Tesis de autoría de Bernardo Giraldo para optar por el título de Doctor en Medicina y Cirugía, en la que analiza diferentes aspectos relacionados con los transtornos del habla y la comunicación en los humanos.

Resumen: Antecedentes y objetivo: Se llevó a cabo una revisión de la literatura que evidencia problemas y necesidades en la diada paciente – cuidador familiar en cuidados paliativos durante el proceso de transición entre el hospital y el hogar. Estas necesidades tienen relación con: los conocimientos relacionados con la enfermedad, los sentimientos del cuidador y del paciente al alta, la comunicación efectiva, la educación para el cuidado a domicilio, el apoyo a la diada en el domicilio y la sobrecarga del cuidado - soporte social para el cuidador. La escasa evidencia sobre las experiencias en el proceso de transición hospital-hogar, así como de estudios en el ámbito latinoamericano, llevan a plantear una propuesta de investigación con el objetivo de describir la experiencia de la diada paciente – cuidador familiar en cuidado paliativo durante el proceso de transición entre el hospital y el hogar, en el contexto colombiano. Materiales y métodos: Esta propuesta se llevará a cabo utilizando metodología cualitativa con abordaje de teoría fundamentada. Los informantes del estudio serán pacientes y cuidadores familiares en cuidados paliativos en una institución sanitaria de Bogotá-Colombia. Para la recogida de datos, se utilizará la técnica de la entrevista familiar semiestructurada, que se realizará a las diadas en el hospital y posteriormente en el domicilio. El análisis de los datos se hará a través del método comparativo constante. Implicaciones prácticas: Conocer las experiencias de la diada al alta hospitalaria, saber los retos a los que se enfrentan en el domicilio y las necesidades que tienen durante este proceso, ayudaría a mejorar la atención a estas familias que requieren de cuidados paliativos. Abstract : BACKGROUND AND OBJECTIVE: We carried out a review of the literature that evidences problems and needs in the patient - caregiver family in palliative care during the transition process between the hospital and the home. These needs are related to: knowledge related to illness, feelings of caregiver and patient on discharge, effective communication, education for home care, home support and care overload - support For the caregiver. The lack of evidence on experiences in the transition process from home to hospital, as well as from studies in the Latin American context, lead to a research proposal with the objective of describing the experience of the patient-caregiver family in palliative care during the Process of transition between the hospital and the home, in the Colombian context. Materials and methods: This proposal will be carried out using qualitative methodology with a grounded theory approach. The informants of the study will be patients and family caregivers in palliative care at a health institution in Bogota-Colombia. For the collection of data, the semi-structured family interview technique will be used, which will be done at the dyads in the hospital and later at the home. The analysis of the data will be done through the constant comparative method. Practical implications: Knowing the experiences of the hospital discharge, knowing the challenges they face at home and the needs they have during this process, would help to improve care for these families that require palliative care.

Tesis presentada por Leonardo de la Motta para obtener el título de doctor en Medicina y Cirugía de la Facultad de Medicina en la Universidad Nacional de Colombia en 1891, en la que discute acerca de los procedimientos utilizados para curar heridas por armas de fuego. A lo largo del documento se explican los procedimientos a seguir en dos tipos de tratamiento: el general que exige reposo, y el tratamiento local que se aplica en casos de hemorragia, desbridamiento, extracción de cuerpos extraños y amputación. Adicionalmente, el autor presenta una serie de consideraciones a tener en cuenta según el sitio de la herida, estas últimas documentadas con registros de pacientes que acudieron a la clínica del Hospital San Juan de Dios y casos de hombres heridos en campos de batalla.

En el presente estudio se analizan los mecanismos implicados en la fragmentación del aparato de Golgi (AG) en células neuronales PC12 tratadas con las neurotoxinas 6-hidroxidopamina o metanfetamina como modelos celulares de la enfermedad de Parkinson (EP). Nuestros datos demuestran que la fragmentación del AG precede y podrían dar lugar a la agregación de la proteína ?-sinucleína, con la subsecuente formación de inclusiones, conduciendo a alteraciones en el transporte anterógrado y retrógrado entre el retículo endoplásmico y el AG, y daño en el citoesqueleto. Por el contrario, la fragmentación del AG está directamente relacionada con alteraciones en los niveles de expresión de las GTPasas Rab1, 2 y 8 y la proteína SNARE sintaxina 5. Así, la sobreexpresión de las proteínas Rab1 y 8 y la depleción de Rab 2 y sintaxina 5 restauran la morfología del AG. En conclusión, la homeostasis de un número limitado de proteínas Rab y SNARE es importante para la comprensión de la citopatología de la EP. La fragmentación del AG puede ser una especie de señal indicativa de que algo en la célula está mal y que el mecanismo de defensa celular se debe iniciar, lo que podría inducir la formación de cuerpos de inclusión del tipo agresomas, que funcionarían como un sistema de adaptación y “supervivencia” celular.

