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El objetivo de este ensayo es aportar elementos para el debate sobre la crisis del Sistema General de Seguridad Social en Salud de Colombia, el derecho fundamental a la salud y sus implicaciones y, asimismo, proponer otros elementos para el nuevo sistema de salud que requiere el país, sin que se constituya este ensayo en un proyecto de reforma. El resultado del análisis muestra que la Ley 100 de 1993 no solo profundizó las inequidades, sino que además generó nuevas desigualdades evitables y regresivas, como la carencia de atención integral, el deterioro de la salud pública, la rentabilidad financiera por encima de los derechos de las personas, la negación de los servicios, la inadecuada regulación del Estado y la corrupción de la mayoría de sus actores. Las reformas a dicha ley, mediante las leyes 1122 de 2007 y 1438 de 2011, y la promulgación del derecho fundamental a la salud en la Ley 1751 de 2015, no han logrado cambios significativos en el sistema de salud, a pesar de la emisión de nuevas normas regulatorias esperanzadoras, dado que el sistema actual se basa en el neoliberalismo. La salud es producto de la acción social y no un mero resultado de la atención médica; en consecuencia, el derecho a la salud debe transcender de la enfermedad al bienestar, como garantía proporcionada por el Estado. La base de un nuevo sistema de salud será, sin duda, la dignidad humana en sus elementos objetivos y subjetivos, como máxima expresión del cumplimiento de los derechos humanos.
The objective of this essay is to contribute elements for the debate on the crisis of the General System of Social Security in Health of Colombia, the fundamental right to health and its implications, and thus to propose other elements for the new health system required by this country, without this essay constituting a reform project. The result of the analysis shows that Law 100 of 1993 not only deepened inequities, but also generated new avoidable and regressive inequalities, such as the lack of comprehensive care, the deterioration of public health, placing financial profitability above the rights of the people, the denial of services, the inadequate Government regulation and the corruption of the majority of its actors. The amendments to said law (Laws 1122 of 2007 and 1438 of 2011) and the promulgation of the fundamental right to health in Law 1751 of 2015, have not achieved significant changes in the health system, despite the issuance of hopeful new regulatory norms, given that the current system is based on neoliberalism. Health is a product of social action and not a mere result of medical care. Consequently, the right to health must go beyond illness to well-being, as a guarantee provided by the Government. The foundation of a new health system will undoubtedly be human dignity in its objective and subjective elements, as the highest expression of compliance with human rights.
O objetivo deste ensaio é fornecer elementos para o debate sobre a crise do Sistema Geral de Segurança Social em Saúde da Colômbia, o direito fundamental à saúde e suas implicações e, igualmente, propor outros elementos para o novo sistema de saúde que o país requer, sem que este ensaio comporte um projeto de reforma. O resultado da análise mostra que a Lei 100 de 1993 não só aprofundou as assimetrias, mas gerou novas desigualdades evitáveis e regressivas, como a ausência de atenção integral, a degradação da saúde pública, a rentabilidade financeira por cima dos direitos das pessoas, a negação dos serviços, a inadequada regulação do Estado e a corrupção da maioria de seus atores. As reformas de tal lei, por meio das leis 1122 de 2007 e 1438 de 2011, e a promulgação do direito fundamental à saúde na Lei 1751 de 2015, não atingiram câmbios significativos no sistema de saúde, apesar da emissão de novas normas regulatórias esperançosas, pois o sistema atual se baseia no neoliberalismo. A saúde é produto da ação social e não um mero resultado da atenção médica; em consequência, o direito à saúde deve transcender da doença para o bem-estar, como garantia providenciada pelo Estado. A base de um novo sistema de saúde será, sem dúvida, a dignidade humana em seus elementos objetivos e subjetivos, como máxima expressão do cumprimento dos direitos humanos.
