, mainly in Beijing-Tianjin-Hebei region, Chengdu-Chongqing metropolitan area, and Wuhan metropolitan area. In 2011, no significant differences were observed in depression and cognitive function among the three groups of middle-aged and elderly populations (Kruskal Wallis test: Pdepression=0.864, Pcognition=0.239). Significant differences were found in depression and cognitive function in both low-response group A and medium-response group B in 2018 compared to 2011 (paired Wilcox test, all P<0.001). However, in the high-response group C, there was no significant difference in depression in 2018 compared to 2011 (P=0.195), while a significant difference was detected in cognitive function (P=0.006). As PM2.5 concentrations decreased, the DID model showed that the depression of the middle-aged and elderly people in the high-response group C decreased by 7.55% (95%CI: 2.83%-12.03%), and the cognitive function improved by 2.70% (95%CI: 0.25%-5.22%) compared with the low-response group A. However, no intervention effect was observed in group B with moderate response level compared with group A with low response level. Conclusion After the implementation of the Air Pollution Prevention and Control Action Plan policy, the decrease of PM2.5 concentration has an ameliorative effect on the depression and cognitive function of middle-aged and elderly people in China. Given the aging population and the increasing burden of mental-related diseases in China, the promotion of environmental air pollution control has important public health implications.

A case report on SMART-EST action plan with lifestyle medicine approach in the non-pharmacologic management of the metabolic syndrome

@#Obesity and overweight are considered health risks for non-communicable diseases. Most clinical practice guidelines suggest lifestyle modification as the primary management and as an adjunct to pharmacologic treatment. Using the SMART-EST goaloriented action plan and lifestyle medicine may improve weight reduction outcomes. The case presented had clinical criteria (3/5) for metabolic syndrome, diagnosed previously as obese stage II, asthma moderately uncontrolled, prediabetes, and mild dyslipidemia. Baseline weight and waist-to-hip ratio were taken and interpreted as obese stage II with a very severe risk for comorbidity. The diagnostics used were fasting plasma glucose, lipid profile, HbA1c, and 2-D echocardiography on the eight months of intervention only. Using the SMART-EST action plan plus Lifestyle medicine approaches as non-pharmacologic management for metabolic syndrome. There was an 11.4 % reduction in weight, improved fasting glucose, lipid profile, and 2-D echocardiography within the eight months of intervention.

Antimicrobial Resistance Patterns of Bacterial Isolates from Tertiary Care Hospital of North India

Antimicrobial resistance is one of the serious health threats in the world and death due to it is projected to reach up to 10 million every year by 2050. In India, the government implemented a National Action Plan on Antimicrobial Resistance (NAP-AMR) intending to develop a laboratory-based AMR surveillance system, guidelines and practices to promote the awareness of the rational use of antibiotics in healthcare communities. In this plane, only five major hospitals are included which is not sufficient to provide the actual status of AMR. The present study focused on the AMR patterns analysis for bacteria isolated from the different health units in SSB heart and multispecialty hospital, Faridabad, Haryana. Clinically relevant samples such as pus & Body fluid, respiratory, urine and blood samples from the suspected patients were screened over a period of 5 months (February to June 2021) and AMR pattern analysis was carried out by using the disc diffusion method (Kirby–Bauer test) and interpretation was made as per the guidelines of recent Clinical and Laboratory Standards Institute. The study revealed that E. coli was the most dominated resistant bacteria. Moreover, aminoglycosides showed 55% resistance against maximum bacterial isolates from respiratory samples while fosfomycin had higher sensitivity i.e. 85% against pathogens from urine samples. The present study concluded that regular susceptibility testing should be conducted with a defined interval to detect the current trend of resistance which helps clinicians in the effective infectious disease management and leads to reducing the burden of AMR.

Achievement in prevention and control of endemic diseases in China in the past 10 years (2012-2021), challenges in the future and countermeasures / 中华地方病学杂志

In the past 10 years, remarkable progress has been made in prevention and control of endemic diseases in China through implementation of the National Plan for Prevention and Control of Endemic Diseases during the "12th Five Year Plan" and the "13th Five Year Plan" and the Three-year Action Plan for Tackling Key Problems in Prevention and Control of Endemic Diseases. Based on analysis of the monitoring data of endemic diseases in China for 10 consecutive years, this paper summarized the progress made in prevention and control of endemic diseases in China, discussed the main problems faced at present, and put forward key tasks of prevention and control of the diseases in the future.

