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A Ugalde

Publications and source records attributed to A Ugalde.

15 recordsLinked to original sources
PubMed2001

Improving the use of pharmaceuticals through patient and community level interventions.

Pharmaceuticals represent an increasing share of private and public health care expenditures. However, while most governments are interested in ensuring availability and access to drugs, the issue of adequate use of drugs remains a low priority in most third world countries. This paper summarizes the results of interventions conducted in developing countries aimed at improving patients' compliance with the advice of health professionals and/or to decrease the unnecessary use of drugs by the general population. Forty-five studies were identified through literature searches and networking; and only about a third of them fulfilled the eligibility criteria for inclusion in the review. Given the paucity of information available and the importance of the topic the authors report on all 45 studies identified. Although much remains to be explored there are several interventions that deserve to be highlighted. The authors argue that improving the use of pharmaceuticals through interventions directed only to consumers may have a small impact and suggest that in order to obtain meaningful changes it might be necessary to design interventions to modify the behavior of all the actors in the medication cycle (manufacturers, health professionals, retailers, consumers and governments). They suggest that the extraordinary therapeutic effects of antibiotics, coupled with the problems that may arise when they are inappropriately used and with the extraordinary amount of resources spent on antibiotics worldwide justify a global effort to reduce their inappropriate use and promote their adequate administration. The complexity of this type of intervention would require the support of the pharmaceutical industry, governments, private foundations, and international organizations.

Community Health Planning↗
PubMed2001

Scientific evaluations of interventions to improve the adequate use of pharmaceuticals in Third World countries.

The inadequate use of pharmaceuticals continues to be a severe problem in most parts of the world. Developing nations waste very large amounts of scarce health resources on medicines of doubtful therapeutic value, and many persons do not comply with physicians advice or engage in risky self-medication practices contributing to additional misuse of resources and iatrogenia. This paper examines the few scientifically designed interventions at the community and patient s levels to improve the appropriate use of pharmaceuticals in developing nations. The authors analyze the contribution made by these studies and identify several limitations including the absence of independent evaluations of outcomes, lack of sufficient information to judge the quality and adequacy of the instruments used, problems relating to replicability of interventions at regional or country level, or outside the cultural context within which they took place, lack of information on costs of interventions, a crucial variable in poor countries, and the absence of standardized outcome measures that makes comparative analysis very difficult.

Developing Countries↗
PubMed1994

Research on patient compliance in developing countries.

Patient compliance with health care provider advice is a subject of particular importance in developing countries, one that has not been sufficiently studied. This article begins by explaining why this type of research is important and describing the various methodologies used to examine patient compliance in developed nations--notably self-reporting by the patient, collateral reporting by friends or relatives, pill or bottle counting, review of the patient's clinic attendance, review of clinical outcomes, and use of biochemical tracers. The applicability of each of these methods to scenarios commonly found in developing countries is then considered, and the results of the limited compliance research performed in developing countries are described. In general, it is suggested that self-reporting, collateral reporting, and pill or bottle counting can be employed effectively in many Third World situations. The article also notes the importance of standardizing research procedures, provides logistic advice about applying various compliance research methods in Third World conditions, and points up the need to validate the accuracy of the methods used.

Attitude to Health↗
PubMed1989

Towards an epidemiology of political violence in the Third World.

Political violence is distressingly widespread in many parts of the world. This paper reviews the forms and effects of political violence and devotes particular attention to experiences from Central America and Southern Africa. The forms of violence vary from those which are extensive such as civil unrest and war, to those which are intensive, such as assassinations, disappearances and torture. The effects of violence on health may be direct, such as deaths, disabilities, psychological stress and the destruction of health services, or indirect such as the erosion of innovative health policies in favour of increased military expenditure. Health workers have a role to play in opposing political violence, providing care for those affected by violence, and documenting and analysing its impact on health. Research needs include documenting the impact of different forms of violence on health, and analysing the social and political factors which promote and support political violence. It is hoped that increasing recognition of political violence and man-made violence as being of major public health concern will play a part in promoting a more peaceful world.

Developing Countries↗
PubMed1985

Ideological dimensions of community participation in Latin American health programs.

