Impact of stabilizing mutations on the antigenic profile and glycosylation of membrane-expressed HIV-1 envelope glycoprotein.

Recent HIV-1 vaccine development has centered on "near native" soluble envelope glycoprotein (Env) trimers that are artificially stabilized laterally (between protomers) and apically (between gp120 and gp41). These mutations have been leveraged for use in membrane-expressed Env mRNA vaccines, although their effects in this context are unclear. To address this question, we used virus-like particle (VLP) produced in 293T cells. Uncleaved (UNC) trimers were laterally unstable upon gentle lysis from membranes. However, gp120/gp41 processing improved lateral stability. Due to inefficient gp120/gp41 processing, UNC is incorporated into VLPs. A linker between gp120 and gp41 neither improved trimer stability nor its antigenic profile. An artificially introduced enterokinase cleavage site allowed post-expression gp120/gp41 processing, concomitantly increasing trimer stability. Gp41 N-helix mutations I559P and NT1-5 imparted lateral trimer stability, but also reduced gp120/gp41 processing and/or impacted V2 apex and interface NAb binding. I559P consistently reduced recognition by HIV+ human plasmas, further supporting antigenic differences. Mutations in the gp120 bridging sheet failed to stabilize membrane trimers in a pre-fusion conformation, and also reduced gp120/gp41 processing and exposed non-neutralizing epitopes. Reduced glycan maturation and increased sequon skipping were common side effects of these mutations. In some cases, this may be due to increased rigidity which limits access to glycan processing enzymes. In contrast, viral gp120 did not show glycan skipping. A second, minor species of high mannose gp160 was unaffected by any mutations and instead bypasses normal folding and glycan maturation. Including the full gp41 cytoplasmic tail led to markedly reduced gp120/gp41 processing and greatly increased the proportion of high mannose gp160. Remarkably, monoclonal antibodies were unable to bind to this high mannose gp160 in native protein gels. Overall, our findings suggest caution in leveraging stabilizing mutations in nucleic acid-based immunogens to ensure they impart valuable membrane trimer phenotypes for vaccine use.

Real world outcomes with Bortezomib Thalidomide dexamethasone and Cyclophosphamide Bortezomib dexamethasone induction treatment for transplant eligible multiple myeloma patients in a Latin American country. A Retrospective Cohort Study from Grupo Argentino de Mieloma Múltiple.

Data about treatment outcomes and toxicity in Latin America are scarce. There are differences with central countries based on access to healthcare system and socioeconomic status. Argentinean Society of Hematology recommends bortezomib-based triplets for induction treatment of transplant eligible newly diagnosed multiple myeloma patients. Most common options are CyBorD (cyclophosphamide, bortezomib and dexamethasone) and VTD (bortezomib, thalidomide and dexamethasone). Main goal of our retrospective, multicentric study was to compare very good partial response rate (VGPR) or better after induction treatment in a real-world setting in Argentina. Secondary objectives included comparison of complete response (CR) post-induction and after bone marrow transplantation, grade 3-4 adverse events (AEs), progression-free survival (PFS) and overall survival (OS). Three hundred twenty-two patients were included (median age at diagnosis: 57 years; 52% male; 28% had ISS3; 14% with high-risk cytogenetics; median follow up: 34 months). CyBorD was indicated in 74% and 26% received VTD. In VTD arm, 72.62% of patients achieved at least VGPR vs 53.36% receiving CyBorD (odds ratio, OR: 1.96 [95% confidence interval, CI: 1.08-3.57; P = .026] after adjusting by age, ISS [International Staging System], lactate dehydrogenase levels (LDH) and cytogenetic risk. Difference in VGPR was 19.26% (95% CI: 15-24). CR rate were 35.92% (VTD) vs 22.55% (CyBorD) (adjusted OR: 2.13 [95% CI: 1.12-4.05]). Difference in CR was 13.37% (95% CI: 9.6-17.53). Adverse events (AEs) were more common with VTD (69.05% vs 55.46% for CyBorD; P = .030), especially grade 3-4 neuropathy (P = .005) and thrombosis (P = .001). Thromboprophylaxis was inadequate in 20.24% of patients. Hematological AEs were more common with CyBorD, especially thrombocytopenia (P = .017). PFS and OS at 24 months were not different between treatments. In this real-world setting, VTD was associated with better CR and VGPR than CyBorD. Nevertheless, CyBorD continues to be the preferred induction regimen in Argentina, based on safety profile. Frontline autologous stem cell transplantation improves quality of responses, especially in countries with limited access to new drugs.

