Ensuring access to essential health products: Lessons from Colombia's leishmaniasis control and elimination initiative.

BACKGROUND: This paper identifies opportunities and challenges for leishmaniasis control and elimination in Colombia, emphasizing the role of pooled procurement of essential medicines and supplies. Colombia is among the countries most affected by leishmaniasis globally, and also faces the dual challenge of procuring critically needed medicines in the context of limited national resources. It recently renewed its commitment to the control and elimination of leishmaniasis under its 2022-2031 Public Health Plan (PDSP) through a comprehensive public health approach. METHODOLOGY/PRINCIPAL FINDINGS: The methodology comprises a comprehensive literature review and key informant interviews with leishmaniasis experts from the Colombian national control program and PAHO/WHO, focusing on cutaneous, mucocutaneous, and visceral leishmaniasis. Leishmaniasis is endemic throughout Colombia, with over 11 million people at risk, many of whom live in poverty-stricken, remote and isolated rural areas with limited access to health services. Leishmaniasis care, including medicines, is provided free of charge, but many barriers were nonetheless identified at environmental, population, and health system levels, including the supply of quality-assured medicines. Opportunities to alleviate these barriers were identified, including the support of the PAHO Strategic Fund. Within the context of the sustainable development goals and international leishmaniasis control and elimination targets, Colombian officials have established their own priorities, the highest of which is the reduction of deaths from visceral leishmaniasis. CONCLUSIONS/SIGNIFICANCE: The elimination of leishmaniasis as a public health problem presents significant challenges, given its biological complexity and diversity, physical and clinical manifestations, social and economic impacts, frequently burdensome treatment regimens, and insufficient supply of necessary medicines. However, rigorous prevention and control efforts through strong political commitment and a highly motivated workforce can dramatically reduce its burden. Colombia's new PDSP, which highlights leishmaniasis control, is an opportunity for a revitalized health system response through committed leadership, intersectoral actions, and partnerships with international organizations that share a common vision.

New Brassinosteroid Analogs with 23,24-Dinorcholan Side Chain, and Benzoate Function at C-22: Synthesis, Assessment of Bioactivity on Plant Growth, and Molecular Docking Study.

The synthesis and biological evaluation of brassinosteroids (BRs) analogs with chemical modification in the side alkyl chain is a matter of current interest. Recently, a series of BR analogs with phenyl or benzoate groups in the alkyl chain have been reported. The effect of substitution in the aromatic ring on the biological activities of these new analogs has been evaluated, and the results suggest that the bioactivity is enhanced by substitution with an F atom. In this context, we have synthesized, characterized, and evaluated a series of new analogs of 23,24-bisnorcholenic type in which the benzoate group at the C-22 position is substituted with an F atom at "ortho or para" positions. Plant growth-promoting activities were evaluated by using the rice lamina inclination test and bean second internode biotest. The results obtained with both bioassays indicate that the compound with an F atom in the para position on the aromatic ring is the most active BR analog and in some cases is even more active than brassinolide. The docking study confirmed that compounds with an F atom adopt an orientation similar to that predicted for brassinolide, and the F atom in the "para" position generates an extra hydrogen bond in the predicted binding position.

HEALTH ASSESSMENT OF CAPTIVE PSITTACINE SPECIES IN PRERELEASE PROGRAMS AT COSTA RICAN RESCUE CENTERS.

With stricter laws regulating the capture and possession of wild animals in Costa Rica, local wildlife-rescue centers have been overwhelmed by an influx of confiscated or relinquished illegal pets, specifically of psittacine species. As part of a nationwide health-assessment program targeting these centers, 122 birds representing five psittacine species ( Ara macao, Amazona autumnalis, Amazona auropalliata, Amazona farinosa, Aratinga finschi) and one hybrid macaw ( Ara macao × Ara ambiguus) were examined and tested between January 2011 and October 2012. Physical examination, hematology, and serum biochemical analyses were performed. Blood and feathers were tested for psittacine beak and feather disease virus (PBFDV) and avian polyomavirus (APV) via PCR. A DNA-based prevalence and sequence analysis characterized the strains of PBFDV and APV isolated. Physical abnormalities observed in 36% of the 122 birds examined were limited to thin body condition and poor feather quality. None of the feather abnormalities were characteristic of disease caused by either PBFDV or APV. Results of hematological and biochemical analyses were within normal limits except for five birds with leukocytosis and heterophilia, three birds with uric acid values above 16 mg/dl, and two additional birds with AST values above 400 IU/L. No hemoparasites were detected during blood smear examination. Overall prevalences of 9.8% (12/122) for PBFDV and 3.3% (4/122) for APV were documented, with only one bird testing positive for both PBFDV and APV. Birds from two of the eight centers were negative for both viruses. Findings from this study constitute the beginning of a standardized surveillance program for Costa Rican rescue centers, targeting the management of avian species enrolled in propagation and reintroduction programs and expanding of the spectrum of pathogen surveillance and husbandry recommendations in prerelease centers.