National action plan on antimicrobial resistance: An evaluation of implementation in the World Health Organization Africa region

In line with global instruments, within the last five years, two-thirds of all countries in the WHO Africa Region (WHO AFR) have developed a National Action Plan (NAP) on Antimicrobial Resistance (AMR). We sought to evaluate progress made across the countries implementing NAP for effective response to AMR. A semi-structured survey tool was administered to obtain information from national focal persons on the implementation of strategic elements of NAP on AMR. This was followed by a Lessons Learnt Workshop in June 2019 at Douala, Cameroon, where focal persons made presentations on the country's progress. Later, a desktop review of the LLW report and other key documents was conducted. Countries in WHO AFR that have set up a national surveillance system and are enrolled into the WHO global antimicrobial resistance surveillance system have progressively increased to 30 (of 47 countries), of which 15 are already submitting surveillance data. Of the 20 countries at the Lessons Learnt Workshop, 14 have infection prevention and control (IPC) policies and functional healthcare facility IPC programs, 15 participate in the commemoration of the annual world hand hygiene days. Although almost all countries surveyed have national standard treatment guidelines, only five have incorporated the WHO AWaRe classification into the national essential medicines list. Fourteen of 20 countries have established an active/functional national secretariat/coordinating center for AMR. Discernible progress is being made on the implementation of NAP in WHO AFR region. Gaps identified in the strategic elements of action plans need to be filled for effective AMR control.

Achievement during the 13th Five-Year Plan and analysis of the 14th Five-Year Plan on prevention and control of endemic diseases in China / 中华地方病学杂志

During the 13th Five-Year Plan period, remarkable progress has been made in prevention and control of endemic diseases in China through implementation of the national plan for prevention and control of endemic diseases and the special three-year action plan for prevention and control of endemic diseases. This paper reviewed the achievements made in prevention and control of endemic diseases in China during the 13th Five-Year Plan period, discussed the current problems we are facing on prevention and control of endemic diseases. The key tasks of prevention and control of endemic diseases during the 14th Five-Year Plan period are indicated in order to carry out scientific and accurate prevention and control of endemic diseases.

Concerns children with anaphylaxis in China: Implementing China Children′s Anaphylaxis Emergency Action Plan / 中华实用儿科临床杂志

The prevalence of anaphylaxis, which is underdiagnosed and undertreated, has been increasing recently.It was reported that about one fourth of anaphylaxis patients were children and there were some critical gaps in the initial treatment of anaphylaxis, including epinephrine use, when compared to the guidelines.Since most of anaphylaxis cases happen outside of medical institutions, and could recur unexpectedly, it is important for children with anaphylaxis to get long-term management.In order to improve management of anaphylaxis, a written China Children′s Anaphylaxis Emergency Action Plan (CCAEAP) is developed.It is a tool for children and parents/caregiver to recognize the symptoms and signs of anaphylaxis as early as possible and take proper action immediately, including using a predefined dose of intramuscular epinephrine and accessing to emergency department.

Validation of the Filipino version of the written asthma action plan for 5- to 18-year-old patients

@#<p style="text-align: justify;"><strong>Background.</strong> Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation. Asthma is one of the most common chronic diseases in the world and its burden of disease is exceedingly high. According to current guidelines, the asthma action plan is a cornerstone in the management and control of asthma exacerbations. Written action plans are now recommended for all children with asthma as part of initial home management of acute wheezing episodes and exacerbations. Translating the written asthma action plan to Filipino and testing it for cultural content validity and reliability will make it useful on a wider scale in our country, help reduce morbidity, and improve asthma control in the Filipino pediatric population.</p><p style="text-align: justify;"><strong>Objectives.</strong> To perform content and cultural validation and reliability testing of the Filipino Written Asthma Action Plan (FWAAP).</p><p style="text-align: justify;"><strong>Methods.</strong> The Written Asthma Action Plan was translated to Filipino following conventional translational steps: 1) forward translation, 2) back translation, 3) pilot testing and validation, 4) final translated version. We conducted a cross-sectional study and administered the FWAAP during pilot testing among children and caregivers with asthma attending an asthma clinic.</p><p style="text-align: justify;"><strong>Results.</strong> We included 31 patients. The participants considered the FWAAP to be relevant to their disease, understandable, concise and useful in the management of asthma. The tool was shown to be highly consistent (Cronbach's alpha coefficient = 0.9235 showing that the. Seigel and Castellan's Kappa (Inter-rater or Inter-observer consistency) showed inter-rater agreement of 0.9615 (kappa of 0.7787) and 0.923 (kappa of 0.8846) respectively showing adequate inter-rater agreement.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The Filipino asthma action plan is a reliable and valid tool for managing asthma in the home setting.</p>

