General Social Security System Research Articles

Burden of dengue in the State of Meta, Colombia (2010-2016).

In Colombia, dengue is a disease of great impact due to its morbidity and mortality, however, studies on the effects of the economic burden at the local level are scarce. Therefore, our study sought to describe the economic burden of dengue epidemics between 2010 and 2016 in the State of Meta, Colombia. A longitudinal study was performed using information from the records of the epidemiological information system (Sistema Nacional de Vigilancia en Salud Pública - SIVIGILA), and the indicator of disability-adjusted life years (DALYs) was determined as an estimator of the burden of dengue. To assess the economic impact, two assessment scenarios were considered (minimum range and maximum range), which allowed the estimate of the effects of the years of life lost (YLLs). Mortality cases presented heterogeneity in the age groups, mainly affecting groups under 15 years and over 65 years, with YLLs raging between 158.58 and 300.38. In total, 2010 showed the highest medical care costs of the study period, with USD 664,123 for women and USD 740,221 for men. In the epidemic years (2010, 2012-2015) between 91,072.3 and 184,175.1 DALYs were lost per million inhabitants, which generated social burden costs higher than the USD 669.6 million. In conclusion, dengue can be considered a disease of high cost at the local level, economically affecting the General Social Security System in Health and social welfare.

Doctor-Patient relationship in healthcare institutions of Medellin, Colombia

To understand the perceptions that doctors and patients have about their relationships and how the current conditions of the General System of Social Security in Health (GSSSH) influence their relationship. The collection and analysis of information was based on the saturation principle proposed by qualitative research, through direct observation and semi-structured interviews applied to 17 patients and 15 physicians during the exercise of their roles, in the waiting and consultation environment within the selected healthcare institutions. The interviews recorded, transcribed and analyzed under five precepts of the Grounded Theory of Corbin and Strauss. The sample design was theoretical for convenience. Health system conditions on the doctor's doing, abuse of the right by some patients, the perception of uneven quality between health care promotion entities, communication failures in the Doctor-Patient Relationships, loss of prestige of the general doctors, perception of disbelief towards young doctors, among other identified perceptions, hint that changes in the GSSSH contribute to the construction of current Doctor-Patient Relationships. It is essential that the actors of the GSSSH propose interventions that reinforce the communicative and psychosocial capacities in the doctors from their formative processes, as well as the provision of the GSSSH to provide conditions that allow the doctor to develop a health care focused on the patient.

The cost of hospital care for HIV patients in Colombia: an insurer's perspective.

The aim of this study was to evaluate the cost derived from the hospitalization of people living with HIV (PLHIV) in Colombia between 2011 and 2015. This is an analysis of the direct cost of PLHIV hospitalization from the perspective of an insurer of the Colombian General Social Security System. The costs were calculated in Colombian pesos and corrected for inflation on the basis of the 2017 Consumer Price Index of the Bank of the Republic of Colombia. It was converted to US dollars at the Market Representative Exchange Rate of the same year. We analyzed 1129 hospitalizations in 612 PLHIV, of which 12% started with a diagnosis of HIV during the same hospitalization, with the majority in the AIDS stage (63%). The median overall cost of hospitalizations was US$1509 (25th and 75th percentiles: US$711-US$3254), being even higher in patients with AIDS and as the CD4 T lymphocyte count decreased. The cost derived from the medical care of PLHIV increases as the clinical control of the disease worsens, and it is a key indicator of the impact of the strategies implemented for the timely identification of the infection and subsequent management of the disease.

Model for the interoperability between health service providers (IPS), based on the electronic clinical information standard (HL7) and architecture to design and develop distributed systems (SOA)

This study addresses the need to exchange clinical records, efficiently and uniform among health institutions (IPS Spanish acronym for Instituciones Prestadoras de Salud), which is generated in clinical care users from using the Hospital Information Systems (HIS). From defining a model for interoperability, with reference to the regulations governing the General System of Social Security in Health in Colombia (SGSSS Spanish acronym for Sistema General de Seguridad Social en Salud), the standards to facilitate electronic exchange of clinical information Health Level Seven (HL7) and service oriented architecture (SOA). The model it wasdesigned in two dimensions, on the one hand horizontally would facilitate electronic exchange of clinical information between IPS and on the other side vertically was projected was obtained as they settled components for the exchange of healthcare and administrative records the SGSSS different actors, in this case with the health Promotion Companies (EPS Spanish acronym for Empresas Promotoras de Salud) and the Territorial Entities through health secretaries.

