Resumen En este estudio se caracterizan los impactos ambientales asociados al ciclo de vida de 1 m3 de agua potable en Pereira, Colombia. Se analizaron cuatro escenarios: un escenario base y tres escenarios ambientales hipotéticos. Se describió el ciclo de vida, se hizo el inventario de flujos de materia y energía y se establecieron los impactos ambientales de punto medio y punto final del escenario base mediante la aplicación del método Impact 2002+, asimismo, se definieron los impactos ambientales de tres escenarios hipotéticos. Los resultados determinaron que los procesos relacionados con la producción de agua potable generaron la mayor cantidad de impactos negativos del ciclo (75-100 %) en 12 de las 15 categorías de punto medio en el escenario base. Asimismo, en dicho escenario el agua potable contribuyó al 56 % del impacto de punto final. Por otra parte, impulsar la reducción del 20 % en el consumo de agua junto con el tratamiento de las aguas residuales sería el mejor escenario futuro, tanto para reducir impactos de punto medio, como para reducir los de punto final.

Abstract In this study, the environmental impacts associated with the life cycle of 1 m3 of drinking water in Pereira, Colombia were characterized. Four scenarios were analyzed: a baseline scenario and three hypothetical environmental scenarios. The life cycle was described, the inventory of matter and energy flows was made, and the environmental impacts of the midpoint and endpoint of the baseline scenario were established using the Impact 2002+ method, the environmental impacts of three hypothetical scenarios were defined also. The results determined that the processes related to the production of drinking water generated most of the negative impacts of the cycle (75-100 %) in 12 of the 15 categories of midpoint in the baseline scenario. Likewise, in this scenario, drinking water contributed 56 % of the endpoint impact. On the other hand, promoting a 20 % reduction in water consumption along with the treatment of wastewater would be the best future scenario, both to reduce mid-point impacts and to reduce end-point impacts.

Resumo Neste estudo, caracterizamos os impactos ambientais associados ao ciclo de vida de 1 m3 de água potável em Pereira, na Colômbia. Quatro cenários foram analisados: um cenário-base e três cenários ambientais hipotéticos. Descreveu-se o ciclo de vida, fez-se um inventário de fluxos de matéria e energia e estabeleceram-se os impactos ambientais orientados a ponto médio e a ponto final do cenário-base por meio da aplicação do método Impact 2002+. De igual forma, definiram-se os impactos ambientais de três cenários hipotéticos. Os resultados determinaram que os processos relacionados com a produção de água potável geraram a maior quantidade de impactos negativos do ciclo (75-100 %) em 12 das 15 categorias de ponto médio no cenário-base. Do mesmo modo, em tal cenário a água potável contribuiu em 56 % do impacto de ponto final. Por outro lado, incentivar a redução de 20 % do consumo de água juntamente com o tratamento das águas residuais seria o melhor cenário futuro - tanto para reduzir impactos de ponto médio quanto para reduzir os de ponto final.

Health systems face the challenge of helping to improve health conditions. They occupy a priority place in middle- and lower-income countries, since the absence or fragility of health systems adversely impacts expected health outcomes. Thus, due to the direct relationship between programs and systems, the absence or weakness of either will result in a consequent deficiency in public health and the very execution of the programs. In the same vein, weakened health systems are one of the main bottlenecks to attaining the Millennium Development Goals. Systems thinking is one of the "four revolutions in progress" that are helping to transform health and health care systems. Within that framework, this article identifies conceptual and operational elements of systems applicable to health systems that contribute to overcoming the obstacles and inertia that hinder health activities and outcomes. It discusses relevant concepts characteristic of systems thinking, such as structural variables and dynamic complexity, the relationship between programs and health systems, and the monitoring and evaluation function, together with the role of innovation and systems integration as high-priority elements. This will aid in the development of designs that also stress the context of the components that guide management, identifying processes and outcomes in a health management continuum.

Los sistemas de salud enfrentan el desafío de contribuir a mejorar las condiciones de salud, ocupando un lugar de importancia prioritario en los países de ingresos medios y bajos, dado que la ausencia o precariedad de los sistemas de salud repercuten de manera negativa en los resultados sanitarios esperados. Así también, debido a la directa relación entre los programas y sistemas, ya sea por la ausencia o debilidad de ambos, esto impactará en una consecuente falla en la salud pública y en la propia ejecución de los programas. En ese mismo sentido, los sistemas de salud debilitados son uno de los principales cuellos de botella en la consecución de los Objetivos de Desarrollo del Milenio. El pensamiento sistémico constituye una de las "cuatro revoluciones en curso" que contribuyen a transformar la salud y sus sistemas de atención. En ese marco, este trabajo identifica aquellos elementos sistémicos de tipo conceptual y operacional aplicados a los sistemas de salud que ayudan a superar las trabas e inercias que entorpecen la gestión y los resultados sanitarios. Resultan relevantes conceptos propios del pensamiento sistémico tales como las variables estructurales y la complejidad dinámica, así como la incorporación de la relación entre los programas y los sistemas de salud, la función de monitoreo y evaluación junto al rol de la innovación y la integración de los sistemas como elementos de primera importancia. Esto contribuirá a establecer diseños que ponen de relieve también el contexto de aquellos componentes que orientan la gestión, identificando los procesos y resultados en un continuo de la gestión sanitaria.

