Una investigación etnográfica sobre la violencia médica en los centros de salud de Nepal / Ethnographic Investigation into Medical Violence in Nepali Healthcare Facilities / Uma investigação etnográfica da violência médica em centros de saúde no Nepal

Introducción: la violencia no es un subproducto inherente de las relaciones humanas, pero los con-flictos sí lo son. En este artículo se examinan los factores y circunstancias que conducen a la tensión y los conflictos entre las personas que buscan atención médica y los establecimientos médicos nepalíes y los miembros del personal que trabajan allí. Desarrollo: embebido con una revisión de la literatura relevante, a través del análisis de datos etnográficos generada a partir de la investigación de campo y el análisis de contenido de la representación de noticias seleccionada, el artículo se desarrolla en cuatro secciones diferentes. La primera parte trata sobre el contexto de las consultas médicas que resultan en el desarrollo de una relación problemática. A esto le sigue el examen de los diferentes tipos de violencia, enfrentamientos y protestas que surgen a través de tales relaciones. En la tercera parte se analizan las implicaciones de las crecientes promesas médicas y el consiguiente aumento de las expectativas, mien-tras que la última parte destaca cómo las prácticas médicas típicas que existen en los propios hospitales nepaleses aumentan la posibilidad de enfrentamientos y violencia. Conclusión: la frecuente ocurrencia de peleas y violencia médica tanto en hospitales públicos como privados en Nepal sugiere que hay una bre-cha de comunicación entre los proveedores de servicios y el paciente debido a la naturaleza esotérica de la medicina. El conflicto y la violencia hacia los proveedores de servicios también pueden prosperar en el contexto de un modelo explicativo diferencial de las dos partes. La creciente animosidad también indica una disminución de la confianza entre los proveedores de atención médica y los solicitantes en Nepal

Introduction: Violence is not an inherent by-product of human relationships, but conflicts are. This arti-cle examines the factors and circumstances that lead to tension and conflicts between health seekers, and their counterpart Nepali medical establishments, and their staff members. Development: The article is divided into four sections by embedding a relevant literature review, analyzing ethnographic data generated from field research, and analyzing the content analysis of selected news portrayals. The first section discusses the context of the medical consultations that lead to the development of a problematic relationship. This is followed by examining the various types of violence, confrontations, and protests that arise from such relationships. The implications of rising medical promises and resulting height-ened expectations are discussed in the third section. The last section focuses on how common medical practices in Nepali hospitals increase the possibility of confrontations and violence. Conclusions: The prevalence of tussles and medical violence in Nepal's public and private hospitals suggests that they can occur in any hospital, regardless of ownership. Because of the esoteric nature of medicine, there is always a communication gap between service providers and patients. Conflict and violence against service providers can thrive in the context of a two-sided differential explanatory model. The growing hostility also indicates a decline in trust between healthcare providers and patients in Nepal

Introdução: a violência não é um subproduto inerente às relações humanas, mas o conflito é. Este artigo examina os fatores e circunstâncias que levam à tensão e ao conflito entre as pessoas que pro-curam cuidados médicos e os estabelecimentos médicos nepaleses e os funcionários que aí trabalham. Desenvolvimento: incorporada a uma revisão da literatura relevante, através da análise de dados etno-gráficos gerados a partir da pesquisa de campo e da análise de conteúdo da representação noticiosa selecionada, o artigo desenvolve-se em quatro seções distintas. A primeira parte trata do contexto das consultas médicas que resultam no desenvolvimento de uma relação problemática. Em seguida, exa-minamos os diferentes tipos de violência, confrontos e protestos que surgem através de tais relações. A parte três discute as implicações das crescentes promessas médicas e o consequente aumento das expectativas, enquanto a última parte destaca como as práticas médicas típicas que existem nos próprios hospitais nepaleses aumentam o potencial de confrontos e violência. Conclusão: a frequente ocorrência de brigas e violência médica em hospitais públicos e privados no Nepal sugere-nos que podem ocorrer em qualquer hospital, independentemente do proprietário. Sempre existe uma lacuna de comunicação entre os prestadores de serviços e o paciente devido à natureza esotérica da medicina. O conflito e a vio-lência contra os prestadores de serviços também podem florescer no contexto de um modelo explicativo diferencial das duas partes. A crescente animosidade também indica um declínio na confiança entre os prestadores de cuidados de saúde e os requerentes no Nepal

Pilot test of a measure to assess clients' perceptions of their home visitors.