Guía de práctica clínica para la prevención, el diagnóstico, el tratamiento y la rehabilitación de la falla cardiaca en población mayor de 18 años, clasificación B, C y D. Componente de rehabilitación cardiaca

IntroductionCardiac rehabilitation programs combine the performing of supervised exercise with secondary prevention and psycho-social support that helps to improve adherence to measures, with a clear impact on the morbidity and mortality in patients with heart failure. MethodologyFor the development of the evidence-based clinical practice guidelines, the steps followed were those defined in the Methodological Guidelines for the Preparation of Clinical Practice Guidelines with an Economic Assessment in the General Social Security System in Colombian Health by the Ministry of Health and Social Protection of Colombia. ResultsRecommendations were established for the adequate development of an integrated cardiac rehabilitation program for patients with heart failure. The aspects approached included the assessment of functional capacity, effectivity and safety of the exercise, dosification, methodology, and rehabilitation in patients with devices. ConclusionThe practice of exercise in patients with stable heart has shown to reduce the number of hospital admissions, improve the quality of life and functional capacity. It has also shown to be safe in those that have a device implanted.

Causas de cancelación de cirugía programada en una clínica de alta complejidad de Popayán, Colombia

Introducción. La cancelación de cirugía programada es un indicador de calidad que puede relacionarse con ineficiencia en los procesos de planificación estratégica para la seguridad del paciente y es un fenómeno frecuente en las instituciones de salud.Objetivo. Identificar las causas de cancelación de cirugía programada durante el segundo trimestre de 2016 en una clínica de alta complejidad de Popayán, Colombia.Materiales y métodos. Estudio descriptivo retrospectivo de corte transversal con 185 cirugías canceladas de 2 787 programadas. La información se obtuvo de los registros magnéticos de la coordinación de cirugía de la institución objeto de estudio y se realizó una distribución del evento según los actores del Sistema General de Seguridad Social en Salud (SGSSS): asegurador, prestador y paciente.Resultados. La proporción de cancelación fue del 2.7%. El 56.7% de las causas fueron atribuidas al paciente, el 40.5% al prestador y el 2.7% al asegurador.Conclusiones. Las causas de cancelación de cirugía programada identificadas son altamente prevenibles y evidencian fallas organizacionales y procedimentales que requieren mejoramiento a nivel administrativo y asistencial para disminuir los costos de no calidad.

A systemic perspective on children’s well-being in military families in different countries

Introduction: Children are influenced by different environments – home, friends, school, community, society, and the existence and availability of various services – and child well-being is the outcome of the interrelationships between the child and these environments. The military is one of the environments that shapes the well-being of children in military families, and the environments interact with each other. Methods: Our main assumption is that the effect of military environment on child well-being may vary in different societies depending on the general social security system. We describe how the military children’s well-being is embedded in military systems, which in turn is embedded in welfare state. The main question is how the well-being of children from military families varies across countries and how much variation can be explained by the interplay between military systems and different welfare regimes. Results: We begin by describing the differences in welfare states and military systems, and then give a short overview of children’s well-being in the context of different welfare regimes (e.g., availability of public child care, health care, and access to education and extracurricular activities). Discussion: Next, we look at the interplay between the military and welfare regimes and, finally, we show how the well-being of military children is supported across countries by their different welfare regimes.

Social Security System Presented in the North Korea’s Constitution and Regulations

