Características sociodemográficas y clínicas de pacientes con hipertensión arterial en un área de salud de Niquero / Sociodemographic and clinical characteristics of patients with hypertension in a health area of Niquero

Introducción: La hipertensión arterial es la enfermedad crónica de mayor morbilidad a escala mundial, la cual representa un problema de salud por su multicausalidad y sus consecuencias. Objetivo: Describir las principales características sociodemográficas y clínicas de pacientes con hipertensión arterial, pertenecientes a un área de salud de Niquero. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 370 pacientes con hipertensión arterial, quienes pertenecían al Consultorio Médico de la Familia No. 4 de Niquero, provincia de Granma, desde junio de 2021 hasta igual mes de 2022. Se estudiaron las variables edad, sexo, color de la piel, clasificación según cifras tensionales y evolución, así como estado del paciente y complicaciones. Resultados: Predominaron los grupos etarios de 40-59 (37,6 %) y 60-79 años (36,5 %), el sexo femenino (58,4 %), así como el color de la piel mestizo (55,9 %). Resultaron mayoría los pacientes con hipertensión arterial de grado II en fase 1 (44,3 %) y los parcialmente compensados (55,9 %). La enfermedad arterial periférica fue la principal complicación (21,1 %). Conclusiones: La descripción de las características sociodemográficas y clínicas de los pacientes con hipertensión arterial constituye un elemento a tener en cuenta para el adecuado control de los afectados en las áreas de salud.

Introduction: Hypertension is the chronic disease of more morbidity worldwide, which represents a health problem due to its multicausality and consequences. Objective: To describe the main sociodemographic and clinical characteristics of patients with hypertension, belonging to a health area of Niquero. Methods: An observational, descriptive and cross-sectional study of 370 patients with hypertension who belonged to the Family Doctor Office No. 4 of Niquero, Granma province, was carried out from June, 2021 to the same month in 2022. The variables age, sex, color of the skin, classification according to tension figures and evolution were studied, as well as patient state and complications. Results: There was a prevalence of the 40-59 (37.6 %) and 60-79 (36.5 %) age groups, female sex (58.4 %), as well as the mixed race color of the skin (55.9 %). The patients with grade II hypertension in phase 1 (44.3 %) and partially compensated (55.9 %) were the majority. Peripheral arterial disease was the main complication (21.1 %). Conclusions: The description of the sociodemographic and clinical characteristics of patients with hypertension constitutes an element to take into account for the appropriate control of those affected in the health areas.

Genetically programmed cell-based synthesis of non-natural peptide and depsipeptide macrocycles.

The direct genetically encoded cell-based synthesis of non-natural peptide and depsipeptide macrocycles is an outstanding challenge. Here we programme the encoded synthesis of 25 diverse non-natural macrocyclic peptides, each containing two non-canonical amino acids, in Syn61Δ3-derived cells; these cells contain a synthetic Escherichia coli genome in which the annotated occurrences of two sense codons and a stop codon, and the cognate transfer RNAs (tRNAs) and release factor that normally decode these codons, have been removed. We further demonstrate that pyrrolysyl-tRNA synthetase/tRNA pairs from distinct classes can be engineered to direct the co-translational incorporation of diverse alpha hydroxy acids, with both aliphatic and aromatic side chains. We define 49 engineered mutually orthogonal pairs that recognize distinct non-canonical amino acids or alpha hydroxy acids and decode distinct codons. Finally, we combine our advances to programme Syn61Δ3-derived cells for the encoded synthesis of 12 diverse non-natural depsipeptide macrocycles, which contain two non-canonical side chains and either one or two ester bonds.

Aplicación de la medicina natural y tradicional por profesionales de la salud en el nivel primario de atención / Use of natural and traditional medicine by health professionals in the primary care level i: en

