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1.

La participación juvenil en la Política Pública de Juventud, 1997 – 2011 (Caldas, Colombia)/ The participation of young people in the Youth Public Policy, 1997-2011 (Caldas, Colombia)/ A participação dos jovens na Política Pública de Juventude, 1997-2011 (Caldas, Colômbia)

Peralta-Duque, Beatriz del Carmen
| Idioma(s): Español
Analizo aquí la participación política de los sujetos jóvenes en las políticas públicas de juventud en Caldas (Colombia), según sus garantías constitucionales y sus condiciones sociopolíticas, económicas y culturales, a partir de la Ley 375 de 1997 hasta 2011, a la culminación de los períodos de las alcaldías. En cuanto a la metodología, se trata de un estudio de caso efectuado en los municipios de Manizales, Palestina, Chinchiná, Neira y Villamaría, Región Centro Sur de Caldas. Cómo técnicas utilicé la observación directa y el análisis de artículos periodísticos, así como grupos focales, entrevistas en profundidad y encuesta. Según los resultados de la investigación, los sujetos jóvenes de los Grupos y Clubes juveniles y de las Casas de la Cultura, hacen de las artes y la ecología espacios de participación, más que los Consejos Municipales de Juventud. El Gobierno Escolar incentiva la participación. La Iglesia Católica y el movimiento MIRA promueven la participación juvenil. This article analyses the political participation of young people in youth public policies in the department of Caldas (Colombia) based on their constitutional rights and socio-political, economic and cultural conditions between the creation of Law 375 of 1997 until 2011. The methodology involved case studies in the municipalities of Manizales, Palestina, Chinchiná, Neira and Villamaría, forming the southern central region of Caldas. The techniques used included direct observation and analysis of new articles, focus groups, in-depth interviews and surveys. The results showed that young people participating in Youth Groups and Clubs and Culture Houses turn their practice of arts and interest in ecology into participation spaces more than the Municipal Youth Councils. The study also found that school governments encourage student participation while the Catholic Church and the MIRA political movement promote youth participation. Neste trabalho é analisada a participação dos jovens nas políticas públicas de juventude em Caldas (Colômbia) de acordo com suas garantias constitucionais e suas condições sociopolíticas, econômicas e culturais, a partir da Lei 375 de 1997 até 2011, segundo as datas da prefeitura. Método: estudo de caso nos municípios de Manizales, Palestina, Chinchiná, Neira e Villamaría, Região Centro-Sul de Caldas. Metodologia: observação direta e análise de artigos jornalísticos, grupos focais, entrevistas em profundidade e pesquisa. Resultados: os jovens dos grupos e clubes juvenis e das Casas de Cultura fazem das artes e da ecologia espaços de participação em maior proporção que os Conselhos Municipais de Juventude. O Governo Escolar incentiva a participação. A Igreja Católica e o movimento MIRA promovem a participação dos jovens.
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2.

Impacto económico del tabaquismo en los sistemas de salud de América Latina: un estudio en siete países y su extrapolación a nivel regional/ Financial impact of smoking on health systems in Latin America: A study of seven countries and extrapolation to the regional level