북한의 국적을 소지한 공민은 북한 헌법상 규정되어 있는 무상치료를 받을 수 있는 권리를 갖게 되며, 질병 및 장애가 있거나 노동력을 상실한 자, 그리고 노인 및 어린이의 경우는 국가로부터 물질적 지원과 혜택을 받을 권리를 가진다. 이 권리는 국가로부터 원칙적으로 무상치료제의 혜택을 받게 되며 각종 요양소를 비롯한 의료시설을 제공 받을 수 있도록 헌법과 각종 부문법규를 통해 보장받는다. 북한은 일찍이 1978년 4월 「사회주의노동법」을 처음 채택하면서 사회보장에 관하여 일반적으로 규정해 왔다. 이후 2008년 1월「사회보장법」을 처음 채택하면서 사회보장에 대한 기본적 틀을 갖추고 있다. 이는 북한 주민에 대한 하나의 사회보장제 유인책으로서 입법된 것으로 보인다. 과거와 달리 북한의 「외국인투자기업 노동규정」이나 「개성 공업지구 노동규정」은 근로계약제의 도입 등 나름의 변화를 통해 북한 사회보장제도 차원의 큰 획을 긋는 변화로 분석된다. 이 논문에서는 시기적으로 북한 정권 초기인 1948년 헌법상에서 처음으로 국가사회 보험 및 사회보장제도를 규정했기 때문에 지금까지 변화해 온 헌법상 사회보장 규정의 연혁을 살펴보고자 한다. 그리고 사회보장 관련한 기본법의 성격을 가진 북한「사회보장법」의 주요 내용을 알아보고, 최근 법률 환경의 변화에 따라 속속 입법되고 개정돼 온 개별 부문법규의 사회보장제도의 내용을 고찰한다. 사회보장제도가 북한을 바라보는 또 하나의 기준 내지 척도가 된다는 점에서 사회적 기본권으로서의 사회보장제에 대한 연구는 중요하다고 하겠다. 다만, 이와 관련한 연구 범위를 우리의 사회보장제도 일반론에서 다루어지는 소득보장제도와 의료보장 및 사회서비스제도에 대해서는 논외로 하되, 관련 법률에 대한 소개는 간략히 다루어 북한 사회보장제도의 이해에 도움을 주고자 한다.Any citizen holding North Korean nationality has a right to receive free medical care specified in the Constitution of North Korea, and those suffering from diseases, the physically-challenged or those unable to work, seniors and children have rights to receive material support and benefits from the nation. In principle, the right involves benefits related to free medical care provided by the nation, and the Constitution and various relevant regulations guarantee provision of a variety of nursing homes and medical institutions. North Korea has defined matters associated with social security as it first adopted the “Socialism Labor Law” in April, 1978. Afterward, it adopted the first “Social Security Law” in January 2008, which prepared a basic framework of social security. This might have been legislated to induce North Korean citizens into a uniform social security system. Unlike the past, the “Labor Regulations for Foreign-Invested Enterprises” or “Labor Regulations for Gaeseong Industrial Complex” in North Korea seem to have marked a new era in terms of the social security system as it demonstrated changes, such as adopting labor (employment) contracts. The paper examines the national social insurance and social security system presented in the Constitution during the initial stage of its administration in 1948 based on the fundamental rights of the society. In addition, the paper looks into major matters set forth in the “Social Security Law” of North Korea that is characterized as the fundamental law related to social security and the social security system of individual regulations legislated and/or amended according to the latest changes to the legal environment are considered. Taking into account that the social security system may be a(n) standard or index of perceiving North Korea, it is significant to study the system as the fundamental right of a given society. However, the study leaves out income security, medical security and social service system that are commonly dealt in our general social security system. The purpose of this study is to briefly introduce related laws and regulations to provide an understanding of the social security system in North Korea.

El desarrollo del Sistema General de Seguridad Social en Salud desde la implementación de la Ley 100 de 1993 a la fecha (una opinión libre)

This article wants to make a free analysis about the development of the General Social Security System from the moment it was implemented by virtue of Law 30, 1993 and further complementary regulations. First of all, it briefly analysis the system, taking as a reference the established principles, the National Constitution, and the Law 100; then, it continues with a critical view of it in order to determine the main failures and decisive points where corruption has severely criticized it; it has also located some actors who have taken advantage of it, and some others who have been losers both in the development of the system and in its results. Once the process of criticism and analysis has been concluded, this article presents a clear position about the General Social Security Health System, regarding structural logic it is based on, and it also adds a judgment worthy of a broader discussion on the role of the health professionals, both in their performance and as active actors to generate a change.

¡Los modelos preventivos más necesarios hoy!

