[Hegemony in medical pluralism: articulations and relationships in care, a case study]. / Hegemonía en el pluralismo médico: articulaciones y relaciones en la atención, un estudio de caso.

This study aims to describe and analyze the medical pluralism and the type of hegemony-subordination relation between forms of care or knowledge in the treatment of a patient with glaucoma to show the articulatory and transactional process between several therapeutic resources and understand which structural elements shaped the treatment itinerary and option. This is a qualitative research that used a narrative case study. To reconstruct the narrative, a semi-structured interview was conducted based on a thematic script previously established by a set of a priori categories to later transcribe the data and perform hermeneutic triangulation. Results showed that the hegemony in medical pluralism was based on equivalence relations, so that the patient replaced the use of pharmacological drugs with alternative medicine treatments. However, the relational process of equivalence developed itself in a context of biomedical significance, in which the treatment or control of intraocular pressure configured the substitution premise. Thus, the processes that triggered the hegemonic relations were constituted by various social, cultural, and economic factors such as unemployment, social security, and gender, which played a fundamental role during the search for care.

Este estudio tiene como objetivo describir y analizar el pluralismo médico y el tipo de relaciones de hegemonía-subalternidad entre diversas formas o saberes de atención, que se desarrollaron en el itinerario terapéutico de una padeciente de glaucoma, para mostrar el proceso articulatorio y transaccional entre distintos recursos terapéuticos, así como comprender qué elementos estructurales configuraron el itinerario y la elección terapéutica. La investigación es cualitativa, un estudio de caso en el cual se utilizó el enfoque narrativo. Para la reconstrucción de la narrativa se realizó una entrevista semiestructurada, dirigida por una guía temática previamente determinada por un conjunto de categorías apriorísticas, para posteriormente transcribir la entrevista y realizar un proceso de triangulación hermenéutica. Los resultados mostraron, en este caso, que la hegemonía en el pluralismo médico se constituyó mediante relaciones de equivalencia, así, la padeciente sustituyó el uso de medicamentos farmacológicos por terapias de medicina alternativa, no obstante, el proceso relacional de equivalencia se desarrolló en un contexto de significación biomédica, en el cual tratar o controlar la presión intraocular fue la premisa del remplazo. Asimismo, los procesos que desencadenaron la presencia de relaciones hegemónicas se constituyeron por diversos factores sociales, culturales y económicos como el desempleo, la seguridad social y el género, que desempeñaron un papel fundamental durante la búsqueda de la atención y del cuidado.

Este estudo visa descrever e analisar o pluralismo médico e o tipo de relação de hegemonia-subalternidade entre diversas formas de atendimento ou conhecimentos, que ocorreram no tratamento de um paciente com glaucoma, com a finalidade de mostrar o processo articulatório e transacional entre diferentes recursos terapêuticos, bem como entender quais elementos estruturais moldaram o itinerário e a opção de tratamento. Trata-se de uma pesquisa qualitativa, que utilizou um estudo de caso com abordagem narrativa. Para a reconstrução da narrativa, foi realizada uma entrevista semiestruturada, com base em um roteiro temático previamente estabelecido por um conjunto de categorias a priori, para posteriormente transcrever os dados e realizar a triangulação hermenêutica. Os resultados mostraram que a hegemonia no pluralismo médico esteve baseada em relações de equivalência, de modo que o paciente substituiu o uso de medicamentos farmacológicos por tratamentos da medicina alternativa; no entanto, o processo relacional de equivalência desenvolveu-se em um contexto de significância biomédica, na qual o tratamento ou controle da pressão intraocular foi a premissa para a substituição. Desse modo, os processos que desencadearam a presença de relações hegemônicas foram constituídos por fatores sociais, culturais e econômicos diversos como desemprego, previdência social e gênero, os quais tiveram papel fundamental durante a busca por atendimento e cuidado.

Perceived economic inequality enlarges the perceived humanity gap between low- and high-socioeconomic status groups.

In this paper, we analyze the influence of the perceived level of economic inequality in daily life on people's recognition of the perceived humanity gap between low- and high-socioeconomic groups within society. To achieve this purpose, in Studies 1A-B, we analyzed the relationship between economic inequality and the humanity gap. In Studies 2A-B, we manipulated the level of inequality (low vs. high) to identify differences in the humanity gap. Results indicated that higher perceptions of economic inequality lead individuals to recognize a wider humanity gap between low- and high-socioeconomic groups in society. Implications are discussed.

