La enseñanza de la educación para la salud: ¿una confrontación a la teoría y la práctica de la salud pública como disciplina? / Teaching education for health: ¿a confrontation with the theory and practice of public health as a discipline?

Objetivo: comprender la enseñanza de la educación para la salud (EpS) en la Facultad Nacional de Salud Pública (fnsp) de la Universidad de Antioquia. Metodología: entrevistas grupales e individuales a profesores, estudiantes y egresados, así como con la revisión de los planes de estudio de los programas académicos de la Facultad. Resultados: es predominante la enseñanza de la EpS como herramienta o estrategia, concebida desde una perspectiva biomédica y fundada en un modelo pedagógico tradicional/coactivo; además, que la enseñanza de la EpS en la fnsp no tiene la relevancia que se esperaría, lo que aparentemente supone una contradicción. Discusión: La reflexión teórica realizada propone una salida diferente: esta situación, lejos de ser una contradicción, corresponde a una consecuencia lógica para una perspectiva de salud pública imperante en la fnsp. El papel que cumple la educación en la salud pública depende de la corriente en la cual se inscribe. Se presentan otras versiones de salud pública en las cuales la educación tiene un sentido básico y fundante y se plantea desde modelos pedagógicos alternativos. Así, abordar la enseñanza de la EpS y definir el perfil del salubrista no es un asunto neutral ni técnico para incluir ciertos contenidos; corresponde al producto de un debate teórico y político sobre la salud pública que debe orientar los currículos de los programas académicos y, en general, las acciones de la Facultad.

Objective: to understand the manner in which health education (HE) is taught at the National Faculty of Public Health (NFPH) of the University of Antioquia in Medellín, Colombia. Methodology: group and individual interviews with teachers, students and graduates. Likewise, the curricula of the Faculty's academic programs were reviewed. Results: The predominant approach is to teach HE as a tool or strategy conceived from the biomedical standpoint and grounded on a traditional/coercive pedagogical model. Furthermore, the teaching OF HE at the NFPH does not have the relevance that should be expected, which is a contradiction in itself. Discussion: the theoretical reflection developed proposes a different explanation: it is not a contradiction; rather this situation pertains to a logical consequence of a public health perspective prevailing at the NFPH. The role of health education depends on the public health approach with which it is aligned. Other public health approaches are presented in which education has a basic and foundational sense and it is conceived from the point of view of alternative pedagogical models. So addressing HE teaching and defining the profile of public health professionals is not a neutral and technical issue for including certain topics. It is rather a consequence of a theoretical and political debate about the type of public health that should guide the curricula of academic programs and actions at the Faculty.

Generalización e inferencia: un acercamiento a su compresión desde tres enfoques / Generalization and inference: an understanding based on three approaches

Se trata de una reflexión que busca poner en discusión los diferentes significados que pueden adquirir los conceptos de generalización e inferencia, de acuerdo con el enfoque o perspectiva desde el cual se pretendan utilizar. Para este propósito, en primer lugar, se pone en consideración la importancia y el uso que se ha dado a estos conceptos en el campo de la epidemiología clásica-moderna, especialmente para definir asuntos de validez interna y externa y para la formulación de hipótesis. Seguidamente, se presentan las principales argumentaciones que al respecto defiende Clifford Geertz desde su perspectiva epistemológica de la etnografía interpretativista y de acuerdo con su concepción teórica de la cultura. Posteriormente, se presentan las ideas que sustenta Juan Samaja desde su enfoque epistemológico y metodológico para la investigación en salud, abogando principalmente por el razonamiento abductivo, y no sólo el inductivo y el deductivo que han sido privilegiados en los estudios lógicos. Por último se presenta una discusión y unas conclusiones destacando que en estas tres perspectivas la salud pública tiene una oportunidad para enriquecer sus procesos de generación de nuevo conocimiento y para comprender de mejor manera las condiciones de salud y de bienestar colectivo.