Introducción: La medicina natural y tradicional es una alternativa terapéutica inocua, económica y de fácil aplicación; sin embargo, aún persiste el poco empleo de sus modalidades. Objetivo: Describir el uso de la medicina natural y tradicional por profesionales de la salud en el nivel primario de atención. Métodos: Se efectuó un estudio observacional, descriptivo y transversal, desde enero hasta marzo de 2022, que incluyó a los 167 médicos y enfermeros que laboraban en los 42 consultorios pertenecientes al Policlínico Docente Ernesto Guevara de la Serna del municipio de Niquero, provincia de Granma. Entre las variables analizadas figuraron: perfil profesional de los integrantes del equipo básico de salud, frecuencia de aplicación de la medicina natural y tradicional, modalidades más empleadas, prescripción según afecciones y fortalezas para garantizar la práctica de este tratamiento. Resultados: Predominaron los residentes de medicina general integral (34,8 %), el uso frecuente del tratamiento (43,1 %), así como la fitoterapia (86,8 %) y la apiterapia (73,6 %) como modalidades más empleadas; asimismo, la mayoría de las prescripciones fueron para los pacientes con enfermedades osteomioarticulares y cardiovasculares (55,7 y 37,1 %, respectivamente). Conclusiones: El empleo de la medicina natural y tradicional en la atención primaria de salud en el municipio de Niquero proporcionó la información necesaria a los profesionales de la salud para confeccionar planes futuros y trazar estrategias relacionadas con las variantes de tratamiento.

Introduction: The natural and traditional medicine is an innocuous, economic therapeutic alternative of easy application; however, the little use of its modalities still persists. Objective: To describe the use of natural and traditional medicine by health professionals in the primary care level. Methods: An observational, descriptive and cross-sectional study was carried out from January to March, 2022, that included the 167 doctors and male nurses that worked in the 42 family doctor offices belonging to Ernesto Guevara de la Serna Teaching Polyclinic of Niquero municipality in Granma. Among the analyzed variables were the following: professional profile of the health basic team, frequency of natural and traditional medicine use, most used modalities, prescription according to affections and strengths to guarantee the practice of this treatment. Results: There was a prevalence of residents in comprehensive general medicine (34.8 %), the frequent use of the treatment (43.1 %), as well as fitotherapy (86.8 %) and apitherapy (73.6 %) as most used modalities; also, most of the prescriptions were for the patients with osteomioarticular and cardiovascular diseases (55.7 and 37.1 %, respectively). Conclusions: The use of natural and traditional medicine in primary health care in Niquero municipality provided the health professionals with the necessary information to make future plans and trace strategies related to the treatment variants.

Sense codon reassignment enables viral resistance and encoded polymer synthesis.

It is widely hypothesized that removing cellular transfer RNAs (tRNAs)-making their cognate codons unreadable-might create a genetic firewall to viral infection and enable sense codon reassignment. However, it has been impossible to test these hypotheses. In this work, following synonymous codon compression and laboratory evolution in Escherichia coli, we deleted the tRNAs and release factor 1, which normally decode two sense codons and a stop codon; the resulting cells could not read the canonical genetic code and were completely resistant to a cocktail of viruses. We reassigned these codons to enable the efficient synthesis of proteins containing three distinct noncanonical amino acids. Notably, we demonstrate the facile reprogramming of our cells for the encoded translation of diverse noncanonical heteropolymers and macrocycles.

Creating custom synthetic genomes in Escherichia coli with REXER and GENESIS.

We previously developed REXER (Replicon EXcision Enhanced Recombination); this method enables the replacement of >100 kb of the Escherichia coli genome with synthetic DNA in a single step and allows the rapid identification of non-viable or otherwise problematic sequences with nucleotide resolution. Iterative repetition of REXER (GENESIS, GENomE Stepwise Interchange Synthesis) enables stepwise replacement of longer contiguous sections of genomic DNA with synthetic DNA, and even the replacement of the entire E. coli genome with synthetic DNA. Here we detail protocols for REXER and GENESIS. A standard REXER protocol typically takes 7-10 days to complete. Our description encompasses (i) synthetic DNA design, (ii) assembly of synthetic DNA constructs, (iii) utilization of CRISPR-Cas9 coupled to lambda-red recombination and positive/negative selection to enable the high-fidelity replacement of genomic DNA with synthetic DNA (or insertion of synthetic DNA), (iv) evaluation of the success of the integration and replacement and (v) identification of non-tolerated synthetic DNA sequences with nucleotide resolution. This protocol provides a set of precise genome engineering methods to create custom synthetic E. coli genomes.

Reprogramming the genetic code.