Health risk assessment of gaseous elemental mercury (GEM) in Mexico City.

Emissions of gaseous elemental mercury (GEM or Hg0) from different sources in urban areas are important subjects for environmental investigations. In this study, atmospheric Hg measurements were conducted to investigate air pollution in the urban environment by carrying out several mobile surveys in Mexico City. This work presents atmospheric concentrations of GEM in terms of diurnal variation trends and comparisons with criteria for pollutant concentrations such as CO, SO2, NO2, PM2.5, and PM10. The concentration of GEM was measured during the pre-rainy period by using a high-resolution active air sampler, the Lumex RA 915 M mercury analyzer. In comparison with those for other cities worldwide, the GEM concentrations were similar or slightly elevated, and they ranged from 0.20 to 30.23 ng m-3. However, the GEM concentration was significantly lower than those in contaminated areas, such as fluorescent lamp factory locations and gold mining zones. The GEM concentrations recorded in Mexico City did not exceed the WHO atmospheric limit of 200 ng m-3. We performed statistical correlation analysis which suggests equivalent sources between Hg and other atmospheric pollutants, mainly NO2 and SO2, emitted from urban combustion and industrial plants. The atmospheric Hg emissions are basically controlled by sunlight radiation, as well as having a direct relationship with meteorological parameters. The area of the city studied herein is characterized by high traffic density, cement production, and municipal solid waste (MSW) treatment, which constantly release GEM into the atmosphere. In this study, we included the simulation with the HYSPLIT dispersion model from three potential areas of GEM release. Emissions from industrial corridors and volcanic plumes localized outside the urban area contribute to the pollution of Mexico City and mainly affect the northern area during specific periods and climate conditions. Using the USEPA model, we assessed the human health risk resulting from exposure to inhaled GEM among residents of Mexico City. The results of the health risk assessment indicated no significant noncarcinogenic risk (hazard quotient (HQ) < 1) or consequent adverse effects for children and adults living in the sampling area over the study period. GEM emissions inventory data is necessary to improve our knowledge about the Hg contribution and effect in urban megacity areas with the objective to develop public safe policy and implementing the Minamata Convention.

La Promoción de la Salud en Colombia y su alcance en el complejo entramado político nacional (1990-2019)

El presente artículo examina el alcance de la promoción de la salud en el marco del escenario político colombiano, a la luz de los lineamientos planteados en la Carta de Ottawa, en el año de 1986. Teniendo en cuenta que la Carta de Ottawa definió unos prerrequisitos o condiciones para la salud, la paz, la educación, la vivienda, la alimentación, la renta, un ecosistema estable, la justicia social, la equidad y que determinó para su acción cinco áreas operativas, formulación de políticas públicas saludables, creación de entornos saludables, fortalecimiento de participación social, desarrollo de aptitudes personales y reorientación de servicios de salud, se aborda la estrategia, en este ensayo, desde el carácter político de la promoción de la salud, moviéndose en el terreno de la salud pública, las políticas públicas saludables y las nociones de política, poder y poder político. A nivel país, se argumentan como fuerzas de influencia sobre el tránsito político de la promoción de la salud en Colombia, desde su adopción en el año 1992, la reglamentación de la descentralización, la Constitución de 1991, la reforma del sistema de salud en 1993 y sus respectivas transiciones, los cambios en el modelo económico, la guerra, la violencia, el narcotráfico, la pobreza, la inequidad y las desigualdades territoriales; internacionalmente, la globalización, la corriente neoliberal, las recomendaciones de la Organización Mundial de la Salud (OMS) y las fluctuaciones conceptuales y operativas de los principios de la Promoción de la Salud y de Atención Primaria en Salud.

