Reforma del sistema de salud de Bolivia, 1999 / Health system reform from Bolivia, 1999

Los cambios estructurales iniciados en Bolivia a partir del año 1993 concuerdan con la mayoría de las recomendaciones de los organismos internacionales para acelerar la implementación de la Atención Primaria de Salud y así alcanzar la meta social de Salud para Todos con equidad, eficiencia, eficacia y calidad, con solidaridad y universalidad. Se cumplen seis años de un proceso de cambio estructural, que se condiera todavía breve para medir los impactos en las condiciones de vida de la población. Es evidente el cambio importante en el desarrollo y fortalecimiento de los servicios de primer nivel aumentando de esta forma la accesibilidad geográfica de los sectores más marginados. Otro logro importante en este proceso es la implementación del seguro básico de salud que permite romper las barreras económicas para la gran mayoría de la población y de esta forma aumentar la cobertura en salud particularmente de los grupos vulnerables. Por último es innegable, el valor de la incorporación de la comunidad, dentro de este proceso de cambio al asumir con responsabilidad la toma de decisiones y control de las acciones de salud

Square-wave endurance exercise test (SWEET) for training and assessment in trained and untrained subjects. I. Description and cardiorespiratory responses.

A new 45 min Square-Wave Endurance Exercise Test (SWEET) performed on a cycle ergometer and designed for endurance training was studied in 43 normal subjects: Untrained (U), twelve women and seven men and Trained (T), eight women and 16 men. Among them seven were elite sportsmen (E). Preliminary measurements were made of VO2 max by constant power and Maximal Tolerated Power (MTP) in a progressive test (+ 30 W/3 min). To the SWEET's base, established as a % of individual MTP, a peak of 1 min at MTP was added every 5 minutes. Maximum Intensity of Endurance during the SWEET (MIE45) is defined by both maximal heart rate (HR) at the end of the test and the impossibility of maintaining 5% above the percent MTP of the MIE45 for 45 min. Exhaustion was reached at the end of the MIE45, which could be expressed as % MTP, as total energy expenditure (TEE) in liters of O2, or as total mechanical work (TMW) in kiloJoules per kg of weight (kJ . kg-1). VE, VCO2, VO2 and HR were continuously measured. VO2 max, TMW and % MTP were significantly higher in T than in U subjects. The E subjects show the highest values of those parameters. TMW and TEE were well correlated (r = 0.992, p less than 0.001, n = 43) indicating good efficiency. TMW in T (r = 0.453) and in E men (r = 0.442) were however less well correlated to the VO2 max. MIE45 therefore gives different information in the evaluation of "endurance capacity" at the time of measurement than that provided by VO2 max. Because of the high TEE per session it could be useful for endurance training of T and U subjects.

VO2 max during progressive and constant bicycle exercise in sedentary men and women.

VO2 max, as obtained by five cycloergometric test protocols, was studied in 14 normal sedentary subjects: seven women (from 21--35 years) and seven men (from 21--48 years) who carried out four (n = 14) or five (n = 8) of the following exercise programmes: triangular tests, which consist of increasing the load (1) 20 W/min; (2) 30 W/3 min, rectangular tests at constant load; (3) the highest load which the subject could maintain for about 10 min (MSP + 20 W); (4) maximal supported power (MSP) during 20 min; (5) trapezoidal test, consisting of a rectangular exercise of 40 W (10 min), followed test no. 2. Exercises were performed on a cycle ergometer, while VE, VO2, VCO2, f and fH were continuously measured with an open circuit system. In women, the VO2 max (mean +/- SEM) was lower (36.5 +/- 2.1 ml . kg-1 . min-1) than in men (48.7 +/- 3.6 ml . kg-1 . min-1). The highest ventilation rate observed during exercise for the whole group (VE = 101 + 13 l . min-1) was always lower than the maximal voluntary ventilation (MVV = 144 +/- 131 . min-1, p less than 0.001). VO2 max strongly correlated with lean body weight, VC, FEV1, and MVV. In spite of the significant differences between the maximal load level sustained with the first three tests, the VO2 max values were not significantly different. Moreover, there exists an excellent correlation between them. It appears that neither the absolute load sustained in the tests, nor the duration nor intensity of the submaximal load which preceded the maximal level (tests 1, 2, and 5), influence the value of VO2 max.