Home visiting services for caregivers of infants and young children have been found to be an effective method for promoting child development. Unfortunately, such services suffer from high rates of attrition, suggesting the need to identify factors related to client retention in services. Research has indicated that the client-provider relationship is an important predictor of client retention in home visiting services; however, measures to assess this relationship are limited. This study reports on a pilot test of the Client Perceptions of Home Visitors Questionnaire, developed to assess home visiting clients' perceptions of their relationship with their home visitor. The measure was completed by 39 diverse home visiting clients during pregnancy in a midwestern town in the United States. The scale was found to have good internal consistency. Validity analyses found that the scale was positively associated with client satisfaction with services and perceived provider cultural sensitivity. The scale was also positively associated with retention in services at an 8-month follow-up. Additional research should examine the measure's psychometrics with larger samples.

Se ha determinado que los servicios de visita a casa para quienes prestan el cuidado a infantes y niños pequeños es un eficaz método para promover el desarrollo del niño. Desafortunadamente, tales servicios sufren de altas tasas de deserción, lo cual sugiere que hay una necesidad de identificar los factores relacionados con la retención del cliente en los servicios mencionados. La investigación ha señalado que la relación entre cliente y proveedor es un importante factor de predicción de la retención del cliente en los servicios de visita a casa; sin embargo, las medidas para evaluar esta relación son limitadas. Este estudio reporta acerca de un examen experimental del Cuestionario sobre las Percepciones del Cliente acerca de los Visitadores a Casa, desarrollado para evaluar las precepciones que tienen los clientes de visitas a casa acerca de su relación con el visitador a casa. Treinta y nueve clientes diversos de las visitas a casa completaron la medida durante el embarazo en un pueblo del medio oeste de los Estados Unidos. Se determinó que la escala tenía una buena consistencia interna. Los análisis de validez determinaron que la escala se asociaba positivamente con la satisfacción del cliente en cuanto a los servicios y la percibida sensibilidad cultural del proveedor. También se asoció la escala positivamente con la retención en los servicios al momento del seguimiento a los 8 meses. La investigación adicional debe examinar los aspectos sicométricos de la medida utilizando grupos muestras más grandes.

On considère que les services de visite à domicile pour les personnes prenant soin de bébés et de jeunes enfants sont une méthode efficace pour promouvoir le développement de l'enfant. Malheureusement de tes services souffrent de taux élevés d'attrition, suggérant donc le besoin d'identifier des facteurs liés à la rétention du client dans ces services. Les recherches ont indiqué que la relation client-prestataire est un facteur de prédiction important pour la rétention du client dans les services de visite à domicile. Cependant les mesures pour évaluer cette relation sont limitées. Cette étude porte sur un test pilote du Questionnaire des Perceptions du Client de la Visite à Domicile, développé afin d'évaluer les perceptions des clients de visite à domicile de leur relation au visiteur à domicile. La mesure a été remplie par 39 clients de visite a domicile, de milieux divers, durant la grossesse dans une ville du centre nord des Etats-Unis d'Amérique. On a trouvé que l'échelle avait une bonne consistance interne. Des analyses de validité ont trouvé que l'échelle était liée de manière positive à la satisfaction du client avec les services et à la sensibilité culturelle perçue du prestataire. L'échelle était aussi liée de manière positive à la rétention dans les services à un suivi à 8 mois. Des recherches supplémentaires devraient examiner la psychométrie de la mesure avec des échantillons plus grands.

Asociación entre los factores del proveedor de salud y el número de atenciones prenatales en las usuarias de un Hospital Peruano / Association Between Health Care Provider Factors And The Number Of Prenatal Visits In Peruvian Hospital Users