This paper examines the scope of health promotion within the Colombian political scenario in the light of the guidelines set forth in the Ottawa Charter of 1986. It also addresses the political nature of the health promotion strategy in the context of public health, healthy public policies, and the concepts of politics, power, and political power. All of this takes into account the prerequisites or conditions for health defined in the Ottawa Charter, which are peace, education, shelter, food, income, a stable ecosystem, social justice, and equity, as well as five action means, namely, the formulation of healthy public policies, the creation of supportive environments, the strengthening of community action, the development of personal skills, and the reorientation of health services. At the national level, we present the regulation of decentralization, the 1991 Constitution, the 1993 health sector reform and its associated transitions, changes in the economic model, war, violence, drug trafficking, poverty, inequity, and territorial inequalities as forces that have influenced the political aspect of health promotion in Colombia since its adoption in 1992. On the international level, the impact of globalization, the neoliberal tendency, the recommendations of the World Health Organization (WHO), and the conceptual and operational changes of the concepts of Health Promotion and Primary Health Care are described.

Economic Inequality Increases the Preference for Status Consumption.

Prior research has shown the relationship between objective economic inequality and searching for positional goods. It also investigated the relationship between social class and low income with conspicuous consumption. However, the causal relationship between economic inequality (the difference in wealth between individuals and groups living in a shared context and consumer behavior) has been less explored. Furthermore, there are also few studies looking for the psychological mechanisms that underlie these effects. The current research's main goal is to analyze the consequences of perceived economic inequality (PEI) on conspicuous and status consumption and the possible psychological mechanisms that could explain its effects. Furthermore, the current research aims to examine whether there is a causal relationship between PEI and materialism preferences and attitudes toward indebtedness. This work includes two preregister experimental studies. In the Study 1 (n = 252), we manipulated PEI and its legitimacy through a 2 (high vs. low inequality) × 2 (Illegitimate vs. legitimate) between-participants experiment. Results showed a main effect of PEI on status consumption, status seeking, status anxiety, materialism, and attitude toward indebtedness. No interaction effect between legitimacy and inequality was found. In the Study 2 (n = 301), we manipulated the PEI through the Bimboola Paradigm. We replicated the effect of PEI on status consumption, status seeking, and materialism and found that status seeking mediated the relationship between PEI and status and conspicuous consumption. Economic inequality affects consumer behavior and favors consumption preferences for products that provide desirable symbolic values associated with status. These results could have important implications in the interpersonal and intergroup processes, including those related to consumption and purchase.

Lacking socio-economic status reduces subjective well-being through perceptions of meta-dehumanization.

Previous research has identified that both low- and high-socio-economic groups tend to be dehumanized. However, groups that have a deprived position are more willing to interiorize the negative perceptions that others have about them compared with affluent groups. In this project, we address the role of meta-(de)humanization (the perceived humanity one thinks is ascribed or denied to one's group) based on socio-economic status differences and its influence in the perceived psychological well-being. We conducted two studies: In Study 1 (correlational, N = 990), we analysed the relationship between socio-economic status, meta-dehumanization, and well-being. Results indicated that lower socio-economic status positively predicted more meta-dehumanization and worse well-being. Moreover, meta-dehumanization mediated the relationship between socio-economic status and well-being. In Study 2 (experimental, N = 354), we manipulated socio-economic status (low-, middle-, and high-socio-economic status conditions) to evaluate its influence on meta-dehumanization and well-being. Results indicated that individuals of low (vs. higher)-socio-economic status perceived more meta-dehumanization and reported worse well-being. Finally, a multicategorical mediational analysis indicated that low (vs. middle or high)-socio-economic status led to worse well-being through higher perceived meta-dehumanization. We discuss differences in perceived meta-(de)humanization based on groups' socio-economic status and implications on the population's well-being.

Animalizing the disadvantaged, mechanizing the wealthy: The convergence of socio-economic status and attribution of humanity.

Differences between groups in socio-economic status (SES) are becoming more salient nowadays. In this context, we examined the animalistic and mechanistic dehumanization that both low and high-SES groups may experience respectively by conducting three studies. In study 1, we manipulated the SES of two fictitious groups (low vs. high-SES) and measured the humanity ascribed to them. Results showed that the low-SES group was animalized in comparison with the high-SES group, which was mechanized. In study 2, we manipulated the humanity of two fictitious groups by describing them as animals or machines and measured the perceived SES of the groups. Participants tended to attribute lower SES to the group described as animals and higher SES to the group described as machines. Finally, in study 3, we used an Implicit Association Test to replicate the results of studies 1 and 2. Taken together, these studies show that low-SES groups are considered as animal-like whereas high-SES groups are seen as robot-like. We discuss the implications of these findings in relation to the justification of income inequality within our society.