Epidemiological and clinical characteristics and outcome of monoclonal gammopathy of renal significance-related lesions in Latin America.

BACKGROUND: Monoclonal gammopathy of renal significance (MGRS)-related lesions are infrequent entities. There are no publications on these disorders in Latin America (LA). The aim of this study was to describe epidemiological and clinical characteristics of these patients in LA. METHODS: We performed a multicentre retrospective study. Patients with diagnosis of MGRS between 2012 and 2018 were included. Epidemiological and clinical data were collected from clinical records. RESULTS: Twenty-seven patients from Chile, Argentina, Ecuador and Uruguay were included. Half debuted with a nephrotic syndrome, and 32% required dialysis. Proliferative glomerulonephritis with monoclonal immunoglobulin deposits was found in 33%, amyloidosis in 26% and monoclonal immunoglobulin deposition disease also in 26%. The immunoglobulin most frequently found in renal biopsies was IgG kappa. In 67% a paraprotein was found. Twenty patients received an anti-plasma cell regimen, and 3 a rituximab-based regimen (IgM-MGRS). Renal response (RR) was achieved in 56%. Early treatment (≤3 months) was associated with higher RR (75% vs 43%). Three patients relapsed within 21.5 months, and 3 progressed: 1 to multiple myeloma, 1 to systemic amyloidosis and another to systemic light-chain deposition disease. Two patients died, both due to infection during induction treatment. CONCLUSION: There was a higher than expected frequency of patients requiring dialysis. The most common MGRS-related lesion was PGNMD. Early treatment was associated with better response. As a rare disease, increasing awareness and promoting early diagnosis are necessary in LA to improve outcomes. SUMMARY AT A GLANCE A collection of 27 cases of MGRS from Latin America with information on epidemiology, clinical characteristics, treatment and outcome of patients diagnosed of MGRS-related renal lesions.

Primary plasma cell leukemia in Latin America: demographic, clinical, and prognostic characteristics. A study of GELAMM group.

Primary plasma cell leukemia (pPCL) is an infrequent and aggressive plasma cell disorder. The prognosis is still very poor, and the optimal treatment remains to be established. A retrospective, multicentric, international observational study was performed. Patients from 9 countries of Latin America (LATAM) with a diagnosis of pPCL between 2012 and 2020 were included. 72 patients were included. Treatment was based on thalidomide in 15%, proteasome inhibitors (PI)-based triplets in 38% and chemotherapy plus IMIDs and/or PI in 29%. The mortality rate at 3 months was 30%. The median overall survival (OS) was 18 months. In the multivariate analysis, frontline PI-based triplets, chemotherapy plus IMIDs and/or PI therapy, and maintenance were independent factors of better OS. In conclusion, the OS of pPCL is still poor in LATAM, with high early mortality. PI triplets, chemotherapy plus IMIDs, and/or PI and maintenance therapy were associated with improved survival.

Patients Age 40 Years and Younger With Multiple Myeloma Have the Same Prognosis as Older Patients: An Analysis of Real-World Patients' Evidence From Latin America.