Pichon-Riviere, Andrés; Bardach, Ariel; Augustovski, Federico; Alcaraz, Andrea; Reynales-Shigematsu, Luz Myriam; Pinto, Márcia Teixeira; Castillo-Riquelme, Marianela; Torres, Esperanza Peña; Osorio, Diana Isabel; Huayanay, Leandro; Munarriz, César Loza; de Miera-Juárez, Belén Sáenz; Gallegos-Rivero, Verónica; Puente, Catherine De La; Navia-Bueno, María del Pilar; Caporale, Joaquín
| Idioma(s): Español
RESUMEN Objetivo Estimar los costos médicos directos atribuibles al tabaquismo en los sistemas de salud de América Latina. Métodos Se utilizó un modelo de microsimulación para cuantificar el impacto económico en enfermedad cardiovascular y cerebrovascular, enfermedad pulmonar obstructiva crónica (EPOC), neumonía, cáncer de pulmón y otras nueve neoplasias. Se realizó una búsqueda sistemática de datos epidemiológicos y de costos de los eventos. El modelo se calibró y validó para Argentina, Bolivia, Brasil, Chile, Colombia, México y Perú, países que representan el 78% de la población de América Latina; luego se extrapolaron los resultados a nivel regional. Resultados Cada año el tabaquismo es responsable de 33 576 millones de dólares en costos directos para el sistema de salud. Esto equivale a 0,7% del producto interno bruto (PIB) de la región y a 8,3% del presupuesto sanitario. La enfermedad cardiovascular, la EPOC y el cáncer fueron responsables de 30,3%, 26,9% y 23,7% de este gasto, respectivamente. El costo atribuible al tabaquismo varió entre 0,4% (México y Perú) y 0,9% (Chile) del PIB y entre 5,2% (Brasil) y 12,7% (Bolivia) del gasto en salud. En la región, la recaudación impositiva por la venta de cigarrillos apenas cubre 37% del gasto sanitario atribuible al tabaquismo (8,1% en Bolivia y 67,3% en Argentina). Conclusiones El tabaquismo es responsable de una importante proporción del gasto sanitario en América Latina, y la recaudación impositiva por la venta de cigarrillos está lejos de llegar a cubrirlo. La profundización de medidas como el aumento de impuestos al tabaco debería ser seriamente considerada por los países de la región. ABSTRACT Objective Estimate smoking-attributable direct medical costs in Latin American health systems. Methods A microsimulation model was used to quantify financial impact of cardiovascular and cerebrovascular disease, chronic obstructive pulmonary disease (COPD), pneumonia, lung cancer, and nine other neoplasms. A systematic search for epidemiological data and event costs was carried out. The model was calibrated and validated for Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, countries that account for 78% of Latin America’s population; the results were then extrapolated to the regional level. Results Every year, smoking is responsible for 33 576 billion dollars in direct costs to health systems. This amounts to 0.7% of the region’s gross domestic product (GDP) and 8.3% of its health budget. Cardiovascular disease, COPD, and cancer were responsible for 30.3%, 26.9%, and 23.7% of these expenditures, respectively. Smoking-attributable costs ranged from 0.4% (Mexico and Peru) to 0.9% (Chile) of GDP and from 5.2% (Brazil) to 12.7% (Bolivia) of health expenditures. In the region, tax revenues from cigarette sales barely cover 37% of smoking-attributable health expenditures (8.1% in Bolivia and 67.3% in Argentina). Conclusions Smoking is responsible for a significant proportion of health spending in Latin America, and tax revenues from cigarette sales are far from covering it. The region’s countries should seriously consider stronger measures, such as an increase in tobacco taxes.
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3.

Huella de carbono en Santa Marta, Colombia: Análisis desde el enfoque de los determinantes sociales de la salud - 2014/ Carbon footprint in Santa Marta, Colombia: An Analysis from social determinants of health approach - 2014