Gran parte de los Sistemas de Salud en el ámbito mundial se han constituido en fenómenos sociopolíticos que se mueven en la incertidumbre cuando intentan responder a múltiples intereses y necesidades, con respecto a la eficiencia y sostenibilidad financiera de la atención sanitaria o frente a la equidad e igualdad en los resultados de mejores estados de salud. En nuestras sociedades asistimos pasivamente a la confrontación entre un robusto modelo médico industrial y un tímido modelo preventivo, que pretende avanzar hacia una salud universal. En las últimas décadas países de América Latina y el Caribe ha adoptado compromisos de reforma estructural y sectorial de sus sistemas sanitarios, con pocas iniciativas para aumentar su capacidad de respuesta institucional y social frente a necesidades sociales en salud de sus países; han generado un débil escenario para la adopción e implementación de la Atención Primaria en Salud (APS), la cual nos permitiría un fortalecimiento de los niveles de atención haciéndolos más resolutivos, accesibles e insertos en los contextos particulares de nuestras sociedades. Este año, el mundo se reunirá en la Conferencia Mundial sobre APS con el compromiso de posicionar la atención primaria en salud en todas las políticas y alcanzar la cobertura sanitaria universal en el siglo XXI. La Conferencia, se celebrará en Kazajstán los días 25 y 26 de octubre con ocasión del 40º aniversario de la declaración de Alma-Ata. La APS se ha considerado desde los años 20 del siglo pasado un recurso y herramienta de operación que permitiría responder con una atención sanitaria integral a necesidades sociales en salud de la población pobre y vulnerable de países en vía de desarrollo. Los discursos de la OMS, organismos internacionales y gobiernos que ven a la APS como una tecnología de eficiencia de los sistemas de salud, son insuficientes frente a la actual concepción de salud y bienestar de nuestra sociedad, la cual aspira a tener otra lectura más allá del fortalecimiento de la atención curativa y privilegiar otras dimensiones en relación a la APS que ponemos a discusión. Proponemos responder tanto a una necesidad de formación en los programas de pregrado y postgrado, como construir respuestas a las actuales necesidades sociales en salud de toda la sociedad colombiana. También nos interesa explorar otras formas de operar el modelo de atención que el país tiene actualmente. En este mirada amplia, no debemos centrarnos en generar talento humano que responda a una concepción de APS como estrategia de operación del SGSSS, sino que debemos profundizar en la pregunta fundamental, ¿Cuál es el tipo de talento humano que deben formar nuestras Facultades de Salud frente a la situación sanitaria de la sociedad y de nuestro sistema de salud? Aquí la discusión parte de considerar no solamente que la APS es una estrategia de operación de la atención sanitaria, o que la “APS es otro elemento de la Salud Pública”, o considerar que la APS es una forma especial del ejercicio de lo médico, tesis que nos colocan en una postura particular frente a la tendencia actual de un contexto de fortalecimiento de la APS como filosofía, con equipos de salud más allá del saber de las ciencias de la vida. Se requiere un dialogo de saberes y competencias frente al actual escenario sanitario del país. En este ejercicio requerimos conocer una serie de visiones y experiencias frente a la APS, para llegar a consensos, y posibilidades de proponer ajustes en los diferentes programas de ciencias de la salud y ciencias sociales que ofertan nuestras universidades con contenidos relacionados con la APS. Debemos visibilizar diferentes niveles del problema además de reformar el modelo pedagógico para la praxis de la APS: reconocer desde la interculturalidad los cambios en las prácticas sanitarias sustentables, o mejorar las prácticas preventivas insuficientes, para alterar el ejercicio biomédico en relación con la atención primaria. Consideramos que debemos trabajar no solo en fortalecer la capacidad de respuesta social proponiendo modelos de atención más preventivos que incorporen a nuestros ciudadanos en las decisiones de asistencia sanitaria. El fenómeno de la salud debe estar visibilizado en todas las políticas para alcanzar un verdadero fortalecimiento de la APS en el país.

