Dissection of the autophagic route in oocytes from atretic follicles.

BACKGROUND INFORMATION: Autophagy is a conserved process that functions as a cytoprotective mechanism; it may function as a cell death process called programmed cell death type II. There is considerable evidence for the presence of autophagic cell death during oocyte elimination in prepubertal rats. However, the mechanisms involved in this process have not been deciphered. RESULTS: Our observations revealed autophagic cell death in oocytes with increased labeling of the autophagic proteins Beclin 1, light chain 3 A (LC3 A), and lysosomal-associated membrane protein 1 (Lamp1). Furthermore, mTOR and phosphorylated (p)-mTOR (S2448) proteins were significantly decreased in oocytes with increased levels of autophagic proteins, indicating autophagic activation. Moreover, phosphorylated protein kinase B (p-AKT) was not expressed by oocytes, but mitogen-activated protein kinase/extracellular signalregulated kinase (MAPK/ERK) signaling was observed. Additionally, selective and elevated mitochondrial degradation was identified in altered oocytes. CONCLUSIONS: All these results suggest that mTOR downregulation, which promotes autophagy, could be mediated by low energy levels and sustained starvation involving the phosphoinositide 3-kinase (PI3K)/AKT/mTOR and MAPK/ERK pathways. SIGNIFICANCE: In this work, we analyzed the manner in which autophagy is carried out in oocytes undergoing autophagic cell death by studying the behavior of proteins involved in different steps of the autophagic pathway.

Realizing the right to health in Latin America, equitably.

This special issue "Realizing the Right to Health in Latin America and the Caribbean" provides an overview of one of the most challenging objectives of health systems: equity and the realization of the right to health. In particular, it concentrates on the issues associated with such a challenge in countries suffering of deep inequity. The experience in Latin America and the Caribbean demonstrates that the efforts of health systems to achieve Universal Health Coverage are necessary but not sufficient to achieve an equitable realization of the right to health for all. The inequitable realization of all other human rights also determines the realization of the right to health.

Paraptosis in human glioblastoma cell line induced by curcumin.

Curcumin is a polyphenol compound extracted from Curcuma longa plant, is a molecule with pleiotropic effects that suppresses transformation, proliferation and metastasis of malignant tumors. Curcumin can cause different kinds of cell death depending of its concentration on the exposed cell type. Here we show that exposure of the glioblastoma cell line A172 to curcumin at 50 µM, the IC50, causes morphological change characteristic of paraptosis cell-death. Vesicles derived from the endoplasmic reticulum (ER) and low membrane potential of the mitochondria were constantly found in the exposed cells. Furthermore, changes in expression of the ER Stress Response (ERSR) genes IRE1 and ATF6, and the microRNAs (miRNAs) miR-27a, miR-222, miR-449 was observed after exposure to curcumin. AKT-Insulin and p53-BCL2 networks were predicted being modulated by the affected miRNAs. Furthermore, AKT protein levels reduction was confirmed. Our data, strongly suggest that curcumin exerts its cell-death properties by affecting the integrity of the reticulum, leading to paraptosis in the glioblastoma cells. These data unveils the versatility of curcumin to control cancer progression.

Lessons from 20 Years of Capacity Building for Health Systems Thinking.

In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.

Looking for Evidence of the Impact of Introducing a Human Rights-Based Approach in Health: The SaluDerecho Experience.

This paper summarizes the background, methodology, results, and lessons learned from SaluDerecho, the Initiative on Priority Setting, Equity and Constitutional Mandates in Health. Originally facilitated by the capacity-building arm of the World Bank in 2010, it was implemented in Latin American countries and later expanded to other regions of the world. Segmentation, decentralization, and lack of coordination in health systems; weak information systems; stratified societies; and hierarchical power relations in participating countries are some of the characteristics that inhibit a human rights-based approach to health. Hence, deliberate interventions like SaluDerecho are vital. Facilitating the participation of multiple stakeholders in a more informed and transparent dialogue creates a "safe" working environment to co-create policy solutions to improve transparency and accountability. The proposed evaluation methodology involves several steps that begin with an assessment of behavioral changes in actors (including policy makers, citizens, payers, and health care providers) that reshape relationships and, over time, change the functioning of health systems. Despite certain limitations, SaluDerecho has provided evidence of positive change among participating countries.

