Preliminary Technical Validation of LittleBeats™: A Multimodal Sensing Platform to Capture Cardiac Physiology, Motion, and Vocalizations.

Across five studies, we present the preliminary technical validation of an infant-wearable platform, LittleBeats™, that integrates electrocardiogram (ECG), inertial measurement unit (IMU), and audio sensors. Each sensor modality is validated against data from gold-standard equipment using established algorithms and laboratory tasks. Interbeat interval (IBI) data obtained from the LittleBeats™ ECG sensor indicate acceptable mean absolute percent error rates for both adults (Study 1, N = 16) and infants (Study 2, N = 5) across low- and high-challenge sessions and expected patterns of change in respiratory sinus arrythmia (RSA). For automated activity recognition (upright vs. walk vs. glide vs. squat) using accelerometer data from the LittleBeats™ IMU (Study 3, N = 12 adults), performance was good to excellent, with smartphone (industry standard) data outperforming LittleBeats™ by less than 4 percentage points. Speech emotion recognition (Study 4, N = 8 adults) applied to LittleBeats™ versus smartphone audio data indicated a comparable performance, with no significant difference in error rates. On an automatic speech recognition task (Study 5, N = 12 adults), the best performing algorithm yielded relatively low word error rates, although LittleBeats™ (4.16%) versus smartphone (2.73%) error rates were somewhat higher. Together, these validation studies indicate that LittleBeats™ sensors yield a data quality that is largely comparable to those obtained from gold-standard devices and established protocols used in prior research.

Effects of repeated embryo flushing without PGF2α administration on luteal function, percentage of unwanted pregnancy and subsequent fertility in mares.

BACKGROUND: PGF2α is commonly given at the end of embryo flushing (EF) to shorten the interval to the next oestrus and ovulation. OBJECTIVES: To determine the effect of repeated EF on plasma progesterone concentration, percentage of mares with endometritis, unwanted pregnancy and subsequent fertility in mares flushed without the use of PGF2α. STUDY DESIGN: Controlled experiments. METHODS: Nine mares were inseminated in seven consecutive cycles (n = 63), to either perform an EF (n = 54) 7-9 days after ovulation or left pregnant (n = 9). PGF2α was not used to induce oestrus. Ultrasound examination and blood sampling were performed just before the EF and 72 h later to determine changes in progesterone concentration and signs of endometritis. RESULTS: The overall percentage of positive EF/pregnancy was 55.5% (30/54) and 66.7% (6/9), respectively. The likelihood of pregnancy/positive EF in the first three cycles was 55.5% (15/29). This was not different (p > 0.1) from the fertility of the last four cycles (69.4%, 25/36). In five EF cycles (9.3%), mares had signs of endometritis and early luteolysis (progesterone <2 ng/mL) 72 h after EF. The reduction in progesterone concentration by 72 h after EF was greater (p < 0.05) for Day 9 (-2.3 ± 0.7 ng/mL) than Day 7 (-1.0 ± 0.8 ng/mL) or Day 8 (-1.3 ± 1.1 ng/mL) cycles. The progesterone concentration in non-flushed mares did not vary significantly during the sampled period (Day 7-12). There were 5 cycles in which the donor mare remained pregnant after the EF, although four were from a single mare. MAIN LIMITATIONS: The mare population was limited to barren and maiden mares. The cycle order and operator allocation to each EF were not randomised. CONCLUSIONS: EF induces a subtle, but significant reduction in progesterone concentrations compared with non-EF cycles. However, the percentage of mares with EF-induced full luteolysis is low (9.3%). The fertility of mares after repeated EF without administration of PGF2α was unaffected; however, there is a considerable risk of unwanted pregnancy (5/27 = 18.5%) in donors from which an embryo was not recovered.

Expanding capabilities to evaluate readiness for return to duty after mTBI: The CAMP study protocol.