Antimicrobial resistance in the environment: The Indian scenario

Antimicrobial resistance (AMR) continues to pose a significant public health problem in terms of mortality and economic loss. Health authorities of several countries including India have formulated action plans for its containment. In this fight against AMR, it is important to realize the contribution by all the following four spheres: humans, animals, food and environment. This review incorporates all the spheres of One Health concept from the Indian perspective. India has one of the highest rates of resistance to antimicrobial agents used both in humans and food animals. The environment, especially the water bodies, have also reported the presence of resistant organisms or their genes. Specific socio-economic and cultural factors prevalent in India make the containment of resistance more challenging. Injudicious use of antimicrobials and inadequate treatment of waste waters are important drivers of AMR in India. Use of sludge in agriculture, improper discard of livestock animals and aquaculture industry are considered AMR contributors in other countries but Indian data regarding these are lacking. Efforts to combat AMR have been initiated by the Indian health authorities but are still at preliminary stages. Keeping in view the challenges unique to India, future directions are proposed.

Progress and prospects of application of Children Asthma Action Plan / 国际儿科学杂志

The Children Asthma Action Plan is a personalized asthma management document devel-oped by clinicians for children with asthma. It can help school and their parents identify early signs of acute asth-ma attacks and take appropriate measures to prevent or reduce the serious deterioration of asthma. It can reduce the number of acute episodes of children, the number of emergency medical visits, the absence days of children and missing work days of parents, improve medication compliance, enhance the confidence of disease treat-ment, and thus improve the control level of asthma. However, in clinical practice, the application of the Chil-dren Asthma Action Plan is not ideal. This review summarizes the specific meanings, contents and forms of evo-lution, the purpose and significance of implementation, and the common problems and solutions in the promotion.

Gestión del conocimiento para mejorar los servicios de salud. Una visión para IMIA-LAC / Knowledge management to improve health services. A vision for IMIA-LAC

Introducción: La generación de mecanismos de aplicación del conocimiento en el desarrollo de nuevos productos y procesos e incluso de nuevas formas de organización social es el recurso fundamental en la Sociedad de la Información -Conocimiento. Objetivo: Proponer tareas para concertar, a través de IMIA-LAC, los atributos de las herramientas informáticas y los procesos que caracterizan la Gestión del Conocimiento. Método: Se revisaron los sitios de IMIA e IMIA-LAC para obtener información sobre el desarrollo de esa organización en el mundo. Utilizando estrategias de búsqueda se obtuvo la información necesaria para vincular la estrategia gerencial de gestión del conocimiento con el desarrollo alcanzado, de las aplicaciones informáticas y de los procesos de informatización de los servicios de salud. Resultados: Se argumenta una propuesta de Planes de Acción para potenciar el desarrollo a través de IMIA-LAC: a) Estrategias dirigidas desde la organización, por ejemplo mejorar la identidad corporativa de esta b) Estrategias dirigidas a la búsqueda de mejoras en los servicios de salud, usando los vínculos efectivos con organizaciones claves en el sector Conclusiones: Se proponen un conjunto de acciones para concertar los procesos que caracterizan la Gestión del Conocimiento a través de IMIA-LAC utilizando las herramientas informáticas(AU)