This paper is a reflection which seeks to stimulate discussion and debate concerning the different meanings that the concepts of generalization and inference can take on, based on the approach or perspective that is being employed. For this purpose the importance and usage which has been accorded to these concepts within the field of classic-modern epidemiology is taken into consideration, especially in order to define internal and external validity issues and to formulate hypotheses. Next the main arguments are presented and are defended by Clifford Geertz from his epistemological perspective of interpretive ethnography and based on his theoretical conception of culture. Subsequently the ideas maintained by Juan Samaja are presented from his epistemological and methodological approach for research into health, advocating primarily for abductive reasoning, and not simply inductive and deductive, which have until now been privileged in logic studies. Finally a discussion and conclusions are presented, highlighting that from these three perspectives public health has the opportunity to expand its new knowledge generation processes and to better understand the conditions for good collective health and wellbeing.

El educador como investigador de su práctica pedagógica: la importancia de la reflexión en la educación para la salud / Teacher as researcher of its own practice: the importance of reflection for health educaction

Objetivo: presentar el proceso y los resultados de una inves-tigación-acción en el ámbito de la educación, en el programa de crecimiento y desarrollo de una institución prestadora de servicios de salud de la ciudad de Medellín. Metodología: si¬guiendo los planteamientos de Stenhouse sobre un educador-investigador, se llevó a cabo un proceso reflexivo donde los miembros de los equipos del programa, investigaron sus prác¬ticas pedagógicas y las analizaron a la luz de su propia expe¬riencia y de la teoría proveniente de investigaciones realizadas en su institución, y de la literatura científica. Resultados: me¬diante la reflexión y la investigación de su práctica pedagó¬gica los educadores lograron concebir el programa desde una perspectiva más amplia: la crianza. Así mismo consiguieron situarse de manera diferente hacia la educación y el educando y generar propuestas alternativas. Discusión: la experiencia investigativa muestra la dificultad para realizar cambios en las perspectivas pedagógicas en el ámbito de de la educación para salud, generalmente sustentadas en modelos tradicionales o conductistas. Teniendo en cuenta los resultados obtenidos, se presenta esta propuesta investigativa como una vía para avan¬zar en el fortalecimiento de la dimensión educativa en el ámbi¬to de salud desde una perspectiva alternativa.

Objective: to present the process and results of an action research in the educational dimension, the growth and development program of a health institution in Medellin. Methodology: following Stenhouse’s ideas about a teacher-researcher, it was developed a reflective process where the program’s teams, researched their pedagogical practices, and analyzed them taking in consideration their own experience as well as theory coming from past research done in their institution, and the scientific literature. Results: through a reflective process and by investigating their pedagogical process, educators were able to design the program from a wider perspective: child rearing. Also they were able to locate themselves in a different way with respect to education and to parents generating alternative proposal for education Discussion: research experience shows the difficulty of making changes in pedagogical perspectives in health education, usually based on traditional or behavioral models. According to the results, this research proposal is presented as a way to forward in the strengthening of a educational dimension in health field from an alternative perspective.

Evaluación del programa "La aventura de la vida" desde la perspectiva de sus actores en una escuela de educación básica primaria, Medellín, 2002-2004: estudio de caso / Evaluation of the program "La Aventura de la Vida" from the perspective of its staff working in an elementary school, Medellín, 2002-2004: a case study

Esta investigación tiene como base la evaluación del programa "La aventura de la vida", trabajo conjunto entre la Universidad de Antioquia y Surgir, organización no gubernamental encargada de dicho programa en Medellín. Se escuchó a sus participantes para comprender los conocimientos, percepciones y relaciones en las comunidades educativas donde se aplicó y en esa medida se pudo establecer cómo los componentes del programa pueden dar cuenta de prácticas e interacciones de sus actores, que producen efectos e impactos. Este estudio indagó sobre dichos efectos e impactos en términos de proceso social y como vehículos transformadores de la cultura ciudadana frente al problema de la fármacodependencia. Para ello, se exploraron las concepciones y significados de la comunidad educativa sobre prevención de problemáticas socialmente relevantes asociadas a las drogas y promoción de estilos de vida saludables. La evaluación fue de tipo cualitativa (estudio de caso), lo que permitió comprender el desarrollo real del programa utilizando diferentes técnicas, tales como entrevistas en profundidad, observaciones participantes y grupos focales de niños y niñas y de sus personas significantes.