Physical Therapists affiliated with Intrepid Spirit Centers evaluate and treat Active Duty Service Members (ADSM) who have duty-limiting post-concussion symptoms to improve the ability to perform challenging tasks associated with military service. The Complex Assessment of Military Performance (CAMP) is a test battery that more closely approximates the occupational demands of ADSM without specific adherence to a particular branch of service or military occupational specialty. Subtasks were developed with military collaborators to include high level skills that all service members must be able to perform such as reacting quickly, maintaining visual stability while moving and changing positions, and scanning for, noting, and/or remembering operationally relevant information under conditions of physical exertion. OBJECTIVE: The purpose of this observational longitudinal study is to: 1- establish typical performance parameters for ADSM on the CAMP test battery 2- determine the element of the CAMP battery that demonstrate the greatest differences from standard performance and serve as predictors for successful return to duty and 3- develop clinician-facing feedback algorithms and displays and 4-develop materials for clinical dissemination. This ongoing multi-site study is currently funded through the CDMRP and has been approved by the Naval Medical Center Portsmouth IRB. METHODS: ADSM undergoing post-concussion rehabilitation at the Intrepid Spirit Centers will be tested within one week of their initial Physical Therapy evaluation and after completing Physical Therapy. Control participants will include males, females, and ADSM from the Special Operations community. Participants will complete an intake form that includes questions about demographics, military service, deployment and concussion history, and profile and duty status. Other measures include those that explore concussion symptoms, sleep quality, post-traumatic stress, and perceptions of resilience. The CAMP includes three separate 10-15 minute tasks. Movement is recorded by wearable inertial sensors and heart rate variability is recorded with a POLAR10 monitor. The "Run-Roll" task requires rapid position changes, combat rolls and quick running forwards and backwards while carrying a simulated weapon. Visual stability before and after the task is also performed. The "Dual-Task Agility" task includes rapid running with and without a weighted vest and a working memory task. The "Patrol Exertion" task requires repeated stepping onto an exercise step while watching a virtual patrol video. Additional tasks include monitoring direction of travel, observing for signs of enemy presence, and reacting to multiple auditory signals embedded in the video. DISCUSSION: Measures that evaluate relevant skills are vital to support safe return to duty for ADSM who may be exposed to imminent danger as part of training or mission demands. The CAMP is designed to be an ecologically valid and clinically feasible assessment that may be more sensitive to capturing subtle impairments that impact duty performance as test skills are integrated into dual and multi-tasks that reflect occupational demands. Assessment results may serve as a more robust indicator of readiness for full return to duty after concussion.

Evaluación de la política y plan andino de recursos humanos en salud 2018 - 2022 / Evaluation of the Andean policy and plan for human resources in health 2018 - 2022 ​

La presente publicación analiza y evalúa el avance en la planificación y gestión a escala nacional y escala regional de la política andina de recursos humanos 2018-2022, a partir de un esquema metodológico de trabajo e identifica líneas estratégicas para la Política 2023-2030". plantea como visión la necesidad de avanzar en la conformación de una fuerza laboral de salud adecuada a las necesidades de transformación de los sistemas de salud, que se desarrolla y desempeña en condiciones laborales de trabajo decente. A partir del marco estratégico y valórico que aportan las declaraciones de propósito y visión, se estructura en torno a cinco líneas de acción, las que se desagregan en objetivos con sus respectivos indicadores y compromisos a escala nacional y regional

Preliminary evidence of transcutaneous vagus nerve stimulation effects on sleep in veterans with post-traumatic stress disorder.

Sleep problems are common among veterans with post-traumatic stress disorder and closely associated with hyperarousal symptoms. Transcutaneous vagus nerve stimulation (tVNS) may have potential to improve sleep quality in veterans with PTSD through effects on brain systems relevant to hyperarousal and sleep-wake regulation. The current pilot study examines the effect of 1 h of tVNS administered at "lights out" on sleep architecture, microstructure, and autonomic activity. Thirteen veterans with PTSD completed two nights of laboratory-based polysomnography during which they received 1 h of either active tVNS (tragus) or sham stimulation (earlobe) at "lights out" with randomised order. Sleep staging and stability metrics were derived from polysomnography data. Autonomic activity during sleep was assessed using the Porges-Bohrer method for calculating respiratory sinus arrhythmia (RSAP-B ). Paired t-tests revealed a small decrease in the total sleep time (d = -0.31), increase in N3 sleep (d = 0.23), and a small-to-moderate decrease in REM sleep (d = -0.48) on nights of active tVNS relative to sham stimulation. tVNS was also associated with a moderate reduction in cyclic alternating pattern (CAP) rate (d = -0.65) and small-to-moderate increase in RSAP-B during NREM sleep. Greater NREM RSAP-B was associated with a reduced CAP rate and NREM alpha power. This pilot study provides preliminary evidence that tVNS may improve sleep depth and stability in veterans with PTSD, as well as increase parasympathetically mediated nocturnal autonomic activity. These results warrant continued investigation into tVNS as a potential tool for treating sleep disturbance in veterans with PTSD.