Alvarez-Miño, Lídice; Taboada-Montoya, Robinson; Trujillo-Montes, Andrés Camilo; Salazar-Ceballos, Alexander
| Idioma(s): Español
Objetivo. Se estableció como objetivo estimar la huella de carbono para la ciudad de Santa Marta- Colombia, a partir de las prácticas de consumo de alimentos, medios de transporte, servicios públicos y compra de bienes y servicios per cápita y relacionar dicha huella con aspectos determinantes de la salud como el nivel socio-económico y socio-demográfico de la población. Materiales y métodos. Se realizó un estudio de corte transversal de encuesta en Santa Marta-Colombia para 2014, con una muestra de 811 personas seleccionadas aleatoriamente. Los datos se analizaron en EpiInfo 7 a través de análisis bivariado con ANOVA y Ji2 para identificar dependencias y multivariado por OR para identificar asociaciones. Resultados. Se encontró que la huella de carbono estimada promedio fue de 29,95 tCO2e por prácticas de consumo. Se estableció que tener 35 años o menos, niveles educativo profesional universitario o superior, estrato socioeconómico medio alto y alto, e ingresos altos son aspectos que aumentan la probabilidad de tener una huella de carbono mayor o igual a 39,3tCO2e. Conclusión. El tamaño de la huella de carbono se relaciona inversamente con la edad, y directamente con los ingresos económicos, estrato y nivel educativo. Objective: The goal was to estimate the carbon footprint for Santa Marta by consumption per capita of food, transportation, goods and services, and housing, and to relate carbon footprint with the health determinants such as socio-economic status and socio-demographic characteristics of the population. Materials and Method: A cross-sectional study with survey design was conducted in Santa Marta-Colombia for 2014, with a sample of 811 randomly selected people. Data were analyzed in software EpiInfo 7. For bivariate analysis we used ANOVA and Chi2 to identify dependencies, and for multivariate analysis OR was used to identify associations. Result: The carbon footprint average by consumption patterns was 29.95 tCO2e. We found that people 35 years old or younger, professional or higher educational level, with medium-high and high socioeconomic status, and higher incomes have more probability to produce bigger carbon footprint (39.4 tCO2e or more). Conclusion: The size of the carbon footprint is inversely related to age but directly related with incomes, level of education and socioeconomic status.
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4.

Identificación de capacidades en salud ambiental de las autoridades ambientales en Colombia/ Identification of capacities in environmental health from environmental authorities in Colombia

Agudelo-Calderón, Carlos A; Vaca-Bohórquez, Martha L; García-Ubaque, Cesar A; Robledo-Martínez, Rocío; García-Ubaque, Juan C
| Idioma(s): Español
Objetivos Elaborar un diagnóstico rápido de capacidades de las autoridades ambientales y el Ministerio de Ambiente y Desarrollo Sostenible para asumir su rol en salud ambiental con base en el modelo de capacidades del Programa de las Naciones Unidas para el Desarrollo-PNUD. Método Se utilizaron los métodos de revisión documental, entrevista dirigida en aspectos clave y una encuesta comentada. Se seleccionaron 84 entidades a las cuales se les aplicó la encuesta de manera personalizada. Se obtuvo información completa de 76 instituciones. Resultados La valoración de favorabilidad del entorno se encontró entre las categorías aceptable y poco favorable, las capacidades en gestión del conocimiento se observaron precarias y la valoración de capacidades funcionales se reportó entre adecuadas o aceptables. La valoración de capacidades específicas tuvo una valoración de deficientes o apenas aceptables. Conclusión Se apreciaron dos problemas importantes: a. Las autoridades ambientales no conciben ni ponen en práctica estas capacidades desde el modelo del PNUD, sino desde el modelo convencional del Ministerio de Ambiente y Desarrollo Sostenible, y; b. Las autoridades ambientales muestran un nivel bajo de incorporación de las políticas de salud ambiental en su campo de acción específico. Objectives To diagnose the capabilities that environmental authorities and the Ministry of Environment and Sustainable Development have to assume their role in environmental health, based on the capacity model of the United Nations Program for Development UNDP. Method Document review, interviews on key issues and a commented survey were conducted. 84 entities were selected for a tailored survey; complete information was obtained from 76 institutions. Results The valuation of environment favorability was within the acceptable and unfavorable categories; knowledge management capabilities were found to be precarious and assessment of functional capabilities ranged between appropriate and acceptable. The assessment of specific capabilities had a rating of poor or barely acceptable. Conclusions Two major problems were found: a. The environmental authorities do not conceive or implement these capabilities based on the UNDP model but on the conventional model of the Ministry of Environment, Housing and Territorial Development; b. Environmental authorities show an incipient level of incorporation of environmental health policies in their field of action.
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5.

Inclusion of the equity focus and social determinants of health in health care education programmes in Colombia: a qualitative approach.