Increasing access to comprehensive care for Chagas disease: development of a patient-centered model in Colombia / Aumento del acceso a la atención integral de la enfermedad de Chagas: elaboración de un modelo centrado en el paciente en Colombia / Maior acesso à atenção integral para doença de Chagas: construção de um modelo centrado no paciente na Colômbia

ABSTRACT Worldwide, over 6 million people are infected with Trypanosoma cruzi, the pathogen that causes Chagas disease (CD). In the Americas, CD creates the greatest burden in disability-adjusted life years of any parasitic infection. In Colombia, 437 000 people are infected with T. cruzi, of whom 131 000 suffer from cardiomyopathy. Colombia's annual costs for treating patients with advanced CD reach US$ 175 016 000. Although timely etiological treatment can significantly delay or prevent development of cardiomyopathy—and costs just US$ 30 per patient—fewer than 1% of people with CD in Colombia and elsewhere receive it. This represents a missed opportunity for increasing patients' healthy, productive years of life while significantly reducing the economic burden on the health care system. Key barriers are complexities and delays in the diagnosis and treatment process, lack of awareness of CD among both patients and health care professionals, and administrative barriers at the primary care level. In 2015, stakeholders from government, academia, nongovernmental organizations, and patient associations participated in a seminar in the city of Bogotá on eliminating barriers to diagnosis and treatment for CD. The seminar gave birth to a model of care for increasing patient access, including a patient road map that simplifies diagnostic and treatment processes, shifting them from specialists to primary care facilities. The patient road map was implemented in a pilot project in four endemic communities beginning in 2016, with the goal of testing and refining the model so it can be implemented nationally. This article describes key components in the development of a new, recently implemented model of care for CD in Colombia.(AU)

RESUMEN En todo el mundo, hay más de 6 millones de personas infectadas por el Trypanosoma cruzi, el agente patógeno causante de la enfermedad de Chagas. En la Región de las Américas, esta es la infección parasitaria que tiene la mayor carga en cuanto a años de vida ajustados en función de la discapacidad. En Colombia, 437 000 personas están infectadas por el T. cruzi; de ese total, 131 000 sufren de miocardiopatía. En ese país, el costo anual de tratar a los pacientes que tienen la enfermedad de Chagas se ubica en US$ 175 016 000. A pesar de que un tratamiento etiológico oportuno puede retrasar o prevenir significativamente la aparición de una miocardiopatía —a un costo de apenas US$ 30 por paciente— menos de 1% de las personas con enfermedad de Chagas en Colombia y otros países lo reciben. Esto implica que se pierde la oportunidad de incrementar el número de años de vida saludables y productivos de los pacientes y, al mismo tiempo, reducir significativamente la carga económica que soporta el sistema de atención de salud. Los obstáculos clave son la complejidad y las demoras en los procesos de diagnóstico y tratamiento, la falta de conocimiento sobre la enfermedad de Chagas por parte de los pacientes y de los profesionales de la salud, y las barreras administrativas que existen a nivel de la atención primaria. En el 2015, representantes del gobierno, la comunidad académica, organizaciones no gubernamentales y asociaciones de pacientes participaron en un seminario en Bogotá sobre la eliminación de las barreras al diagnóstico y el tratamiento de la enfermedad de Chagas. En este seminario se elaboró un modelo de atención para aumentar el acceso de los pacientes, incluida una hoja de ruta centrada en el paciente que simplifica los procesos de diagnóstico y tratamiento al trasladarlos de los especialistas a los establecimientos de atención primaria. La hoja de ruta centrada en el paciente se aplicó a principios del 2016 como parte de un proyecto piloto que se puso en marcha en cuatro comunidades endémicas con el objetivo de poner a prueba y perfeccionar el modelo para luego poder aplicarlo en todo el país. En este artículo se describen los componentes clave que se usaron para crear un modelo de atención de la enfermedad de Chagas puesto en marcha recientemente en Colombia.(AU)