Prevalence of Dental Caries in Schoolchildren from the Galapagos Islands: ESSO-Gal Cohort Report.

Objective: Dental caries remains a prevalent disease worldwide. Several epidemiological studies have shown that it affects the oral health of the pediatric population, and the Galapagos population in Ecuador is no exception. The aim of this study was to determine the prevalence of dental caries and its association, based on baseline information from the Galapagos Oral Health Study (ESSO-Gal), in children of the Galapagos Islands, Ecuador. Methods: A cross-sectional study was conducted involving 804 children aged 2-11 years. The prevalence of dental caries was assessed using the International Caries Detection and Assessment System (ICDAS II) criteria, while the presence of dental biofilm was assessed using the Silness-Löe index. Descriptive statistics, including frequency analysis and measures of central tendency and dispersion, were performed. Inferential statistical analyses were conducted to identify associations between variables. Statistical analyses were performed using the SPSS version 25.0 statistical program. Results: The caries prevalence rates based on ICDAS II codes 1-6, 1-2, and 3-6 were 98.01%, 96.9%, and 85%, respectively. A statistically significant difference was observed among the different islands regarding the cutoff point for ICDAS II codes 3-6 (p ≤ 0.001). Participants aged 6-11 years had the highest caries prevalence. Conclusions: The results show a high prevalence of dental caries among children in the Galapagos Islands, which increases with age. Contrary to expectations, the study did not find a significant correlation between the severity of dental caries and the presence of dental biofilm.

Compendio temático virtual de publicaciones ORAS-CONHU (2006-2023) / Virtual thematic compendium of ORAS-CONHU Publications (2006-2023)

La elaboración del presente compendio tiene por objetivo contribuir con la visualización y uso de información científica y técnica en salud andina mediante la gestión de un instrumento de recopilación, organizado temática y cronológicamente; a fin de facilitar la consulta especializada de interés conjunto de los países andinos. Recopila 100 títulos identificados, entre el 2006 y el 2023, con valiosa información normativa y técnica, según planes, políticas, manuales, situación de salud, normatividad, informes, guías, investigaciones, Webinar, Pódcast, otros; que promueven la visibilidad y accesibilidad a la información técnica producida a través del ORAS-CONHU. Asimismo, las publicaciones contenidas en el compendio han sido ingresadas en el Portal Regional BVS de Bireme/OPS/OMS -espacio de integración de fuentes de información que promueve la democratización y ampliación del acceso a la información científica y técnica en salud en AL&C- según Sistema Fi-Admin, por lo cual, el compendio refiere los títulos con enlace al registro BVS Regional.

A nationwide epidemiological and geodemographic analysis of lymphatic filariasis in Ecuador: a neglected and often forgotten disease in Ecuador.

Introduction: Lymphatic filariasis (LF) is a neglected parasitic disease transmitted by mosquitoes and affecting the lymphatic system. The aim of this study was to analyze the epidemiological and sociodemographic characteristics of patients with LF during the last 11 years of available data in Ecuador. Methods: A 11-year nationwide analysis of hospital admission and in-hospital mortality based on the National Institute of Statistics and Census (INEC) data was conducted in Ecuador from 2011 to 2021. The International Classification of Diseases 10th Revision (ICD-10) code for filariasis (ICD: B74) was used to retrieve information on severe LF as a proxy for incidence among 221 Ecuadorian cities. Results: A total of 26 hospital admissions and 3 deaths due to LF were registered. The highest mortality rate was found in populations over 80 years. Men accounted for 62.5% (n = 17) of total number of cases with an average incidence rate of 1.7 cases per/1,000,000, while females accounted for 34.6% (n = 9), representing 1 case per/1,000,000 woman. Cities located at lower altitude (459/1,000,000) reported higher incidence rates than those located at higher altitudes (7.4/1,000,000). Conclusion: This is the first study on LF in Ecuador. Although, Ecuador is not considered endemic for LF, we found evidence of the presence of this disease in recent years. The implementation and improvement of an adequate integrated epidemiological surveillance system will allow early identification of cases and therefore their respective treatment.