A comparative analysis of community participation in urban and agricultural programs, and health programs in Latin America suggests that the promotion of community participation was based in all cases on two false assumptions: the belief that the traditional values of the poor were the main obstacle for development and for health improvement; and the idea that the poor were incapable of organizing themselves. A country by country examination indicates that health participation programs in Latin America, in spite of promotional efforts by international agencies, have not succeeded. Then, the article discusses the political objectives behind international support for these programs. It is argued that, through symbolic participation, international agencies had two purposes in mind: the legitimization of low quality care for the poor, also known as primary health; and the generation of much needed support from the masses for the liberal democracies and authoritarian regimes of the region.

Agriculture↗
PubMed1984

Where there is a doctor: strategies to increase productivity at lower costs. The economics of rural health care in the Dominican Republic.

The study of a rural health district in the Dominican Republic found relatively high levels of public and out-of-pocket primary health expenditures and poor quality of care. The inefficient use of public resources and low efficacy were attributed to: (1) underutilization of health services, (2) low productivity of human and physical resources, which in turn were caused by poor managerial practices, shortages of medicines, dispersion of the population and the compulsory 1-year rural social service required from all graduating physicians (known as pasantía in some Latin American countries and medicatura rural in others). Out-of-pocket health expenditures responded to unnecessary self-referrals and excessive self-medications. The findings suggest that the quality of care can be improved and the public and out-of-pocket expenditures reduced by: (1) the replacement of the social service (pasantía) by permanent physicians, (2) the organization of communal pharmacies and (3) the establishment of outreach health posts. It is argued that today in the Dominican Republic as in many other Latin American countries unemployed or underemployed physicians are willing to take permanent positions in rural areas. The study suggests that rural physicians need and will be willing to accept the fact that much of their medical training has no applicability to the rural setting. The retraining or recycling of rural physicians for their new health roles is discussed also.

Community Health Services↗
PubMedDate not supplied

[Decentralization of the health sector in Latin America].

This paper analyzes the Latin American experience of decentralizing health services within the context of health reform. We examine the meaning of the term decentralization and discuss the various modalities of this concept: geographical, institutional and functional. The objectives that, in general, these objectives have not been achieved. After reviewing the literature and drawing on our own fieldwork, we conclude that in many instances the Latin American decentralization programs have produced results opposite to those intended, i.e., these programs have increased inequality and the cost of services and have reduced efficiency and quality of care. We point out that existing information is insufficient to determine with exactitude whether the failure of decentralization is due to the selection of inappropriate policies or to failures in the implementation process. Decentralization is a complex political process, policy makers should decide on the modality of decentralization they wish to implement, estimate the costs, identify the potential obstacles that could surface during the implementation phase and provide solutions. We conclude by suggesting that the multilateral banks have erred by pressing governments to improvise the implementation of decentralization programs without taking into account the different historical, political and socioeconomic contexts.

Delivery of Health Care↗
PubMedDate not supplied

[Health services privatization: the experiences of Chile and Costa Rica].

This study questions the premises that justify the neoliberal privatization of financing, managing and delivering health services. It also analyses the meaning of privatization and its strategies. We compare privatization in Chile and Costa Rica and suggest that the more limited, selective and locally designed privatization process in Costa Rica has resulted in a more equitable, and efficient health system than the imported privatization model introduced in Chile. The Costa Rican system also produces greater patient satisfaction and at the same time preserves the solidarity principle.

Chile↗
PubMedDate not supplied

Plasmacytoid myoepithelioma of the soft palate. Report of a case with cytologic, immunohistochemical and electron microscopic studies.

BACKGROUND: The plasmacytoid variant is a rare and controversial subtype of myoepithelioma that lacks myogenic differentation and the cytologic findings of which have not been reported previously. CASE: A 46-year-old man presented with a painless tumor located in the soft palate. Fine needle aspiration cytology (FNAC) showed odd-shaped cellular aggregates and single cells with round nuclei and finely granular cytoplasm resembling plasma cells together with strands of metachromatic stroma. The light, immunohistochemical and ultrastructural studies performed on the surgical specimen confirmed the initial cytologic diagnosis. CONCLUSION: Recognition of the cytologic findings of plasmacytoid myoepithelioma on needle aspirates allows a reliable and quick diagnosis that prompts correct management.

Antigens, Neoplasm↗