Introduction: Generating mechanisms for applying knowledge in the development of new products, processes and new forms of social organization is the fundamental resource in the Information-Knowledge Society. Objective: Propose tasks to arrange, through IMIA-LAC, the attributes of IT tools and processes that characterize Knowledge Management. Methods: The IMIA and IMIA-LAC sites were reviewed to obtain information about the work of that organization in the world. Using search strategies the necessary information was obtained to link the managerial strategy of knowledge management with the development achieved of the computer applications and of the computerization processes of the health services. Results: A proposal of Plans of Action is argued to promote the development through IMIA-LAC: a) Strategies directed from the organization, for example to improve the corporate identity of this b) Strategies directed to the search of improvements in the health services, using effective links with key organizations in the sector. Conclusions: A set of actions are proposed to coordinate the processes that characterize the Knowledge Management through IMIA-LAC using the computer tools(AU)

Management of asthma in adults in primary care

@#Asthma is a chronic inflammatory disease of the airway which is often misdiagnosed and undertreated. Early diagnosis and vigilant asthma control are crucial to preventing permanent airway damage, improving quality of life and reducing healthcare burdens. The key approaches to asthma management should include patient empowerment through health education and selfmanagement and, an effective patient-healthcare provider partnership.

Monitorização dos pontos críticos de controle na preparação de lanches tratados termicamente / Monitoring of critical control points in the preparation of heat-treated snacks

A Organização Mundial da Saúde (OMS) refere que, das doenças de origem alimentar, mais de 60% dos casos são decorrentes de técnicas inadequadas de processamento e por alimentos contaminados servidos em restaurantes. O objetivo deste t rabalho foi a elaboração de um plano APPCC, a partir da monitorização da temperatura de alimentos considerados críticos no processo de produção de lanches tratados termicamente em duas Unidades de Alimentação Coletiva, localizadas no estado do RS e SC respectivamente. Trata-se de um estudo de caráter observacional. A monitorização dos Pontos Críticos de Controle (PCC) seguiu os setes princípios básicos estabelecidos pelo Codex Alimentarius. Concluiu- se que os resultados desta pesquisa indicam falhas no controle da temperatura de alguns alimentos durante o processo de produção dos lanches, sendo necessário analisar os PCC e elaborar um plano de ação em busca da solução dos problemas encontrados.

The World Health Organization (WHO) states that the food-borne diseases, over 60% of cases are due to inadequate processing techniques and contaminated food served in restaurants. The objective of this work was the development of a HACCP plan, from the temperature monitoring of food considered critical in snacks production process thermally treated in two Collective Power Units, located in the state of RS and SC respectively. This is an observational study. Monitoring of PCCs followed the seven basic principles established by the Codex Alimentarius. It was concluded that the results of this research indicate failures in the temperature control of some food during the snacks production process, being necessary to analyze the Critical Control Points (CCP) and draw up an action plan seeking the solution of the problems encountered.

Assessment of Barangay Nutrition Action Plan (BNAP) implementation in selected municipalities in Ifugao, Bulacan, Siquijor: Barangay nutrition scholar's perspectives

INTRODUCTION: The Barangay Nutrition Action Plan (BNAP) is the local version of the Philippine Plan of Action for Nutrition (PPAN), the country's directional framework for nutrition improvement. The Barangay Nutrition Scholars (BNS) spearhead the BNAP implementation.OBJECTIVE: To assess the implementation of BNAP in selected municipalities with high and low prevalence of undernutrition in the province of Ifugao, Bulacan, and Siquijor.MATERIALS AND METHODS: Qualitative method of data collection was employed to assess the BNAP formulation and implementation. A total of 57 BNS consented to participate in a focus group discussion.RESULTS: This paper presents the BNS perspectives on how BNAP is formulated and implemented in their barangays. While program elements that distinguish the low and high prevalence municipalities were observed, unique program elements, which may explain the program impact in terms of of children's nutritional status, cannot be isolated. BNS' perception of the program inputs that contributed to the positive outcome of the BNAP implementation are as follows: political support, functional barangay nutrition committees, support and guidance from their supervisors, and their high credibility in the community as source of nutrition information that serves as their inspiration and motivation. The perceived program processes that contributed to improving the nutritional status of children in the community, are as follows: the presence of inter-agency collaboration, collective formulation of the BNAP, BNS' resourcefulness and innovativeness in soliciting support from other BNC member agencies.DISCUSSION AND RECOMMENDATIONS: Across all municipalities, the BNS shared similar program inputs and processes that they perceived can contribute to improved BNAP implementation. They shared similar recommendations ranging from increased budgetary support for nutrition activities, more incentives for BNS (both monetary and non-monetary), security of tenure as BNS and cooperation from the community beneficiaries in their barangays. In high prevalence municipalities, BNS hope that the NNC will take notice of their problems particularly those that relate to BNAP implementation. Majority hopes that their appointment be apolitical to ensure their security of tenure. Some proposed that their Barangay Chairs be oriented on BNAP, BNC, BNS and their important roles in BNAP implementation. Recommendations to improve BNAP implementation included: political support to ensure funding of BNAP, functional BNC, continuous guidance from their supervisors, continuous BNS capacity building to enhance their program management skills and to enable them to effectively promote inter-agency collaboration and sustained advocacy at the national level for the passage of the Magna Carta for BNS that will increase their allowance and provide them with opportunities to upgrade technical capability to efficiently plan and manage local nutrition programs. 