Situación de la salud infantil y el desarrollo infantil temprano en la región andina / Situation of child health and early childhood development in the Andean region

En la primera parte del presente documento se expone la situación de salud y del Desarrollo Infantil Temprano (DIT) de los niños y niñas en sus primeros 5 años de vida, la situación de salud de las madres y las principales barreras para el ejercicio de los derechos de unos y otras, en el marco de la agenda de los Objetivos de Desarrollo Sostenible (ODS). Para la primera parte se privilegió la información obtenida de fuentes secundarias, de instituciones como el Organismo Andino de Salud Convenio Hipólito Unanue (ORAS-CONHU), la OPS/OMS, UNICEF, UNESCO), el Banco Mundial y otras. Con el fin de contar con una referencia más allá de los seis países miembros del ORAS-CONHU, en varios casos se incorporó información del conjunto de países de ALC (Anexo 1). La segunda parte del documento presenta las políticas, programas, planes u otras intervenciones que se vienen implementando o aplicando en los países andinos, que contribuyan a la salud materna e infantil y que se constituyen en avances y acciones hacia el alcance del óptimo DIT

Experimental Therapeutics: Opportunities and Challenges Stemming From the National Institute of Mental Health Workshop on Novel Target Discovery and Psychosocial Intervention Development.

There has been slow progress in the development of interventions that prevent and/or reduce mental-health morbidity and mortality. The National Institute of Mental Health (NIMH) launched an experimental-therapeutics initiative with the goal of accelerating the development of effective interventions. The emphasis is on interventions designed to engage a target mechanism. A target mechanism is a process (e.g., behavioral, neurobiological) proposed to underlie change in a defined clinical endpoint and through change in which an intervention exerts its effect. This article is based on discussions from an NIMH workshop conducted in February 2020 and subsequent conversations among researchers using this approach. We discuss the components of an experimental-therapeutics approach such as clinical-outcome selection, target definition and measurement, intervention design and selection, and implementation of a team-science strategy. We emphasize the important contributions of different constituencies (e.g., patients, caregivers, providers) in deriving hypotheses about novel target mechanisms. We highlight strategies for target-mechanism identification using published and hypothetical examples. We consider the decision-making dilemmas that arise with different patterns of results in purported mechanisms and clinical outcomes. We end with considerations of the practical challenges of this approach and the implications for future directions of this initiative.

Plan estratégico 2023-2030 del Organismo Andino de Salud - Convenio Hipólito Unanue (ORAS-CONHU) / Strategic Plan 2023-2030 of the Andean Health Agency - Hipólito Unanue Agreement (ORAS-CONHU)

El Plan Estratégico al 2030, aprobado por Resolución REMSAA Ext. XXXVI/2, constituye la hoja de ruta para afianzar la integración regional y el abordaje de una agenda en común de las prioridades en salud pública de los seis países andinos. Incluye cinco líneas estratégicas: 1. Posicionamiento de la salud como eje central del desarrollo humano, 2. Promoción del derecho a la salud con justicia social y ambiental, 3. Reducción de las desigualdades e inequidades en salud, 4. Integración y cooperación regional, 5. Fortalecimiento institucional. El Plan, parte de un diagnóstico que muestra cómo la pandemia afectó la garantía del derecho a la vida, la salud y el bienestar, pero aclarando que los efectos de dicha pandemia fueron más funestos donde la estructura de desigualdades exacerbó el riesgo de enfermar. Por ello, los datos muestran que los países con alta desigualdad y sistemas de protección débiles han tenido altos índices de contagios y letalidad.

Plan estratégico de integración en salud 2023-2030 / Strategic health integration plan 2023-2030

La presente publicación incorpora ampliamente algunas dimensiones relevantes con las que hasta el momento se venía trabajando como el cambio climático y las desigualdades sociales en salud. luna agenda en común de las prioridades en salud pública de los seis países andinos. Incluye cinco líneas estratégicas 1. Posicionamiento de la salud como eje central del desarrollo humano, 2. Promoción del derecho a la salud con justicia social y ambiental, 3. Reducción de las desigualdades e inequidades en salud, 4. Integración y cooperación regional, 5. Fortalecimiento institucional. El Plan, parte de un diagnóstico que muestra cómo la pandemia afectó la garantía del derecho a la vida, la salud y el bienestar, pero aclarando que los efectos de dicha pandemia fueron más funestos donde la estructura de desigualdades exacerbó el riesgo de enfermar. Por ello, los datos muestran que los países con alta desigualdad y sistemas de protección débiles han tenido altos índices de contagios y letalidad.

