Financiamiento en investigación en salud: obteniendo financiamiento. Consejos útiles para aumentar las chances de éxito. Parte 2 / Health research funding: obtaining grants. Tips to improve the success rate. Part 2

Esta es la segunda parte de un artículo sobre la búsqueda de financiamiento para un proyecto de investigación. Todo proyecto de investigación requiere una fuente de financiamiento para poder ser llevado adelante. La búsqueda de fondos es una tarea que lleva tiempo y esfuerzo con una baja tasa de éxito. Compartimos algunos consejos que podrían ayudar a aumentar esa tasa de éxito en relación con: 1) cómo reconocer la necesidad de búsqueda de una fuente de financiamiento externo, 2) de dónde provienen los fondos, 3) qué gastos se pueden financiar habitualmente con los fondos y 4) cómo mejorar la escritura y la presentación a una convocatoria. (AU)

This is the second part of our series on searching funds for a research plan. Every research proposal requires a source of funding to be carried out. Looking for funds is a time and effort consuming task with a low success rate. We share some tips that may help to improve that success rate related to (1) how to recognize the need of an external funding source, (2) where the funds are coming from, (3) what costs can be funded and (4) how to improve a proposal writing and submission. (AU)

Financiamiento en investigación: ¿qué necesito antes de comenzar a buscar una fuente de financiamiento?: parte 1 / Research funding: what do I need before I start looking for a funding source?: part 1

Esta es la primera parte de un artículo sobre la búsqueda de financiamiento para un proyecto de investigación. Esta entrega resume los principales ítems para tener en consideración a la hora de postularse a una convocatoria. Requerimientos del proceso: 1. Tiempo protegido. 2. Propuesta de investigación sólida. 3. Equipo calificado y con experiencia. 4. Definición y organización de actividades. 5. Cronograma de actividades. 6. Estimación de costos. (AU)

This is the first part of an article about finding funding for a research project. This delivery summarizes the main ítems to take into consideration when applying for a call. Process requirements: 1. Protected time. 2. Strong research proposal. 3. Qualified and experienced team. 4. Definition and organization of activities. 5. Schedule of activities. 6. Cost estimate. (AU)

Workaholism among stricto sensu graduate nursing professors in Brazil / Workaholism entre docentes de pós-graduação stricto sensu em enfermagem no Brasil / Workaholism entre los docentes de posgrado en enfermería de stricto sensu en Brasil

Objective: to identify the prevalence and factors associated with workaholism among stricto sensu graduate nursing professors. Method: a cross-sectional study with 333 professors of master's/doctorate degrees from 47 Brazilian public universities. Participants answered a characterization questionnaire and the Dutch Work Addiction Scale, which were analyzed descriptively and by multiple logistic regression. Results: the prevalence of workaholism was 10.5%. The factors associated with the dimensions of workaholism were: having a marital relationship, being dissatisfied with work and sleep, indicating low ability to concentrate and few leisure opportunities, belonging to Graduate Programs with grades 3, 4 and 5, receiving a research productivity grant, considering the influence of work on life as negative, showing difficulty in combining work with personal life, to present work-related anxiety, feel pressure for scientific publishing, elaborate more than 11 articles simultaneously, give more than 21 opinions in the last year, work an extra 11 hours a week in addition to the work schedule and dedicate less than 10 hours a week to graduate school. Conclusion: there is an indication of workaholism in the investigated professors, and the associated factors were related to working conditions and requirements. Universities must adhere to management models that include occupational health promotion.