Introducción: La atención de la salud materno infantil es una prioridad para los servicios de salud. Objetivo: Identificar la asociación entre los factores del proveedor de salud y el número de atenciones prenatales en las usuarias del Hospital Carlos Lanfranco La Hoz atendidas en el año 2019. Métodos. Estudio cuantitativo, relacional y observacional. Conformaron la muestra 342 usuarias gestantes atendidas de enero a diciembre del 2019, las cuales fueron seleccionadas mediante un muestreo probabilístico sistemático. Para el análisis estadístico se usó una estadística descriptiva mediante la distribución de frecuencias absolutas y relativas y una estadística inferencial mediante el uso de la regresión de Poisson. Resultados: Predominó la edad de 18 a 35 años (74%), el grado de instrucción secundaria (62,9%), el estado civil conviviente (71,1%) y el seguro integral de salud (92,7%). Los factores asociados al número de atenciones prenatales fueron el factor técnico científico-recibir orientación sobre los resultados de análisis en la atención prenatal" (p <0,001; expB=1,2 IC95% 1,10­1,39), y que el médico u obstetra le recomiende medicamentos en su consulta prenatal (p=0,003; expB=1,2 IC95% 1,05­1,27)-: y como factor humano-médico u obstetra la llama por su nombre durante la consulta prenatal (p<0,001; expB=1,5 IC95% 1,19­1,77)-. Conclusión: Existe asociación entre los factores del proveedor de salud y el número de atenciones prenatales en las usuarias del Hospital Carlos Lanfranco La Hoz atendidas en el año 2019.

Introducción: Maternal and child health care is a priority for health services, it is essential that all pregnant women comply with the necessary amount of prenatal care for proper supervision of pregnancy and the detection of possible warning signs or complications in a timely manner. Objective: To identify the association between the health provider factors and the number of prenatal care in the users of the Carlos Lanfranco La Hoz hospital attended in 2019. Methods: quantitative, relational and non-experimental design study. 342 pregnant users attended from January to December 2019, who were selected through a systematic probability sampling. For the statistical analysis, a descriptive statistic was used through the distribution of absolute and relative frequencies and an inferential statistic through the use of Poisson regression. Results: The age from 18 to 35 years (74%) predominated, the degree of secondary instruction (62.9%), the cohabiting marital status (71.1%) and the comprehensive health insurance (92.7%). The factors associated with the number of prenatal care were, as a scientific technical factor, receiving guidance on the results of analysis in prenatal care "(p = 0.000; expB = 1.2 95% CI 1.10­1.39), and the doctor or obstetrician if recommended medications in their prenatal consultation (p = 0.003; expB = 1.2 95% CI 1.05-1.27); As a human factor, the doctor or obstetrician calls her by name during the prenatal visit (p = 0.000; expB = 1.5 95% CI 1.19­1.77). Conclusion: There is an association between the health provider factors and the number of prenatal care in the users of the Carlos Lanfranco La Hoz Hospital attended in 2019.

Selección de proveedores de insumos críticos en términos de sostenibilidad, a través de la metodología multicriterio, en una empresa del sector azucarero / Suppliers' selection of critical supplies in terms of sustainability, through the use of multi-criteria methodology, in sugar sector Company / Selecção de fornecedores de inputs críticos em termos de sustentabilidade, através da metodologia multicritério, numa empresa do sector do açúcar

RESUMEN Se presentan aquí, los resultados de una investigación teórico-práctica, en la cual se abarcó el eslabón de suministro, en una cadena de abastecimiento, en una empresa del sector azucarero en el Valle del Cauca. Para la selección de proveedores de insumos críticos, se aplicó la metodología multicriterio, considerando criterios que iban más allá del costo, tomando como referencia una clasificación de insumos de acuerdo a su criticidad en términos de sostenibilidad, para el proceso productivo. Inicialmente, se hizo una caracterización y una selección de los insumos críticos, en términos de sostenibilidad. Igualmente, se identificaron los proveedores para los insumos seleccionados. Luego, y en consenso con un comité escogido al interior de la empresa, se seleccionó y aplicó el método de jerarquía analítica AHP (Analytic Hierarcgy Process). Finalmente, se tomó la decisión más acorde a los requerimientos reales de la organización, los cuales consideraban como criterio principal la sostenibilidad, para alcanzar la competitividad y el desarrollo sostenible. Esto contribuirá con el tiempo, a que la organización sea económicamente viable, ambientalmente soportable y socialmente equitativa. CLASIFICACIÓN JEL 181