Structural Phenomena in a Vesicle Membrane Obtained through an Evolution Experiment: A Study Based on MD Simulations.

The chemical evolution of biomolecules was clearly affected by the overall extreme environmental conditions found on Early Earth. Periodic temperature changes inside the Earth's crust may have played a role in the emergence and survival of functional peptides embedded in vesicular compartments. In this study, all-atom molecular dynamic (MD) simulations were used to elucidate the effect of temperature on the properties of functionalized vesicle membranes. A plausible prebiotic system was selected, constituted by a model membrane bilayer from an equimolar mixture of long-chain fatty acids and fatty amines, and an octapeptide, KSPFPFAA, previously identified as an optimized functional peptide in an evolution experiment. This peptide tends to form the largest spontaneous aggregates at higher temperatures, thereby enhancing the pore-formation process and the eventual transfer of essential molecules in a prebiotic scenario. The analyses also suggest that peptide-amphiphile interactions affect the structural properties of the membrane, with a significant increase in the degree of interdigitation at the lowest temperatures under study.

An 11-year epidemiological analysis of schistosomiasis in Ecuador: Investigating a non-endemic, neglected, and challenging-to-identify parasitic disease.

Schistosomiasis is a neglected disease caused by parasites of the genus Schistosoma and transmitted by snails of the genus Biomphalaria. At least five species have the potential to infect humans living in or visiting tropical areas worldwide. In Latin America, Schistosoma mansoni is particularly common; however, it has not been reported in Ecuador. In this study, we assess the available official data on schistosomiasis in Ecuador to describe the prevalence of this neglected disease. We conducted a nationwide study to determine the demographic and spatial distribution patterns of schistosomiasis infection in Ecuador, using hospital discharge official data as a proxy for infection incidence from 2011 to 2021. We calculated crude and age-sex-adjusted morbidity and hospital admission rates by region, province, canton, and elevation. In the last decade of available data, schistosomiasis accounted for at least 551 hospital admissions in Ecuador. Women represented 53.7% (n = 296) of cases, equivalent to 3.2 cases per 1,000,000 inhabits. The highest number of cases (61.2%, n = 337) was found in the Coastal region. However, the highest incidence rates were observed in the Amazon region's provinces of Pastaza (173.44 cases/1,000,000).

LA SINDEMIA ASOCIADA A COVID-19 Y LOS DERECHOS DE NIÑAS, NIÑOS Y ADOLESCENTES EN LATINOAMÉRICA: ANÁLISIS A PARTIR DE SEIS PAÍSES DE LA REGIÓN, 2023 / The syndemic associated with Covid-19 and the rights of children and adolescents in Latin America: Analysis from six countries in the region, 2023

El presente trabajo constituye un puntal de evidencia científica que queda disponible a los tomadores de decisiones en políticas nacionales y regionales relativas a la población de niñas, niños y adolescentes, y eso por sí solo es una muy buena contribución a la relevancia que debe tener esta población. Este estudio reconoce que vivimos un momento histórico, una ventana de oportunidad para tomar las decisiones adecuadas. Es prioridad contribuir para lograr que las políticas públicas sean eficaces en la garantía de los derechos humanos, esto requiere avanzar en consolidar Estados Sociales de Derecho y Bienestar con sistemas de salud y protección social universales. Asimismo, es fundamental fortalecer las capacidades de trabajo intersectorial y transdisciplinar, la integración regional y la cooperación internacional para hacer realidad la justicia social y ambiental, así como entender que las niñas, niños y adolescentes no son el futuro, son el presente. De lo que hagamos ahora depende el desarrollo y bienestar de nuestros pueblos. En este sentido el análisis se realiza a partir de un marco conceptual que abarca los siguientes aspectos:: Más allá de la pandemia, una sindemia; desigualdades múltiples: una manera de trascender a las desigualdades de ingreso; Derechos Humanos y su operacionalización en el contexto sindémico; Convención sobre los Derechos del Niño; sindemia COVID-19 y los derechos de niñas, niños y adolescentes; sindemia y políticas públicas, sindemia por COVID-19 y un llamado a la acción.

COVID-19 vaccine hesitancy in Spain and associated factors.