Percepción de usuarios de Cali-Colombia acerca de medicamentos genéricos

En la población en general existe gran controversia alrededor del uso de medicamentosinnovadores y de sus copias llamadas medicamentos genéricos. El objetivo de esteestudio es cuantificar la aceptación de los pacientes, del Sistema General de SeguridadSocial en Salud de Colombia (SGSSS) a la prescripción de medicamentos genéricos.Se realizó un estudio de tipo descriptivo con un diseño transversal en 63 hombres y57 mujeres, todos adultos pacientes que asistieron a consulta externa de los sitios depráctica de una Facultad de Medicina de Cali-Colombia.Se concluye que si se usan medicamentos genéricos, se requiere que los médicos y losusuarios tengan confianza en él. Los resultados del presente estudio muestran que,aunque no en forma mayoritaria, todavía un porcentaje importante de los consumidoresentrevistados dudan de la calidad y de los resultados terapéuticos de los genéricos.De manera preocupante, casi una cuarta parte de los participantes en el estudiopiensa que los medicamentos genéricos son productos fraudulentos.

Cancer risk management in Colombia, 2016.

Objective:To describe the outcomes of risk management indicators for five types of cancer in population that is affiliated to the General System of Social Security in Health, in six cities of Colombia.Methods:Based on the data from the administrative cancer registry for the period 2016, the High Cost Disease Fund (CAC in Spanish) as a technical organization of the Colombian health system, processed and analyzed the data for the calculation of risk management indicators established in consensus based on the evidence found in six citiesResults: There is a diversity in the indicators results found among the different cities, evidencing strengths and weaknesses in each of them for the different types of cancer. From the set of indicators, those with the best results presented are related to the greater detection of cancer in early stages or in situ, as well as a decrease in mortality, especially in colorectal and in gastric cancer. Most indicators in gastric cancer showed optimal results. Important measurements such as the opportunity for diagnosis and treatment are below the proposed standard for most types in all the six cities.Conclusions:The descriptive analysis of cancer risk management indicators shows certain weaknesses in the quality and timeliness of the care of cancer patients, the standards agreed upon in the consensus with the different actors of the system are not being reached, situation which may be due to a reality of problems of the Colombian health system, as well as deficiencies in the quality of the report to the CAC.

Spanish

The Congress of the Republic, in 2015, promulgated the Statutory Law 1751, by means of which the fundamental right to health is enshrined, giving guidelines to the Ministry of Health and Social Protection to make significant reforms to the general social security system in health. These include the elimination of the difference between the Compulsory Health Plan (POS), both contributory and subsidized, and the creation of a National Pharmacological Policy, generating concerns about possible disturbances regarding access to medication and the health system. This paper investigates the normative background of this law, as well as the most relevant concepts of the jurisprudence of the Constitutional Court, embodied in some of its judgments, highlighting the T-760 of 2008, which is the central axis of the consecration of health as an autonomous fundamental right. All the above seeks to answer the question whether it really was necessary for Congress to issue a Statutory Law proclaiming the fundamental right to health.

Costo de las tutelas en salud en Colombia 1992 a 2016

En Colombia cada día en promedio se interponen 70 acciones de tutelas, 17 de las cuales solicitan servicios de salud. Lo anterior, en contraste con los múltiples esfuerzos del Estado que, durante los últimos 24 años ha adelantado diversas reformas y ajustes al Sistema General de Seguridad Social en Salud, para impactar cobertura de aseguramiento, accesibilidad, eficiencia en el manejo y distribución de los recursos. Aun así, continúa el incremento de las acciones de tutelas en salud y éstas, además de haberse consolidado como indicador de apropiación de derechos fundamentales, se ha constituido como un indicador de accesibilidad a los servicios de salud. Este artículo realiza una reflexión sobre el valor monetario de los costos directos de las acciones de tutelas para dos instituciones del estado, una del Ministerio Público denominada personería como ente asesor y otra adscrita a la rama judicial de Colombia denominada reparto y juzgado. Por lo general las tutelas pueden pasar por varias instancias según su resolución, sin embargo, para este caso solo se reflexionará con la información de la primera instancia judicial para poder extrapolar los cálculos al nivel Nacional, es decir, asesoría para el escrito de una tutela y el de recepción y análisis del caso en un juzgado, con el fallo en primera instancia y las notificaciones; todo ello, derivado de un análisis retrospectivo, ajustado a valores presentes de 2016. Según la defensoría del pueblo, desde 1992 a 2016 se han interpuesto 5.865.665 tutelas, que representan a precios constantes de 2016, más de 4,3 billones de pesos (COP $4.336.890.408.097). Con estos recursos se podrían pagar más de 114 millones de citas por medicina general, es decir, casi 3 consultas de medicina general por habitante de Colombia, lo cual significa que estos costos son de transacción creciente y que de manera paradójica, terminan generando grandes ineficiencias económicas al Estado colombiano que, además del detrimento representado en la salud de los pacientes, asume el costo de la restitución de un derecho de acceso pagado de manera anticipada por los usuarios y el Estado.