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Circular RNAs (circRNAs),a kind of novel non-coding RNAs, have been shown to play animportant role in cellular redox reactions. In the previous study, we found that hsa_circ_0087354 wasclosely related to the cellular redox state by real-time PCR. After overexpression of hsa_circ_0087354, the relative expression of ROS1 were decreased significantly (P < 0. 01), while the levels of SOD1 wereincreased significantly (P < 0. 05) . The activities of SOD and Gpx as well as GSH concentration weresignificantly increased (P < 0. 01), and cell proliferation was promoted in cells (P < 0. 05) . Bioinformatics analysis predicted that there were binding sites between hsa-miR-199-3p and hsa_circ_0087354 as well as solute carrier family 7 member 11 (SLC7A11), which might have a targetedregulatory relationship. Dual luciferase reporter assay confirmed the targeted regulatory relationshipbetween hsa-miR-199-3p with hsa_circ_0087354, and SLC7A11. Overexpressed hsa_circ_0087354 plasmid and ctrl plasmid were constructed, hsa-miR-199a-3p, hsa-miR-199b-3p and hsa-miR-NC mimicswere synthesized. Real-time PCR analysis showed that the relative expression of hsa-miR-199-3p was observably decreased (P < 0.01), while the relative expression of SLC7A11 in cells was dramaticallyincreased after transfection of has_circ_0087354 plasmid (P < 0.05) . After transfection with hsa-miR-199-3p, the relative expressions of SLC7A11 were markedly decreased (P < 0.001) . The activities ofSOD and Gpx, GSH concentration (P<0.01), and cell proliferation rate (P < 0.05) were significantlyreduced. In conclusion, hsa_circ_0087354 could enhance the expression of SLC7A11, promote theproliferation of cells and reduce the oxidative stress by adsorption of hsa-miR-199-3p.
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Resumen Objetivo: Conocer el significado que otorga el usuario mapuche, adscrito al Programa Salud Cardiovascular 2016, Consultorio Makewe, Temuco, Chile, a la hipertensión arterial. Metodología: Investigación bajo el paradigma cualitativo, con base en la teoría fundamentada. La muestra fue conformada por veintidós usuarios, no probabilística, intencionada de casos por criterios y conveniencia, de acuerdo con criterios de inclusión. La recolección de información se hizo mediante dos grupos focales y ocho entrevistas en profundidad, hasta llegar al punto de saturación, previa firma de consentimiento informado. El análisis se caracterizó por ser dinámico y creativo, basado en la estrategia de método comparativo constante, realizando codificación y análisis simultáneo. La validez se comprobó con criterios de rigor y fue triangulada por investigadores. La investigación fu autorizada por el Comité Ético Científico de la Universidad de La Frontera. Resultados: Para hipertensión arterial emergieron cuatro categorías: "Significado" (definición del concepto), "Causa" (percepción), "Convivir" (cambios) y "Tratamiento" (farmacológico, herbolaria, machi -curandera o consejera-). Conclusiones: Sin haber definido la patología, los mapuches la asocian a signos, síntomas y causas; confían en tratamientos otorgados por un equipo de salud, pero no en las/los machis, reconociendo algunas de ellas como buenas, las que por alta demanda y costo son inaccesibles. En general, se ha descuidado la Ley Indígena 19253 de 1993, que da lugar a la institucionalización del Programa de Salud con Población Mapuche (PROMAP), dependiente del Servicio de Salud Araucanía.
Abstract Objective: to understand the meaning that the Mapuche user subscribed to the Programa Salud Cardiovascular 2016, Makewe Clinic, Temuco, Chile assigns to arterial hyperten sion. Methodology: the research was performed under the qualitative paradigm, based on grounded theory. The non-probabilistic sample was made up of twenty-two users. The cases were chosen by convenience, following inclusion crite ria. The information was collected through focal groups and eight in-depth interviews, until saturation happened, and all participants were required to sign consent forms. Validity was ratified using standard criteria and researchers triangulated the data. The Ethics and Scientific Committee of Universidad de La Frontera authorized the study. Results: four categories for arterial hypertension appeared: "Meaning" (concept's defini tion), "Cause" (perception), "Living with the condition" (chan ges) and "Treatment" (pharmacologic, herbal, Machi- healer or counselor-). Conclusions: without defining the patholo gy, the Mapuche associate the signs, symptoms and causes to it. They trust the treatment indicated by a medical team, but not the one prescribed by Machis. Although they recognize some of these Machis are good, their high demand or high cost makes them unattainable. In general, the Ley Indígena [Indi genous Peoples' Act] 19253 of 1993 has been neglected, even if it allows the institutionalization of the Programa de Salud con Población Mapuche (Health Care Program for Mapuche people- promap in Spanish), a population that depends on the health care service provided by the Araucanía Region.