Introduction: The present study explores the reasons of those who have not been vaccinated in the later stage of the vaccine rollout in Spain and its associated determinants. Methods: Cluster and logistic regression analyses were used to assess differences in claimed reasons for vaccine hesitancy in Spain using two samples of unvaccinated people (18-40 years old) gathered by an online cross-sectional survey from social networks (n = 910) and from a representative panel (n = 963) in October-November 2021. Results: The main reasons for not being vaccinated were believing that the COVID-19 vaccines had been developed too fast, they were experimental, and they were not safe, endorsed by 68.7% participants in the social network sample and 55.4% in the panel sample. The cluster analysis classified the participants into two groups. Logistic regression showed that Cluster 2 (individuals who reported structural constraints and health-related reasons such as pregnancy or medical recommendation) presented a lower trust in information from health professionals, had a lower willingness to get vaccinated in the future, and avoided less social/family events than those in Cluster 1 (reasons centered in distrust on COVID-19 vaccines, conspiracy thoughts and complacency). Conclusions: It is important to promote information campaigns that provide reliable information and fight fake news and myths. Future vaccination intention differs in both clusters, so these results are important for developing strategies target to increase vaccination uptake for those who do not reject the COVID-19 vaccine completely.

Proceso de atención de enfermería en el cuidado al paciente COVID-19 / Nursing process of care in patient care COVID-19 / Processo de cuidados de enfermagem no cuidado ao paciente COVID-19

El microbiota intestinal se encuentra constituida por más un millón de microorganismos entre los cuales las bacterias son de mayor prevalencia. Esta microbiota depende directamente de la localización exacta a lo largo del tubo digestivo, siendo la porción del colon la que alberga la mayor cantidad del microorganismo de la flora. El microbiota de la piel guarda relación directa con el microbiota del intestino por los diversos mecanismos existentes en la formación de la misma. El objetivo del presente estudio fue analizar el uso de probióticos y prebióticos en tratamiento de patología cutáneas y la relación entre la microbiota intestinal y enfermedades de la piel. Se realizó una revisión bibliográfica narrativa de la literatura científica de la relación del microbiota intestinal en patologías cutáneas. Se concluyó que el uso de probióticos y prebióticos juegan un papel importante en enfermedad cutáneas es especial de tipo inflamatoria.

The intestinal microbiota is constituted by more than one million microorganisms among which bacteria are the most prevalent. This microbiota is directly dependent on the exact location along the digestive tract, with the colon portion harboring the largest amount of the microorganism flora. The skin microbiota is directly related to the gut microbiota by the various mechanisms involved in its formation. The aim of the present study was to analyze the use of probiotics and prebiotics in the treatment of skin pathology and the relationship between the intestinal microbiota and skin diseases. A narrative bibliographic review of the scientific literature on the relationship between the intestinal microbiota and skin pathologies was carried out. It was concluded that the use of probiotics and prebiotics play an important role in skin diseases, especially inflammatory ones.

A microbiota intestinal é formada por mais de um milhão de microorganismos entre os quais as bactérias são as mais prevalentes. Esta microbiota depende diretamente da localização exata ao longo do trato gastrointestinal, sendo que a porção de cólon abriga a maior quantidade da flora de microorganismos. A microbiota da pele está diretamente relacionada à microbiota intestinal pelos diversos mecanismos envolvidos em sua formação. O objetivo deste estudo foi analisar o uso de probióticos e prebióticos no tratamento da patologia da pele e a relação entre a microbiota intestinal e as doenças de pele. Foi realizada uma revisão narrativa da literatura científica sobre a relação entre microbiota intestinal e patologias da pele. Concluiu-se que o uso de probióticos e prebióticos desempenha um papel importante nas doenças de pele, especialmente nas doenças inflamatórias da pele.

Cambios en los planes de estudio de ciencias de la salud en pandemia / Experiencias del diálogo interinstitucional andino y suramericano / Changes in health sciences curricula in a pandemic

El contenido del documento tiene la finalidad de constituir un catalizador para seguir impulsando el diálogo y el intercambio de experiencias orientadas a una reforma exitosa en la formación del recurso humano en salud, que aborde oportunamente las necesidades actuales y futuras de la comunidad y, el tema de reorientación curricular se siga desarrollando con mayor fuerza, y las líneas de acción orientadas a la acreditación, la abogacía y la formación de formadores. Destaca la articulación salud-educación: reorientación curricular hacia la atención primaria de todas las carreras de salud