Las poblaciones nativas de cacao Theobroma cacao L., son valoradas en mercados internacionales por sus características organolépticas propias de los cacaos de alta calidad. Sin embargo, esta calidad está amenazada por híbridos más productivos provenientes de material genético foráneo que gradualmente han ido reemplazando las poblaciones nativas. La diversidad y estructura genética de 165 materiales de cacao provenientes de la región de Tumaco y los bancos de germoplasma de Corpoica y Fedecacao fue evaluada mediante el análisis de doce loci ubicados por marcadores microsatélites. Los datos se procesaron mediante los programas: Arlequín ver. 3.5 y TFPGA ver. 1.3. Los marcadores fueron altamente discriminantes, informativos y representativos para la especie. Los promedios de heterocigosidad esperada (He) y observada (Ho) fueron 0,73 y 0,72, respectivamente, indicando alta variabilidad genética y alta tasa de heterocigotos en las tres poblaciones analizadas. El valor del índice de fijación FST= 0,0355 señala mínimos niveles de diferenciación genética entre las poblaciones y el promedio Nm = 6,80 indica que existe un elevado intercambio de genes. El análisis del clúster jerárquico utilizando agrupamiento UPGMA permitió confirmar la similitud genética existente entre las poblaciones.

Cocoa Theobroma cacao L. native populations are valued in international markets because their organoleptic characteristics typical of the high quality cocoas. Never the less, this quality is threatened by more productive hybrids, coming from foreign genetic material which has been replacing gradually the native populations. The genetic diversity and structure of 165 cocoa lines from Tumaco region and the germplasm banks of the Corpoica and Fedecacao institutions, was assessed through twelve loci analysis located by microsatellites markers. Resulting data were processed by the Arlequin ver. 3.5 and TFPGA ver. 1.3 software. Markers were highly discriminating, informative and representative for the species. The average of expected (He) and observed (Ho) heterozygosity were 0,73 and 0,72 respectively, indicating high genetic variability and high rate of heterocygotes in the analyzed populations. The fixation index value FST= 0,0355 indicates minimum levels of genetic differentiation among the populations, and the average Nm= 6,80 indicates a highly exchange of genes existence. The hierarchical cluster analysis using UPGMA grouping allowed confirming the existing genetic similarity among populations.

As populações nativas de cacau Theobroma cacao L., são valorizadas nos mercados internacionais por suas características organolépticas próprias dos cacaus de alta qualidade. No entanto, esta qualidade é ameaçada por plantas mais produtivas de material genético estrangeiro que têm sido gradualmente substituindo as populações nativas. A diversidade e estrutura genética dos 165 materiais de cacau da região de Tumaco e os bancos de germoplasma de CORPOICA e FEDECACAO foi avaliada através da análise de doze loci localizados por marcadores microssatélites. Os dados foram processados utilizando os programas: Harlequin ver. 3.5 e TFPGA ver. 1.3. Os marcadores foram altamente exigentes, informativos e representativos para a espécie. A média de heterozigosidade esperada (He) e observada (Ho) foram 0,73 e 0,72, respectivamente, indicaram alta variabilidade genética e alta taxa de heterozigotos nas três populações analisadas. O valor do índice de fixação FST = 0,0355 indica níveis mínimos de diferenciação genética entre as populações e os Nm média = 6,80 indica uma elevada troca de genes. O análise de cluster hierárquico utilizando análise de agrupamento confirmou a similaridade genética existente entre as populações.