PURPOSE: Multiple myeloma (MM) is a highly heterogeneous, incurable disease most frequently diagnosed in the elderly. Therefore, data on clinical characteristics and outcomes in the very young population are scarce. PATIENTS AND METHODS: We analyzed clinical characteristics, response to treatment, and survival in 103 patients with newly diagnosed MM age 40 years or younger compared with 256 patients age 41-50 years and 957 patients age 51 years or older. RESULTS: There were no statistical differences in sex, isotype, International Scoring System, renal involvement, hypercalcemia, anemia, dialysis, bony lesions, extramedullary disease, and lactate dehydrogenase (LDH). The most used regimen in young patients was cyclophosphamide, bortezomib, dexamethasone, followed by cyclophosphamide, thalidomide, dexamethasone and bortezomib, thalidomide, dexamethasone. Of the patients age 40 years or younger, only 53% received autologous stem-cell transplant (ASCT) and 71.1% received maintenance. There were no differences in overall survival (OS) in the three patient cohorts. In the multivariate analysis, only high LDH, high cytogenetic risk, and ASCT were statistically associated with survival. CONCLUSION: In conclusion, younger patients with MM in Latin America have similar clinical characteristics, responses, and OS compared with the elderly.

Selinexor in Patients from Argentina with Multiple Myeloma Treated with Multiple Prior Therapies: A Case Series.

BACKGROUND Numerous treatment options are available for patients with multiple myeloma (MM). Because of the course of the disease, most patients will experience serial relapse or the MM will become refractory to most of these treatments, leaving patients with few or no treatment options over time. Selinexor, a treatment with a novel mechanism of action, is an oral selective inhibitor of nuclear export (SINE) compound that blocks exportin 1, the major nuclear exporter of tumor suppressor proteins. CASE REPORT In this case series, we report on treatment with the weekly oral administration of selinexor combined with bortezomib and dexamethasone (XVd) in 3 patients from Argentina who were heavily treated (5-7 prior therapies) for MM that relapsed or was refractory to each previous treatment. Two patients had the high-risk cytogenetic abnormality del(17p). All 3 patients experienced efficacy with XVd reaching a best response of partial response or very good partial response. These responses were consistent with those of patients from the BOSTON study who were treated with XVd but were less heavily pretreated (1-3 prior therapies) and had a shorter median time since diagnosis of MM (7 years vs 3.7 years). The 3 patients experienced adverse events (AEs) that included nausea, thrombocytopenia, asthenia, and fatigue, which were similar to the most commonly reported AEs associated with selinexor treatment. CONCLUSIONS With its oral administration, novel mechanism of action, and responses in heavily pretreated patients, selinexor may help to address an important clinical need in the treatment of patients with relapsed/refractory MM.

Real-world outcomes for the treatment of relapsed/refractory multiple myeloma patients with lenalidomide-dexamethasone combinations in a Latin American country. A retrospective cohort study from grupo argentino de mieloma múltiple.

OBJECTIVES: We compared the efficacy of lenalidomide-dexamethasone (Rd) based treatments for relapsed/refractory multiple myeloma patients (pts), in a real-world setting. In addition, we evaluated adverse events (AE), progression-free survival (PFS) and overall survival (OS). METHODS: In our retrospective, multicentric study, 156 pts with RRMM were included. 74/156 pts (47%) were refractory to bortezomib (V) and 43/156 (27%) pts to lenalidomide (R), with 24/156 (15%) of pts double refractory. Eighty-six pts (55%) received Rd with carfilzomib (KRd), 30 pts (19%) bortezomib (VRd), 30 pts (19%) daratumumab (DRd), and 10 pts (6%) ixazomib (IRd). RESULTS: The overall response (ORR) (≥ partial response) for the entire cohort was 71%, with a very good partial response rate or better (≥VGPR) of 35%. We found no significant differences in CR or ≥VGRP rates between treatments (p:0.229). Regardless of the combination received, those patients who achieved CR had significantly improved PFS (p: 0.007). The most frequent cause of treatment discontinuation was disease progression in 55/156 pts (35%). 8 pts (5%) discontinued treatment due to treatment-related adverse events (AE). CONCLUSION: This is the first report of Rd combinations for the treatment of RRMM in Latin America. All combinations proved to be effective with an acceptable toxicity.

Different outcomes for transplant-eligible newly diagnosed multiple myeloma patients in Latin America according to the public versus private management: a GELAMM study.