Objetivo: identificar a prevalência e os fatores associados ao workaholism entre docentes de pós-graduação stricto sensu em enfermagem. Método: estudo transversal com 333 docentes enfermeiros de mestrado/doutorado de 47 universidades públicas brasileiras. Os participantes responderam a um questionário de caracterização e a Dutch Work Addiction Scale, que foram analisados descritivamente e por regressão logística múltipla. Resultados: a prevalência de workaholism foi de 10,5%. Os fatores associados às dimensões do workaholism foram: possuir relacionamento conjugal, estar insatisfeito com trabalho e sono, indicar baixa capacidade de concentração e poucas oportunidades de lazer, pertencer aos Programas de Pós-graduação com conceitos 3, 4 e 5, receber bolsa produtividade em pesquisa, considerar a influência negativa do labor sobre a vida, mostrar dificuldade de compatibilizar trabalho com vida pessoal, apresentar ansiedade laboral, sentir pressão para realizar publicação científica, elaborar mais de 11 artigos concomitantemente, emitir mais de 21 pareceres no último ano, desenvolver mais de 11 horas semanais além do regime de trabalho e dedicar menos de 10 horas semanais à pós-graduação. Conclusão: há indicativo de workaholism nos docentes investigados e os fatores associados estiveram relacionados às condições e exigências laborais. As universidades devem aderir aos modelos gerenciais que englobem a promoção de saúde ocupacional.

Objetivo: identificar la prevalencia y los factores asociados con el workaholism entre los docentes de posgrado stricto sensu en enfermería. Método: estudio transversal con 333 docentes de maestría/doctorado de 47 universidades públicas brasileñas. Los participantes respondieron un cuestionario de caracterización y la Dutch Work Addiction Scale que se analizaron descriptivamente y mediante regresión logística múltiple. Resultados: la prevalencia de adicción al trabajo fue del 10,5%. Los factores asociados con las dimensiones de la adicción al trabajo fueron: tener una relación matrimonial, estar insatisfecho con el trabajo y el sueño, lo que indica una baja capacidad de concentración y pocas oportunidades de ocio, pertenecer a los programas de posgrado con los conceptos 3, 4 y 5, recibir una subvención de productividad, considerar la influencia negativa del trabajo en la vida, mostrar dificultades para combinar el trabajo con la vida personal, experimentar ansiedad laboral, sentir presión para realizar publicaciones científicas, elaborar más de 11 artículos simultáneamente, emitir más de 21 opiniones en el último año, desarrollar más de 11 horas a la semana además del régimen de trabajo y dedicar menos de 10 horas a la semana al posgrado. Conclusión: hay una indicación de adicción al trabajo en los docentes investigados y los factores asociados estaban relacionados con las condiciones y requisitos de trabajo. Las universidades deben adherirse a los modelos de gestión que abarcan la promoción de la salud ocupacional.

Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project / Promover una alianza entre la atención primaria y las organizaciones comunitarias para aumentar las pruebas de detección de cáncer colorrectal: el proyecto HAPPI

Abstract: Objective: The Healthy Aging Partnerships in Preven tion Initiative (HAPPI) aims to increase the use of clinical preventive services (CPS) among underserved Latinos and African Americans in South Los Angeles who are 50+ years old. Materials and methods: HAPPI uses an evidence-based model, SPARC, to leverage existing resources and link community resources. HAPPI's multi-sectoral partnerships include local non-governmental organizations (NGOs), community health centers (CHCs), aging and public health agencies serving the City and County of Los Angeles, and a university. Activities include CHC capacity assessment and training, and community capacity-building that included a small grants program. Results: We engaged five CHCs in quality improvement activities and eight NGOs in networking and programming to increase awareness and receipt of CPS. We discuss barriers and facilitators including the success of trainings conducted with CHC providers and NGO re presentatives. Conclusion: Multi-sectoral collaborations hold promise for increasing awareness and use of CPS in underserved communities.