Resumo Objetivo: conhecer o significado que dá o usuário Mapuche adscrito ao Programa Salud Cardiovascular 2016, consultório Makewe, Temuco, Chile, à hipertensão arterial. Metodologia: a pesquisa foi feita sob o paradigma qualitativo, baseada na teoria fundamentada. A amostra teve vinte e dois usuários, não probabilística, com intenção de casos por critério e conveniên cia, segundo os critérios de inclusão. A informação foi cole tada mediante grupos focais e oito entrevistas aprofundadas, até atingir saturação, depois de ter assinado o consentimento. A análise caracterizou-se por ser dinâmica e criativa, baseada na estratégia de metodologia comparativa constante, realizan do codificação e análise simultâneo. Comprovou-se a validez utilizando critérios correspondentes e com triangulação de pesquisadores. A pesquisa foi autorizada pelo Comité Ético e Científico da Universidad de La Frontera. Resultados: sur giram quatro categorias para hipertensão arterial: "Significa do" (definição do conceito), "Causa" (percepção), "Conviver" (mudanças) e "Tratamento" (farmacológico, herbolária, Machi -curandeira ou aconselhadora-). Conclusões: sem ter defi nido a patologia, os Mapuches a associam aos sinais, sintomas e causas. Eles confiam nos tratamentos fornecidos por uma equipe de saúde, mas não nas/nos Machis, reconhecendo al gumas delas como boas, as que por alta demanda e custos não são acessíveis. Em geral, tem se descuidado a Ley Indígena 19253 de 1993, que permite a institucionalização do Programa de Salud con Población Mapuche (promap), dependente do Servicio de Salud Araucanía.
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Este artigo consiste numa apresentação de informações a respeito das mobilizações e debates causados pela discussão acerca da redução da maioridade penal no Brasil em 2015, proposta feita pelo Projeto de Emenda Constitucional (PEC) nº 171/1993, colocando em foco a questão da opinião pública e suas influências, em perspectiva comparada a acontecimento semelhante ocorrido no Uruguai em 2014 que teve como atores influentes organizações da sociedade civil, empenhadas na mudança da opinião pública a respeito do tema em discussão.
This article consists in a set of informations about reducing the legal age in Brazil, presenting the debates involved in the proposal made by the Constitutional Amendment Project (PEC) nº 171/1993 which was discussed in the country in 2015. The artice focuss the question of public opinion and their influences comparing to a similar event occurred in Uruguay in 2014, which had as an important actor the civil society organizations, committed to changing public opinion on the subject under discussion.
El artículo consiste en una presentación de informaciones sobre las manifestaciones y debates provocados por la discusión de reducción de la edad penal en Brasil en 2015, propuesta realizada por el Proyecto de Enmienda Constitucional (PEC) nº 171/1993, poniendo de relieve la cuestión de la opinión pública y sus influencias en comparación al evento similar ocurrido en Uruguay en 2014, que tenía como actor importante la sociedad civil organizada en el proceso de cambio de la opinión pública sobre el tema de reducción.
Cet article concerne la présentation d'informations sur les mobilisations et les débats suscités par la discussion sur la réduction de la majorité criminelle au Brésil en 2015, proposée par le projet de modification constitutionnelle (PEC) nº 171/1993, portant sur la question de la l'opinion publique et ses influences, en perspective par rapport à un événement similaire survenu en Uruguay en 2014 qui avait comme acteurs influents les organisations de la société civile, engagés à changer l'opinion publique sur le sujet en discussion.