DESIGUALDADE DE RENDA NO BRASIL: A INFLUÊNCIA DO DIFERENCIAL PÚBLICO-PRIVADO, APOSENTADORIAS E PENSÕES

O trabalho investiga o impacto do diferencial nos rendimentos dos trabalhadores do setor público e privado e do diferencial do valor de aposentadorias e pensões superiores ao teto do Regime Geral de Previdência Social (RGPS) sobre a desigualdade de renda. Para tal, utilizam-se o método de decomposição do Índice de Gini, proposto por Lerman e Yitzhaki (1985), e os dados da PNAD do período entre 2004 e 2013. Os resultados apontam que a elevada remuneração dos funcionários públicos foi responsável, em média, por 2,84% da desigualdade de renda no período. Os rendimentos de aposentadorias e pensões oficiais acima do teto foram responsáveis por 1,66% do total do Índice de Gini. Por meio da decomposição foi possível verificar que as parcelas de rendimento atreladas a empregados com maior qualificação são mais regressivas do que as referentes à empregados com menos escolaridade. Outra constatação importante foi a tendência crescente do hiato público-privado, ao longo do período investigado, motivada principalmente pelo crescimento médio real superior dos rendimentos do funcionalismo público em comparação ao privado. Em relação aos rendimentos de aposentadorias e pensões a desigualdade de renda foi atenuado pelo menor crescimento real dos rendimentos acima do teto da RGPS.

El sistema de riesgos laborales frente al trabajador del sector informal

The National Constitution has contemplated work as a basic right within the category of social and economic right, under the principles of equality, liberty, and human dignity. The State is the body responsible for assuring this right through the Integral Social Security System, which is an unalienable right for the entire Colombian population, especially for workers. The National Statistics Administrative Department (DANE, for its initials in Spanish) (DANE, 2015), in its employment report corresponding to the quarter between November 2014 and January 2015, involving 23 cities and metropolitan areas, determined that 49.3% of labor population is found in the informal sector. The objective of this article is to establish whether or not there are juridical elements (including Constitution, Juridical System, and the regulations of the General Social Security System) for the informal worker to be included in the Labor Risk System.

La salud como concepto en un sistema político y económico

En Colombia, la Ley 100 de 1993 da vida al Sistema General de Seguridad Social en Salud, en adelante SGSSS, el cual ha sufrido una serie de cambios o reformas con la intención de mejorar su estructura administrativa. Sin embargo, pese a los esfuerzos realizados, parece un sistema sin posibilidades de subsistencia; por ello aventurarse a realizar un análisis del campo o del concepto de salud y todo lo que él comprende se convierte en una tarea ardua y presenta más que un problema conceptual que permita separar sus componentes fundamentales, un reto en su comprensión, delimitación e implementación.

Agotamiento profesional (burnout) en médicos intensivistas: una visión de la unidad de cuidados intensivos desde la teoría fundamentada