The encoded biosynthesis of proteins provides the ultimate paradigm for high-fidelity synthesis of long polymers of defined sequence and composition, but it is limited to polymerizing the canonical amino acids. Recent advances have built on genetic code expansion - which commonly permits the cellular incorporation of one type of non-canonical amino acid into a protein - to enable the encoded incorporation of several distinct non-canonical amino acids. Developments include strategies to read quadruplet codons, use non-natural DNA base pairs, synthesize completely recoded genomes and create orthogonal translational components with reprogrammed specificities. These advances may enable the genetically encoded synthesis of non-canonical biopolymers and provide a platform for transforming the discovery and evolution of new materials and therapeutics.

Craniofacial characteristics of Syrian adolescents with Class II division 1 malocclusion: a retrospective study.

BACKGROUND: Malocclusion characteristics vary across different ethnic groups and populations. Limited data are available regarding the characteristics of Syrian adolescents with Class II division 1 (Class II-1) malocclusion, and the recent inflow of Syrian refugees and immigrants into Europe and many areas worldwide demonstrate the need for updated studies to discover the craniofacial characteristics of these new immigrants. OBJECTIVES: The present compound cephalometric and tooth-size study sought to assess the dentofacial morphology, upper-airway dimensions, and tooth-size characteristics of Syrian adolescents with Class II-1 malocclusion and compare the results with established Syrian population norms. MATERIALS AND METHODS: The study sample consisted of 43 Syrian patients including 24 females and 19 males with Class II-1 malocclusion (age: 14.3 (±1.5) years, mean (±SD)). Cephalometric radiographs and orthodontic casts were analyzed using special orthodontic software (OnyxCeph3™) and a universal digital caliper, respectively. Statistics were calculated using the SPSS software. RESULTS: In Syrian adolescents with Class II-1 malocclusion, the position of the mandible relative to the nasion perpendicular (mean (95% confidence interval)) was -11.01 (-12.45, -9.57) mm. Facial axis angle showed a negative value: -6.25 (-7.65, -4.85) degrees. An obtuse nasolabial angle was observed: 104.05 (101.77, 106.33) degrees. The average width of the upper pharynx was 11.50 (10.53, 12.47) mm; however, there was no prevalence of an upper-pharyngeal width of 5 mm or less. The average value of the anterior tooth-size ratio was 80.69 (79.85, 81.53) percent. In total, 39.5% of the investigated subjects had anterior ratios outside two standard deviations from Bolton's norm, while 25.6% of the investigated subjects had anterior ratios outside two standard deviations from Syrian population norm. CONCLUSIONS: In this study, the inter-maxillary discrepancy of Class II-1 Syrian adolescents was a consequence of their hyperdivergent facial pattern. The observed small pharyngeal widths were not clinically significant, while the anterior tooth-size discrepancy might be clinically relevant.

Programmed chromosome fission and fusion enable precise large-scale genome rearrangement and assembly.

The design and creation of synthetic genomes provide a powerful approach to understanding and engineering biology. However, it is often limited by the paucity of methods for precise genome manipulation. Here, we demonstrate the programmed fission of the Escherichia coli genome into diverse pairs of synthetic chromosomes and the programmed fusion of synthetic chromosomes to generate genomes with user-defined inversions and translocations. We further combine genome fission, chromosome transplant, and chromosome fusion to assemble genomic regions from different strains into a single genome. Thus, we program the scarless assembly of new genomes with nucleotide precision, a key step in the convergent synthesis of genomes from diverse progenitors. This work provides a set of precise, rapid, large-scale (megabase) genome-engineering operations for creating diverse synthetic genomes.

Total synthesis of Escherichia coli with a recoded genome.

Nature uses 64 codons to encode the synthesis of proteins from the genome, and chooses 1 sense codon-out of up to 6 synonyms-to encode each amino acid. Synonymous codon choice has diverse and important roles, and many synonymous substitutions are detrimental. Here we demonstrate that the number of codons used to encode the canonical amino acids can be reduced, through the genome-wide substitution of target codons by defined synonyms. We create a variant of Escherichia coli with a four-megabase synthetic genome through a high-fidelity convergent total synthesis. Our synthetic genome implements a defined recoding and refactoring scheme-with simple corrections at just seven positions-to replace every known occurrence of two sense codons and a stop codon in the genome. Thus, we recode 18,214 codons to create an organism with a 61-codon genome; this organism uses 59 codons to encode the 20 amino acids, and enables the deletion of a previously essential transfer RNA.