The aim of this study was to describe clinical and survival characteristics of transplant-eligible multiple myeloma (MM) patients in Latin America (LA), with a special focus on differences between public and private healthcare facilities. We included 1293 patients diagnosed between 2010 and 2018. A great disparity in outcomes and survival between both groups was observed. Late diagnosis and low access to adequate frontline therapy and ASCT in public institutions probably explain these differences. Patients treated with novel drug induction protocols, followed by autologous stem cell transplantation (ASCT) and maintenance, have similar overall survival compared to that published internationally.

Impact of Burnout on Organizational Outcomes, the Influence of Legal Demands: The Case of Ecuadorian Physicians.

Interest in burnout has developed extensively worldwide, but there is scarce the literature regarding the consequences that new legal demands have on burnout and on organizational outcomes in physicians. The global context of the medical profession has been characterized in the recent years by changes in the employment patterns, profound intensification of work, and increment of labor flexibility. In this context, the study aims to analyze the influence of burnout on organizational outcomes in physicians, depending on new legal demands perception in Ecuador. Regarding the method, the research was cross sectional and in the first stage, studied the psychometric characteristics, validity and reliability of the instrument to assess burnout through a series of confirmatory factor analyses (CFA). In a second part, we assessed, the robustness of the model of causal relations between the burnout dimensions and organizational outcomes. We carried out a series of path analysis, structural equation model. The study was accomplished in five hospitals and the sample was incidental, comprising 435 physicians from Ecuador. We divided the group in two subcategories, Sample A, composed by participants that considered that new Criminal Code (COIP) affects them and the Sample B, the group of physicians who believed that the COIP does not affect them. Burnout was assessed with the Spanish adaptation of the Maslach Burnout Inventory (MBI), the Organizational outcomes were measured with a seven-item self-report questionnaire, and we included an item regarding to the influence of new Criminal Code. We formulated four hypotheses, that considered that physicians who believed that the COIP affect them experience a greater negative influence of burnout on organizational outcomes. The results indicated that the group of physicians who believed that the COIP affects them (Sample A) experienced a greater negative influence of cynicism on productivity than Sample B. Moreover, the lack of efficacy dimension had more positive influence on turnover in group that believed that the Criminal Code does not affect their practice. The study is unique because incorporated new legal demands to traditional relation burnout and organizational outcomes in physicians.

Labor conditions and the meanings of nursing work in Barcelona.

OBJECTIVE: to analyze the relationship between the quantitative assessment of working conditions and the qualitative perception of one's own work experience. METHOD: a sample of 1,760 nursing professionals from Barcelona answered a questionnaire assessing their working conditions and summarized their own current work experience in five key words. RESULTS: the textual corpus of the meanings of nursing work included 8043 lexical forms, which were categorized and codified. Respondents who rated their work conditions the highest expressed a vision of their work in terms of autonomy, achievement and well-being, while those who rated their work conditions the lowest talked mostly of exhaustion, depersonalization and negative climate. A correspondence analysis showed a close relationship between the quantitative assessments of working conditions and the verbal codes of the meaning of work. CONCLUSIONS: the meanings given to work were not only consistent with the numerical evaluations of the working conditions but also made them more understandable. The information obtained poses challenges for reflection and indicates ways to promote the positive aspects and prevent the negative conditions of nursing work.

Condições de Trabalho e Significados da Experiência Laboral: O Caso dos Trabalhadores da Justiça / Working Conditions and Meanings of Working Experience: The Case of the Justice Workers / Condiciones de Trabajo y Significados de la Experiencia Laboral: El Caso de los Trabajadores de la Justicia

O funcionamento ideal das organizações requer que os trabalhadores estejam satisfeitos com suas condições de trabalho e atribuam significados positivos à sua atividade de trabalho. As reformas do sistema judiciário brasileiro criaram oportunidades para melhorar os serviços e o atendimento ao cliente. O objetivo desta investigação foi o de analisar a relação que os trabalhadores da justiça estabelecem entre a avaliação de suas condições de trabalho e a subjetivação de sua própria experiência profissional, entendida como o conjunto de significados que dão a este trabalho. Método. Uma amostra de 1.537 trabalhadores do setor respondeu ao Questionário sobre Condições de Trabalho (qCT) e a uma pergunta sobre o significado da própria experiência laboral. A análise de correspondência permitiu representar em tabelas de contingência as relações entre as categorias de avaliação quantitativa das condições de trabalho e os significados qualitativos atribuídos à experiência de trabalho. Resultados. Aqueles que pontuaram negativamente em condições de trabalho avaliaram sua experiência de trabalho em termos de desconforto, fadiga, injustiça e pouco comprometimento. Aqueles que os avaliaram positivamente avaliaram sua experiência em termos de oportunidades, relacionamentos e compromisso. Conclusões. O estudo fornece fundamentos empíricos e critérios teóricos para um redesenho das condições de trabalho do sistema de justiça que minimizem os riscos psicossociais para os servidores públicos.