IntroductionThe intensive care unit (ICU) is one of the most complex and costly services in the modern hospital. ICU implies pressures, frustrations, conflicts for the intensive care physician in an ever more stressful environment, with a tendency to develop occupational illnesses. One of these is burnout, comprised of emotional exhaustion, depersonalisation, and lack of personal accomplishment. There is a need to question ICU physicians on their perceptions about the specialty, the job, the very ICU where they work, or their outside environment, topics not so easily quantifiable. Grounded theory is proposed here to explore which structures or processes may promote burnout in them. Materials and methodsA qualitative study was conducted based on grounded theory, as proposed by Strauss and Corbin, under the suspicion of the genesis of burnout mediated by some inter-related features of a) specialty; b) equipment; c) hospital facility; d) environment. Theoretical sampling by convenience and structured interview with questions by blocks to intensive care physicians of Bogota⿿whether they be professors, physicians, residents. Audio transcription to Microsoft Word® 2013; information coded, classified with NVivo 10; contrast and saturation of information against previous ICU situation analyses published between 1995 and 2015. ResultsFourteen physicians were interviewed. According to them, ICU evolution and the Colombian General System of Social Security in Health define its present situation: a) strongly male specialty, reactive to Public Health problems (coronary disease, trauma, sepsis), mainly composed of anaesthesiologists and internists; b) huge dependence on health technologies, namely monitors and ventilators; c) lack of resources and structural improvisation in the hospital; d) concern about biological risks, worsened by occupational, administration risks⿿precarious work, lack of union, and fragile State, cohesion. Awareness of burnout is only seen through foreign literature, thus the physicians consider it as an unrelated issue. ConclusionsICU and intensive care practice in Colombia may reflect conditions of inequality towards the genesis of occupational illnesses. A social epidemiology focus is required to overcome ignorance on burnout, and other possibly conditions related to ICU.

Las reformas de la regulación del trabajo doméstico por cuenta ajena en España

En este artículo se analizan las últimas reformas que se han producido en España en relación con el trabajo por cuenta ajena prestado en el hogar. El legislador español, influido por el Convenio nº 189 de la OIT –que, sin embargo, no ha sido ratificado-, aborda en 2011 una profunda reforma del empleo doméstico. Esta reforma supuso un cambio importante, que ha afectado tanto a la regulación de las condiciones de trabajo de este colectivo como a su sistema de protección social. El objetivo de esta reforma ha sido aproximar la regulación del trabajo doméstico, en estos dos planos, a la regulación común de los trabajadores asalariados, aunque conservando ciertas particularidades. En el ámbito laboral, se mantiene la configuración del empleo doméstico como relación laboral especial, pero se reducen las diferencias con la relación laboral común. En el ámbito de la protección social, se procede a integrar el Régimen Especial de la Seguridad Social de los Empleados de Hogar en el Régimen General, aunque la integración es relativa pues se produce en el marco de un sistema especial. El artículo también examina las modificaciones normativas que, tras el cambio de Gobierno, tuvieron lugar en 2012.

Prevalencia de prescripción conjunta incorrecta de fármacos anticonvulsivantes y anticonceptivos hormonales Colombia, 2014

<p><strong>Objetivo:</strong> determinar la prevalencia de prescripción conjunta de fármacos antiepilépticos para identificar formulación incorrecta que podría afectar la efectividad de los anticonceptivos hormonales en un grupo de mujeres afiliadas al Sistema General de Seguridad Social en Salud de Colombia.</p><p><strong>Materiales y métodos:</strong> estudio de corte transversal, en el que se seleccionaron registros de mujeres de 15 a 45 años que recibían al menos un fármaco antiepiléptico, entre el 1 y el 31 de marzo de 2014, en una base de datos poblacional de dispensación de medicamentos de un operador logístico en Colombia, para población perteneciente al régimen contributivo y subsidiado en el Sistema General de Seguridad Social en Salud de Colombia. Se evaluaron el tipo de anticonceptivo hormonal y de fármaco antiepiléptico. Se utilizó estadística descriptiva.</p><p><strong>Resultados:</strong> de un total de 2092 pacientes usuarias de fármacos antiepilépticos, se identificaron 89 (4,3 %) casos que tenían por lo menos un antiepiléptico y un anticonceptivo simultáneamente. En 48 mujeres (54 %) se encontró formulación incorrecta de métodos de planificación, como el uso de fármacos antiepilépticos inductores enzimáticos e inyectables combinados (20 casos), el uso de anticonceptivos orales combinados de bajas dosis de estrógenos (16 casos), de progestinas orales (10 casos), y el uso de antiepilépticos no inductores enzimáticos y anticonceptivos orales combinados y dosis altas de estrógenos (2 casos).</p><p><strong>Conclusiones:</strong> un importante número de mujeres usuarias de medicamentos antiepilépticos utiliza métodos hormonales de anticoncepción, y cerca de la mitad de ellas tenían una prescripción anticonceptiva incorrecta, lo que podría resultar en embarazos no deseados o incremento del riesgo de enfermedad tromboembólica.</p>