This research evaluated the program "La aventura de la vida" (Adventure of Life), a joint work between University of Antioquia and Surgir, a nongovernmental organization in charge of the program in Medellín. Participants were interviewed to understand what happens with the knowledge, perceptions and relations in the educative community where it was applied. It was possible to establish that components of the program can account for practices and interactions of their actors producing effects and impacts. The study looked for these effects and impacts in terms of social process and as transforming tool of citizen culture facing drug addition problem. Community conceptions and meanings on prevention of socially relevant problems associated to drugs and healthy life styles promotion. With a qualitative and ethnographic approach, the study allowed to understand the real development of the program, using different techniques such as comprehensive interviews, participant observations and focal groups with children and their significant people.

El programa de crecimiento y desarrollo: una alternativa basada en el desarrollo humano, los derechos y la educación / The growth and development monitoring program: an option founded on human development, rights and education

Los tres primeros años de vida constituyen una etapa fundamental para el desarrollo de la persona. La precaria calidad de vida en que muchas familias de nuestro país llevan a cabo sus funciones de crianza configuran ambientes poco propicios para el sano desarrollo de los niños. En este contexto, el programa de crecimiento y desarrollo cobra especial significado, por lo cual el cambio de orientación introducido por la Resolución 412 de 2000 del Ministerio de Salud, desde una visión morbicéntrica, es preocupante. Esta orientación dificulta la comprensión del problema desde una perspectiva integral, lo cual deviene en una visión monosectorial y descontextualizada socioeconómica, cultural y políticamente. Se presenta una propuesta basada en la recuperación de una perspectiva de promoción de la salud centrada en el desarrollo humano, reconociendo en el programa un instrumento para garantizar los derechos de los niños y la satisfacción de sus necesidades, como mecanismo de legitimación del Estado. Para esto el programa deberá reconocer al adulto significativo como sujeto así como la importancia de su participación en la orientación del programa, generar instancias de apoyo emocional y recuperación del tejido social, instaurar un modelo educativo dirigido a promover el desarrollo humano, garantizar un programa de calidad abierto a todos, recuperar las funciones de la salud pública y promover la construcción de una política pública en niñez que dinamice la articulación de los sectores que se requieren para consolidar una perspectiva integral.

El Programa de Crecimiento y Desarrollo: otro factor de inequidad en el sistema de salud / The Growth and Development Program: another inequity agent in the health system

El Programa de Crecimiento y Desarrollo ha sido considerado como una importante acción de salud pública, impulsada por el sistema de salud desde hace más de 20 años. Este programa, como todas aquellas acciones de promoción de la salud y prevención de la enfermedad, han sufrido importantes cambios con la implantación de la Ley 100. La presente investigación, de corte cualitativo, pretendió identificar cuáles fueron estos cambios, sus causas y su impacto para la calidad de las acciones promovida por el programa y por ende, para la promoción de la salud de los niños menores de 6 años y sus familias en la ciudad de Medellín. La información se recolectó revisando fuentes secundarias y realizando entrevistas a padres y funcionarios vinculados al programa, así como con la observación de las sesiones. La investigación concluyó que se han producido importantes cambios en la forma como se administra y se ejecuta el programa, encontró especialmente una gran diferencia de la calidad del servicio entre los programas ofrecidos por el régimen contributivo y el régimen subsidiado, lo que ha generado una situación de marcada inequidad que está afectando a las familias más vulnerables, que precisamente serían las que requerirían mayores esfuerzos del sistema de salud

De léntigo maligno a léntigo maligno melanoma / From maligne lentigus to maligne lentigus melanoma

Se reporta un caso ilustrativo de un paciente de 77 años con lesión nodular pigmentada que apareció sobre una mácula color cafe de 15 años de evolución. La biopsia reporta melanoma maligno Clark IV, Breslow de 4mm. Se revisa el riesgo de trasformación del léntigo maligno a léntigo maligno melanoma

Renal expression of parathyroid hormone-related protein (PTHrP) and PTH/PTHrP receptor in a rat model of tubulointerstitial damage.