Effects of a strategy for the promotion of physical activity in students from Bogotá.

OBJECTIVE: To examine the effect of the promotion of physical activity during recess on the levels of physical activity, sedentary behaviors, and adiposity of Colombian students. METHODS: Three schools were randomly selected by an intervention group in Bogotá, Colombia, in 2013: Intervention (Active Module of Active Recess - MARA) + Text Messages (SMS) (MARA+SMS group), intervention (MARA group), control (control group). Intervention was implemented for ten weeks. The duration and intensity of physical activity and sedentary behaviors were measured objectively using accelerometers Actigraph-GT3X+. Adiposity was measured by body mass index and fat percentage. We measured at baseline (T0) and during the tenth week of intervention (T1). We evaluated the effect of the intervention using a difference-in-difference analysis (DID). RESULTS: We included 120 students (57.5% girls; mean age = 10.5 years; standard deviation [SD] = 0.64). There was a significant increase in the mean daily minutes of moderate to vigorous physical activity in the MARA group (Difference T1-T0 = 6.1 minutes, standard error [SE] = 3.49, p = 0.005) in relation to the control group. There were no significant changes in the minutes of moderate to vigorous physical activity in the MARA+SMS group (Difference T1-T0 = -1.0 minute; SE = 3.06; p = 0.363). The minutes decreased in the control group (Difference T1-T0 = -7.7 minutes; SE = 3.15; p = 0.011). The minutes of sedentary behaviors decreased in the MARA and MARA+SMS groups and increased in the control group (MARA Difference T1-T0 = -15.8 minutes; SE = 10.05; p= 0.279; MARA+SMS Difference T1-T0 = -11.5 minutes; SE = 8.80; p= 0.869; Control Difference T1-T0 = 10.9 minutes; SE = 9.07; p = 0.407). There was a higher participation in the MARA group in relation to the MARA+SMS group (MARA group = 34.4%; MARA+SMS group = 12.1%). There were no significant changes in adiposity at 10 weeks according to difference-in-differences analysis (body mass index p: ΔMARA+SMS group versus Δcontrol group = 0.945, ΔMARA group versus Δcontrol group = 0.847, ΔMARA+SMS group versus ΔMARA group = 0.990; FP p ΔMARA+SMS group versus Δcontrol group = 0.788, ΔMARA group versus Δcontrol group = 0.915, ΔMARA+SMS group versus ΔMARA group = 0.975). CONCLUSIONS: The Active Module of Active Recess is a promising strategy to increase physical activity levels and decrease sedentary behavior in students. The addition of Text Messages was not associated with increased moderate to vigorous physical activity or changes in adiposity.

Effects of a strategy for the promotion of physical activity in students from Bogotá / Efectos de una estrategia de promoción de actividad física en escolares de Bogotá

ABSTRACT OBJECTIVE To examine the effect of the promotion of physical activity during recess on the levels of physical activity, sedentary behaviors, and adiposity of Colombian students. METHODS Three schools were randomly selected by an intervention group in Bogotá, Colombia, in 2013: Intervention (Active Module of Active Recess - MARA) + Text Messages (SMS) (MARA+SMS group), intervention (MARA group), control (control group). Intervention was implemented for ten weeks. The duration and intensity of physical activity and sedentary behaviors were measured objectively using accelerometers Actigraph-GT3X+. Adiposity was measured by body mass index and fat percentage. We measured at baseline (T0) and during the tenth week of intervention (T1). We evaluated the effect of the intervention using a difference-in-difference analysis (DID). RESULTS We included 120 students (57.5% girls; mean age = 10.5 years; standard deviation [SD] = 0.64). There was a significant increase in the mean daily minutes of moderate to vigorous physical activity in the MARA group (Difference T1-T0 = 6.1 minutes, standard error [SE] = 3.49, p = 0.005) in relation to the control group. There were no significant changes in the minutes of moderate to vigorous physical activity in the MARA+SMS group (Difference T1-T0 = -1.0 minute; SE = 3.06; p = 0.363). The minutes decreased in the control group (Difference T1-T0 = -7.7 minutes; SE = 3.15; p = 0.011). The minutes of sedentary behaviors decreased in the MARA and MARA+SMS groups and increased in the control group (MARA Difference T1-T0 = -15.8 minutes; SE = 10.05; p= 0.279; MARA+SMS Difference T1-T0 = -11.5 minutes; SE = 8.80; p= 0.869; Control Difference T1-T0 = 10.9 minutes; SE = 9.07; p = 0.407). There was a higher participation in the MARA group in relation to the MARA+SMS group (MARA group = 34.4%; MARA+SMS group = 12.1%). There were no significant changes in adiposity at 10 weeks according to difference-in-differences analysis (body mass index p: ΔMARA+SMS group versus Δcontrol group = 0.945, ΔMARA group versus Δcontrol group = 0.847, ΔMARA+SMS group versus ΔMARA group = 0.990; FP p ΔMARA+SMS group versus Δcontrol group = 0.788, ΔMARA group versus Δcontrol group = 0.915, ΔMARA+SMS group versus ΔMARA group = 0.975). CONCLUSIONS The Active Module of Active Recess is a promising strategy to increase physical activity levels and decrease sedentary behavior in students. The addition of Text Messages was not associated with increased moderate to vigorous physical activity or changes in adiposity.