ABSTRACT We undertake a theoretical-practical investigation in which we study the supply function carried out by a company in the sugar sector at the Valle del Cauca. For the selection of critical input suppliers, we apply a multi-criteria methodology in which we take into account other criteria besides cost by considering a supplies' classification based on how critical these supplies are for the production process in terms of sustainability Initially we classify and select supplies that are more critical in regards to sustainability. Likewise, the suppliers for the selected inputs were identified. Then, in agreement with a committee chosen within the company we select and apply the analytical hierarchy method AHP (Analytic Hierarchy Process). Finally according to the real requirements of the organization, the most appropriate decision is made, which considers sustainability as the main criterion to achieve competitiveness and sustainable development. This will contribute to an economically feasible, environmentally bearable, and socially equitable company JEL CLASSIFICATION 181

RESUMO São aqui apresentados os resultados de uma investigação teórico-prática, que abrangeu o elo de abastecimento de uma cadeia de abastecimento de uma empresa do sector do açúcar no Valle del Cauca. Para a selecção de fornecedores de inputs críticos foi aplicada a metodologia multicritérios, considerando critérios que iam além do custo, tomando como referência uma classificação dos inputs de acordo com a sua criticidade em termos de sustentabilidade, para o processo produtivo. Inicialmente, foi feita uma caracterização e selecção de inputs críticos em termos de sustentabilidade. Do mesmo modo, foram identificados os fornecedores dos factores de produção seleccionados. Em seguida, e em consenso com um comité escolhido na empresa, foi seleccionado e aplicado o método AHP (Analytic Hierarchy Process). Finalmente, foi tomada a decisão mais consentânea com os requisitos reais da organização, que considerou a sustentabilidade como o principal critério para alcançar a competitividade e o desenvolvimento sustentável. Isto contribuirá, com o tempo, para tornar a organização economicamente viável, ambientalmente sustentável e socialmente equitativa. CLASSIFICAÇÃO JEL 181

Desarrollo de la autonomía del niño en la atención pediátrica: hacia un modelo ético / Developing child autonomy in pediatric healthcare: towards an ethical model

Los cambios del nuevo Código Civil y Comercial de la Argentina impulsa el desarrollo de la autonomía en niños y adolescentes. En este trabajo, estructuramos un modelo que describe la autonomía en la atención de la salud infantil. Hicimos un análisis bibliográfico enfocado en I) concepto de autonomía relacionado con el valor absoluto del individuo autónomo y II) el proceso de desarrollo de toma idónea de decisiones en función de la edad. Resumimos nuestros hallazgos mediante el desarrollo de un modelo conceptual en el niño, el pediatra y los padres. La relación pediatra-niño se fundamenta en formas de orientación y cooperación con diversos niveles de actividad y pasividad. La autoridad de los padres influye sobre el grado de autonomía en función del nivel de respeto e igualdad moral del niño. Al aplicar el modelo para facilitar el diálogo entre pediatras, niños, padres y otros, se considerarán las circunstancias contextuales, existenciales, conceptuales y socio-éticas.

The changes initiated by the new National Civil and Commercial Code in Argentina underline the pediatric task to empower children's and adolescents' developing autonomy. In this paper, we have framed a model describing autonomy in child healthcare. We carried out a literature review focusing on i) the concept of autonomy referring to the absolute value of the autonomous individual, and ii) the age-driven process of competent decisionmaking development. We summarized our findings developing a conceptual model that includes the child, the pediatrician and the parents. The pediatrician-child relationship is based on different forms of guidance and cooperation, resulting in varying levels of activity and passivity. Parental authority influences the extent of autonomy, based on the level of respect of the child's moral equality. Contextual, existential, conceptual, and social-ethical conditions shall be considered when applying the model to facilitate dialogue between pediatricians, children, parents and other actors.

Barriers and opportunities in recalls management at the health care provider level / Barreras y oportunidades en la gestión de retiro de productos farmacéuticos en las instituciones proveedoras de salud / Barreiras e oportunidades na gestão de lembranças no nível do provedor de cuidado da saúde

Abstract One of the operational risks to which a Health Care Provider (HCP) is exposed is the receiving and use of products such as pharmaceuticals and medical devices that could become subject to a health alert. This patient safety issue has to be managed in order to prevent and mitigate adverse events at the last echelon of the supply chain. This article aims to expose a characterization of the alerts response process at the HCP level based on a review of the literature. Additionally, local regulations, strengths and weaknesses were identified. Finally, the study allowed for the identification of the principal opportunities and barriers that should be addressed in order to integrate the recall management process within and outside the HCP. Among these opportunities is traceability along the supply chain, and among the barriers is the high investment in the technology required to facilitate supply chain integration.