The correlation between the quality of oral hygiene and oral HPV infection in adults: a prospective cross-sectional study.

OBJECTIVES: Various risk factors for oral human papillomavirus (HPV) infections have been described, including tobacco smoking and sexual behavior. However, less is known about the influence of oral health on such infections. The present study aimed to determine a possible association between the quality of oral hygiene and the presence of oral HPV. METHODS: In a prospective analysis, the approximal plaque index (API), the gingival bleeding index (GBI), and the lifetime number of extracted teeth was determined in 187 patients. Additionally, the presence of oral low-risk and/or high-risk HPV was investigated by brush smear testing in all participants. RESULTS: Seventy-four patients had an API < 20%, 84 participants showed an API of 20-40%, and in 29 cases, an API > 40% was recorded. Ninety-six patients presented a GBI < 20%, 75 had a GBI of 20-40%, and 16 showed a GBI > 40%. One hundred four patients had experienced one to three extractions, and 36 had lost more than three teeth. Thirty-nine participants had a positive oral HPV testing (27 high-risk HPV, 26 low-risk HPV, 14 low- and high-risk HPV). A higher API respectively GBI and a greater number of extracted teeth were significantly correlated with the presence of high-risk HPV. The presence of low-risk HPV was significantly higher in patients with API > 40% and GBI > 40% (OR 7.89). Similar results were found regarding the number of extracted teeth. CONCLUSION: The present analysis confirms a relationship between the quality of oral hygiene, determined by objective markers. Thus, improvement of oral health may reduce the incidence of oral HPV infection. CLINICAL SIGNIFICANCE: The present article investigates the relationship between oral hygiene and the presence of oral HPV. As a significant correlation between these two factors could be recorded, improvement of oral hygiene may reduce actively the incidence of oral HPV. Thereby, good oral hygiene may contribute oral cancer prevention.

Recent Changes in Nitrogen Sources and Load Components to Estuaries of the Contiguous United States.

Regional Spatially Referenced Regressions on Watershed models were used to update 2002 delivered nitrogen (N) loads to estuaries of the contiguous US for 2011, supplemented by direct estuarine atmospheric deposition from the Community Multiscale Air Quality Model. Median 2011 watershed N yields were greatest for the Puget Trough, Virginian. and Oregon-Washington-Vancouver Coast marine ecoregions (MEs; 13. 7, 11.0, and 9.9 kg N/ha watershed/year, respectively); intermediate for the Floridian, Southern California Bight, and Northern California MEs (4.4-6.3 kg N/ha watershed/year); and lowest for the Northern Gulf of Mexico, Carolinian, and Gulf of Maine MEs (2.4-3.2 kg N/ha watershed/year). Dominant sources varied across marine ecoregions, with direct atmospheric deposition as the dominant source only in the far northern Gulf of Maine ME. Delivered N loads from atmospheric deposition have significantly decreased (p < 0.05) for most estuaries on the Atlantic and Gulf coasts for 2002-2012. Estimated point source delivered N loads for 2002-2012 increased for most estuaries with upstream treatment plants, with estimated loads to only seven estuaries decreasing by more than 50%. Urban runoff increased for most estuaries in the Puget Trough and Carolinian MEs and either increased or had no significant trend for the remaining marine ecoregions. The magnitude of change in total N delivered loads is uncertain due to incomplete monitoring for most minor dischargers. In areas with increased population growth and decreases in agricultural land, decreasing agricultural fertilizer inputs have been insufficient to offset increases in urban runoff.

Human papillomavirus prevalence in a Mid-European oral squamous cell cancer population: A cohort study.