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AIM: To investigate the role of HGF/c-Met signaling pathway in crizotinib-induced apoptosis of different lung carcinoma cell lines and to analyze its potential regulatory mechanisms .METHODS: EML4-ALK positive cell line H2228, c-Met proliferation cell line H1993 and control cell line A549 were treated with crizotinib at different doses for different time periods .The viability of the cell lines was measured by MTT assay .The apoptosis was analyzed by flow cytometry with PI staining.The protein levels of MET and phosphorylated MET (p-MET) of HGF/c-Met signaling pathway as well as its down-stream key proteins AKT , ERK, p-AKT and p-ERK in the cell lines before and after crizotinib treatment were examined by Western blot .RESULTS:The growth of H1993, H2228 and A549 cell lines was inhibited after crizoti-nib treatment for 72 h in a dose-dependent manner .Apoptotic rates of H1993 cells and H2228 cells were increased with the crizotinib concentration and exposure time .Down-regulation of p-MET, p-AKT and p-ERK at protein levels in H1993 cells and H2228 cells after exposure to crizotinib for 72 h was confirmed by Western blot .No obvious change of the related-pro-teins of HGF/c-Met signaling pathway was found in A 549 cell line.CONCLUSION: HGF/c-Met signaling pathway may contribute to crizotinib-induced apoptosis of H1993 cells and H2228 cells, which provides the experimental basis for MET-targeting treatment of lung cancer .
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El presente trabajo objetiva sustentar teóricamente el impacto de la ausencia del Consejo Nacional de Bioética (CNB) en la normatividad sobre investigación en seres humanos de Colombia (Resolución 8430/1993 del Ministerio de Salud). Para tal fin, fue dividido el abordaje del tema en tres partes: la primera trata sobre la experiencia previa del país en relación con la implementación del CNB; la segunda revisa la normatividad colombiana actual sobre experimentación en humanos, y la tercera analiza críticamente el contenido de la resolución referida. En Colombia, los debates sobre temas que exigen la reflexión bioética se dan a nivel del Estado, sin la asesoría de un consejo nacional de bioética que facilite una orientación desde dicha perspectiva. Por esta razón, es urgente la reglamentación de la Ley 1374/2010 que crea el CNB; además, considerando la protección de los sujetos participantes de las investigaciones, es pertinente que la bioética en Colombia transforme su fundamentación epistemológica, adoptando referenciales bioéticos consonantes con su realidad social. Por lo tanto, se propone la Declaración Universal sobre Bioética y Derechos Humanos de la Unesco como directriz bioética internacional de la investigación en seres humanos.
This paper discusses the impact of the absence of the National Council of Bioethics (CNB) in the regulations of human research at Colombia, especially with regard to Resolution 8430/1993 of Ministry of Health. For this purpose, the approach to the topic was divided into three parts: the first deals with the experience of Colombia in the implementation of a CNB, the second topic reviews the current regulations on human experimentation, and the third topic analyses, in a critical way, the content of the aforementioned Resolution. In Colombia, discussions on topics that require the bioethical reflection occur at the level of the State, without the advice of a National Council of Bioethics, which provide guidance, from this perspective. For this reason, a regulation of the Law 1374/2010, which creates the CNB, is urgent. Whereas the protection of the participating of people in biomedical research, is relevant a transformation of bioethics in Colombia regarding its epistemological foundation, in order to adopt a bioethical referential connected to their social reality. We suggest the Universal Declaration on Bioethics and Human Rights, at UNESCO, as a leader guide in revision of Colombian directive on human's research.
O presente trabalho tem como objetivo é sustentar teoricamente o impacto da ausência do Conselho Nacional de Bioética (CNB) na normatividade sobre investigação em seres humanos da Colômbia (Resolução 8430/1993 do Ministério da Saúde). Para este fim, a abordagem da questão foi divido em três partes: a primeira trata sob a experiência anterior do país em relação à implementação do CNB; a segunda revisa a normatividade colombiana atual sobre experimentação em humanos, e a terceira analisa criticamente o conteúdo da resolução em causa. Na Colômbia, os debates sobre questões que exigem a reflexão bioética ocorrem em nível estadual sem a assessoria de um conselho nacional de bioética para fornecer orientações a partir dessa perspectiva. Por esta razão, é urgente o regulamento da Lei 1374/2010, que cria o CNB; considerando também a proteção dos sujeitos envolvidos nas pesquisas, é adequado que a bioética na Colômbia mude sua fundamentação epistemológica, adotando referenciais bioéticas consonantes com a sua realidade social. Portanto, propõe-se a Declaração Universal sobre Bioética e Direitos Humanos da UNESCO como diretriz bioética internacional da pesquisa em seres humanos.