A community based model for effective malaria control in a known endemic area of a metropolitan city.

Background: Malaria is a global health problem causing impact on Health and socio economic development of country. Mumbai city with high density population is endemic region with unstable malaria transmission. Surveillance data of malaria cases in tertiary care hospital indicated the need for strategic plan for community based effective interventions. This highlights sharing information, strengthening community partnerships and a structured plan for malaria control in addition to the regular surveillance activities of public health department. Methods: 2 city zonal areas (wards) having high prevalence of malaria cases and deaths in the previous year were identified as study units. One of the 2 wards was designated as control unit where no interventions (were executed by the investigator). In study area activities were implemented in three phases. 1) Preparatory - baseline epidemiological survey, enlistment of risk factors. 2) Interventional - enlistment and elimination of breeding places, mobilizing supportive community participation, team building with PSM department faculty, public health department staff, general practitioners, youth club members and the co-operative societies. 3) Evaluation - compliance of housing societies, analysis of indicators& comparison of prevalence with previous year. Results: In study area no deaths are reported in 2010. 12 deaths in 2010 in control area. Also number of malaria cases in 2010 in study area were drastically reduced as compared to 2009. Conclusions: Malaria control is essentially a multidimensional event dependant on active community participation. Malaria control cannot be achieved in isolation by singular efforts of the Public Health Department alone. A community based multipronged approach is necessary for malaria control in urban area.

Examples of Holistic Good Practices in Promoting and Protecting Mental Health in the Workplace: Current and Future Challenges

BACKGROUND: While attention has been paid to physical risks in the work environment and the promotion of individual employee health, mental health protection and promotion have received much less focus. Psychosocial risk management has not yet been fully incorporated in such efforts. This paper presents good practices in promoting mental health in the workplace in line with World Health Organization (WHO) guidance by identifying barriers, opportunities, and the way forward in this area. METHODS: Semistructured interviews were conducted with 17 experts who were selected on the basis of their knowledge and expertise in relation to good practice identified tools. Interviewees were asked to evaluate the approaches on the basis of the WHO model for healthy workplaces. RESULTS: The examples of good practice for Workplace Mental Health Promotion (WMHP) are in line with the principles and the five keys of the WHO model. They support the third objective of the WHO comprehensive mental health action plan 2013e2020 for multisectoral implementation of WMHP strategies. Examples of good practice include the engagement of all stakeholders and representatives, science-driven practice, dissemination of good practice, continual improvement, and evaluation. Actions to inform policies/legislation, promote education on psychosocial risks, and provide better evidence were suggested for higher WMHP success. CONCLUSION: The study identified commonalities in good practice approaches in different countries and stressed the importance of a strong policy and enforcement framework as well as organizational responsibility for WMHP. For progress to be achieved in this area, a holistic and multidisciplinary approach was unanimously suggested as a way to successful implementation.