OBJECTIVES: Human papillomavirus infection has been investigated intensively regarding oropharyngeal carcinoma. However, there is still lack of knowledge about the impact of oral HPV infections concerning oral squamous cell carcinoma. This study investigates the prevalence of oral HPV infection in such patients, identifying possible differences between HPV+ and HPV- patients. SUBJECTS AND METHODS: One hundred and six consequent patients were investigated. After completion of a study questionnaire regarding risk factors, a brush smear sample was taken in each subject to identify the individual oral HPV status (overall/low risk/high risk). RESULTS: About 35.8% of the patients were tested positive for HPV in the oral cavity (14% low risk, 28.3% high risk). Patients with oral HPV infection and high-risk HPV infection were significantly younger (p < 0.001) and had a higher alcohol consumption (p = 0.0075 resp. p = 0.0022). A high number of different sexual partners were significantly correlated with any type of HPV infection. At last, patients with high-risk oral HPV infection had experienced more tooth extractions during their lifetime. CONCLUSION: Oral HPV infections may influence the course of disease of oral squamous cell carcinoma as HPV+ patients are about 10 years younger. It seems that high alcohol consumption facilitates high-risk HPV infection. It may be presumed that both alcohol consumption and high-risk oral HPV infection act synergistically, explaining earlier cancer onset.

[Human resources for health in Ecuador's new model of care]. / Los recursos humanos en salud según el nuevo modelo de atención en Ecuador.

OBJECTIVE: Describe strategies implemented by Ecuador's Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012-2015. METHODS: A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. RESULTS: In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform's objectives. CONCLUSIONS: Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

[Positioning Ecuador in the global health agenda as a result of sector reform]. / Posicionamiento de Ecuador en la agenda de salud global como producto de la reforma sectorial.

OBJECTIVE: Analyze strategies implemented by Ecuador's Ministry of Public Health (MPH) to position the country in the global health agenda during the period 2011-2015 as a result of health sector reform. METHOD: Documentary review and interviews with stakeholders in national and international agencies with respect to positioning in the global health sphere during the study period. RESULTS: It was observed that the reform process produced a new framework to manage international health relations. The MPH implemented strategies and mechanisms to place national health priorities and interests on the global health agenda at bilateral, regional, and global levels. As a result, the country took a leadership role in certain processes and attained recognition at various international forums. CONCLUSIONS: The MPH reform process contributed to recognition and establishment of Ecuador's public policy priorities in the global health agenda through strategies such as giving importance to putting national priorities on the global health agenda, guiding the global health approach exercised by the highest health authority, developing technical capabilities and skills in the International Relations Office, and raising awareness in technical bodies.

La reforma en salud del Ecuador

Para comprender el proceso de reforma del sector salud en el Ecuador, es necesario partir del marco normativo e ideológico sobre el cual se basa la transformación sanitaria de la última década. A partir del año 2008 Ecuador reconoce en su Constitución el derecho a la salud con una visión sistémica, vinculándolo con el ejercicio de otros derechos. La Carta Magna del 2008 establece al Estado como garante del derecho a la salud a través de la formulación de políticas, planes y programas orientados a brindar acceso a servicios de promoción y atención integral bajo los principios de equidad, universalidad, solidaridad, interculturalidad, calidad, eficiencia, eficacia, precaución y bioética, con enfoque de género y generacional (1). De este modo, el mandato constitucional determina la necesidad de iniciar el proceso de reforma y define el ámbito en el cual se conduciría dicho proceso para lograr que el Estado cumpla con las nuevas obligaciones establecidas en la Constitución [...] El sistema de salud ecuatoriano sin duda se ha fortalecido con el profundo y ambicioso proceso de reforma, el cual ha sido posible gracias a un apoyo político explícito y sostenido, expresado en la priorización de la salud como un derecho de todos y de todas. No obstante, existen grandes retos aún pendientes, entre los cuales se destacan la implementación de un modelo de financiamiento sostenible con un fondo mancomunado para el sistema público, que permita una mayor eficiencia en el gasto en salud y garantice la sostenibilidad del sistema en el mediano plazo; el fortalecimiento de la vigilancia epidemiológica y del sistema de información en salud, a fin de detectar de manera temprana y oportuna los brotes epidémicos y las enfermedades crónicas no transmisibles evitando que éstas se transformen en enfermedades catastróficas; la consolidación de las estrategias de prevención y control –las cuales requieren fortalecerse en el marco del proceso de reforma–; la implementación del MAIS y su materialización en rutinas de atención para los enfermos agudos pero sobre todo para los portadores de enfermedades crónicas no transmisibles, a fin de asegurar la continuidad de los cuidados; y la construcción efectiva de redes integradas de provisión de servicios de salud con mecanismos estables y eficientes de referencia y contrarreferencia. Estas son las tareas a abordar en el futuro inmediato como parte de la consolidación de la reforma sanitaria, y como parte de la ruta del sistema de salud ecuatoriano hacia la salud universal.

