Health in Chile's Recent Constitutional Process: A Qualitative Thematic Analysis of Civil Proposals.

(1) Background: In response to the recent political crisis in Chile, the "Agreement for Social Peace and the New Constitution'' was approved. We aimed to analyze the health-related civil proposals uploaded to the official website for popular participation in the new constitution in Chile. (2) Methods: We carried out a qualitative thematic analysis of 126 health-related valid proposals. Moreover, we analyzed their link to the Health Goals 2030, established by the Ministry of Health of Chile and to the Sustainable Development Goals (SDGs). (3) Results: Sixteen main categories were reached. In all, they were organized into four main areas: (i) the right to health and the establishment of a universal health system; (ii) effective access to selected healthcare services; (iii) improving health outcomes for all and for the relevant subgroups; and (iv) the social determinants of health, health in all the policies, and community health. We found that these four areas were strongly linked to the Health Goals 2030 for Chile and to the SDGs. (4) Conclusions: Despite the fact that the new constitutional proposal was rejected in September 2022, the civil health-related proposals and the areas of health and healthcare were of interest to the citizens as the request showed a strong demand from the population for participation in matters of health, healthcare, and public health.

Women in Sex Work and the Risk Environment: Agency, Risk Perception, and Management in the Sex Work Environments of Two Mexico-U.S. Border Cities.

Sex work around the world takes place under conditions of structural violence and vulnerability. The México-U.S. border region is characterized by the presence of factors that increase the risk for health harms among female sex workers (FSW); located in this context, the risk environments of Tijuana and Ciudad Juárez have similar yet distinct characteristics that influence how risk is produced and experienced among FSWs. Exploring the ways in which FSWs enact agency in risk environments can illustrate how environmental characteristics shape perceived risks and the strategies that FSWs develop to manage them. This approach also identifies the limits that are placed by environmental characteristics over the capacity for harm reduction and prevention practices among FSWs. We analyzed the role of agency in the work environments of female sex workers and its relationship with risk perception and management in the cities of Tijuana and Cd. Juárez.

Comparative in vitro and experimental in vivo studies of the anti-epidermal growth factor receptor antibody nimotuzumab and its aglycosylated form produced in transgenic tobacco plants.

A broad variety of foreign genes can be expressed in transgenic plants, which offer the opportunity for large-scale production of pharmaceutical proteins, such as therapeutic antibodies. Nimotuzumab is a humanized anti-epidermal growth factor receptor (EGFR) recombinant IgG1 antibody approved in different countries for the treatment of head and neck squamous cell carcinoma, paediatric and adult glioma, and nasopharyngeal and oesophageal cancers. Because the antitumour mechanism of nimotuzumab is mainly attributed to its ability to interrupt the signal transduction cascade triggered by EGF/EGFR interaction, we have hypothesized that an aglycosylated form of this antibody, produced by mutating the N(297) position in the IgG(1) Fc region gene, would have similar biochemical and biological properties as the mammalian-cell-produced glycosylated counterpart. In this paper, we report the production and characterization of an aglycosylated form of nimotuzumab in transgenic tobacco plants. The comparison of the plantibody and nimotuzumab in terms of recognition of human EGFR, effect on tyrosine phosphorylation and proliferation in cells in response to EGF, competition with radiolabelled EGF for EGFR, affinity measurements of Fab fragments, pharmacokinetic and biodistribution behaviours in rats and antitumour effects in nude mice bearing human A431 tumours showed that both antibody forms have very similar in vitro and in vivo properties. Our results support the idea that the production of aglycosylated forms of some therapeutic antibodies in transgenic plants is a feasible approach when facing scaling strategies for anticancer immunoglobulins.

Phase I single-dose study of intracavitary-administered Nimotuzumab labeled with 188 Re in adult recurrent high-grade glioma.