Das Krankenhaus als Schlüsselakteur im Gesundheitswesen muss heutzutage die Herausforderungen des Marktes und Wettbewerbes annehmen, dafür soll es eine Wettbewerbsstrategie folgen. Die zunehmenden Umweltprobleme mit der einhergehenden sozialen Ungerechtigkeit und Armut haben die Notwendigkeit erweckt, Unternehmen stärker in die Verantwortlichkeit ihres Handelns einzubinden. Krankenhäuser sind wichtiger Arbeitgeber, bedeutender Verbraucher von Ressourcen, und damit auch größere Erzeuger von Emissionen und Abfälle. Die vorliegende Arbeit soll klären, welche Wettbewerbsvorteile durch Nachhaltigkeitsmanagement in kolumbianischen Krankenhäusern aufgebaut und gehalten werden können. In der Einführung dieser Masterarbeit wird das kolumbianische Gesundheitssystem kurz vorgestellt sowie das externe Umfeld der Krankenhäuser erläutert, um eine allgemeine Strategie zu empfehlen. Im Anschluss wird der Einfluss von Nachhaltigkeitsmaßnahmen auf Wettbewerbsvorteile analysiert. Das kolumbianische System für soziale Sicherheit im Gesundheitswesen fördert die Qualität der Dienstleistung und Patientenorientierung als Grundlagen für die Wahl der Gesundheitseinrichtung bei Patienten. Neben den Ergebnissen der Analyse des Makroumfelds wird die Schlussfolgerung gezogen, dass eine Differenzierungsstrategie, die auf Qualität und Patientenorientierung basiert ist, das Konzept der Lebensqualität durch Wohlbefinden, Vitalität und Gesundheit in ihrer Struktur als Basis immer enthalten sollte. Der positive Einfluss von Nachhaltigkeitsmaßnahmen auf Wettbewerbsvorteile wird durch Ursache-Wirkungsbeziehungen dargestellt. Entlang der gesamten Wertschöpfungskette ist dann ihre Anwendung aufgezeigt. Einige der in der Masterarbeit identifizierten Maßnahmen sind: Risikoanalyse, Biosicherheit, Weiterbildung, Ethikkodex, effizientere Technologie, nachhaltige Beschaffung, Corporate Citizenship, u.a. Am Ende der Masterarbeit kommt der Autor zu dem Entschluss, sowohl Investitionen in Qualität als auch eine Rationalisierung von Kosten durch die Anwendung von Öko- und Sozioeffizienz in einer Weise durchzuführen, dass die Qualität der Dienstleistungen nicht belastet wird. Durch diesen Lösungsvorschlag kann das Krankenhaus attraktive Preise mit Krankenkasse handeln und gleichzeitig die Treue der Patienten behalten.