Plan de acción para la preservación documental en la biblioteca del Policlínico Norte del municipio Florida, Camagüey / Action Plan for document preservation at the library of the North Polyclinic in Florida, Camaguey

Objetivo: elaborar un plan de acción que contribuya a la preservación documental en la biblioteca del Policlínico Norte, de Florida, en Camagüey. Métodos: se realizó un estudio de evaluación durante los meses de marzo a junio de 2012. Se aplicó el método de análisis documental a una muestra de 325 documentos monográficos, con el propósito de identificar el grado de deterioro físico de la colección. Resultados: la observación permitió diagnosticar las condiciones de almacenamiento. Se aplicó también una matriz DAFO como instrumento gerencial. El fondo bibliográfico mostró elevados niveles de deterioro. Las condiciones de almacenamiento no propiciaban la preservación documental. Conclusiones: Se constató el predominio de las debilidades sobre las fortalezas, así como de las amenazas sobre las oportunidades, lo que ubica a la unidad en el cuarto cuadrante de la matriz. De acuerdo con esto, se propone un conjunto de acciones que eviten el incremento del deterioro

Objective: to develop an action plan that contributes to the documentary preservation at the Library of North Polyclinic in Florida, Camagüey. Methods: an evaluation study was conducted from March to June 2012. The method of document analysis to a sample of 325 case records was applied in order to identify the degree of physical deterioration of the collection. The observation led to the diagnosis of storage conditions. A SWOT matrix was also applied as a management tool. Results: the bibliographic showed high levels of impairment. Storage conditions were not conducive to documentary preservation. The predominance of the weaknesses of the strengths was found, as well as threats of the opportunities, which placed the unit in the fourth quadrant of the matrix. Accordingly a set of actions that prevent increased deterioration is proposed. The bibliographic showed high levels of impairment. Storage conditions were not conducive to preservation documentary. Conclusions: the predominance of weaknesses over strengths was found, as well as threats over opportunities, which places this unit in the fourth quadrant of the matrix. Accordingly a set of preventing against increased deterioration is proposed

Plan de acciones para potenciar el funcionamiento docente-educativo del Diplomado de Dirección en Salud / An action plan to potentiate the teaching-learning work in the Health Direction Course

Se realizó una investigación cualitativa en el Centro Provincial de la Escuela Nacional de Salud Pública en Villa Clara, curso 2010_2011, para diseñar un plan de acciones que eleve la calidad del Diplomado de Dirección en Salud. La muestra estuvo conformada por 13 profesores del claustro, 20 cursistas y tres profesores experimentados como informantes claves. Se aplicaron encuestas, guías de observación, entrevistas y análisis de documentos, y se aplicó la técnica participativa "lluvia de ideas" a informantes claves para conocer el estado actual del funcionamiento del objeto de estudio. Se comprobó que existen dificultades que atentan contra la ejecución correcta del diplomado y se proponen acciones a partir de objetivos. La planificación, ejecución, evaluación, sistematización y socialización de ellas contribuyen a fomentar elementos medulares en la formación de los directivos del sistema, a fin de propiciar cambios organizacionales para la excelencia en la dirección de los servicios de salud.

A qualitative research work was carried out in the provincial center of the National Health School in Villaclara, in the academic course 2010-2011, to design an action plan to elevate the quality of the Health Direction Course. The sample was comprised by 13 teachers, 20 students and three experienced professors. Different techniques were applied among them we can find surveys, observation guidelines, interviews and review of documents. A brain storming technique was applied to the experienced professors to know about the functioning of the object of study. It was tested that there are difficulties that interfere in the development of the course. That´s why actions are proposed taking into account the objectives stated. The planning, execution, evaluation, systematization and socialization of these actions contribute to spread out key elements in the formation of the managers of the system, so as to apply organizational changes which contribute to excellence in the health services management.

Educación en los programas de rehabilitación respiratoria de los pacientes con enfermedad pulmonar obstructiva crónica / Education in pulmonary rehabilitation programs for patients with chronic obstructive pulmonary disease

Education is considered a core component of pulmonary rehabilitation. Rather than to simply provide didactic education, the recommendation now is to promote self-efficacy through teaching self-management skills (quality evidence B, moderate recommendation). The main components of self-management education are the use of action plan for early treatment of exacerbations, breathing strategies and bronchial hygiene techniques and the adherence to exercise at home. There still need of evidence about which mechanisms of self-management education have the most perdurable effects.