The optimal functioning of organizations requires that workers be satisfied with their work-ing conditions and assign positive meanings to their work activity. The reforms of the Brazilian judicial system created opportunities to improve services and customer service. The objective of this investigation was to analyze the relationship that justice workers establish between the evaluation of their working conditions and the subjectivation of their own professional experience, understood as the set of meanings they give to this work. Method. A sample of 1,537 workers in the sector answered the Questionnaire on Working Conditions (QWC) and a question about the meaning of their own work experience. A correspon-dence analysis made it possible to represent the relationships between the categories of a quantitative assessment of working conditions and the qualitative meanings attributed to work experience in contin-gency tables. Results. Those who scored negatively on working conditions evaluated their work experience in terms of discomfort, fatigue, injustice, and little commitment. Those who rated them positively judged their experience in terms of opportunities, relationships, and commitment. Conclusions. The study pro-vides empirical foundations and theoretical criteria for a redesign of the working conditions of the justice system that minimizes psychosocial risks for civil servants

Work, malaise, and well-being in Spanish and Latin-American doctors.

OBJECTIVE: To analyze the relations between the meanings of working and the levels of doctors work well-being in the context of their working conditions. METHOD: The research combined the qualitative methodology of textual analysis and the quantitative one of correspondence factor analysis. A convenience, intentional, and stratified sample composed of 305 Spanish and Latin American doctors completed an extensive questionnaire on the topics of the research. RESULTS: The general meaning of working for the group located in the quartile of malaise included perceptions of discomfort, frustration, and exhaustion. However, those showing higher levels of well-being, located on the opposite quartile, associated their working experience with good conditions and the development of their professional and personal competences. CONCLUSIONS: The study provides empirical evidence of the relationship between contextual factors and the meanings of working for participants with higher levels of malaise, and of the importance granted both to intrinsic and extrinsic factors by those who scored highest on well-being.

Labor conditions and the meanings of nursing work in Barcelona / Condições de trabalho e significados do trabalho em enfermagem em Barcelona / Condiciones laborales y significados del trabajo en enfermería en Barcelona

ABSTRACT Objective: to analyze the relationship between the quantitative assessment of working conditions and the qualitative perception of one's own work experience. Method: a sample of 1,760 nursing professionals from Barcelona answered a questionnaire assessing their working conditions and summarized their own current work experience in five key words. Results: the textual corpus of the meanings of nursing work included 8043 lexical forms, which were categorized and codified. Respondents who rated their work conditions the highest expressed a vision of their work in terms of autonomy, achievement and well-being, while those who rated their work conditions the lowest talked mostly of exhaustion, depersonalization and negative climate. A correspondence analysis showed a close relationship between the quantitative assessments of working conditions and the verbal codes of the meaning of work. Conclusions: the meanings given to work were not only consistent with the numerical evaluations of the working conditions but also made them more understandable. The information obtained poses challenges for reflection and indicates ways to promote the positive aspects and prevent the negative conditions of nursing work.