Resumen: Objetivo: HAPPI se propone aumentar el uso de servicios clínicos preventivos (SCP) en personas mayores de 50 años en Los Ángeles. Material y métodos: HAPPI es una colaboración intersectorial e incluye organizaciones no gu bernamentales (ONG) locales, centros de salud comunitarios (CSC), centros de servicios para personas mayores, agencias de salud pública que dan servicio a la ciudad y al condado de Los Ángeles, y una universidad pública para movilizar recur sos comunitarios y promover lazos entre las asociaciones. Sus actividades incluyen asesorar y aumentar la capacitación de CSC y la comunidad, además de un programa de becas. Resultados: Se colaboró con cinco CSC para la mejora de calidad y con ocho ONG para abrir conciencia de los SCP. Se presentaron barreras y facilitadores incluyendo el éxito de las enseñanzas con proveedores de CSC y representantes de las ONG. Conclusión: Las colaboraciones multi-sectoriales son prometedoras para amplificar conciencia del uso de SCP en personas mayores.

Profile and scientific output of researchers recipients of CNPq productivity grant in the field of medicine

SUMMARY BACKGROUND. This study aimed to evaluate the scientific production of researchers in the field of Medicine who receive a productivity grant from the CNPq. METHODS: The curriculum Lattes of 542 researchers with active grants from 2012 to 2014 were included in the analysis. Grants categories/levels were stratified into three groups according to the CNPq database (1A-B, 1C-D, and 2). RESULTS. There was a predominance of grants in category 2. During their academic career, Medicine researchers published 76512 articles, with a median of 119 articles per researcher (IQ, interquartile range, 77 to 174). Among the 76512 articles, 36584 (47.8%) were indexed in the Web of Science (WoS database). Researchers in Medicine were cited 643159 times in the WoS database, with a median of 754 citations (IQ, 356 to 1447). There were significant differences among the categories of grants concerning the number of citations in WoS (P <0.001). There was a significant difference in the number of times researchers were cited according to the specialty included in Medicine area. (P < 0.001). CONCLUSION. Strategies to improve the scientific output qualitatively possibly can be enhanced by the knowledge of the profile of researchers in the field of Medicine.

RESUMO OBJETIVO: O objetivo deste estudo foi avaliar a produção científica de pesquisadores da área de Medicina que recebem bolsa de produtividade do CNPq. MÉTODOS: Os currículos Lattes de 542 pesquisadores com bolsas ativas de 2012 a 2014 foram incluídos na análise. As categorias/níveis das bolsas de produtividade foram estratificadas em três grupos de acordo com a classificação do CNPq (1A-B, 1C-D e 2). RESULTADOS: Houve predomínio de bolsas na categoria 2. Durante a carreira acadêmica, pesquisadores da Medicina publicaram 76.512 artigos, com mediana de 119 artigos por pesquisador (Intervalo Interquartil, IQ, 77 a 174). Entre os 76.512 artigos, 36.584 (47,8%) foram indexados no banco de dados da Web of Science (WoS). Pesquisadores em Medicina receberam 643.159 citações no banco de dados de WoS, com uma mediana de 754 citações (IQ, 356 a 1.447). Houve diferenças significativas entre as categorias de bolsas em relação ao número de citações em WoS (P < 0,001). Houve uma diferença significativa no número de citações recebidas pelos pesquisadores de acordo com a especialidade incluída na área de Medicina (P < 0,001). CONCLUSÃO: Estratégias para melhorar qualitativamente a produção científica possivelmente podem ser aprimoradas pelo conhecimento do perfil dos pesquisadores no campo da Medicina.

The Current and Future State of Academic Medicine in Korea: Education, Research, and Patient Care / 의학교육논단

Academic medicine is built from a foundation of education, research, and patient care. Since good patient care results from the application of medical research and continuous education, these three components cannot be separated for medical development to occur. In Korea, many obstacles hinder the achievement of academic medicine, such as an inefficient medical delivery system, limitations of primary care, low insurance prices, and no long-term health care plan. Medical education has changed to outcome-based education, but presented temporal integration status. Governance of healthcare research is not centralized, and Korea is awarded relatively fewer grants than other countries. Medical professors have reached a burnout state due to patient care responsibilities in addition to research and education duties. Many medical systems, including the medical delivery system and insurance problems, may contribute to distrust between doctors and patients. The government is not involved in a long-term health care policy. The multitude of factors mentioned here are hindering the achievement of academic medicine in Korea.