Hernández-Rincón, Erwin H; Pimentel-González, Juan P; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción
| Idioma(s): Inglés
PURPOSE: The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training programmes in Colombia. We studied the incorporation of EF and SDH in the curricula of several universities in Colombia to identify opportunities to strengthen their inclusion. METHODS: Qualitative methodology was performed in two stages: (i) initial exploration (self-administered questionnaires and review of curricula) and (ii) validation of the information (semi-structured interviews). RESULTS: The inclusion of the EF and SDH in university curricula is regarded as an opportunity to address social problems. This approach addresses a broad cross-section of the curriculum, especially in the subjects of public health and Primary Health Care (PHC), where community outreach generates greater internalization by students. The dominance of the biomedical model of study plans and practice scenarios focusing on disease and little emphasis on community outreach are factors that limit the inclusion of the approach. CONCLUSIONS: The inclusion of EF and SDH in university curricula in Colombia has primarily focused on increasing the knowledge of various subjects oriented towards understanding the social dynamics or comprehensiveness of health and disease and, in some programmes, through practical courses in community health and PHC. Increased integration of EF and SDH in subjects or modules with clinical orientation is recommended.
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6.

Factores de riesgo total en familias migrantes en Soledad, Atlántico/ Fatores de risco total em famílias migrantes em Soledad, Atlântico/ Total risk factors in migrant families in Soledad, Atlántico

Sánchez Isaza, Dora Cecilia; Cataño Ordoñez, Nhora
| Idioma(s): Español
Introducción: Colombia vive hoy por hoy uno de sus más grandes problemas sociales como es la migración de familias a nivel inter-municipales e inter-departamentales, lo que hace necesario la caracterización del factor de riesgo total en estas familias para su intervención. Materiales y Métodos: Estudio cuantitativo descriptivo transversal donde se seleccionaron 70 familias migrantes constituidas por 344 individuos, que viven aledaños a un barrio del municipio de Soledad, y se utilizó el instrumento Riesgo Familiar total (RFT 5-33) de Pilar Amaya, con las categorías: socio-demográfico, factores de riesgo y riesgo total. Resultados: Dentro de todos los factores de riesgo familiar que pone en un riesgo alto a estas familias migrantes son: condiciones de vivienda y vecindario con un 59%, situación económica con un 24% y condiciones afectivas con un 14%, menor frecuencia se da en servicios y practica de salud con un 10% y manejo de menores con 10%. Discusión: La problemática que viene afectando a las poblaciones rurales, aun cuando el gobierno viene desarrollando planes direccionados hacia las familias migrantes, los problemas de infraestructura de las viviendas y la situación socio-económica en ellos se refleja en su salud. Y más aun cuando algunas investigaciones han demostrado como se les ha venido vulnerando sus derechos. Conclusiones: Sobre el predominio de las familias migrantes con riesgo alto, se aprecia que estadísticamente los componentes de estas variables son independientes, pero el comportamiento observado puede ser el resultado de efectos causales similares. Introdução: Colômbia hoje está passando por um dos seus maiores problemas sociais, tais como a migração das famílias para nível inter-municipal e inter-departamental, tornando-se necessário caracterizar o fator de risco global nessas famílias para a sua intervenção. Materiais e Métodos: Estudo transversal quantitativo onde foram selecionados 70 famílias migrantes que consistem de 344 indivíduos que vivem ao lado de um bairro do município de Soledad, eo instrumento de risco familiar total (RFT 5-33) de Pilar Amaya foi utilizado, com a Categorias: sociodemográficas, fatores de risco e risco global. Resultados: Dentre todos os fatores de risco familiar que os colocam em alto risco para essas famílias migrantes são as condições de habitação e vizinhança com 59% situação económica com 24% e condições emocionais com 14% ocorre com menos frequência e prática nos serviços de saúde com 10% e gestão 10% menor. Discussão: O problema que está afetando as populações rurais, mesmo quando o governo está desenvolvendo planos voltados para famílias migrantes, os problemas de infra-estrutura habitacional e da situação sócio-económica neles se reflete na sua saúde. E ainda mais quando algumas pesquisas têm mostrado como foram violando seus direitos. Conclusões: Com predomínio de famílias migrantes de alto risco, mostra que estatisticamente os componentes dessas variáveis são independentes, mas o comportamento observado pode ser o resultado de efeitos causais semelhantes. Introduction: Colombia today is experiencing one of its greatest social problems such as the migration of families to inter-municipal and inter-departmental level, making it necessary to characterize the total risk factor in these families in order to be intervened. Material and Methods: Cross-sectional quantitative study, where 70 migrant families were selected, the sample was formed by 344 individuals, who lived adjacent to a neighborhood at the Soledad municipality. Total Family Risk Instrument (TFR 5-33) from Pilar Amaya was used. The categories were: socio-demographic, risk factors and total risk. Results: The main risk factors that contribute to situate the migrant family in high risk were: housing conditions and neighborhood with 59%, economic situation with 24% and emotional conditions with 14%, finally. Risk factors with low frequently were health service and practice with 10% and child breeding with 10%. Discussion: Although government is developing plans directed toward migrant families, they have been affected by housing infrastructure problems and socio-economic situation, which are reflected in their health. Conclusions: Migrant families with high risk show that components of these variables are independent statistically, but the observed behavior may be the result or similar causal effects.
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7.

Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia.

Syed, Sana; Addo, O Yaw; De la Cruz-Góngora, Vanessa; Ashour, Fayrouz A Sakr; Ziegler, Thomas R; Suchdev, Parminder S
| Idioma(s): Inglés
Anemia affects approximately 25% of school-aged children (SAC-aged 5.00-14.99 years) globally. We determined in three countries the prevalence and determinants of anemia in SAC. Data on sociodemographics, inflammation and nutrition status were obtained from the 2006 Mexican National Nutrition Survey, the 2003-6 US National Health and Nutrition Examination Surveys, and the 2010 Encuesta Nacional de Nutrición Situación Colombia. In the US, vitamin A and iron deficiency (ID) were available only for girls aged 12.00-14.99 years to which our analysis was limited. Associations were evaluated by country using multivariable logistic regression adjusting for confounders and complex survey design. The prevalence of anemia and ID were: Mexico 12% (ID 18%), n = 3660; US 4% (ID 10%), n = 733; and Colombia 4% (ID 9%), n = 8573. The percentage of anemia associated with ID was 22.4% in Mexico, 38.9% in the US and 16.7% in Colombia. In Mexico, anemia was associated with ID (adjusted OR: 1.5, p = 0.02) and overweight (aOR 0.4, p = 0.007). In the US, anemia was associated with black race/ethnicity (aOR: 14.1, p < 0.0001) and ID (aOR: 8.0, p < 0.0001). In Colombia, anemia was associated with black race/ethnicity (aOR: 1.6, p = 0.005), lowest socio-economic status quintile (aOR: 1.8, p = 0.0005), ID (aOR: 2.7, p < 0.0001), and being stunted (aOR: 1.6, p = 0.02). While anemia was uniformly associated with iron deficiency in Mexico, Columbia, and the United States, other measured factors showed inconsistent associations with anemia. Additional data on anemia determinants in SAC are needed to guide interventions.
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8.

Las capacidades de investigación en Determinantes Sociales de la Salud de grupos Registrados en Colciencias, Colombia (2012-2014)/ The research capabilities on social determinants of health of research groups registered in Colciencias, Colombia (2012-2014)/ As capacidades de pesquisa em Determinantes Sociais da Saúde de grupos Registrados em Colciencias, Colômbia (2012-2014)