RESUMEN OBJETIVO Examinar el efecto de una intervención de promoción de actividad física durante el recreo en los niveles de actividad física, comportamientos sedentarios y adiposidad de los escolares de Colombia. MÉTODOS Tres colegios fueron asignados aleatoriamente a un grupo de intervención en Bogotá, Colombia en el 2013: Intervención (Módulo Activo Recreo Activo - MARA)+Mensajes de Texto (SMS) (grupo MARA+SMS), intervención (grupo MARA), control (grupo de control). La intervención se implementó durante 10 semanas. La duración e intensidad de actividad física y comportamientos sedentarios se midieron objetivamente usando acelerómetros Actigraph-GT3X+. La adiposidad se midió mediante índice de masa corporal y porcentaje de grasa. Se realizaron mediciones en línea de base (T0) y durante la décima semana de intervención (T1). El efecto de la intervención se evaluó utilizando un análisis de diferencia-en-diferencias (ADD). RESULTADOS Fueron incluidos 120 escolares (57,5% niñas; edad promedio = 10,5 años; desviación estándar [DE] = 0,64). Hubo un aumento significativo en el promedio diario de minutos de actividad física moderada-vigorosa en el grupo MARA (Diferencia T1-T0 = 6,1 minutos; error estándar [EE] = 3,49; p = 0,005) con respecto al grupo de control. No se observaron cambios significativos en los minutos de actividad física moderada-vigorosa en el grupo MARA+SMS (Diferencia T1-T0 = -1,0 minuto; EE = 3,06; p = 0,363). En el grupo de control los minutos disminuyeron (Diferencia T1-T0 = -7,7 minutos; EE = 3,15; p = 0,011). Los minutos de comportamientos sedentarios disminuyeron en los grupos MARA y MARA+SMS y aumentaron en el grupo de control (MARA Diferencia T1-T0 = -15,8 minutos; EE = 10,05; p = 0,279; MARA+SMS Diferencia T1-T0 =-11,5 minutos; EE = 8,80; p = 0,869; Control Diferencia T1-T0 = 10,9 minutos; EE = 9,07; p = 0,407). Se registró mayor participación en el grupo MARA respecto al grupo MARA+SMS (grupo MARA = 34,4%; grupo MARA+SMS = 12,1%). No hubo cambios significativos en adiposidad en las diez semanas según análisis de diferencia-en-diferencias (índice de masa corporal p: Δgrupo MARA+SMS versus Δgrupo de control = 0,945, Δgrupo MARA versus Δgrupo control = 0,847, Δgrupo MARA+SMS versus Δgrupo MARA = 0,990; PG p Δgrupo MARA+SMS versus Δgrupo control = 0,788, Δgrupo MARA versus Δgrupo control = 0,915, Δgrupo MARA+SMS versus Δgrupo MARA = 0,975). CONCLUSIONES El Módulo Activo Recreo Activo es una estrategia prometedora para incrementar los niveles de actividad física y disminuir comportamientos sedentarios en escolares. Adicionar Mensajes de Texto no se asoció con incremento de actividad física moderada-vigorosa o en cambios en adiposidad.

Corrigendum: Marital Satisfaction, Sex, Age, Marriage Duration, Religion, Number of Children, Economic Status, Education, and Collectivistic Values: Data from 33 Countries.