Resumen Uno de los riesgos operacionales a los que está expuesto un Proveedor de Atención Médica (HCP por sus siglas en inglés) es la recepción y uso de productos farmacéuticos y dispositivos médicos que podrían estar sujetos a una alerta de salud. Este problema de seguridad del paciente tiene que ser manejado con el fin de prevenir y mitigar los eventos adversos en el último escalón de la cadena de suministro. Este artículo pretende exponer una caracterización del proceso de respuesta de alertas desde el HCP basado en una revisión de la literatura. Además, se identificaron la normativa local, fortalezas y debilidades. Finalmente, el estudio permitió identificar las principales oportunidades y barreras que se deben abordar para integrar el proceso de gestión de retiro de productos dentro y fuera del HCP. Entre estas oportunidades está la trazabilidad a lo largo de la cadena de suministro, y entre las barreras está la alta inversión en la tecnología requerida para facilitar la integración de la cadena de suministro.

Resumo Um dos riscos operacionais aos que está exposto um Provedor de Atenção Médica (HCP) é a recepção e o uso de produtos como produtos farmacêuticos e dispositivos médicos que poderiam estar sujeitos a uma alerta de saúde. Este problema de segurança do paciente tem que ser manejado com o fim de prevenir e mitigar os eventos adversos no último degrau da cadeia de fornecimento. Este artigo pretende expor uma caracterização do processo de resposta de alertas a nível do HCP baseado numa revisão da literatura. Ademais, identificaram-se as regulações locais, fortalezas e debilidades. Finalmente, o estudo permitiu identificar as principais oportunidades e barreiras que devem-se abordar para integrar o processo de gestão de produtos dentro e fora do HCP. Entre estas oportunidades está a traçabilidade ao longo da cadeia de fornecimento, e entre as barreiras está o alto investimento na tecnologia requerida para facilitar a integração da cadeia de fornecimento.

Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi.

OBJECTIVE: To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. METHODS: A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. RESULTS: Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. CONCLUSIONS: Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources.

Impacts of a new insurance benefit with capitated provider payment on healthcare utilization, expenditure and quality of medication prescribing in China.

OBJECTIVES: To assess a new Chinese insurance benefit with capitated provider payment for common diseases in outpatients. METHODS: Longitudinal health insurance claims data, health administrative data and primary care facility data were used to assess trajectories in outpatient visits, inpatient admissions, expenditure per common disease outpatient (CD/OP) visit and prescribing indicators over time. We conducted segmented regression analyses of interrupted time series data to measure changes in level and trend overtime, and cross-sectional comparisons against external standards. RESULTS: The number of total outpatient visits at 46 primary care facilities (on the CD/OP benefit as of July 2012) increased by 46 895 visits/month (P = 0.004, 95% CI: 15 795-77 994); the average number of CD/OP visits reached 1.84/year/enrollee in 2012; monthly inpatient admissions dropped from 6.4 (2009) to 4.3 (2012) per 1000 enrollees; the median total expenditure per CD/OP visit dropped by CNY 15.40 (P = 0.16, 95% CI: -36.95~6.15); injectable use dropped by 7.38% (P = 0.03, 95% CI: -14.08%~-0.68%); antibiotic use was not improved. CONCLUSIONS: Zhuhai's new CD/OP benefit with capitated provider payment has expanded access to primary care, which may have led to a reduction in expensive specialist inpatient services for CD/OP benefit enrollees. Cost awareness was likely raised, and rapidly growing expenditures were contained. Although having been partially improved, inappropriate prescribing of antibiotics and injectables was still prevalent. More explicit incentives and specific quality of care targets must be incorporated into the capitated provider payment to promote scientifically sound and cost-effective care and treatment.