Posicionamiento de Ecuador en la agenda de salud global como producto de la reforma sectorial / Positioning Ecuador in the global health agenda as a result of sector reform

Objetivo. Analizar las estrategias implementadas por el Ministerio de Salud Pública del Ecuador (MSP) para posicionar al país en la agenda de salud global durante el periodo 2011-2015 como producto del proceso de reforma del sector salud. Método. Revisión documental y entrevistas con actores clave de instancias nacionales e internacionales respecto al posicionamiento en el ámbito de la salud global durante el periodo estudiado. Resultados. Se observa que el proceso de reforma generó un nuevo marco para la gestión de las relaciones internacionales en materia de salud. El MSP implementó estrategias y mecanismos para situar las prioridades e intereses nacionales en salud en la agenda de salud global a escala bilateral, regional y mundial. Como consecuencia de ello, el país asumió un papel de liderazgo en ciertos procesos y alcanzó el reconocimiento en diversos foros internacionales. Conclusiones. El proceso de reforma del MSP contribuyó al reconocimiento y al establecimiento de las prioridades de política pública de Ecuador dentro de la agenda de salud global a través de estrategias tales como otorgar importancia a la proyección de las prioridades nacionales a nivel de la salud global, liderar el abordaje de la salud global ejercido por la Máxima Autoridad Sanitaria, desarrollar capacidades técnicas y destrezas en la Oficina de Relaciones internacionales, y lograr la concienciación en las instancias técnicas.

Objective. Analyze strategies implemented by Ecuador’s Ministry of Public Health (MPH) to position the country in the global health agenda during the period 2011-2015 as a result of health sector reform. Method. Documentary review and interviews with stakeholders in national and international agencies with respect to positioning in the global health sphere during the study period. Results. It was observed that the reform process produced a new framework to manage international health relations. The MPH implemented strategies and mechanisms to place national health priorities and interests on the global health agenda at bilateral, regional, and global levels. As a result, the country took a leadership role in certain processes and attained recognition at various international forums. Conclusions. The MPH reform process contributed to recognition and establishment of Ecuador’s public policy priorities in the global health agenda through strategies such as giving importance to putting national priorities on the global health agenda, guiding the global health approach exercised by the highest health authority, developing technical capabilities and skills in the International Relations Office, and raising awareness in technical bodies.

Los recursos humanos en salud según el nuevo modelo de atención en Ecuador / Human resources for health in Ecuador’s new model of care

Objetivo. Describir las estrategias implementadas por el Ministerio de Salud Pública del Ecuador (MSP) para fortalecer la rectoría de los recursos humanos en salud y responder al nuevo modelo de atención, como parte del proceso de reforma durante el periodo 2012–2015. Métodos. Se realizó una revisión documental sobre el desarrollo del recurso humano en salud antes y después de la reforma recabando información en fuentes primarias y secundarias. Resultados. En el periodo de estudio, Ecuador generó un nuevo marco institucional y normativo para desarrollar recursos humanos en salud a fin de responder a los requisitos de un modelo de atención basado en la Atención Primaria en Salud (APS). El MSP consolidó su papel rector estableciendo alianzas estratégicas, aplicando métodos de planificación de los recursos humanos y realizando una inversión sin precedentes en la formación del personal sanitario, contrataciones e incrementos salariales. Estos elementos constituyen los ejes iniciales para la construcción de una política de recursos humanos en salud y una carrera sanitaria coherentes con los objetivos de la reforma. Conclusiones. En el marco de la reforma realizada entre 2012 y 2015, el desarrollo del recurso humano en salud muestra logros importantes gracias al trabajo intersectorial realizado por el MSP. Entre dichos logros destacan el fortalecimiento de la rectoría, el desarrollo e implementación de normativa e instrumentos regulatorios, la creación de nuevos perfiles de profesionales, y el contrato de profesionales con el objetivo de implementar el Modelo de atención integral de salud (MAIS), lo cual contribuyó a resolver problemas arrastrados durante los años previos a la reforma.