[This corrects the article on p. 1199 in vol. 8, PMID: 28785230.].

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

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.

Evaluación de la política pública de escuela saludable en Colombia: fase de formulación (1999-2006) / Evaluating public policy regarding the concept of healthy schools in Colombia: the formulation phase (1999-2006)

Objetivo Evaluar la formulación de la política pública de escuela saludable en Colombia en el período de 1999 a 2006. Métodos Investigación cualitativa de análisis del ciclo de política pública. Se utilizaron como estrategias centrales de recolección de información la revisión documental de fuente secundaria y la entrevista semi-estructurada (fuente primaria). Se llevó a cabo el análisis de contenido temático. Resultados Se identificaron dos momentos de formulación de políticas o lineamientos de la Estrategia Escuelas Saludables en Colombia. El primero relacionado con la publicación del documento "Escuela Saludable, la alegría de vivir en paz", cuyo contenido presenta los lineamientos nacionales para implementar la política y el segundo posterior a la promulgación de la Declaración del Milenio, articulándose a la política los ámbitos de vivienda y salud. Los resultados tuvieron como categorías de integración de la información en normas, observación de actores, relaciones, problemas, objetivos, líneas de acción, tiempos de acción de la política y toma de decisión. Conclusiones La escuela saludable no ha sido objeto prioritario de las políticas pública del Estado Colombiano, pese a ser un compromiso asumido por el Estado con la Organización Panamericana de la Salud/Organización Mundial de la Salud, y de los altos mandatarios en las reuniones internacionales y ser una estrategia crucial para lograr las metas de los Objetivos de Desarrollo de Milenio.

Objective Evaluating public policy formulation regarding the concept of healthy schools in Colombia, 1999 to 2006. MethodsThis study involved qualitative research aimed at analysing the cycle of public policy. The main strategies used were collecting information, a documental review of secondary sources and holding semi-structured interviews (primary source). Thematic content was analysed. ResultsTwo moments were identified regarding the formulation of policy or guidelines for the "Healthy schools in Colombia" strategy. The first was related to the publication of a document entitled, "A healthy school: the joy of living in peace," whose content was aimed at presenting national guidelines for implementing such policy whilst the second (following the enactment of the United Nations' Millennium Declaration) was an attempt at promoting housing and healthcare policy. The results were seen in terms of categories for integrating information regarding standards, observing pertinent actors, relationships, problems, objectives, lines of action and time-lines regarding policy and decision-making time-frames. ConclusionsThe idea of a healthy school has not been a priority in the Colombian state's public policy, in spite of having been a state commitment in line with PAHO/WHO's stated policy, commitments promised by high officials during international meetings and representing a crucial strategy for achieving Millennium Development Goals (MDG).

[Evaluating public policy regarding the concept of healthy schools in Colombia: the formulation phase (1999-2006)]. / Evaluación de la política pública de escuela saludable en Colombia: fase de formulación (1999-2006).

OBJECTIVE: Evaluating public policy formulation regarding the concept of healthy schools in Colombia, 1999 to 2006. METHODS: This study involved qualitative research aimed at analysing the cycle of public policy. The main strategies used were collecting information, a documental review of secondary sources and holding semi-structured interviews (primary source). Thematic content was analysed. RESULTS: Two moments were identified regarding the formulation of policy or guidelines for the "Healthy schools in Colombia" strategy. The first was related to the publication of a document entitled, "A healthy school: the joy of living in peace," whose content was aimed at presenting national guidelines for implementing such policy whilst the second (following the enactment of the United Nations' Millennium Declaration) was an attempt at promoting housing and healthcare policy. The results were seen in terms of categories for integrating information regarding standards, observing pertinent actors, relationships, problems, objectives, lines of action and time-lines regarding policy and decision-making time-frames. CONCLUSIONS: The idea of a healthy school has not been a priority in the Colombian state's public policy, in spite of having been a state commitment in line with PAHO/WHO's stated policy, commitments promised by high officials during international meetings and representing a crucial strategy for achieving Millennium Development Goals (MDG).