BACKGROUND: PTHrP, which appears to act as a growth/differentiation factor in a variety of tissues, is present in the kidney; however, its role is unclear. METHODS: The expression of PTHrP and the PTH/PTHrP receptor were investigated by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in the remnant kidney of uninephrectomized (UNX) rats after protein overloading [1 g/day of bovine serum albumin (BSA)]. RESULTS: Compared with UNX-control rats, proteinuria in BSA-overloaded animals was detected within the first 24 hours and increased during the entire study period (28 days). Kidney examination by light microscopy showed no significant renal lesions at day 1 of BSA treatment, whereas at days 8 and 28, tubular lesions, infiltration of mononuclear cells, and mesangial expansion were observed. PTHrP mRNA expression in the renal cortex was already increased at day 1 (fourfold) and plateaued between days 8 and 28 (12- and 15-fold, respectively) in BSA-overloaded animals compared with UNX-control rats. At day 8, immunohistochemical analysis with two different anti-PTHrP antibodies showed a dramatic increase of PTHrP staining in the damaged proximal and distal tubules from BSA-overloaded rats with respect to UNX-control rats. Moreover, intense PTHrP immunostaining was also observed in glomerular mesangial and endothelial cells in BSA-overloaded rats, but not in the UNX-control rats. A reciprocal decrease of PTH/PTHrP receptor mRNA and immunostaining, without significant changes in the cellular localization (proximal and distal tubule, and glomerular mesangial and epithelial cells) of the PTH/PTHrP receptor positivity was found to occur in the renal cortex of BSA-overloaded rats. At day 8, coinciding with the up-regulation of PTHrP, an increase in the angiotensin converting enzyme and preproendothelin-1 gene expression was observed in the renal cortex of BSA-overloaded rats compared with UNX-control rats. CONCLUSIONS: These results indicate that PTHrP can be added to the group of genes that are up-regulated in proximal tubular cells in response to intense proteinuria. Our results, together with previous findings, suggest that the vasoactive hormones angiotensin II and endothelin-1 could participate in the PTHrP production in the renal cortex of BSA-overloaded rats. Further experiments are required to clarify the mechanisms of PTHrP up-regulation and its possible role in the response to renal damage in this animal model.

Parathyroid hormone-related protein increases DNA synthesis in proximal tubule cells by cyclic AMP- and protein kinase C-dependent pathways.

The present study was performed to characterize the possible involvement of cAMP synthesis and protein kinase C (PKC) activation in the DNA synthesis-stimulating effect of parathyroid hormone-related protein (PTHrP) in proximal tubule cells. We found that DNA synthesis was stimulated by 10 microM 8BrcAMP, and 1 microM Sp-cDBIMPS, two cAMP analogs, and also by 1 microM phorbol 12-myristate 13-acetate (PMA) and 100 microM 1,2-dioctanoyl-sn-glycerol, two PKC activators, and 10 nM [Cys23] human (h)PTHrP (24-35) amide in rabbit proximal tubule cells (PTC). Both Sp-cDBIMPS and PMA, at 1 microM, also increased DNA synthesis in SV40-immortalized mouse proximal tubule cells MCT. Human PTHrP (7-34) amide [PTHrP (7-34)] dose dependently stimulated DNA synthesis in a similar manner as [34Tyr]PTHrP (1-34) amide [PTHrP (1-34)], in PTC. PMA pre-treatment for 20 h, which downregulates PKC, completely blocked the effect induced by PTHrP (7-34), but not that of PTHrP (1-34), in the latter cells. In contrast, the same PMA pre-treatment abolished the DNA synthesis stimulation by PTHrP (1-34) and PTHrP (7-34) in MCT cells, which appear to have PTH receptors mainly coupled to phospholipase C and not adenylate cyclase. Our results indicate that the stimulatory effect of PTHrP on DNA synthesis in proximal tubule cells is mediated by a cAMP- and PKC-dependent mechanism.