Conventional agricultural practices are often contrary to human health and environmental conservation. Use of and exposure to pesticides in agricultural communities in tropical countries is a pressing public health problem and an important facet of environmental degradation. This research project was undertaken by documenting use and exposure behaviors among agricultural communities in San Cristobal, Antioquia (Colombia). The research questions were: (1) What are the primary factors associated with the use of pesticides and do those factors differ between pesticide users and agroecological adherents? (2) How do campesino pesticide users and agroecological adherents(non-pesticide users) differ in their attitudes and beliefs with regards to pesticide use and exposure? and (3) How do these factors influence campesinos‟ behaviors associated with pesticide use and exposure? I implemented qualitative and quantitative methods in this investigation. The qualitative approach was based on community participatory ethnographic research. The latter involved participant observation, interviews, and focus groups aimed at existing pesticides users and agroecological adherents. The quantitative approach used questionnaires to derive demographic information, scale-based evaluations of attitudes and beliefs, pesticides decision making, perceived confidence, and perceived control. Findings showed that the most relevant factors related to pesticide use and their categories included: a) individual: beliefs, attitudes and knowledge; b) interpersonal: family support and cultural acceptance of pesticide use; c) economic: fear of living within financially unviable constraints, market conditions and lack of economic support from the government; d) cultural: collective acceptance or tolerance of pesticide use and exposure and onset of negative reactions when stopping pesticide use; e) political: deficient regulations for controlling pesticide use control and adequate utilization of protective equipment. Pesticide users experienced the most apprehension regarding stopping pesticide use as they often believed pesticides allow them to obtain better crop yields and, therefore, higher monetary gains. Pesticide users lacked a positive attitude toward personal protectionequipment, regardless of the risks to which they may be exposed. Pesticide training was deficient in this population showing a clear need to improve safety conditions and training to reduce occupational hazards. Future studies should explore with greater detail these attitudes and beliefs so as to promote mid- to long-term public health interventions that directly address the sense of food and income insecurity found among the population of pesticides users, which blocks their transition into a non-pesticide scenario for agricultural production. Over the short-term, public health programs should continue to educate the population of pesticide users on the immediate risks of exposure. The decision making process surrounding pesticide use in the studied population was influenced by a variety of factors. Campesinos who were prone to use pesticides for their crops often exhibited diminished degrees of knowledge about adverse effects of pesticides on human health, believed pesticides are necessary for their crops, had negative attitudes about stopping pesticide use, had a strong family influence toward the use of pesticides, experienced economic fear of stopping pesticide use, cultivated flowers as their main source of income, expressed strong social acceptance of pesticide use, experienced negative community reactions when attempting to stop pesticide use, received government subsidies for pesticide use, and had never received any training on the use of required protective equipment. Campesinos who showed more proclivities towards the use of pesticides were convinced that pesticides are necessary for their crops as they guarantee substantial yields and larger specimens of the different crop varieties. They also exhibited low perceived control, low perceived confidence, and a low perception of adverse pesticide effects on human health and the natural environment. Future studies are required to fully comprehend the unique occupational health and safety needs of these campesinos. Additionally, future studies should be aimed at designing and introducing long-term, well-structured public health interventions to increase awareness about the harmfulness of pesticides on human and environmental health so as to promote a well-established behavioral change in relation to pesticides use reduction among these communities.

Tesis de Nicolás Osorio para optar al título de Doctor en Medicina, en la Facultad de Medicina de París, en 1865. A lo largo del documento, escrito en francés, Osorio analiza el comportamiento de los tumores que obstruyen el líquido cefalorraquídeo.

Physical activity promotion (PAP) has reached policy agendas worldwide due to the social and economic burden that non-communicable diseases have generated. Colombia is one of the countries that have taken the challenge of promoting healthy lifestyles in order to reduce this burden and in addition, take advantage of other benefits that promoting this healthy lifestyle brings. Although some research has been done on the field, no studies related to the local government contribution were found. The local government plays a crucial role in PAP, considering that it has a great influence on the physical and social environment of a city and consequently in the individual behavior of its citizens. Additionally, it has a great responsibility concerning public health, social and economic development and environmental sustainability, aspects that are related to PAP. The present research, aims to provide a general overview on the current state of PAP in the Municipal Sport Authorities (MSAs) of one department of Colombia. In this sense, it is important to highlight that the sport sector has had a major role in PAP in the country and the department. Hence, structured interviews were conducted among heads of the MSAs of the 14 municipalities of the department and development plans were analyzed. Using this data, two main aspects were studied in order to achieve the research aim: the current PAP interventions and the conditions to promote physical activity (PA) in the department. Results indicate that the current PAP interventions have both strengths and weaknesses. Among the most important aspects, it was noticed that PAP in Risaralda has neglected important environmental determinants for PA behavior. PAP has been oriented from an “anthropic” perspective (targeting the individual). However, this seems to have had a positive effect on PA levels in the department. Concerning the conditions to promote PA, there are important findings related to the knowledge and skills of policy-makers and the management process used to develop the interventions. Some of the weaknesses found in the interventions might be related to the conditions to develop them. Recommendations to MSAs and for further research are given.