Aproximación a la construcción teórica de la promoción de la salud / An approach to the theoretical construction of healthcare promotion

Se examinan las definiciones de promoción de la salud desde la teoría del conocimiento, en sus aspectos ontológicos y epistemológicos como son considerados por diversos paradigmas. Se utiliza una periodización en tres fases En la fase de antecedentes (1920-1973) se producen los primeros distanciamientos frente al paradigma positivista y la promoción de la salud hace parte de las definiciones de salud pública. En la fase fundacional (1974-1986) la promoción de la salud adquiere identidad propia y se transforma en políticas explícitas, en medio de escenarios de confluencia de paradigmas. En la fase de consolidación (1987-2008), se articulan ampliamente los paradigmas positivistas y no positivistas, extendiéndose a los aspectos metodológicos.

Definitions of healthcare promotion were examined from the theory of knowledge regarding its ontological and epistemological aspects as considered by several paradigms. Three-phase periodisation was used. The first distancing regarding the positivist paradigm and healthcare promotion through definitions of public health was made during the background phase (1920-1973). The promotion of healthcare acquired its own identity and became explicit policy in the midst of scenarios involving the confluence of paradigms during the foundational phase (1974-1986). Positivist and non-positivist paradigms became broadly articulated during the consolidation phase (1987-2008), becoming extended to methodological aspects.

[The Colombian healthcare system: 20 years of achievements and problems]. / Sistema de salud en Colombia: 20 años de logros y problemas.

An overview of some of the key processes and results of Colombia's National Health System is presented. A systematic review of the literature evaluating the quality of the evidence published in indexed journals and literature not published in journals was made. Health system financial resources have seen a sustained increase while spending on health has remained at around 8% of GNP. Coverage, measured by affiliation to contributory and subsidized regimes, is in the order of 92% of the total population. The Mandatory Health Plan, defining the benefits to which one has access, has been broadly maintained but has been hampered by mechanisms for making legal complaints, thereby leading to financial deficits. The health system has contributed towards improving the poorest sector's income, but inequalities persist due to the lack of universal coverage, differences in health plans and the system's expenditure according to the population's income. Advances made in the National Health System have been positive but universality has not been achieved and this has stagnated in matters regarding access to services and equality.

Sistema de salud en Colombia: 20 años de logros y problemas / The Colombian healthcare system: 20 years of achievements and problems

Se presenta un balance de algunos procesos claves y resultados del Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Se realizó una revisión sistemática de literatura publicada en revistas indexadas con valoración de la calidad de la evidencia, y literatura no publicada en revistas. Los recursos financieros del sistema de salud, se han incrementado de manera sostenida, mientras el gasto en salud se ha situado alrededor del 8 por ciento del PIB. La cobertura, medida por la afiliación a los regímenes contributivo y subsidiado, se encuentra alrededor del 92 por ciento de la población total. El Plan Obligatorio de Salud, que define las prestaciones a las cuales se tiene acceso, se ha mantenido con un carácter amplio y ha sido rebasado por mecanismos de reclamo jurídico (tutelas), generándose déficits financieros. El sistema de salud ha contribuido al mejoramiento del ingreso de los más pobres, pero persisten las inequidades que provienen de la ausencia de cobertura universal, de las diferencias en los planes de salud y en el gasto del sistema según ingresos de la población. El avance del SGSSS es positivo pero no ha logrado alcanzar la universalidad y se ha estancado en acceso a los servicios y equidad.

An overview of some of the key processes and results of Colombia's National Health System is presented. A systematic review of the literature evaluating the quality of the evidence published in indexed journals and literature not published in journals was made. Health system financial resources have seen a sustained increase while spending on health has remained at around 8 percent of GNP. Coverage, measured by affiliation to contributory and subsidized regimes, is in the order of 92 percent of the total population. The Mandatory Health Plan, defining the benefits to which one has access, has been broadly maintained but has been hampered by mechanisms for making legal complaints, thereby leading to financial deficits. The health system has contributed towards improving the poorest sector's income, but inequalities persist due to the lack of universal coverage, differences in health plans and the system's expenditure according to the population's income. Advances made in the National Health System have been positive but universality has not been achieved and this has stagnated in matters regarding access to services and equality.

[An approach to the theoretical construction of healthcare promotion]. / Aproximación a la construcción teórica de la promoción de la salud.