Morales-Borrero, Carolina
| Idioma(s): Español
Objetivo: actualizar la información obtenida del estudio "Las capacidades de investigación en Determinantes Sociales de la Salud de grupos registrados en Colciencias, Colombia (2005-2012)" tomando como fuente de estudio la información registrada en la plataforma Scienti de Colciencias en el periodo comprendido 2013 y 2014 y aportes de líderes de grupos de investigación. Metodología: Se realizó un estudio observacional descriptivo apoyado en información registrada en la base de datos de Colciencias, sobre los grupos de investigación y la producción científica en determinantes sociales de la salud, "DSS". Se revisó el contexto histórico y político que atraviesa la producción científica nacional en salud con el fin de identificar las razones por las cuales las capacidades de investigación en DSS se debilitan. Resultados: De los 65 grupos existentes con registro en el Programa de Ciencias de la Salud de Colciencias para el año 2012, 3 de ellos (4,61%) ya no se encuentran vinculados a Colciencias. La producción de los grupos restantes en artículo científico logró 17 productos entre 2013-2014, 11 de estos, (64,7%) en idioma español y sólo 6 en inglés (35,3%). En general los grupos continúan privilegiando los estudios sobre Determinantes Sociales de la Salud , Sistemas de Salud y Atención Primaria en Salud, con énfasis en desigualdades en salud, estrés y cáncer . Ha surgido el estudio del agua como un tema esencial entre los grupos de salud , y se ha continuado el desarrollo de proyectos en red de carácter nacional. Conclusiones: Predominan los estudios realizados bajo el enfoque propuesto por la Comisión de Determinantes Sociales de la Salud en 2005. Los criterios para la distribución de recursos para investigar privilegian los grupos reconocidos por Colciencias y con larga trayectoria, lo cual fortalece solo una parte de la investigación pues al mismo tiempo se generan desigualdades entre los grupos por ubicación institucional y regional, por tema de investigación y tamaño de los equipos de los investigadores. Se precisa de estudios que comparen las capacidades de investigación en Latinoamérica, y estudios que expliquen el predominio de temas y enfoques en la investigación en salud. Objective: to update the information obtained from the study entitled "the research capabilities on Social Determinants of Health of research groups registered in Colciencias, Colombia (2005-2012)" using the information recorded in the Scienti Colciencias platform in the period between 2013 and 2014 and the contributions from leading research groups as a source of study. Methodology: a descriptive, observational study based on information recorded in the Colciencias database of research groups and scientific production on social determinants of health, "SDH". The historical and political context affecting national health-related research was reviewed in order to identify the reasons behind the weakening of the SDH research capabilities. Results: of the 65 existing groups that are registered in the Health Sciences Program in Colciencias for 2012, 3 (4.61%) are no longer linked to Colciencias. The remaining groups produced 17 scientific papers between 2013 and 2014, 11 of which (64.7%) were written in Spanish and the remaining 6 (35.3%) in English. In general, groups continue to favor the studies on Social Determinants of Health, Health Systems and Primary Health Care; emphasis on health inequalities, stress and cancer was observed. The study of water has emerged as a key issue among health research groups, and the development of networked projects at the national level has continued. Conclusions: studies using the approach proposed by the Commission on Social Determinants of Health in 2005 are prevalent. The criteria for allocating resources to research favor groups recognized by Colciencias and with broad experience. This strengthens only a part of the field of research because it also generates inequalities between groups due to institutional and geographic location, research topics, group size and research project scope. Studies comparing research capabilities in Latin America are required, as are those explaining the predominance of topics and approaches in health research. Objetivo: atualizar informação obtida na pesquisa "As capacidades de pesquisa em Determinantes Sociais da Saúde de grupos registrados Em Colciencias, Colômbia (2005-2012)", utilizando como fonte de estudo a informação registrada na plataforma Scienti de Colciencias no período entre 2013 e 2014 e contribuições proporcionadas por líderes de grupos de pesquisa. Metodologia: realizou-se um estudo observacional descritivo, apoiado em informação registrada na base de dados de Colciencias, sobre os grupos de pesquisa e sobre a produção científica em determinantes sociais da saúde, "DSS". Revisou-se o contexto histórico e político da produção científica nacional relacionada com saúde, visando identificar os motivos pelos quais as capacidades de pesquisa em DSS enfraquecem-se. Resultados : Dos 65 grupos registrados no Programa de Ciências da Saúde de Colciencias no ano 2012, 3 (4,61%) estão agora desvinculados de Colciencias. Os outros grupos conseguiram publicar 17 artigos científicos entre 2013-2014, 11 dos quais (64,7%) estão em espanhol e somente 6 em inglês (35,3%). Em geral, os grupos privilegiam estudos sobre Determinantes Sociais da Saúde , Sistemas de Saúde e Atenção Primária à Saúde, com ênfase em desigualdades em saúde, estresse e câncer . O estudo da água tem surgido como temática essencial para os grupos de saúde, e continua o desenvolvimento de projetos em rede a nível nacional. Conclusões: Dominam as pesquisas realizadas sob o enfoque proposto pela Comissão de Determinantes Sociais da Saúde em 2005. Os critérios para a distribuição de recursos para pesquisa privilegiam os grupos reconhecidos por Colciencias e com longa trajetória. Isso fortalece só uma parte da pesquisa e ao mesmo tempo gera desigualdade entre grupos institucionais e regionais, pelas temáticas de pesquisa, o tamanho das equipes de pesquisadores e o alcance das pesquisas. São necessários estudos comparando capacidades de pesquisa na América Latina, e estudos explicando a dominância de temáticas e enfoques de pesquisa em saúde. Recomendações: Desenvolver estratégias para fortalecer as capacidades de estudo, de acordo com agendas e prioridades de pesquisa, visando intervir a inequidade em saúde. Incluir enfoques críticos na formação de pesquisadores em saúde.
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9.

