El "derecho a la salud": dificultades, logros y desafíos / The 'right to health': difficulties, achievements, and challenges

RESUMEN El derecho a la salud como derecho ha sido parte de las consignas sociales de los últimos tiempos. Este artículo realiza un análisis de la salud como un derecho humano positivizado y profundiza en lo que implica definir la salud como un derecho aplicado al contexto colombiano.

ABSTRACT The right to health as a right has been part of the social slogans of recent times, this article analyzes it as a positive human right and delves into what it means to define health as a right applied to the Colombian context.

Modelos evaluativos para intervenciones complejas en salud / Evaluative models for complex health interventions

RESUMEN Este artículo presenta los modelos evaluativos para intervenciones complejas en salud. Dichas intervenciones se caracterizan por ser dinámicas, altamente influenciadas por el contexto (político, social, económico y cultural), y cuentan con múltiples actores y multicomponentes. Las intervenciones complejas en salud se ejecutan simultáneamente con otras intervenciones de otros sectores; requieren tiempo para mostrar resultados y a veces es difícil estimar su contribución social e individual a la población blanco. Este artículo pretende identificar los modelos evaluativos propuestos para intervenciones complejas en salud con sus respectivas características, a fin de tener referentes teóricos para evaluaciones de programas de esta naturaleza. Por mucho tiempo las intervenciones en salud y su evaluación se entendieron de manera lineal; sin embargo, bajo la perspectiva teórica de la complejidad (en la que se integran múltiples dimensiones del fenómeno), el contexto tiene un papel central. Esto permite entender que las intervenciones no tienen el mismo resultado en diferentes espacios y que esta forma de evaluación permite dar cuenta de ello.

ABSTRACT This paper presents evaluative models for complex health interventions. The complex health interventions are characterized by being dynamic, highly influenced by the con-text (political, social, economic, and cultural), which have multiple actors, multicomponent. Furthermore, they are executed simultaneously with other interventions from other sectors, they require time to show results and sometimes it is difficult to estimate the contribution to the social and individual impact of the target population. This paper aims to identify the proposed evaluative models for complex health interventions with their respective characteristics, to have theoretical references for evaluations of pro-grams of this nature. For a long time, health interventions and their evaluation were understood in a linear manner, however, under the theoretical perspective of the complexity (in which multiple dimensions of the phenomenon are integrated), the context plays a central role, making it possible to understand that interventions do not have the same result in different spaces and that this form of evaluation allows to account for it.

[The 'right to health': difficulties, achievements, and challenges]. / El "derecho a la salud": dificultades, logros y desafíos.

The right to health as a right has been part of the social slogans of recent times, this article analyzes it as a positive human right and delves into what it means to define health as a right applied to the Colombian context.

El derecho a la salud como derecho ha sido parte de las consignas sociales de los últimos tiempos. Este artículo realiza un análisis de la salud como un derecho humano positivizado y profundiza en lo que implica definir la salud como un derecho aplicado al contexto colombiano.

[Evaluative models for complex health interventions]. / Modelos evaluativos para intervenciones complejas en salud.

This paper presents evaluative models for complex health interventions. The complex health interventions are characterized by being dynamic, highly influenced by the con-text (political, social, economic, and cultural), which have multiple actors, multicomponent. Furthermore, they are executed simultaneously with other interventions from other sectors, they require time to show results and sometimes it is difficult to estimate the contribution to the social and individual impact of the target population. This paper aims to identify the proposed evaluative models for complex health interventions with their respective characteristics, to have theoretical references for evaluations of pro-grams of this nature. For a long time, health interventions and their evaluation were understood in a linear manner, however, under the theoretical perspective of the complexity (in which multiple dimensions of the phenomenon are integrated), the context plays a central role, making it possible to understand that interventions do not have the same result in different spaces and that this form of evaluation allows to account for it.

Este artículo presenta los modelos evaluativos para intervenciones complejas en salud. Dichas intervenciones se caracterizan por ser dinámicas, altamente influenciadas por el contexto (político, social, económico y cultural), y cuentan con múltiples actores y multicomponentes. Las intervenciones complejas en salud se ejecutan simultáneamente con otras intervenciones de otros sectores; requieren tiempo para mostrar resultados y a veces es difícil estimar su contribución social e individual a la población blanco. Este artículo pretende identificar los modelos evaluativos propuestos para intervenciones complejas en salud con sus respectivas características, a fin de tener referentes teóricos para evaluaciones de programas de esta naturaleza. Por mucho tiempo las intervenciones en salud y su evaluación se entendieron de manera lineal; sin embargo, bajo la perspectiva teórica de la complejidad (en la que se integran múltiples dimensiones del fenómeno), el contexto tiene un papel central. Esto permite entender que las intervenciones no tienen el mismo resultado en diferentes espacios y que esta forma de evaluación permite dar cuenta de ello.

Application of the micronucleus test and comet assay in Trachemys callirostris erythrocytes as a model for in situ genotoxic monitoring.