Current status and directions of resident education

A resident is a preliminary specialist with a medical license. It is also the status of an employee at a training hospital who is trained by clinical faculty. This duality makes the role of a resident unique, because its interpretation differs dramatically depending on whether one focuses on a resident's status as a trainee or as an employee. Issues regarding patient safety have emerged as residents have come to emphasize their role as employees in discussions of how to balance their work duties with their learning responsibilities. The workload that was taken for granted is no longer considered natural. Two years have elapsed since the enactment of the resident law, which was passed to improve the training environment and working conditions of residents, and limits them to 80 hours of work per week. However, confusion persists in the field. In order to solve problems regarding resident education, new education program with hospitalists and the financial and administrative support from hospitals and the government are important.

Upcoming direct acting antivirals for hepatitis C patients with a prior treatment failure

Despite the high efficacy of direct acting antivirals (DAAs) not all patients successfully clear hepatitis C virus infection, in fact, approximately 1–3% fail to reach a sustained virological response 12 weeks after end of treatment. DAA failures are characterized by advanced liver disease, specific genotypes/subtypes and resistance associated substitutions to the DAA class they have been treated with. Current European Association for the Study of the Liver guidelines recommend three therapeutic options for such patients. The first is a 12 week course of sofosbuvir (SOF), velpatasvir (VEL) and voxilaprevir (VOX), which has shown to be effective in 90–99% of patients and was granted A1 level recommendation. The second option, reserved for patients who have predictors of failure consists in 12 weeks regimen with glecaprevir (GLE) and pibrentasvir (PIB), effective in 90–97%. Finally, although not supported by published data, for especially difficult to treat patients there should theoretically be a benefit in prolonged combinations of SOF+GLE/PIB or SOF/VEL/VOX±ribavirin. This review presents the latest evidence from both clinical trials and real-life on such therapeutic strategies.

Current Korean Medical Specialty and Subspecialty System for Preparation of Privileging and Credentialing of ERCP Subspecialty / 대한췌담도학회지

A primary mission of the Korean pancreatobiliary association (KPBA) is to promote high quality patient care and safety in the field of pancreatobiliary diseases. Among these, endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important procedure among various endoscopic procedures. The purpose of this document is to provide a current Korean medical detailed and departmental specialty system that should be considered before preparing of privileging and credentialing for ERCP subspecialty and making suitable framework for determining the competency of practicing endoscopists and for the granting of privileges to perform ERCP. As such, this document provides current situation of Korean medical specialty and subspecialty system to assist KPBA in making credentialing organizations especially for ERCP subspecialty.

Banco Mundial, reforma dos Estados e ajuste das políticas sociais na América Latina / The World Bank, state reform, and the adjustment of social policies in Latin America

Resumo Este artigo analisa brevemente os pontos centrais da agenda do Banco Mundial para a reforma dos Estados nacionais na América Latina, no período de 1980 a 2017. O texto se baseia em documentos do próprio Banco Mundial e na literatura especializada. Inicialmente, apresenta alguns aspectos relevantes da história do Banco Mundial e de sua configuração como organização multilateral. A seguir, discute o papel da instituição na promoção de programas de ajuste estrutural das economias da região durante a década de 1980, baseado numa agenda hipermercadista. Após, aborda o processo de renovação e ampliação da agenda política do Banco do final dos anos 1990 em diante, calcado na manutenção do ajuste macroeconômico, na promoção de reformas institucionais e no combate à pobreza extrema. Por fim, discute as linhas centrais da agenda do Banco de reforma das políticas sociais, entre as quais a de saúde.