Idosos Provedores: a importância dos recursos da aposentadoria para as famílias brasileiras / Providers elderly: the importance of resources toretirement the brazilian families / Proveedores ancianos: la importancia de los fondos dejubilación para las familias brasileñas

Este trabalho traz como recorte o “idoso provedor” que através do benefício da previdência social (aposentadoria e pensões) é o mantenedor de sua família, o “chefe”. Nesta investigação foram entrevistadas 34 pessoas com mais de 60 anos, provedores do núcleo familiar com o recurso de sua aposentadoria e/ou pensão. Encontrou-se na amostra 59% de aposentados e 57,3 % destes relatam viver somente dos recursos da aposentadoria, 22,4% dos pesquisados vivem de pensão e 14,2 % apontam os alugueis como forma de se manter. Os idosos se reconhecem como provedores dos seus núcleos familiares e, isto está lhes causando preocupação e restrição da liberdade, porém também se sentem importantes e valorizados.(AU)

This paper presents how snip the "old provider" that through the benefit of social foresight (retirement and pension) is the maintainer of your family, the "boss". In this investigation we interviewed 34 people with over 60 years old, core family providers with the resource of your retirement and / or pension. It was found in the sample 59% of retirees and 57,3% from these report that live only with the retirement resources, 22,4% of the surveyed lives from the pension and 14,2% link the rents as a way of keeping. The elderly recognize it self as providers of their core family and, this is causing concern and restriction of freedom, but also they feel important and valued.(AU)

En este trabajo se lleva a cabo el corte de edad "anciano proveedor" que utilizade los beneficios de la seguridad social (jubilaciones y pensiones) es elencargado de mantener a su familia , el "jefe". En esta investigación seentrevistó a 34 personas con más de60 años, los proveedores de la familianuclear con la capacidad de jubilación y / o pensión. Se encontró en la muestra59 % de los pensionistas y el 57,3 % de ellos informan experimentar sólo de losfondos de retiro, el 22,4 % de los encuestados viven de pensiones y el 14,2 %dijo rentas con el fin de mantener. Los ancianos son reconocidos comoproveedores de sus hogares,y esto les está causando preocupación y larestricción de la libertad, sino también sentir importante y valorado.(AU)

Idosos Provedores: a importância dos recursos da aposentadoria para as famílias brasileiras / Providers elderly: the importance of resources toretirement the brazilian families / Proveedores ancianos: la importancia de los fondos dejubilación para las familias brasileñas

Este trabalho traz como recorte o “idoso provedor” que através do benefício da previdência social (aposentadoria e pensões) é o mantenedor de sua família, o “chefe”. Nesta investigação foram entrevistadas 34 pessoas com mais de 60 anos, provedores do núcleo familiar com o recurso de sua aposentadoria e/ou pensão. Encontrou-se na amostra 59% de aposentados e 57,3 % destes relatam viver somente dos recursos da aposentadoria, 22,4% dos pesquisados vivem de pensão e 14,2 % apontam os alugueis como forma de se manter. Os idosos se reconhecem como provedores dos seus núcleos familiares e, isto está lhes causando preocupação e restrição da liberdade, porém também se sentem importantes e valorizados.(AU)

This paper presents how snip the "old provider" that through the benefit of social foresight (retirement and pension) is the maintainer of your family, the "boss". In this investigation we interviewed 34 people with over 60 years old, core family providers with the resource of your retirement and / or pension. It was found in the sample 59% of retirees and 57,3% from these report that live only with the retirement resources, 22,4% of the surveyed lives from the pension and 14,2% link the rents as a way of keeping. The elderly recognize it self as providers of their core family and, this is causing concern and restriction of freedom, but also they feel important and valued.(AU)

En este trabajo se lleva a cabo el corte de edad "anciano proveedor" que utilizade los beneficios de la seguridad social (jubilaciones y pensiones) es elencargado de mantener a su familia , el "jefe". En esta investigación seentrevistó a 34 personas con más de60 años, los proveedores de la familianuclear con la capacidad de jubilación y / o pensión. Se encontró en la muestra59 % de los pensionistas y el 57,3 % de ellos informan experimentar sólo de losfondos de retiro, el 22,4 % de los encuestados viven de pensiones y el 14,2 %dijo rentas con el fin de mantener. Los ancianos son reconocidos comoproveedores de sus hogares,y esto les está causando preocupación y larestricción de la libertad, sino también sentir importante y valorado.(AU)

Impact of systematic HIV testing on case finding and retention in care at a primary care clinic in South Africa.