Trachemys callirostris is a turtle species endemic to northern South America. In northern Colombia it occurs in the middle and lower Magdalena River drainage and its principal tributaries (lower Cauca and San Jorge rivers) and in other minor drainages such as the lower Sinú River. In recent years, industrial, agricultural, and mining activities have altered natural habitats in Colombia where this species occurs, and many of the pollutants released there are known to induce genetic alterations in wildlife species. The micronucleus test and comet assay are two of the most widely used methods to characterize DNA damage induced by physical and chemical agents in wildlife species, but have not been employed previously for genotoxic evaluations in T. callirostris. The goal of this study was to optimize these genotoxic biomarkers for T. callirostris erythrocytes in order to establish levels of DNA damage in this species and thereby evaluate its potential as a sentinel species for monitoring genotoxic effects in freshwater environments in northern Colombia. Both genotoxic techniques were applied on peripheral blood erythrocytes from 20 captive-reared T. callirostris individuals as a negative control, as well as from samples obtained from 49 individuals collected in Magangué (Magdalena River drainage) and 24 individuals collected in Lorica (Sinú River drainage) in northern Colombia. Negative control individuals exhibited a baseline frequency of micronuclei of 0.78±0.58 and baseline values for comet tail length and tail moment of 3.34±0.24µm and 10.70±5.5, respectively. In contrast, samples from both field sites exhibited significantly greater evidence of genotoxic effects for both tests. The mean MN frequencies in the samples from Magangué and Lorica were 8.04±7.08 and 12.19±12.94, respectively. The mean tail length for samples from Magangué and Lorica were 5.78±3.18 and 15.46±7.39, respectively. Finally, the mean tail moment for samples from Magangué and Lorica were 23.59±18.22 and 297.94±242.18, respectively. The frequency of micronuclei in the samples was positively related to comet tail length and tail moment. Thus, this study showed that both genotoxicity biomarkers may be applied to T. callirostris erythrocytes as a sentinel organism for assessing the effects of environmental pollutants in freshwater ecosystems in northern South America.

NIVELES DE MERCURIO EN HUEVOS, EMBRIONES Y NEONATOS DE Trachemys callirostris (TESTUDINES, EMYDIDAE) / Mercury Levels in Eggs, Embryos, and Neonates of Trachemys callirostris (Testudines, Emydidae)

Cuantificamos la concentración total de mercurio en cáscaras, yemas y embriones de 16 nidos de hicotea (Trachemys callirostris). Los nidos fueron colectados en diferentes estadios de desarrollo embrionario. No hubo una correlación entre el tiempo estimado desde el desove y los niveles de mercurio en los huevos, sugiriendo que el metal no fue absorbido del substrato, sino que probablemente éste fue transferido a los huevos durante el proceso de foliculogénesis en las hembras reproductivas, las cuales bioacumularon el mercurio de fuentes ambientales. La concentración promedio de mercurio fue mayor en los embriones que en las cáscaras o yemas, indicando que los embriones también bioacumulan el metal presente en otros tejidos del huevo. La variación de la concentración de mercurio dentro de una misma nidada fue relativamente alta. Las concentraciones de mercurio en las yemas no estuvieron asociadas con ninguna de las medidas de fitness que fueron evaluadas (éxito de eclosión, tamaño inicial de los neonatos y tasas de crecimiento de los juveniles en el primer mes). Después de cinco meses de mantenimiento en cautiverio, en un ambiente libre de mercurio, 86 % de los juveniles había eliminado completamente este metal de sus tejidos.

We quantified total mercury concentrations in eggshells, egg yolks, and embryos from 16 nests of the Colombian Slider (Trachemys callirostris). Nests were collected in different stages of development, but estimated time of incubation in natural substrates was not correlated with mercury levels in the eggs, suggesting that mercury was not absorbed from the substrate, but more likely passed on to the embryos during folliculogenesis by the reproductive females who had bioaccumulated the mercury from environmental sources. Mean mercury concentrations were higher in embryos than in eggshells or egg yolks, indicating that embryos also bioaccumulate mercury present in other egg tissues. Intra-clutch variation in egg yolk mercury concentrations was relatively high. Egg yolk mercury concentrations were not associated with any of the fitness proxies we quantified for the nests (hatching success rates, initial neonate sizes and first-month juvenile growth rates). After five months of captive rearing in a mercury-free laboratory environment, 86 % of the juveniles had eliminated the mercury from their tissues.

Mercury concentrations in tissues of Colombian slider turtles, Trachemys callirostris, from northern Colombia.

This study determined the total mercury (THg) concentrations in pectoral muscle, blood and carapace tissue in turtles collected from Magangué and Lorica, Colombia. THg concentrations in µg/g (wet weight) were 0.39 ± 0.16 in muscle, 0.15 ± 0.08 in carapace and 0.07 ± 0.03 in blood for turtles from the Magdalena River and 0.25 ± 0.18 in muscle, 0.14 ± 0.09 in carapace and 0.06 ± 0.04 in blood for turtles from the Sinú River. Twenty-nine and ten percent of turtle muscle samples from Magangué and Lorica, respectively, exceeded the consumption advisory limit of 0.5 µg Hg/g for fish. There was a significant correlation between carapace length and THg levels for this specie, depending on the sample site. In addition, a significant correlation was observed in THg concentrations in carapace and muscle. However, significant differences were observed in the THg levels between the two study locations, with turtles caught in the Magdalena River having higher levels of THg.