Universal health coverage and litigation in Latin America.

PURPOSE: Over the last five years many middle-income Latin American countries have seen a steep increase in the number of cases litigating access to curative services. The purpose of this paper is to explore this complex phenomenon and outline some of its roots and impacts. DESIGN/METHODOLOGY/APPROACH: The authors use an interdisciplinary approach based on a literature review and workshops convened to discuss the issue. FINDINGS: A range of reasons can explain this increased legal activity. These include: a renewed judicial approach to the enforcement of the right to health; a more demanding public interest; an increased prevalence of non communicable diseases; and limited capacity for fair benefit package. ORIGINALITY/VALUE: The findings in this paper argue for the need to incorporate a rights-based approach to health policy as a foundation of societal efforts to achieve universal health coverage in Latin America.

Reform of how health care is paid for in China: challenges and opportunities.

China's current strategy to improve how health services are paid for is headed in the right direction, but much more remains to be done. The problems to be resolved, reflecting the setbacks of recent decades, are substantial: high levels of out-of-pocket payments and cost escalation, stalled progress in providing adequate health insurance for all, widespread inefficiencies in health facilities, uneven quality, extensive inequality, and perverse incentives for hospitals and doctors. China's leadership is taking bold steps to accelerate improvement, including increasing government spending on health and committing to reaching 100% insurance coverage by 2010. China's efforts are part of a worldwide transformation in the financing of health care that will dominate global health in the 21st century. The prospects that China will complete this transformation successfully in the next two decades are good, although success is not guaranteed. The real test, as other countries have experienced, will come when tougher reforms have to be introduced.

Chile health insurance issues: Old age and catastrophic health costs

This paper analyzes Chilean data in search of answers to questions about the effects on health care costs of population aging and of catastrophic events. Its main purpose is to ground current discussions about these aspects of the country's health care system in empirical data and to analyze alternatives to deal with catastrophic and elderly health care costs. The purpose of this research is not; however, to provide specific recommendations on how to shape the health care system in Chile.

Paraguay: Estudio Domiciliario sobre la percepción y consumo de servicios de salud

Presenta un estudio sobre la percepción y el consumo de servicios de salud y tiene entre sus objetivos la provisión de información que ayude a priorizar las inversiones del programa. Consisten en estudios de infraestructura, de epidemiología y de recursos humanos, todos esfuerzos analíticos desarrollados dentro del marco del programa

Paraguay: estudio domiciliario sobre la percepción y consumo de servicios de salud / Paraguay: domiciliang study on the perseption and consumption of services of health

Estudio que informa sobre la utilizacioón de los servicios de salud curativos, preventivos y obstrétricos, resultado de una encuesta llevada a cabo a parte de la población de los departamentos Central, Cordillera, Paraguarí, Caaguazú y Guairá (región objetivo del estudio). Incluye: generalidades del sistema de salud de Paraguay: salud y demografía, organización sectorial, gasto en salud y principales problemas del sector, metodología utilizada: diseño muestral de la encuesta de hogares, instrumento de la encuesta de hogares e implementación en terreno, caracterización de la muestra de hogares, encuesta de establecimientos, resultados: caracterización de los hogares, caracterización de los proveedores, atención preventiva y vacunación de niños menores de 5 años, atención curativa menores de 5 años,atención preventiva mayores de 5 años, atención curativa y mayores combinados, atención obstétrica, y atención hospitalaria, consideraciones preliminares sobre priorización de inversiones