RESUMO Em todo o mundo, cerca de 6 milhões de pessoas são infectadas pelo Trypanosoma cruzi, o patógeno causador da doença de Chagas. Nas Américas, esta infecção parasitária é responsável pela maior carga de anos de vida perdidos ajustados por incapacidade. Na Colômbia, estima-se que 437 mil pessoas são infectadas pelo T. cruzi, das quais 131 mil têm miocardiopatia. O custo anual para tratar os pacientes com doença de Chagas em estágio avançado chega a US$ 175.016.000. Embora o tratamento oportuno mirando o agente etiológico possa postergar significativamente, ou prevenir, a ocorrência de miocardiopatia, ao custo de apenas US$ 30 por paciente, menos de 1% dos portadores da doença de Chagas é tratado na Colômbia e em outros lugares. Representa uma perda de oportunidade de prolongar os anos de vida saudável e produtiva dos pacientes e de reduzir consideravelmente o ônus econômico ao sistema de saúde. Os principais entraves são a complexidade e a demora do processo de diagnóstico e tratamento, a falta de conhecimento sobre a doença por parte dos pacientes e dos profissionais da saúde e os obstáculos administrativos ao nível da atenção primária. Em 2015, interessados diretos de setores do governo, comunidade acadêmica, organizações não governamentais e associações de pacientes participaram de um seminário realizado na cidade de Bogotá em que discutiram como eliminar as barreiras ao diagnóstico e ao tratamento da doença de Chagas. Deste seminário nasceu um modelo para aumentar o acesso dos pacientes à atenção à saúde, com a preparação de um guia simplificado para o diagnóstico e o tratamento e a transição do atendimento dos serviços especializados aos serviços de atenção primária. Como parte de um projeto-piloto, a partir de 2016, o guia do paciente foi implantado em quatro comunidades endêmicas com o propósito de testar e aprimorar o modelo para que possa ser implantado em todo o país. O presente artigo descreve os principais componentes deste modelo de atenção para a doença de Chagas recém-implantado na Colômbia.(AU)

[Health and humanization Diploma: the value of reflection and face to face learning]. / Diplomado de salud y humanización: el valor de la reflexión y el aprendizaje presencial.

BACKGROUND: In a rapidly changing culture like ours, with emphasis on productivity, there is a strong need to find the meaning of health care work using learning instances that privilege reflection and face to face contact with others. The Diploma in Health and Humanization (DSH), was developed as an interdisciplinary space for training on issues related to humanization. AIM: To analyze the experience of DSH aiming to identify the elements that students considered key factors for the success of the program. MATERIAL AND METHODS: We conducted a focus group with DSH graduates, identifying factors associated with satisfaction. Transcripts were coded and analyzed by two independent reviewers. RESULTS: DSH graduates valued a safe space, personal interaction, dialogue and respect as learning tools of the DSH. They also appreciates the opportunity to have emotional interactions among students and between them and the teacher as well as the opportunity to share personal stories and their own search for meaning. DISCUSSION: DSH is a learning experience in which their graduates value the ability to think about their vocation and the affective interaction with peers and teachers. We hope to contribute to the development of face to face courses in the area of humanization. Face to face methodology is an excellent teaching technique for contents related to the meaning of work, and more specifically, to a group of learners that require affective communication and a personal connection of their work with their own values and beliefs.

Diplomado de salud y humanización: el valor de la reflexión y el aprendizaje presencial / Health and humanization Diploma: the value of reflection and face to face learning

Background: In a rapidly changing culture like ours, with emphasis on productivity, there is a strong need to find the meaning of health care work using learning instances that privilege reflection and face to face contact with others. The Diploma in Health and Humanization (DSH), was developed as an interdisciplinary space for training on issues related to humanization. Aim: To analyze the experience of DSH aiming to identify the elements that students considered key factors for the success of the program. Material and Methods: We conducted a focus group with DSH graduates, identifying factors associated with satisfaction. Transcripts were coded and analyzed by two independent reviewers. Results: DSH graduates valued a safe space, personal interaction, dialogue and respect as learning tools of the DSH. They also appreciates the opportunity to have emotional interactions among students and between them and the teacher as well as the opportunity to share personal stories and their own search for meaning. Discussion: DSH is a learning experience in which their graduates value the ability to think about their vocation and the affective interaction with peers and teachers. We hope to contribute to the development of face to face courses in the area of humanization. Face to face methodology is an excellent teaching technique for contents related to the meaning of work, and more specifically, to a group of learners that require affective communication and a personal connection of their work with their own values and beliefs.

A cost-effectiveness evaluation of a home visit program for adolescent mothers.

A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers' mental health and nutritional state, as well as on the children's levels of linguistic development.