Radioimmunotherapy (RIT) may improve the management of malignant gliomas. A Phase I clinical trial was performed to evaluate, for the first time, the toxicity and clinical effect of an intracavitary administration of a single dose of Nimotuzumab (h-R3) labeled wit (188)Re. Nimotuzumab is a humanized monoclonal antibody directed against epidermal growth factor receptors. Three patients with anaplastic astrocytoma (AA) and 8 with glioblastoma multiforme (GBM) were intended to be treated with 3 mg of mAb labelled with 10 or 15 mCi of (188)Re. In patients treated with 10 mCi (n=6) transitory worsening of pre-existing neurological symptoms were observed. Two patients treated with 15 mCi (n=4) developed early severe neurological symptoms and one also developed late severe toxicity (radionecrosis). In the group treated with 10 mCi, 1 GBM patient died in progression 6 months after the treatment, 2 patients (1 GBM and 1 AA) developed stable disease during 3 months. One GBM patient had partial response for more than 1 year and 2 patients (1 GBM and 1 AA) were asymptomatic and in complete response after 3 years of treatment. Maximal tolerated dose of the radioimmunoconjugate (188)Re-Nimotuzumab was 3 mg of the h-R3 labelled with 10 mCi of (188)Re. The radioimmunoconjugate showed a high retention in the surgical created resection cavity and the brain adjacent tissues with a mean value of 85.5 % of the injected dose one hour post-administration. This radioimmunoconjugate may be relatively safe and a promising therapeutic approach for treating high grade gliomas.

Biodistribution and internal dosimetry of the 188Re-labelled humanized monoclonal antibody anti-epidemal growth factor receptor, nimotuzumab, in the locoregional treatment of malignant gliomas.

OBJECTIVE: To evaluate the biodistribution, internal radiation dosimetry and safety of the 188Re-labelled humanized monoclonal antibody nimotuzumab in the locoregional treatment of malignant gliomas. METHODS: Single doses of 370 or 555 MBq of 188Re-labelled nimotuzumab were locoregionally administered to nine patients with recurrent high-grade gliomas, according to an approved dose-escalation study. SPECT, planar scintigraphy and magnetic resonance images were combined for dosimetric and pharmacokinetic studies. Blood and urine samples were collected to evaluate clinical laboratory parameters and for absorbed doses calculations. Biodistribution, internal dosimetry, human anti-mouse antibody response and toxicity were evaluated and reported. RESULTS: The 188Re-nimotuzumab showed a high retention in the surgically created resection cavity with a mean value of 85.5+/-10.3%ID 1 h post-injection. It produced mean absorbed doses in the tumour region of approximately 24.1+/-2.9 Gy in group I (patients receiving 370 MBq) and 31.1+/-6.4 Gy in group II (patients receiving 555 MBq); the normal organs receiving the highest absorbed doses were the kidneys, liver and urinary bladder. About 6.2+/-0.8%ID was excreted by the urinary pathway. The maximum tolerated dose was 370 MBq because two patients showed severe adverse effects after they received 555 MBq of 188Re-nimotuzumab. No patient developed human anti-mouse antibody response. CONCLUSIONS: A locoregional single dose of 188Re-labelled nimotuzumab of approximately 370 MBq could be used safely in the routine treatment of patients suffering with high-grade gliomas. The efficacy of this therapy needs to be evaluated in a phase II clinical trial.

[Globalization and infectious diseases in Mexico's indigenous population]. / Globalización y enfermedades infecciosas en las poblaciones indígenas de México.

This paper discusses the health status of indigenous populations in Mexico. The first section characterizes the concept of globalization and its links to the population's health. Based on available statistical data, the second section documents the current indigenous populations' health status in the country. The article then argues that the presupposition of equity, crucial to globalization theory, does not apply to this case. Using the Mexican National Health Survey (2000), the third section further analyzes the health status of indigenous populations and identifies important inconsistencies in the data. The discussion section contends that these inconsistencies derive from the fact that such health surveys fail to contemplate the cultural specificities of indigenous peoples, thus leading to erroneous interpretations of the data. The article concludes that statistics on indigenous peoples' health must be interpreted with extreme caution and always with the support of social science theories and research methods.

Globalización y enfermedades infecciosas en las poblaciones indígenas de México / Globalization and infectious diseases in Mexico's indigenous population

Se presenta un análisis sobre la salud de los indígenas de México. La primera parte analiza el concepto de globalización y busca identificar sus principales vínculos con la salud de las poblaciones. La segunda muestra, con base en datos estadísticos, el grado de rezago en que se encuentran las poblaciones indígenas y el incumplimiento del presupuesto de equidad, central en la teoría de los beneficios de la globalización. La tercera parte presenta un análisis de la salud de los indígenas en México basado en los datos de la Encuesta Nacional de Salud 2000 y muestra la existencia de importantes inconsistencias de esta información. En la sección de discusión se propone que tales inconsistencias derivan del hecho de que las mediciones estadísticas no contemplan las particularidades culturales de los pueblos indígenas, lo que lleva a interpretaciones erróneas. Se concluye que las estadísticas de salud de los indígenas deben ser valoradas con precaución y atendiendo a los desarrollos alcanzados en las ciencias sociales.