The perinatal outcome of 7 cases of monoamniotic twin pregnancies is analysed. All cases with live foetus were resolved by caesarean section at 32 week. The perinatal mortality rate of this series was 143/1000 live birth

Se presenta el análisis de 7 casos de embarazo gemelar monocorial monoamniótico. Todos los casos con fetos vivos fueron resueltos por cesárea a las 32 semanas. La mortalidad perinatal a los 7 días de vida fue 143/1000 nacidos vivos

Objective: To obtain comparative indices between countries, related to the real situation of the pregnant woman _used resources and obtained results_ in the Region of the Americas. Material and Methods: We compiled information on the countries of the Region of the Américas, published by WHO and PAHO, corresponding to variables related directly to the pregnant woman and potential resources used in her clinical attention, in addition to the obtained results from this attention. The last complete and official available information is used. Nine variables were studied: total fertility rate, birth rate, maternal mortality ratio, prevalence of use of contraceptive methods, pregnant population proportion taken care of by trained personnel during pregnancy, deliveries assisted by trained personnel, national health cost per person per year and as a proportion of the BIP and health public cost as a proportion of the national health cost. The principal components analysis technique was applied, and the correlation matrix R was used. Results: The two first principal components were selected, with an accumulated percentage of explained variability of 67.31%. Conclusions: The first component relates to the prevalence of use of contraceptive methods and the proportion of pregnant population whose deliveries are assisted by trained personnel. An inverse relation of the first component with the total fertility rate, birth rate and maternal mortality ratio exists. This first component would lead us to the positive results that offer suitable services strategies that privilege responsible paternity. The second principal component is related to the national health cost as a proportion from BIP and inversely with the public health cost per year as a proportion from national health cost

Objetivo: Obtener índices comparativos entre países, respecto a la real situación de la mujer gestante _recursos utilizados y resultados obtenidos_ en la Región de las Américas. Material y Métodos: Se recopila información oficial de los países de la Región de las Américas, publicada por OMS y OPS, correspondiente a variables relacionadas con la mujer embarazada y los recursos potenciales utilizados en su atención, además de los resultados obtenidos en dicha atención. Se estudiaron 9 variables: tasa global de fecundidad, tasa de natalidad, razón de mortalidad materna, prevalencia de uso de anticonceptivos, proporción de población gestante atendida por personal capacitado durante el embarazo y partos atendidos por personal capacitado, gasto nacional en salud per cápita por año y como proporción del PIB y gasto público en salud como proporción del gasto nacional en salud. Aplicamos componentes principales a partir de la matriz de correlación R. Resultados: Se seleccionaron las dos primeras componentes principales, con un porcentaje acumulado de variabilidad explicada de 67,31%. Conclusiones: La primera componente tiene relación con la prevalencia de uso de anticonceptivos y la proporción de población gestante cuyo parto es atendido por personal capacitado. Existe una relación inversa de la primera componente con la tasa global de fecundidad, la tasa de natalidad y la razón de mortalidad materna. Orientaría esta primera componente a los resultados positivos que ofrecen estrategias adecuadas de servicios que privilegien la paternidad responsable. La segunda componente principal se relaciona con el gasto nacional en salud como proporción del PIB y en forma inversa con el gasto público en salud por año como proporción del gasto nacional en salud

Background: Diagnosis related groups (DRGs) are the most reliable patient classification system in hospital management. When this information is unavailable, other reliable classification system must be used. Aim: To obtain useful indices for hospital management, based on descriptive multivariate techniques. Material and Methods: Data on admissions to a University Hospital during 2003 were analyzed. Number of discharges, lethality rate, re-admission rate, number of outpatient consultations, length of hospital stay and surgical complexity index were analyzed, using information obtained by the Operations Management Department. The Principal Components Analysis (PCA) technique was applied and the R correlation matrix was used. Results: A total of 24,345 discharges were analyzed. The first two principal components were selected, accounting cumulatively for 76% of data variability (47% for the first and 29% for the second). Conclusions: The first component may be assimilated to a new index representing the difficulty of the attended cases, which we have termed Case Complexity. The second principal component would explain the number of attended persons, which we have termed Case Load. These two indices allow us to classify hospital services (Rev Méd Chil 2005; 133: 202-8)

Background: Chile has a National Health Services System, formed by 29 Health Services. An efficient resource distribution among this services is crucial for an efficient health care delivery. Aim: To obtain indices from the Chilean Public Health Services, that could improve allocation of resources. Material and methods: Information from the Chilean Public Health Services, corresponding to activities during 2001 budgetary period, was collected. This is the latest complete and official information for the totality of Health Services in the country. Seventeen variables generated or monitored by the Instituto Nacional de Estadísticas (INE), the Ministerio de Salud (MINSAL), the Ministerio de Hacienda, the Ministerio de Planificación y Cooperación (MIDEPLAN) and the Fondo Nacional de Salud (FONASA) were studied. The Main Components Analysis (ACP) was used, obtained from the R correlation matrix. Results: The first two main components were selected, with an accumulated percentage of explained variability of 63.05%. The first component is related to the population assigned to each Health Service. This corresponds to the number of people needed to treat in the hospitals of these Services and their answer to this demand, justified by the expenses in which each Health Service incurs. There is an inverse relation of the first component with health indicators, measured by burden of disease and death. The second main component would represent the social and economic characteristics of the population, poor and ery poor populations and public health insurance beneficiaries, to take care of in each Health Service. Conclusions: Health indicators in each Health Service are not considered a priority for resource distribution among Health Services in the country. The transference is done considering the indices contained in the two main components defined (Rev Méd Chile 2004; 132: 1532-42).