Objective. Describe strategies implemented by Ecuador’s Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012–2015. Methods. A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. Results. In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform’s objectives. Conclusions. Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

Posicionamiento de Ecuador en la agenda de salud global como producto de la reforma sectorial / Positioning Ecuador in the global health agenda as a result of sector reform

RESUMEN Objetivo Analizar las estrategias implementadas por el Ministerio de Salud Pública del Ecuador (MSP) para posicionar al país en la agenda de salud global durante el periodo 2011-2015 como producto del proceso de reforma del sector salud. Método Revisión documental y entrevistas con actores clave de instancias nacionales e internacionales respecto al posicionamiento en el ámbito de la salud global durante el periodo estudiado. Resultados Se observa que el proceso de reforma generó un nuevo marco para la gestión de las relaciones internacionales en materia de salud. El MSP implementó estrategias y mecanismos para situar las prioridades e intereses nacionales en salud en la agenda de salud global a escala bilateral, regional y mundial. Como consecuencia de ello, el país asumió un papel de liderazgo en ciertos procesos y alcanzó el reconocimiento en diversos foros internacionales. Conclusiones El proceso de reforma del MSP contribuyó al reconocimiento y al establecimiento de las prioridades de política pública de Ecuador dentro de la agenda de salud global a través de estrategias tales como otorgar importancia a la proyección de las prioridades nacionales a nivel de la salud global, liderar el abordaje de la salud global ejercido por la Máxima Autoridad Sanitaria, desarrollar capacidades técnicas y destrezas en la Oficina de Relaciones internacionales, y lograr la concienciación en las instancias técnicas.

ABSTRACT Objective Analyze strategies implemented by Ecuador’s Ministry of Public Health (MPH) to position the country in the global health agenda during the period 2011-2015 as a result of health sector reform. Method Documentary review and interviews with stakeholders in national and international agencies with respect to positioning in the global health sphere during the study period. Results It was observed that the reform process produced a new framework to manage international health relations. The MPH implemented strategies and mechanisms to place national health priorities and interests on the global health agenda at bilateral, regional, and global levels. As a result, the country took a leadership role in certain processes and attained recognition at various international forums. Conclusions The MPH reform process contributed to recognition and establishment of Ecuador’s public policy priorities in the global health agenda through strategies such as giving importance to putting national priorities on the global health agenda, guiding the global health approach exercised by the highest health authority, developing technical capabilities and skills in the International Relations Office, and raising awareness in technical bodies.

Los recursos humanos en salud según el nuevo modelo de atención en Ecuador / Human resources in health according to the new model of care in Ecuador

RESUMEN Objetivo Describir las estrategias implementadas por el Ministerio de Salud Pública del Ecuador (MSP) para fortalecer la rectoría de los recursos humanos en salud y responder al nuevo modelo de atención, como parte del proceso de reforma durante el periodo 2012–2015. Métodos Se realizó una revisión documental sobre el desarrollo del recurso humano en salud antes y después de la reforma recabando información en fuentes primarias y secundarias. Resultados En el periodo de estudio, Ecuador generó un nuevo marco institucional y normativo para desarrollar recursos humanos en salud a fin de responder a los requisitos de un modelo de atención basado en la Atención Primaria en Salud (APS). El MSP consolidó su papel rector estableciendo alianzas estratégicas, aplicando métodos de planificación de los recursos humanos y realizando una inversión sin precedentes en la formación del personal sanitario, contrataciones e incrementos salariales. Estos elementos constituyen los ejes iniciales para la construcción de una política de recursos humanos en salud y una carrera sanitaria coherentes con los objetivos de la reforma. Conclusiones En el marco de la reforma realizada entre 2012 y 2015, el desarrollo del recurso humano en salud muestra logros importantes gracias al trabajo intersectorial realizado por el MSP. Entre dichos logros destacan el fortalecimiento de la rectoría, el desarrollo e implementación de normativa e instrumentos regulatorios, la creación de nuevos perfiles de profesionales, y el contrato de profesionales con el objetivo de implementar el Modelo de atención integral de salud (MAIS), lo cual contribuyó a resolver problemas arrastrados durante los años previos a la reforma.

ABSTRACT Objective Describe strategies implemented by Ecuador’s Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012–2015. Methods A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. Results In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform’s objectives. Conclusions Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.