Cyclosporine increases renal parathyroid hormone-related protein expression in vivo in the rat.

BACKGROUND: Clinical use of cyclosporine (CsA) is limited by its known nephrotoxicity. Parathyroid hormone (PTH)-related protein (PTHrP) increases after acute renal ischemia and stimulates proliferation of renal cells in culture. Herein, we have examined whether the renal expression of PTHrP and its PTH/PTHrP receptor is affected by chronic CsA nephrotoxicity. METHODS: Rats were randomly assigned to receive daily intramuscular injections of either CsA (25 mg/kg) or the same volume of the vehicle olive oil (control) for 3 weeks. At this time interval, under ether anesthesia, rat blood and kidneys were obtained for analytical determinations, and total RNA isolation or immunohistochemistry, respectively. RESULTS: Serum urea was 11+/-2 and 6+/-1 mmol/L (P < 0.01) in CsA-treated and control rats, respectively. We found that PTH/PTHrP receptor mRNA was unchanged, but PTHrP mRNA, and also transforming growth factor-beta1 mRNA expression as positive control, was about twofold increased in the kidney of CsA-treated rats. This was accompanied by increased PTHrP immunostaining in renal cortical tubules, associated with tubule vacuolation. CONCLUSION: This study demonstrates an up-regulation of PTHrP, associated with chronic CsA-induced nephrotoxicity. Our findings support a role for PTHrP in the CsA-injured kidney.

Transforming growth factor-beta and its receptors in rabbit renal proximal tubules after uninephrectomy.

Transforming growth factor-beta (TGF beta) and its receptors were studied in proximal tubules isolated from rabbit renal cortex at different times after uninephrectomy (UNX). Scatchard analysis of TGF beta-binding data in proximal tubules from control kidneys revealed two types of binding sites, with Kd 21 and 208 pM, and Bmax 33 and 104 fmol/mg protein, respectively. Kd values were similar in these animals at 1 or 2 weeks after either UNX or sham operation (SNX). However, Bmax increased in parallel with the observed increase in the protein/DNA ratio of the proximal tubules at 2 weeks after UNX. In contrast, [125I]-insulin binding per milligram of protein was lower in proximal tubules from uninephrectomized compared to sham-operated animals within the same time period. Affinity labeling of [125I]-TGF beta 1-binding sites in proximal tubules from either sham-operated or uninephrectomized rabbits displayed two labeled proteins with apparent molecular weights of > 143 and 43 kD. We found an increased TGF beta bioactivity in the conditioned medium of proximal tubules at 2 weeks following UNX. This protein increase was associated with an increased TGF beta 1 mRNA expression in these tubules. In contrast, no significant changes in TGF beta bioactivity were observed in rabbit glomeruli conditioned medium or in rabbit urine at this time period after UNX. Our data indicate that hypertrophy of the proximal tubule is associated with an increased TGF beta production and a lack of downregulation of its receptors in this nephron portion.

Comparison of antiproliferative effects of atrial natriuretic peptide and transforming growth factor beta on rabbit kidney proximal tubule cells.

The effects of atrial natriuretic peptide (ANP) and transforming growth factor beta (TGF beta) on cell proliferation were investigated in rabbit kidney proximal tubule cells. At 48 h, each agonist inhibited cell growth dose dependently. Moreover, the antiproliferative effect of both factors together was greater than that of each factor alone. However, coincubation of a high concentration (100 nM) of ANP and epidermal growth factor (EGF) was found to induce cell hypertrophy. This hypertrophic effect induced by ANP in the presence of EGF was mimicked by 8-BrcGMP but not by various cAMP analogues, at 100 microM, and was independent of the tyrosine kinase inhibitor genistein (10 microM). However, it was inhibited by 100 pM TGF beta. These in vitro results suggest that the antiproliferative effects of ANP and TGF beta may be part of a mechanism to modulate the hyperplastic effect of EGF in the renal proximal tubule during compensatory kidney growth.

Hypertrophy of rabbit proximal tubule cells is associated with overexpression of TGF beta.