Objective: To create maternity management indexes based on descriptive multivariate statistical techniques. Material and methods: The latest complete and official available information for the entirely Chilean health services is analyzed. Information was collected from public maternities in Chile belonging to type 1 and 2 hospitals that inform in a releasing way the obstetrical data on their activities for the budgetary period of 2001. Generated variables were studied and/or monitored by the National Institute of Statistics (INE), the Ministry of Health (MINSAL), the Ministry of Treasure, the Ministry of Cooperation and Planning (MIDEPLAN) and the National Fund of Health (FONASA). We applied main components (ACP) starting from the correlation matrix R. Results: The first three main components were selected, with an accumulated percentage of explained variability of 63.6%. Conclusions: The first component is related to the average hospitalization days observed as a consequence of pregnancy, delivery or puerperium. It includes miscarriages, hypertensive disorders, delivery and puerperium related complications and other unclassified obstetrical disorders that account for the 25.3% of the variability. The second main component represents the lethality rate for similar causes and explains the 20.1% of the variability. The third main component accounts for the 18.2% of the variability and is related to the population characteristics and the cost in which the various health establishments incur

Objetivo: Crear índices de gestión de maternidades basados en técnicas estadísticas multivariantes descriptivas. Material y métodos: Durante el mes de enero de 2004 se recopila información de las maternidades públicas de Chile, pertenecientes a Hospitales tipo 1 y 2, que informan de manera desagregada su información obstétrica, correspondiente a sus actividades para el período presupuestario 2001, última información completa y oficial disponible para la totalidad de los Servicios de Salud del país. Se estudiaron variables generadas y/o monitorizadas por el Instituto Nacional de Estadísticas (INE), el Ministerio de Salud (MINSAL), el Ministerio de Hacienda, el Ministerio de Planificación y Cooperación (MIDEPLAN) y el Fondo Nacional de Salud (FONASA). Aplicamos componentes principales (ACP) a partir de la matriz de correlación R. Resultados: Se seleccionaron las tres primeras componentes principales, con un porcentaje acumulado de variabilidad explicada de 63,6%. Conclusiones: La primera componente tiene relación con el promedio de días de estada en las diferentes maternidades, observada como consecuencia de la atención de embarazo, parto y puerperio, abortos, trastornos hipertensivos del embarazo, del parto y del puerperio, complicaciones del embarazo y parto y complicaciones relacionadas principalmente con el puerperio y otras afecciones obstétricas no clasificadas en otra parte y explica el 25,3% de la variabilidad. La segunda componente principal representa la tasa de letalidad por similares causas y explica el 20,1% de la variabilidad. La tercera componente principal explica el 18,2% de la variabilidad y se relaciona con las características de la población a atender y el gasto en el cual incurren los diferentes establecimientos de salud

Prelabor rupture of membranes at term is a condition that most obstetricians manage with inmediate labor induction in order to reduce maternal and neonatal infection. Different methods for labor induction and prophylaxis antibiotic treatments are proposed in the medical literature to prevent neonatal sepsis and to lower the cesarean section rate. This retrospective observational study reports the results of a policy of expectant management of 24 hours in 115 consecutive cases between January and April, 2001, in the presence of prelabour rupture of membranes at term. Patients were excluded if clinical chorioamnionitis, fetal distress or labor were present at admission. Patients who did not begin spontaneous labor after 24 hours received intravenous oxytocin for labor induction. The incidence of cesarean section was 16%, with 9.5% of patients with corioamnionitis during labor. There was a 6.9% of neonatal infection without mortality or long term sequelae were present

La conducta más difundida en pacientes con rotura prematura de membranas (RPM) al término es la inducción inmediata por el riesgo de infecciones maternas y neonatales. Para reducir estas complicaciones y mantener una adecuada tasa de parto vaginal se comunican diversos métodos de inducción del parto y profilaxis antibiótica. Este estudio retrospectivo muestra los resultados de una conducta expectante por 24 horas en 115 pacientes consecutivas con embarazos de término entre enero y abril de 2001 con el diagnóstico de RPM; sin signos clínicos de infección, sufrimiento fetal o trabajo de parto al momento de consultar. Una vez cumplidas las 24 horas, las pacientes que no iniciaron trabajo de parto fueron inducidas con oxitocina. Los resultados muestran una tasa de parto vaginal de 84% y un 9,5% de infección ovular clínica en trabajo de parto. La incidencia de infección neonatal fue de 6,9%, sin mortalidad ni secuelas a mediano plazo