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Humanos , Bioética , Colombia , Legislación , Ética en Investigación , Sujetos de InvestigaciónRESUMEN
OBJETIVO: reconstruir la ruta jurídica de la tutela en salud y determinar los costos de este proceso y de los servicios de salud invocados en una muestra de tutelas de la ciudad de Medellín. METODOLOGIA: estudio descriptivo con enfoque cualitativo para la reconstrucción de la ruta jurídica y una orientación cuantitativa para la estimación de los costos; se utilizaron tarifas de Seguro Obligatorio de Accidentes de Tránsito a precios de 2009 para la valoración de los servicios; para el costeo de los recuros del proceso jurídico se utilizó la perspectiva del micro-costeo incorporada en la metodología de costos Basados en Actividades y su valoración a precios de mercado de 2009. RESULTADOS: por cada $100 correspondiente al costo de los servicios negados por las entidades promotoras de salud, el sistema judicial de Medellín gastó $48 en el trámite de cada tutela. En más del 50% de los casos el costo de la acción jurídica resultó ser superior al costo de los servicios. DISCUSION: el costo del proceso jurídico de las tutelas en salud presentadas en el país en el período 1999-2009 podría estar representando el 2% de los dineros que circulan en todo el sistema de salud. Este costo constituye sólo parte de los costos de transacción que se derivan del incumplimiento de las EPS de un contrato social contemplado en la constitución política y en la mayoría de los casos del incumplimiento del contrato privado que ellas han sucrito con los usuarios afiliados al sistema de salud.
OBJECTIVE: to retrace the legal route of writs for the protection of constitutional rights involving health care services and to determine the cost of such processes and those of the health care services invoked in a sample of such writs taken in Medellín city. METHODOLOGY: a descriptive study with a qualitative focus for retracing the legal route of the writs, and a quantitative approach for the purpose of cost estimation. The 2009 SOAT (Mandatory Car Insurance) fees were used for assessing the cost of the health care services. As for the assessment of the legal costs, we used the micro-costing approach together with the activity-based costing methodology. RESULTS: for each $100 corresponding to the cost of the services denied by the health care services provider, the Medellín judicial system spent around $48 on each legal process. In more than half of the cases, the cost of the legal action was higher than the services' cost. DISCUSSION: the cost of the legal process involving the writs for the protection of constitutional rights regarding health care services that were filed in the country between 1999 and 2009 could represent 2% of the budget circulating throughout the entire health system. This cost is just a part of the transaction costs generated by the health care services providers' breach of the social contract established by the Colombian Constitution. Furthermore, in most cases there is also a breach of the private contract between these service providers and the health system users.
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Derecho a la Salud , Costos de la Atención en Salud , Costos y Análisis de Costo , Derechos HumanosRESUMEN
La noción de que la esencia de la investigación científica es la producción de conocimiento y que la literatura científica constituye la manifestación de ese conocimiento hace que los acercamientos bibliométricos retraten a la ciencia por sus resultados. La identificación de estos grupos se realiza a través de las firmas conjuntas, agrupando a todos aquellos autores que mantienen relaciones directas o indirectas en función de las firmas de trabajos científicos. En el presente trabajo, los autores analizan la recepción del psicoanálisis y la evolución de las ideas psicológicas en Argentina, así como el papel jugado en el mismo por el español Ángel Garma, basándose en aspectos tanto biográficos como cuantitativos.
The idea that the essence of scientific investigation is the production of knowledge and that scientific literature constitutes a manifestation of this knowledge means that bibliometric approaches portray science through its results. These groups can be identified by their co-authorship, by grouping together all those authors who were directly or indirectly involved in writing the scientific papers. In this study, the authors analyze the reception of psychoanalysis and the development of ideas on psychology in Argentina, as well as the role played in this field by Spaniard Angel Garma, based on both biographical and quantitative data.