This paper discusses the health status of indigenous populations in Mexico. The first section characterizes the concept of globalization and its links to the population's health. Based on available statistical data, the second section documents the current indigenous populations' health status in the country. The article then argues that the presupposition of equity, crucial to globalization theory, does not apply to this case. Using the Mexican National Health Survey (2000), the third section further analyzes the health status of indigenous populations and identifies important inconsistencies in the data. The discussion section contends that these inconsistencies derive from the fact that such health surveys fail to contemplate the cultural specificities of indigenous peoples, thus leading to erroneous interpretations of the data. The article concludes that statistics on indigenous peoples' health must be interpreted with extreme caution and always with the support of social science theories and research methods.

Migration and AIDS in Mexico: an overview based on recent evidence.

OBJECTIVES: Provide an overview of the relation between migration to the United States and AIDS cases in Mexico. Characterize the sexual behaviors of Mexican migrants. Describe HIV/AIDS prevention and clinical attention actions developed. METHODS: The following were analyzed: AIDS cases databases, various prevalence studies, the migrants survey, and information of the Ministries of the Interior and of Health. A documental analysis was undertaken of works published between 1992 and 2000 on migration and AIDS. RESULTS: In terms of their sexual practices, migrants in the past year had more sexual partners, tended to use a condom in their most recent relation in greater proportion, and had greater use of injected medicines and drugs. Two bi-national programs undertake epidemiological surveillance activities, while several initiatives have used innovative formats to provide prevention information to migrants. Imminent universal coverage leaves the challenge to assure quality of attention for migrants. CONCLUSIONS: Studies to evaluate the impact of international migration on distribution of infected persons will be indispensable to establish priorities in prevention and attention among migrants. More information is needed on bi-national health projects to understand the impact they may have in prevention, while continuity of the prevention initiatives must be guaranteed. Attention to migrants in bi-national contexts requires information exchange agreements on migrants living with the HIV/AIDS.

Mobile populations and HIV/AIDS in Central America and Mexico: research for action.

OBJECTIVE: To present a multi-centre study that analyses the socioeconomic, cultural and political contexts that give rise to population mobility, and its relationship to vulnerability to sexually transmitted infections (STI)/HIV/AIDS, in order to provide information that can be used to design appropriate and focused interventions. METHODS: In each of 11 transit stations (border towns, port cities, areas where mobile populations congregate) in Central America and Mexico, a household survey of the local population was conducted to analyse demographic, socioeconomic characteristics, and information known and opinions held about HIV/AIDS and mobile populations. In-depth interviews with key informants, community members and mobile populations were held to ascertain knowledge about prevention and transmission of STI/HIV/AIDS. Likewise, an ethnographic study was undertaken to identify interactions between local and mobile populations. RESULTS: The transit stations share low educational levels among the local population, few public services, repeated human rights violations, violence, poverty and corrupt authorities. Within this social context, transactional sex, sex for survival, rape and non-professional commercial sex happen in conditions that increase the risk of the transmission of STI/HIV, such as infrequent condom use. Migrant women and sex workers are particularly vulnerable in this context. A wide gap exists between information about STI/HIV transmission and reported prevention practices. CONCLUSION: Given the conditions that exist in these transit stations, interventions should be multisectoral, sustainable, and should defend the human rights of various groups, including women and people living with HIV/AIDS.