Definitions of healthcare promotion were examined from the theory of knowledge regarding its ontological and epistemological aspects as considered by several paradigms. Three-phase periodisation was used. The first distancing regarding the positivist paradigm and healthcare promotion through definitions of public health was made during the background phase (1920-1973). The promotion of healthcare acquired its own identity and became explicit policy in the midst of scenarios involving the confluence of paradigms during the foundational phase (1974-1986). Positivist and non-positivist paradigms became broadly articulated during the consolidation phase (1987-2008), becoming extended to methodological aspects.

El Cuadro de Mando Integral en la ejecución del plan estratégico de un hospital general / The Balanced Scorecard in strategic plan implementation of a general hospital

Este estudio se centra en el proceso de aplicación del Cuadro de Mando Integral (CMI), como instrumento de gestión que alinea y comunica los objetivos estratégicos de la organización. Objetivo: Evaluar la utilidad del Cuadro de Mando Integral en la ejecución del Plan Estratégico de un hospital general. Material y métodos: Estudio descriptivo, observacional y retrospectivo realizado en el Hospital Nacional Cayetano Heredia (HNCH) desde enero 2008 a junio de 2009. Resultados: Reducción de los rechazos por prestaciones valorizadas al Seguro Integral de Salud de 13,64% a 8,93%, disminución de las operaciones suspendidas de 13,04% a 9,83%, optimización de la utilización de camas de 79,23% a 91,15%, el desempeño de los planes operativos de las unidades orgánicas que alcanzaron nivel óptimo fue de 33,33% y las unidades orgánicas que expusieron las mejores presentaciones se incrementó de 8% a 40%. Conclusiones: La aplicación del CMI fue útil como instrumento de seguimiento y control de la ejecución del Plan Estratégico Institucional.

This research focuses on the process of implementing the Balanced Scorecard (BSC) as a management tool that aligns and communicates the strategic objectives of the organization. Objective: To evaluate effect of BSC in the Strategic Plan in a highly specialized general hospital. Material and methods: Descriptive, observational and retrospective research developed at the Hospital Nacional Cayetano Heredia. Results: A reduction of benefits refusals by the Comprehensive Health Insurance from 13.64% to 8.93%, a reduction of suspended surgical procedures from 13.04% to 9.83%, and an increase in the optimal use beds from 79.23% to 91.15% were observed. The performance of operational plans of the areas that achieved optimal level was 33.33% and the organic units that gave the best presentations increased from 8% to 40%. Conclusions: The implementation of BSC was useful in a general hospital as a tool for monitoring and control of the execution of the Institutional Strategic Plan.

Características socioculturales de la actividad física en tres regiones de Colombia / Socio-cultural characteristics of physical activity in three regions of Colombia

Objetivo: Se indagaron los aspectos socioculturales relacionados con la vida en comunidad y la actividad física en las regiones de Bogotá, Antioquia y Quindío. Métodos: Se realizó un estudio exploratorio, cualitativo, cuyo interés sobre el objeto de estudio se enmarcó en las relaciones culturales de las regiones indagadas. Las estrategias de investigación utilizadas fueron observación en terreno, entrevistas individuales y participativas semi-estucturadas (fuentes primarias) y revisión documental relacionada con los procesos culturales de las regiones de estudio (fuentes secundarias). Resultados: Los resultados obtenidos fueron de dos tipos: comunes para las tres regiones y específicos para cada una de ellas teniendo en cuenta los procesos culturales y las dinámicas comunitarias propias. Conclusiones: Los elementos identificados mediante la observación en terreno y los hallazgos interpretativos resultantes del estudio de las entrevistas, fueron concordantes con la teoría y las experiencias previas de otros países, aportando adicionalmente nuevas consideraciones asociadas al contexto cultural y comunitario específico de las regiones indagadas.

Objective: Investigating socio-cultural aspects related to living in a community and physical activity in Bogotá and the departments of Antioquia and Quindío. Methods: An exploratory, qualitative study was carried out within the framework of the cultural relationships found in the regions being investigated. The research strategies used were field-observation, semi-stuctured individual and participative interviews (primary sources) and documentary review related to the cultural processes employed in the regions being studied (secondary source). Results: Two types of results were obtained which were common for the three regions and specific for each of them, bearing in mind their own cultural processes and community dynamics. Conclusions: The elements identified by field-observation and interpretative findings resulting from studying the interviews agreed with the theory and prior experience of other countries, providing new considerations associated with specific cultural and community context of the regions being investigated.