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Humanos , Psicoanálisis/historia , Ciencia , Argentina , Investigación , Conocimiento , Capacitación ProfesionalRESUMEN
Durante el segundo semestre del año 2000 se realizó un estudio descriptivo de corte entre los médicos generales que laboran en la ciudad de Medellín, cuyos objetivos fueron: establecer sus expectativas respecto a especializarse, sus motivaciones para mantenerse en la práctica de la medicina general, sus condiciones laborales después de implantada la reforma a los servicios de salud y cómo perciben su formación con respecto a la realidad práctica de la profesión.Para el estudio poblacional se utilizó el número de médicos generales que laboran en cada una de las Instituciones Prestadoras de Servicios de Salud registradas oficialmente. Encontramos que los médicos generales de Medellín se sienten técnicamente bien preparados para su labor, pero encuentran carencias en la formación en las áreas de la salud pública y sociales, así como en aspectos laborales y de la reforma en los servicios de salud. La mayoría no se ha especializado por razones económicas y una tercera parte de la población no considera necesaria la especialización. Hay un notorio señalamiento a la Ley 100 de 1993, como causante del desprestigio de la profesión y de las condiciones laborales desventajosas para el ejercicio médico en la actualidad.
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Reforma de la Atención de Salud , Curriculum , Medicina , Médicos , ColombiaRESUMEN
This study surveyed and measured the level and structure of cancer deaths and their trends over time for offering the fundamental data of the cancer prevention and control in Pusan city in the future. Authors conducted the study of descriptive epidemiology using materials derived from the computerized data of total 3,722 certified cancer deaths in Pusan city from January 1 to December 31, 1993 registered on the National Statistical Office, the Republic of Korea. The obtained results were as follows: 1. According to the total registered cases of deaths(16,331 cases) in Pusan city during 1993, cancer(3,722 cases) and cerebrovascular disease(2,718 cases) were the first and second cause of deaths as 23.1% and 16.9%, respectively. These pattern showed the change between cancer(14.7%) and cerebrovascular disease(18.5%) in order of frequency in comparison to 1982. Also, the total number of cancer deaths was increased in comparison to 1982. The rate of death certification by physicians was 87.1% of all registered deaths, which was increased to 6.8% in comparison to 1982(80.3%). 2. Crude death rate and cancer specific death rate was 4.06 per 1,000 populations and 93.8 per 100,000 populations(male:117.8, female:70.0), respectively. The former was similar to that of 1982, but the latter was increased to 1.6 times as that of 1982. 3. Age-adjusted cancer specific death rate by standardization with whole country population was 111.9(male:141.5, female:106.7) per 100,000 populations, higher than not age-adjusted cancer specific death rate(93.8), and the sex difference was statistically significant with male predominance(p<0.05). 4. Cancer specific death rate by age was generally increased with age and most of cancer deaths(male:91.8%, female:88.5%) occurred since 40 years old. 5. The major cancer(cancer specific death rate per 100,000 populations) in male was liver(30.6) followed by stomach(25.6), lung(21.9), and GB and EHBD(5.7), in female stomach(15.7), liver(9.9), lung(7.3), and uterus(6.9). The relative frequency of the leading three cancer among total cancer deaths marked 66.3% in male and 47.1% in female, and decreased in comparison to 1982(male:72.2%, female:54.5%). 6. The total ratio of male to female cancer specific death rate showed 1.68 to 1 with male predominance. And the ratio was above 2.0 in larynx, oral cavity & pharynx, esophagus, liver, lung, bladder cancer and the ratio was 1.0~1.9 in stomach, pancreas, gall bladder and EHBD, brain, rectum and anus cancer, leukemia, but the ratio was reversed in thyroid and colon cancer. In conclusion, cancer was the first cause of deaths. The proportion of lung cancer was increased, that of stomach & uterine cancer was decreased relatively, and liver cancer was constantly higher proportion. In the future, it is necessary to conduct the further investigations on the cancer risk factors considering areal specificity.