OBJECTIVE: Systematic, opt-out HIV counselling and testing (HCT) may diagnose individuals at lower levels of immunodeficiency but may impact loss to follow-up (LTFU) if healthier people are less motivated to engage and remain in HIV care. We explored LTFU and patient clinical outcomes under two different HIV testing strategies. METHODS: We compared patient characteristics and retention in care between adults newly diagnosed with HIV by either voluntary counselling and testing (VCT) plus targeted provider-initiated counselling and testing (PITC) or systematic HCT at a primary care clinic in Johannesburg, South Africa. RESULTS: One thousand one hundred and forty-four adults were newly diagnosed by VCT/PITC and 1124 by systematic HCT. Two-thirds of diagnoses were in women. Median CD4 count at HIV diagnosis (251 vs. 264 cells/µl, P = 0.19) and proportion of individuals eligible for antiretroviral therapy (ART) (67.2% vs. 66.7%, P = 0.80) did not differ by HCT strategy. Within 1 year of HIV diagnosis, half were LTFU: 50.5% under VCT/PITC and 49.6% under systematic HCT (P = 0.64). The overall hazard of LTFU was not affected by testing policy (aHR 0.98, 95%CI: 0.87-1.10). Independent of HCT strategy, males, younger adults and those ineligible for ART were at higher risk of LTFU. CONCLUSIONS: Implementation of systematic HCT did not increase baseline CD4 count. Overall retention in the first year after HIV diagnosis was low (37.9%), especially among those ineligible for ART, but did not differ by testing strategy. Expansion of HIV testing should coincide with effective strategies to increase retention in care, especially among those not yet eligible for ART at initial diagnosis.

Características de los ensayos clínicos autorizados en el Perú, 1995-2012 / Characteristics of clinical trials authorized in Peru: 1995-2012

Objetivos. Describir las principales características de los ensayos clínicos (EC) autorizados en el Perú desde 1995 a agosto de 2012. Materiales y métodos. Se realizó un estudio transversal, en el que se revisaron todos los expedientes de protocolos de EC presentados para su evaluación y posible aprobación al INS, cuyos datos forman parte del Registro Peruano de EC. Se realizó el análisis descriptivo de los estados de aprobación de los EC, fase de estudio, especialidad, y otras características afines a ellos. Resultados. Se encontraron 1475 EC, de los cuales 1255 (85,1%) fueron autorizados. De un EC registrado el año 1995 se incrementó a 176 ensayos presentados en el 2008, disminuyendo en el 2011 a 128 ensayos. Entre los EC aprobados, el 64,1% corresponden a EC en fase III. Oncología (22,4%), Infectología (15,5%) y Endocrinología (12,7%) fueron las especialidades más estudiadas y solo el 1.19%, corresponde a enfermedades tropicales desatendidas. Los hipoglicemiantes orales, antivirales de uso sistémico y antineoplásico fueron los medicamentos más estudiados. La industria farmacéutica transnacional fue el principal patrocinador (87,1%) y ejecutor de ensayos clínicos (62,3%) los cuales se realizan mayormente en Lima. Conclusiones. Los ensayos clínicos que se realizan en el país son principalmente en enfermedades no transmisibles y son estudios en fase III. La industria farmacéutica constituye el principal patrocinador. Solo el 1.2%, corresponde a enfermedades tropicales desatendidas, lo cual muestra la poca atención a los problemas de salud de poblaciones en situaciones de vulnerabilidad.

Objective. To identify main characteristics of clinical trials (CT) authorized by the National Institute of Health (INS) of Peru from 1995 to August 2012. Material and methods. Cross-sectional study, which reviewed all records of CT submitted for review and possible approval by INS, whose data are part of the Peruvian Registry of Clinical Trials. We performed a descriptive analysis of the states of the CT approval and other characteristics. Results. 1475 clinical trials were assessed, of which 1255 (85.1%) were authorized. From 1 clinical trial officially registered in 1995, its quantity increased to 176 trials submitted in 2008, and then, declined to 128 in 2011. Among the approved CT, 64.1% was in Phase III. Oncology (22.4%), infectious diseases (15.5%) and endocrinology (12.7%) were the most studied specialties and a only 1.2% were for neglected tropical diseases. The oral hypoglycemic drugs, systemic antiviral and antineoplastic agents were the most studied investigational products. The transnational pharmaceutical industry was the main sponsor (87.1%) and executors (62.3%) of clinical trials were mostly in Lima. Conclusions. Clinical trials in Peru mainly focus on noncommunicable diseases and phase III studies. The pharmaceutical industry is the main sponsor. A very small number of authorized clinical trials in Peru were for neglected tropical diseases that shows little attention to the health problems in vulnerable populations.