La educación es considerada un componente central de la rehabilitación pulmonar. En vez de entregar educación orientada a la mera entrega de conocimientos la tendencia actual es propiciar la autoeficacia del paciente dando especial énfasis a la enseñanza de las habilidades del autocuidado (calidad de la evidencia B, fuerza de la recomendación moderada). Los principales componentes de la educación en el autocuidado son: el reconocimiento y tratamiento precoz de las exacerbaciones agudas mediante el uso de su propio "plan de acción", las técnicas de respiración y de drenaje bronquial y la enseñanza orientada a fortalecer la adherencia a los programas de ejercicio en el hogar. Aún faltan estudios que demuestren cuales son los mecanismos más efectivos para lograr que la educación en el autocuidado tenga efectos perdurables en el tiempo.

Estrategia FIGO para la prevención del aborto inseguro: experiencia en Colombia / Experience in Colombia regarding the FIGO strategy for preventing unsafe abortion

Objetivo: analizar la situación del aborto inseguro en Colombia para establecer: consecuencias, factores determinantes y calidad de la atención e identificar los puntos susceptibles de intervención, para elaborar un plan de acción tendiente a reducir los embarazos no deseados, abortos provocados y sus consecuencias. Materiales y métodos: estudio cualitativo con un componente de revisión de material bibliográfico y otro de consenso de expertos. Se llevó a cabo en dos fases. En la fase 1, de análisis situacional, se recolectó información mediante el formato elaborado por el grupo de trabajo de FIGO (Federación Internacional de Ginecología y Obstetricia). En la fase 2, de elaboración del plan de acción utilizando un marco lógico, se reunieron los representantes de OPS (Organización Panamericana de la Salud), UNFPA (Fondo de Población de las Naciones Unidas), filiales de IPPF (Federación Internacional de Planificación Familiar), ONG locales y agencias del gobierno. Resultados: el análisis situacional se resume en tres ejes: embarazo no deseado, intervenciones para su prevención y aborto. En el plan de acción se definieron cuatro objetivos específicos: mejorar el acceso a los servicios de salud sexual y reproductiva; facilitar el acceso a la interrupción voluntaria del embarazo acorde con la Sentencia C-355 de 2006; promover el acceso al misoprostol para usos ginecoobstétricos; y mejorar la información sobre tasas y complicaciones asociadas al aborto inseguro. Conclusión: a pesar del avance en Colombia con la Sentencia C-355 de 2006, aún persisten grandes retos, tales como reglamentar opciones de fácil acceso al servicio de interrupción voluntaria del embarazo para mujeres víctimas del conflicto armado, protocolos de investigación al interior de los tribunales de ética médica para los asuntos relacionados con objeción de conciencia, clarificar la autonomía y capacidad de menores de catorce años.

Objective: analyzing the situation regarding unsafe abortion in Colombia for establishing its consequences, determinant factors and the quality of attention as well as identifying susceptible intervention points for preparing a action plan aimed at reducing unwanted pregnancies, provoked abortions and their consequences. Materials and methods: this was a qualitative study, having a bibliographic material review component and another regarding expert consensus. It was carried out in two phases: 1. A situational analysis: information was compiled by using a form drawn up by the International Federation of Gynecology and Obstetrics (FIGO) working group; and 2. Preparing an action plan using a logical framework. A meeting was held with representatives from the Pan-American Health Organization (PAHO), the United Nations Population Fund (UNFPA), International Planned Parenthood Federation (IPPF) affiliates, local NGOs and government agencies. Results: the situational analysis revealed three areas of interest: unwanted pregnancy, prevention interventions and abortion. Four specific objectives were defined in the action plan: a) Improving access to sexual and reproductive health services; b) Facilitating access to voluntary interruption of pregnancy according to ruling C-355/2006; c) Promoting access to misoprostol for gynecobstetric use; and d) Improving information about unsafe abortion associated rates and complications. Conclusion: in spite of advances having been made in Colombia via ruling C-355/2006, there are still great challenges to be faced, such as establishing regulations for female victims of armed conflict, options for gaining easy access to the voluntary interruption of pregnancy service, research protocols within medical ethics’ tribunals for matters related to conscientious objection, clarifying the autonomy and ability of minors aged less than fourteen.