Abstract: Background: Allergic rhinitis may affect up to 50% of children. Treatment options include allergen avoidance, pharmacotherapy, immunotherapy and multimodal therapies. Nasal saline douching is well established in the treatment of allergic rhinitis in adults, and has recently gained more acceptability in children as the evidence builds for its effectiveness in this age group. To date, however, there is limited data regarding the acceptability and tolerability of nasal saline douching in children with allergic rhinitis. Methods: A search was conducted using Medline and Embase databases from January 1946 until June 2015 on the use of nasal douching in children aged 4 to 12 with allergic rhinitis. All publications identified that assessed the beneficial effects, acceptability and tolerability were included. The evaluation focused on primary (proportion of patients who adopted nasal douching routinely, symptom and quality of life scores) and secondary outcome measures (effects related to delivered method, dose, technique, and frequency of administration). Results: 35 studies were analyzed. Data varied considerably in terms of saline solutions used, modality of application, participant numbers, study design, follow up and outcomes. Factors that appear to influence the acceptability and tolerability of nasal saline douching are parental and health professionals’ preconceptions, and characteristics of the solution. Overall nasal saline irrigation appears to have a positive impact on quality of life, being accepted and tolerated in the majority of children (78-100%). Conclusions: Nasal saline douching has a significant positive impact on the quality of life in children aged 4 to 12 with allergic rhinitis. Among the principal factors that influence acceptability and tolerability of this therapy are the child´s age, delivery system and method, and tonicity. Encouragement and reinforcement is vital to successful compliance. Saline nasal douching provides an accessible, low cost, low morbidity, easy to use treatment that could be standardized as part of allergic rhinitis management in children. Resumen: Antecedentes: La rinitis alérgica puede afectar hasta el 50% de los niños. Las opciones de tratamiento incluyen evitar el alergeno, la farmacoterapia, la inmunoterapia y las terapias multimodales. La aplicación de la solución salina nasal hace parte del tratamiento de la rinitis alérgica en adultos, y recientemente ha ganado más aceptación en los niños a medida que la evidencia demuestra su eficacia en este grupo etario. Hasta la fecha, sin embargo, hay datos limitados en cuanto a la aceptabilidad y la tolerabilidad de la solución salina nasal en niños con rinitis alérgica. Métodos: Se realizó una búsqueda a través de Medline y EMBASE desde enero de 1946 hasta junio de 2015 sobre el uso de solución salina nasal en niños de 4 a 12 años con rinitis alérgica. Todas las publicaciones identificadas que evaluaron los efectos beneficiosos, la aceptabilidad y la tolerabilidad, fueron incluidas. La evaluación se centró en resultados primarios (proporción de pacientes que adoptaron las duchas nasales de forma rutinaria, los síntomas y la calidad de vida de las puntuaciones) y resultados secundarios (efectos relacionados con el método de entrega, la dosis, la técnica y la frecuencia de administración). Resultados: Se analizaron 35 estudios. Los datos variaron considerablemente en términos de soluciones salinas utilizadas, modalidad de aplicación, el número de participantes, el diseño del estudio, el seguimiento y resultados. Los factores que parecen influir en la aceptabilidad y la tolerabilidad de la solución salina nasal son las ideas preconcebidas de los padres y profesionales de la salud, y las características de la solución. En general, la irrigación salina nasal parece tener un impacto positivo en la calidad de vida, siendo aceptado y tolerado en la mayoría de los niños (78-100%). Conclusiones: La solución salina nasal tiene un impacto significativamente positivo en la calidad de vida en niños de 4 a 12 años con rinitis alérgica. Entre los principales factores que influyen en la aceptabilidad y la tolerabilidad de esta terapia son la edad del niño, el sistema de entrega y su forma, así como la tonicidad de la solución. El estímulo y refuerzo de este hábito como parte de la terapia, es vital para su adherencia. La solución salina nasal proporciona una terapia de bajo costo, accesible, de baja morbilidad, y fácil de usar que podría ser estandarizada como parte del tratamiento de la rinitis alérgica en niños.

Fee-for-service (FFS) payment system has been criticized for affecting quality of care, contributing to the fragmentation of health care, and for rising costs of health care systems. Alternative payment plans (APP) have been introduced as options to the traditional FFS. Despite a link between payment methods and behaviour of physicians has been established, there is a lack of evidence about the impact of payment systems on well-being (motivation and daily distress) of physicians. This dissertation explored the impact of APP on physicians’ perceptions of professional equity and daily distress. The following questions guided this dissertation: 1) Does professional equity perceived by physicians vary among practitioners paid by FFS, APP, or blended alternatives? 2) Is the payment method associated with daily distress of medical practitioners? and 3) Are levels of professional equity, daily distress, and career satisfaction of physicians different by gender and payment methods? In 2011, Physicians practicing in the Saskatoon Health Region, the largest health authority of Saskatchewan, Canada, completed a questionnaire evaluating their perceptions of professional equity and daily distress. In total, 382 (48.1%) physicians participated in the study. Response bias was tested and found to be negligible. The study identified that physicians paid by APP perceived higher professional equity (fair economic rewards and appropriate recognition) in comparison to those paid by FFS. Particularly, family practitioners (FPs) paid by APP perceived higher professional equity than those FPs paid by FFS. The payment method was identified as a factor associated with distress; lower levels of daily distress were predicted among physicians paid by APP who see high proportions of patients with complex conditions. Notwithstanding, female physicians had poorer well-being indicators and the impact of APP on professional equity was only distinguished among males. A potential unequal impact of APP must be recognized between female and male physicians.