RESUMO Objetivo: analisar a relação entre a avaliação quantitativa das condições de trabalho e a percepção qualitativa da própria experiência de trabalho. Método: uma amostra de 1760 profissionais de enfermagem de Barcelona respondeu a um questionário para avaliação de suas condições de trabalho e resumiu em cinco palavras-chave sua própria experiência de trabalho atual. Resultados: o corpus textual dos significados do trabalho incluiu 8043 formas lexicais, que foram categorizadas e codificadas. As pessoas pesquisadas que classificaram mais alto as suas condições de trabalho expressaram uma visão do trabalho em termos de autonomia, realização e bem-estar, ao passo que as que o classificavam mais baixo falavam principalmente de exaustão, despersonalização e clima negativo. Uma análise de correspondências evidenciou uma estreita relação entre as avaliações quantitativas das condições de trabalho e os códigos verbais de significado do trabalho. Conclusões: os significados dados ao trabalho foram não só coerentes com as avaliações numéricas das condições de trabalho, mas também as tornaram mais compreensíveis. A informação obtida coloca desafios para reflexão e aponta caminhos para enfrentar a promoção dos aspectos positivos e a prevenção dos negativos das condições do trabalho de enfermagem.

RESUMEN Objetivo: analizar la relación entre la valoración cuantitativa de las condiciones de trabajo y la percepción cualitativa de la propia experiencia laboral. Método: una muestra de 1.760 profesionales de enfermería de Barcelona respondió a un cuestionario de valoración de sus condiciones de trabajo y resumió en cinco palabras clave su propia experiencia laboral actual. Resultados: el corpus textual de significados del trabajo incluyó 8.043 formas léxicas, que fueron categorizadas y codificadas. Las personas encuestadas que valoraron más alto sus condiciones de trabajo expresaron una visión de su trabajo en términos de autonomía, realización y bienestar; mientras que quienes las valoraron más bajo hablaron sobre todo de agotamiento, despersonalización y clima negativo. Un análisis de correspondencias evidenció una estrecha relación entre las valoraciones cuantitativas de las condiciones laborales y los códigos verbales de significado del trabajo. Conclusiones: los significados dados al trabajo fueron no solo coherentes con las valoraciones numéricas de las condiciones laborales, sino que además las hicieron más comprensibles. La información obtenida plantea desafíos para la reflexión y señala caminos orientados a la promoción de los aspectos positivos y a la prevención de los negativos de las condiciones del trabajo de enfermería.

Las estrategias de educación a pacientes son coste efectivas: reduzca el fósforo ahorrando 200€ al mes por paciente / Educating your patient helps to control serum phosphate and also save 200 € per patient

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Work, malaise, and well-being in Spanish and Latin-American doctors

ABSTRACT OBJECTIVE To analyze the relations between the meanings of working and the levels of doctors work well-being in the context of their working conditions. METHOD The research combined the qualitative methodology of textual analysis and the quantitative one of correspondence factor analysis. A convenience, intentional, and stratified sample composed of 305 Spanish and Latin American doctors completed an extensive questionnaire on the topics of the research. RESULTS The general meaning of working for the group located in the quartile of malaise included perceptions of discomfort, frustration, and exhaustion. However, those showing higher levels of well-being, located on the opposite quartile, associated their working experience with good conditions and the development of their professional and personal competences. CONCLUSIONS The study provides empirical evidence of the relationship between contextual factors and the meanings of working for participants with higher levels of malaise, and of the importance granted both to intrinsic and extrinsic factors by those who scored highest on well-being.

RESUMEN OBJETIVO Analizar las relaciones entre los significados del trabajo y los niveles de bienestar laboral de los profesionales de la medicina en el contexto de sus condiciones de trabajo. MÉTODOS La investigación combinó la metodología cualitativa del análisis textual, y la cuantitativa del análisis factorial de correspondencias. Una muestra de conveniencia, intencional y estratificada, compuesta por 305 profesionales de la medicina de España y de América Latina, respondió un amplio cuestionario sobre los temas de la investigación. RESULTADOS El significado general del trabajo del grupo situado en el cuartil de malestar se configuró en torno a percepciones de incomodidad, frustración y agotamiento. En cambio, quienes expresaron mayores niveles de bienestar, ubicados en el cuartil opuesto, asociaron su experiencia laboral a buenas condiciones de trabajo y al desarrollo de las propias competencias profesionales y personales. CONCLUSIONES El estudio aporta evidencia empírica acerca de la relación entre factores contextuales y significados de trabajo, en los participantes con mayores niveles de malestar; también, sobre la importancia dada a factores tanto intrínsecos como extrínsecos por quienes obtuvieron mayores puntuaciones en bienestar.