Atención médica ambulatoria en México: el costo para los usuarios / Ambulatory medical care in Mexico: the cost for users

Objetivo. Analizar los resultados de la Encuesta Nacional de Salud II (ENSA-II), en lo relativo a los costos del proceso de búsqueda y obtención de la atención médica ambulatoria en diferentes instituciones del sector público y privado. Material y métodos. La información se obtuvo a partir de los indicadores de costos de la atención médica que notificó la población de estudio de la ENSA-II. Los costos para el bolsillo del consumidor fueron la variable dependientes, y las independientes, la condición de aseguramiento y el ingreso económico. Las significancia de los niveles de variación se identificó aplicando la prueba de Duncan. Resultados. Los costos en todo el país, en dólares estadunidenses, fueron: transporte, $ 2.20; consulta general, $7,90; medicamentos, $ 9.60, y estudios de diagnóstico, $13.6. El costo promedio total de la atención ambulatoria fue de $22.70. Los hallazgos empíricos permiten sugerir una nueva propuesta de análisis de los costos en salud, tanto directos como indirectos, en que incurren los consumidores de servicios de salud, dichos costos representan una carga importante en relación con el ingreso familiar, situación que se agudiza en el caso de la población no asegurada. Conclusiones. La incorporación de la perspectiva económica en el análisis de los problemas de los sistemas de salud, no debe limitarse a los costos de producción de servicios en que incurren los proveedores, sobre todo si lo que se busca es resolver los problemas de equidad y accesibilidad que actualmente caracterizan a la oferta de servicios médicos en México

Motivos de no vacunación: un análisis crítico de la literatura internacional, 1950-1990 / Motives for non-vaccination: critical review of the international literature, 1950-1990

En muchos países se reconoce que los programas de vacunación requieren del dominio de elementos técnicos y organizacionales para ser accesibles a las poblaciones. Uno de ellos ha sido menospreciado de manera importante: la participación de la población y las causas que la motivan. El presente trabajo analiza experiencias de diversos países, a partir de una revisión bibliográfica del período 1950-1990. Los resultados muestram que los estudios existentes varían en su enfoque metodológico y conceptual de acuerdo a la región del mundo en donde fueron realizados y de acuerdo al tipo de investigador. Este hecho se explica por el supuesto que existe en muchos investigadores de pensar que conocen a profundidad los determinantes ideológicos de la conducta de las culturas de las que son nativos. A partir de ello utilizan metodologías que apenas les permiten aproximarse a un nivel superficial del conocimiento de la realidad social para hacer inferencias de la respuesta de las poblaciones ante la oferta de las vacunas

Los actores politicos y sociales en la formulación de la reforma sanitaria, en España / Social and political actors in the formulation of health reform in Spain

Analiza el proceso de formulación de la Ley General de Salud (LGS) en Espana con el propósito de conocer la relación entre la participación de actores sociales, políticos y conformación del sistema sanitario espanol. Se realizó un estudio de caso durante 1982-1986. Se nalizó información documental parlamentaria y prensa médica, principales diarios y revistas e informes y prensa de los actores políticos, sociales y sanitarios. La primera versión de LGS presentada por el PSOE propuso un sistema de salud con financiamiento y gestión pública para lograr cobertura universal, atención integral, participación comunitaria y educación sanitaria. Esta proposta fue sometida a compleja negociación con grupos empresariales, sindicatos, profesionales de salud. La LGS aprobada excluye los principios de equidad e incorpora los intereses económicos privados alerededor de la salud: "libre elección"médico-hospitalaria, financiamiento público y la gestión privada del sistema de salud, y estabelece a la seguridad social como rector del sistema.

Cobertura con la vacuna DPT en Oaxaca, México / DPT vaccine coverage in Oaxaca, México

En este documento se estudia la tendencia de la mortalidad y la morbilidad de la tos ferina en México, de 1930 a 1980. Así mismo, se analiza la cobertura vacunal por regiones socioeconómicas en el Estado de Oaxaca, México donde se profundiza el análisis. El método utilizado fue el estudio de caso, concentrándose el análisis en 17 de los 30 distritos de la entidad, los que fueron agrupados de acuerdo con factores socioeconómicos-demográficos, con la técnica de análisis factorial por componentes principales. Se considera la problemática del subregistro de esta enfermedad, y se hacen recomendaciones para la acción mediata e inmediata. La cobertura de la vacuna DPT presenta una relación inversa con las características socioeconómicas de los niños menores de 5 años observados en las regiones media y baja. En el período analizado, la tendencia de la morbilidad y la mortalidad es descendente. La velocidad de decremento es mayor a partir de la década de 1970. Esto probablemente es debido al subregistro, más que a un descenso real de la tos ferina. Se recomienda que las estrategias de inmunización en los niveles Nacional y Estatal consideren las características socioeconómicas, culturales y regionales, como elementos para incrementar selectivamente la cobertura del programa de vacunación contra la tos ferina .