Identifying barriers to move to better health coverage: preferences for health insurance benefits among the rural poor population in La Guajira, Colombia.

Amaya, Jeannette Liliana; Ruiz, Fernando; Trujillo, Antonio J; Buttorff, Christine
| Idioma(s): Inglés
Even though access to health insurance in Colombia has improved since the implementation of the 1993 health reforms (Law 100), universal coverage has not yet been accomplished. There is still a segment of the population under the low-income (subsidized) health insurance policy or without health insurance altogether. The purpose of this research was to identify preferences and behavior regarding health insurance among the subsidized rural population in La Guajira, Colombia, and to understand why that population remains under the subsidized health insurance policy. The field experiment gathered information from 400 households regarding their socioeconomic situation, health conditions, and preferences for health insurance characteristics. Results suggest that the surveyed population gives priority to expanded family coverage, physician and hospital choice, and access to specialists, rather than to attributes associated with co-payments or premiums. That indicates that people value healthcare benefits and family coverage more than health insurance expenses, and policy makers could use these preferences to enroll subsidized population into the contributory regime.
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10.

A qualitative exploration of the impact of the economic recession in Spain on working, living and health conditions: reflections based on immigrant workers' experiences.

Ronda, Elena; Briones-Vozmediano, Erica; Galon, Tanyse; García, Ana M; Benavides, Fernando G; Agudelo-Suárez, Andrés A
| Idioma(s): Inglés
BACKGROUND: This study aimed to analyse how immigrant workers in Spain experienced changes in their working and employment conditions brought about Spain's economic recession and the impact of these changes on their living conditions and health status. METHOD: We conducted a grounded theory study. Data were obtained through six focus group discussions with immigrant workers (n = 44) from Colombia, Ecuador and Morocco, and two individual interviews with key informants from Romania living in Spain, selected by theoretical sample. RESULTS: Three categories related to the crisis emerged--previous labour experiences, employment consequences and individual consequences--that show how immigrant workers in Spain (i) understand the change in employment and working conditions conditioned by their experiences in the period prior to the crisis, and (ii) experienced the deterioration in their quality of life and health as consequences of the worsening of employment and working conditions during times of economic recession. CONCLUSION: The negative impact of the financial crisis on immigrant workers may increase their social vulnerability, potentially leading to the failure of their migratory project and a return to their home countries. Policy makers should take measures to minimize the negative impact of economic crisis on the occupational health of migrant workers in order to strengthen social protection and promote health and well-being.
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