La salud pública en la agenda de los gobiernos municipales de seis ciudades colombianas, periodos 2008-2011 y 2012-2015 / Public Health in the Agenda of Municipal Governments of Six Colombian Cities, 20082011 and 2012-2015 Periods / Saúde pública na agenda dos governos municipais de seis cidades colombianas, períodos 2008-2011 e 2012-2015

Objetivo: analizar los contenidos que en materia de salud pública incluyen los planes de desarrollo, los planes territoriales de salud y los acuerdos municipales, así como la coherencia con la situación de salud de la comunidad reflejada en su perfil epidemiológico. Metodología: se revisaron y compararon los planes de desarrollo municipales, los planes territoriales de salud de los periodos 2008-2011 y 2012-2015 y los acuerdos que los concejos municipales emitieron sobre asuntos de salud pública entre el 2008 y junio del 2013, al igual que los perfiles epidemiológicos de seis ciudades colombianas. Hallazgos: los planes de desarrollo y territoriales poseen algunas líneas estratégicas que generan políticas públicas en diversas temáticas de salud a nivel territorial, pero ninguna ciudad cuenta con una política integral en salud pública. Los acuerdos municipales no recogen suficientemente las necesidades de salud. La mayoría de las políticas y programas en salud pública no tienen continuidad de un periodo de gobierno a otro, ni se llevan a cabo procesos de seguimiento y evaluación para tomar decisiones basadas en resultados. Conclusión: en ninguna de las ciudades hay una política integral de salud pública, hay múltiples políticas y programas enfocados en temas específicos, hay discontinuidad de las políticas y programas entre periodos de gobierno.

Objective: Analyzing the contents included in the development plans, territorial health plans and the municipal agreements regarding public health, as well as their coherence with the health situation of the community, as reflected by their epidemiologic profile. Methodology: We reviewed and compared the municipal development plants, the territorial health plans of the 2008-2011 and 2012-2015 periods, the agreements that the municipal councils issued on public health matters between 2008 and June, 2013, as well as the epidemiologic profiles of six Colombian cities. Findings: The development and territorial plans have some strategic guidelines that generate public policies on different health topics on a territorial level, but none of the cities has an integral policy on public health. The health needs are not sufficiently covered by the municipal agreements. Most of the policies and public health programs are not developed further from a government period to the next; monitoring and assessment programs are not carried out to take decisions based on results either. Conclusion: None of the cities has an integral public health policy; there are multiple policies and programs focused on particular topics; there is no further development on policies and programs between government periods.

Objetivo: analisar os conteúdos que em matéria de saúde pública incluem os planos de desen-volvimento, os planos territoriais de saúde e os acordos municipais, assim como a coeréncia com a situacao de saúde da comunidade reflita no seu perfil epidemiológico. Metodología: revisaram-se e compararam os planos de desenvolvimento municipais, os planos territoriais de saúde dos períodos 2008-2011 e 2012-2015 e os acordos que os Concelhos Municipais emitiram sobre assuntos de saúde pública entre 2008 e junho de 2013, ao igual que os perfis epidemiológicos de seis cidades colombianas. Achados: os planos de desenvolvimiento e territoriais possuem algumas linhas estratégicas que geram políticas públicas em diversas temáticas de saúde no nível territorial, mas nenhuma cidade tem uma política integral de saúde pública. Os acordos municipais nao atendem suficientemente as necessidades de saúde. A maioria das políticas e programas em saúde pública na tem continuidade de um período de governo para o outro, nem se leva a cabo processos de seguimento e avaliacao para tomar decisoes baseadas em resultados. Conclusao: em nenhuma das cidades tem uma política integral de saúde pública, tem múltiplas políticas e programas focados em temas específicos, tem descontinuidade das políticas e programas entre períodos de governo.

Una luz en el control del hiperparatiroidismo secundario. Etelcalcetide intravenoso en hemodiálisis / A light in the control of secondary hyperparathyroidism. Etelcalcetide IV in hemodialysis

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