The expression of transforming growth factor beta (TGF beta) in proximal tubule cells from rabbit kidney cortex after uninephrectomy (UNX) was investigated. Cell protein and [3H]leucine incorporation in these cells were significantly increased, while cell number was decreased, at two weeks following UNX. At this time period after UNX, we found that proximal tubule cells showed a dramatic increase of cytoplasmic immunostaining with a pan-specific anti-TGF beta antibody. This was accompanied by a 3-fold increase in TGF beta 1 mRNA expression in these cells. Furthermore, proximal tubule cells from two-week uninephrectomized rabbits secrete about 2-fold higher TGF beta bioactivity to the cell conditioned medium compared to cells from sham-operated animals. Addition of anti-TGF beta 1, beta 2, beta 3 neutralizing antibody increased the growth of the former cells, and it abolished cell hypertrophy. These results indicate that hypertrophy of proximal tubule cells during compensatory renal growth is associated with overexpression of TGF beta.

Parathyroid hormone-related protein is an autocrine modulator of rabbit proximal tubule cell growth.

Parathyroid hormone-related protein (PTHrP), a likely mediator for humoral hypercalcemia of malignancy, is also synthesized in various normal tissues. In the kidney, PTHrP, mainly detected in proximal and distal tubules, has been shown to stimulate proliferation of rat mesangial cells in culture. Experiments were carried out to investigate the possible mitogenic effect of PTHrP in cultures of rabbit proximal tubule cells (PTC). Immunocytochemical analysis, using antihuman (h)PTHrP antibodies to (38-64) and (107-111) epitopes in the PTHrP molecule, showed strong cytoplasmic staining in PTC and proximal tubule-like LLC-PK1 cells. PTC secreted immunoreactive PTHrP (54.8 +/- 7.0 fmol/10(6) cells) into the culture medium. Human PTHrP(1-141) stimulated proliferation in subconfluent cultures of these cells dose-dependently. This effect was similar to that induced by [Tyr34]hPTHrP(1-34) amide (hPTHrP[1-34]), hPTHrP(1-86), and bovine (b)PTH(1-34), while hPTHrP(38-64) amide, hPTHrP9107-111) amide, and hPTHrP(107-139) amide were ineffective. Addition of anti-hPTHrP neutralizing antibodies to (1-34), (38-64), and (107-111) epitopes of PTHrP decreased PTC growth. The mitogenic effect of these agonists was abolished in confluent PTC. In contrast, [Nle8,18, Tyr34]bPTH(3-34)amide (bPTH[3-34]) increased DNA synthesis in either subconfluent or confluent PTC. In LLC-PK1 cells, which also secreted PTHrP and are devoid of PTH receptors, none of these peptides affected proliferation. Forskolin (10 microM) or H-8 (2 microM), a protein kinase A inhibitor, did not affect basal or hPTHrP(1-34)-stimulated DNA synthesis, respectively, in subconfluent PTC. On the other hand, 10 nM staurosporine and 100 nM calphostin C, protein kinase C (PKC) inhibitors, blunted the effects of hPTHrP(1-34) or bPTH(3-34) on DNA synthesis in these cells. These studies suggest that PTHrP may function as an autocrine factor in the regulation of proximal tubule cell growth by a PKC-mediated mechanism.

Manual para cálculo diseño y proyecto de redes de alcantarillado

El presente Manual de Cálculo, Diseño y Proyecto de Redes de Alcantarillado, es un compendio de las Normas que rigen en el país, el Reglamento de la Empresa local de Servicios y libros o publicaciones especializados en vigencia en nuestro medio.

Determinación de parámetros de floculación utilizando jarras de sección circular y sección cuadrada

Conclusiones finales del proyecto: Se puede suponer que en las vértices de las secciones cuadradas se forman vértices de agitación de dirección contraria al giro de las paletas, lo que permite una mejor mezcla y agitación que en la sección circular. Por tanto cuando se hace una prueba de jarras en vasos de sección circular, para la adopción de los valores de gradiente en las cámaras de agitación es necesario efectuar previamente una corrección utilizando cualquiera de las fórmulas anteriores o haciendo uso del gráfico de corrección