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OBJECTIVES: To review and describe alternative strategies for the supply of vaccines in Latin America. METHODS: We conducted a narrative review to explore and describe alternatives for equitable vaccine access in Latin America. We searched and considered the main access strategies reported in the literature through PubMed, Science Direct, and Google Scholar. Additionally, we reviewed the web sites of key stakeholders. The search was conducted using the following keywords: ("access" or "availability" or "acquisition" or "affordability" or "tiered pricing") and ("vaccine"). Subsequently, documents that met the inclusion criteria were selected. Finally, findings were grouped by means of a thematic analysis and an interpretative synthesis. RESULTS: Twenty-four publications were included. We identified 5 main topics: current supply strategies, challenges for the acquisition of vaccines, vaccine prices equity, alternative supply strategies, and the advantages and impact of a tiered pricing strategy. CONCLUSIONS: Our review suggests that tiered pricing can be an tool for accelerating the process of introducing vaccines in low-income countries at affordable prices and for countries that do not adhere to the current procurement mechanisms or are not eligible for Vaccine Alliance because giving countries prices for vaccines that reflect their ability to pay can result in better programmatic and financial planning for the purchase of these vaccines, and in return, vaccine manufacturers can gain access to wider markets However, this model has not been z improve access to vaccines that are aimed only at developing countries, mainly because the market in these countries is not profitable for producers.
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Custos e Análise de Custo , Acessibilidade aos Serviços de Saúde , Vacinas , Humanos , América Latina , Vacinas/economia , Vacinas/provisão & distribuição , Acessibilidade aos Serviços de Saúde/economia , Países em DesenvolvimentoRESUMO
RESUMEN La ejecución excesiva de instrumentos de viento puede ser un factor causal para el desarrollo de distonía de la embocadura, caracterizada clínicamente por la aparición de contracciones musculares involuntarias, asociadas con la pérdida del control motor. Es importante que los profesionales y especialistas tengan el conocimiento necesario al momento de diagnosticar y tratar a la población que puede presentar este trastorno. El objetivo de esta revisión es examinar la literatura científica disponible en cuanto a la historia, epidemiología, fisiopatología, diagnóstico y tratamiento de la distonía de la embocadura en intérpretes de instrumentos de viento, con el fin de brindar herramientas para la prevención, el diagnóstico y el tratamiento de los músicos potencialmente susceptibles de desarrollar este trastorno.
SUMMARY Excessive practice of musical wind instruments may be a causal factor for the development of embouchure dystonia, clinically characterized by the appearance of involuntary muscle contractions associated with loss of motor control while interpreting a wind instrument. It is important for health professionals to have the necessary knowledge when diagnosing and treating musicians that are at risk or already have this disorder. The purpose of this review is to examine the scientific literature on the history, epidemiology, pathophysiology, diagnosis and treatment of embouchure dystonia in wind instrument interpreters, in order to provide the clinician tools for prevention, diagnosis and treatment in musicians who are susceptible for the development of this disorder.
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Mobilidade UrbanaRESUMO
Abstract Introduction: Individuals aged one hundred years or more are of interest for the study of the aging process, which has been scarcely addressed in Colombia. Objective: To estimate the number and geographical distribution of centenarians in Colombia. Materials and methods: Three sources of information were reviewed: the 2005 Census, the death certificates issued from 2010 to 2013, and the Individual Registries of Health Services Provision (RIPS in Spanish) of 2014. Results: The census recorded data of 3 165 centenarians (1 972 women, 62.3%), finding the highest rates in La Guajira (2.23 x 10 000), Chocó (1.90) and Sucre (1.61). In the four-year period analyzed, 3 611 people died, with the highest proportions (for every 1 000 deaths) found in Chocó (10.4), La Guajira (9.4) and Sucre (6.5). RIPS identified 3 390 centenarians, with a higher frequency in Sucre (2.17 x 10000), Chocó (1.29) and Córdoba (1.11). Conclusions: Although the results are consistent with the number and geographical distribution of centenarians, some errors may be found in the date of birth stated in the records, which is the basis for estimating age in the three sources. Other factors potentially involved in the results may be physical activity, family and community support, low stress and healthy diet in these regions.
Resumen Introducción. Las personas mayores de 100 años han sido poco estudiadas en Colombia, si bien son importantes para entender el envejecimiento. Objetivo. Estimar el número y distribución geográfica de los centenarios en Colombia. Materiales y métodos. Se revisaron tres fuentes de información: el Censo de 2005, los certificados de defunción de 2010 a 2013 y los Registros Individuales de Prestaciones de Servicios de Salud (RIPS) de 2014. Resultados. En el censo, se identificaron 3 165 centenarios (1 972 mujeres, correspondientes al 62.3%) con las tasas más elevadas en La Guajira (2.23 x 10 000), Chocó (1.90) y Sucre (1.61). En el cuatrienio analizado fallecieron 3 611 y se hallaron sus mayores proporciones (por cada 1 000 fallecidos) en Chocó (10.4), La Guajira (9.4) y Sucre (6.5). Los RIPS identificaron 3 390 centenarios, cuyas tasas más altas se ubicaron en Sucre (2.17 x 10 000), Chocó (1.29) y Córdoba (1.11). Conclusiones. Aunque los resultados de la investigación fueron consistentes en el número y la distribución geográfica de los individuos centenarios, pudo haber errores de registro de la fecha de nacimiento, que es la base para estimar la edad en las tres fuentes. Otra explicación de estos resultados podría involucrar la actividad física, el apoyo familiar y comunitario, el bajo nivel de estrés y la dieta saludable en estas regiones.
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Objetivos: determinar la asociación estadística entre el diagnóstico de enfermedad hepática alcohólica según Registros Individuales de Prestaciones de Servicios de Salud (RIPS) y ventas de alcohol por departamento, 2012. Métodos: se realizó un estudio ecológico transversal, comparando tasas de prevalencia estimadas por RIPS (códigos CIE K700-9) y población mayor de 18 años (DANE), con ventas de licores nacionales, licores importados y cervezas, convertidas a unidades de alcohol, según datos de la Federación Nacional de Departamentos. Resultados: las tasa de enfermedad hepática alcohólica nacional fue 10,7 por 100 000 con las tasas más elevadas en Santander (27,1), Risaralda (19,9) y Boyacá (15,0). Después de retirar los datos de departamentos con resultados poco confiables o incompletos, la correlación de Pearson para tasa de enfermedad y ventas de unidades de alcohol fue de 0,6. Conclusiones: existe una correlación positiva entre la tasa de enfermedad hepática alcohólica y las ventas de alcohol por departamento.
Objective: The purpose of this study was to determine the statistical association between the diagnosis of alcoholic liver disease and alcohol sales by department based on the Individual Records of the Health Care Services (Registros Individuales de Prestaciones de Servicios de Salud - RIPS) for 2012. Methods: This was a cross-sectional ecologic study conducted to compare prevalence rates of alcoholic liver disease estimated by RIPS (ICD K700-9) in the over 18 population (DANE) with sales, according to the National Federation of Departments, of domestic and imported spirits, liquors and beers, converted into alcohol units. Results: The national rate of alcoholic liver disease was 10.7 per 100,000 with higher rates in Santander (27.1), Risaralda (19.9) and Boyacá (15.0). After removing the data from departments with unreliable or incomplete results, the Pearson correlation rate of illness and alcohol unit sales was 0.6. Conclusions: There is a positive correlation between the rate of alcoholic liver disease and alcohol sales in each department.