Abstract This article briefly analyses the central points of the World Bank's agenda for the reform of national states in Latin America, between 1980 and 2017. The text is based on World Bank documents and specialized literature. Initially some relevant aspects of the history of the World Bank and its configuration as a multilateral organization are presented. Next, it discusses the role of the institution in the encouragement of structural adjustment programs for the economies of the region during the 1980s, based on a hyper-market oriented agenda. Afterwards, the process of the renewal and expansion process of the Bank's political agenda from the end of the 1990s is looked at, which was based on the maintenance of the macroeconomic adjustment, the encouragement of institutional reforms, and combatting extreme poverty. Finally, the principal lines in the Bank's social policy reform agenda are discussed, including health.

Correction: Detection of Rifampicin Resistance in Mycobacterium tuberculosis by Using Middlebrook 7H9 Broth Medium with 2,3-Diphenyl-5-Thienyl-(2)-Tetrazolium Chloride / 대한임상미생물학회지

The acknowledgement was missed without intention. The authors ask to add the acknowledgement ‘This work was supported by a 2-Year Research Grant of Pusan National University.’ in an appropriate section.

Melatonin Rescues Mesenchymal Stem Cells from Senescence Induced by the Uremic Toxin p-Cresol via Inhibiting mTOR-Dependent Autophagy

p-Cresol, found at high concentrations in the serum of chronic kidney failure patients, is known to cause cell senescence and other complications in different parts of the body. p-Cresol is thought to mediate cytotoxic effects through the induction of autophagy response. However, toxic effects of p-cresol on mesenchymal stem cells have not been elucidated. Thus, we aimed to investigate whether p-cresol induces senescence of mesenchymal stem cells, and whether melatonin can ameliorate abnormal autophagy response caused by p-cresol. We found that p-cresol concentration-dependently reduced proliferation of mesenchymal stem cells. Pretreatment with melatonin prevented pro-senescence effects of p-cresol on mesenchymal stem cells. We found that by inducing phosphorylation of Akt and activating the Akt signaling pathway, melatonin enhanced catalase activity and thereby inhibited the accumulation of reactive oxygen species induced by p-cresol in mesenchymal stem cells, ultimately preventing abnormal activation of autophagy. Furthermore, preincubation with melatonin counteracted other pro-senescence changes caused by p-cresol, such as the increase in total 5′-AMP-activated protein kinase expression and decrease in the level of phosphorylated mechanistic target of rapamycin. Ultimately, we discovered that melatonin restored the expression of senescence marker protein 30, which is normally suppressed because of the induction of the autophagy pathway in chronic kidney failure patients by p-cresol. Our findings suggest that stem cell senescence in patients with chronic kidney failure could be potentially rescued by the administration of melatonin, which grants this hormone a novel therapeutic role.

Study for Lists of Forensic Autopsy Request: Quantitative Analysis about Documents Relating to Autopsy Request / 대한법의학회지

In the Republic of Korea, relevant documents are submitted to forensic doctors or agencies when courts grant confiscation warrants for autopsy. If the essential data on unusual death are not submitted at the time of the autopsy, it may be difficult to properly understand the situation relating to an unusual death prior to the autopsy, thus reducing the accuracy of the autopsy. As many as 6,133 out of 6,610 autopsy data (92.8%) in the Republic of Korea in 2015 were analyzed. Most autopsy appraisal requests (99.8%) were submitted. Unusual death occurrence reports (86.0%) and command recommendations of unusual death (70.3%) were submitted in many cases. However, prosecutor commands on unusual death were submitted only in 27.8% cases, and confiscation warrants were not submitted in 7.4% cases. As for postmortem inspection and death scene investigation reports, 29.3% and 34.1% cases were submitted, respectively. In addition to the above two documents, death certificates and records of statement of a relative had significant regional variations (0.3%–80.1%, 3.1%–64.7%, 27.8%–81.3%, and 40.8%–96.8%, respectively). For postmortem inspection and death scene photos, 2.7% and 3.2% were submitted in black-and-white photographs, respectively. The authors propose a list of forensic autopsy requests including autopsy appraisal requests, unusual death occurrence reports, command recommendations of unusual deaths, prosecutor commands on unusual death, and confiscation warrants unconditionally, as an essential document reflecting the progress of investigations. We suggest that postmortem inspection reports and photos, death scene investigation reports and photos, and death certificates should be included as part of postmortem investigation data.

Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine

OBJECTIVE: To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis.METHODS: We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest.RESULTS: There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively).CONCLUSION: When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine

OBJECTIVE: To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis. METHODS: We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest. RESULTS: There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively). CONCLUSION: When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

Don't take following the guidelines for granted

No abstract available.

The development of Taiwan Fracture Liaison Service network

Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients.

Merkel Cell Carcinoma Metastatic to Pleural Fluid: A Case Report

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine carcinoma of the skin that shows locoregional or distant metastasis. Metastasis of MCC to body cavity effusion is extremely rare; only three cases have been reported so far. Metastatic MCC in effusion cytology shows small blue round cells with fine stippled chromatin like other small blue round cell tumors such as small cell lung carcinoma or lymphoma. The diagnosis of metastatic MCC can grant patients good chances at recently advanced therapeutic options. Here, we present a case of metastatic MCC to pleural effusion with characteristic single file-like pattern.

Smokefree implementation in Colombia: Monitoring, outside funding, and business support / Implementación de los espacios libres de humo en Colombia: vigilancia, financiación externa y apoyo empresarial

Abstract: Objective: To analyze successful national smokefree policy implementation in Colombia, a middle income country. Materials and methods: Key informants at the national and local levels were interviewed and news sources and government ministry resolutions were reviewed. Results: Colombia’s Ministry of Health coordinated local implementation practices, which were strongest in larger cities with supportive leadership. Nongovernmental organizations provided technical assistance and highlighted noncompliance. Organizations outside Colombia funded some of these efforts. The bar owners’ association provided concerted education campaigns. Tobacco interests did not openly challenge implementation. Conclusions: Health organization monitoring, external funding, and hospitality industry support contributed to effective implementation, and could be cultivated in other low and middle income countries.

Resumen: Objetivo: Analizar la implementación exitosa de políticas nacionales de ambientes libres de humo en Colombia, un país de ingresos medios. Material y métodos: Entrevistas con informantes claves a nivel nacional y local, y revisión de artículos en las noticias y resoluciones ministeriales nacionales. Resultados: El Ministerio de Salud de Colombia coordinó las prácticas locales para la implementación, que fueron más fuertes en las ciudades grandes y en las ciudades con líderes políticos que la apoyaron. Organizaciones no gubernamentales proporcionaron asistencia técnica y destacaron el incumplimiento. Organizaciones fuera de Colombia financiaron algunos de estos esfuerzos. La asociación de propietarios de bares proporcionó campañas de educación concertadas. Intereses tabacaleros no desafiaron abiertamente la implementación. Conclusiones. La vigilancia de las organizaciones no gubernamentales, la financiación externa y el apoyo de la industria de la hospitalidad contribuyeron a una implementación eficaz. Tales factores pueden ser cultivados en países de ingresos bajos y medios.

Exploring Alternatives in the Development of Competency-Based Dentistry Curriculum: An Ontological Approach / 의학교육논단

Recently, there has been active reformation of higher education. This trend has resulted in competency-based education (CBE) in many universities around the world, and dentistry education is no exception. However, it is necessary to keep in mind that CBE is both attractive and has its limitations. In particular, higher education is facing the obstacle of preparing students to survive in a supercomplex world in which nothing can be taken for granted. In addition, the frame of understanding and action lacks stability. In these circumstances, competency-based dentistry curriculum (CBDC) needs to be reestablished to deal with the changes and challenges of a supercomplex world. The purpose of this study is to explore alternatives to current CBDC practices, specifically based on an ‘ontological approach.’ To achieve this purpose, the importance of the ontological approach in the development of higher education curriculum in the future was examined. Then, the actual status and characteristics of CBDC in the present situation were investigated. Lastly, the development of CBCD based on an ontological approach in dentistry education was suggested.