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A Historical Review of the Artificial Pollination of Vanilla planifolia: The Importance of Collaborative Research in a Changing World
(2024-11-01) Karremans Lok, Adam Philip
The natural fertilization of Vanilla planifolia has long been a matter of speculation. Stingless (tribe Meliponini) and orchid bees (tribe Euglossini) are often cited as effective pollinators, but direct evidence is notoriously lacking. As with other food-deceptive orchids, the natural fruit-set in V. planifolia is low and does not occur spontaneously outside its native range in Middle America. Fruiting has, therefore, necessitated human intervention through artificial pollination. How Vanilla first came to be artificially pollinated is a controversial issue spurring egotism and nationalism. There are numerous texts offering differing versions of the historical events that led to the discov-ery of the artificial fertilization of V. planifolia and its propagation as a crop. Historical records show Vanilla was simultaneously being pollinated in several parts of the world. I argue that the suspected independent simultaneous discoveries made in Liège, Paris, Padua, the Dutch colony of Java (Indonesia), and the French insular colonies Réunion (Bourbon), Guadeloupe, and Martinique are not unconnected. I conclude that they can be traced back to a single discoverer whose feat was spread around the globe by a tight network of corresponding naturalists. This view contrasts with previous authors. Finally, current concerns regarding Vanilla pollination and production are ad-dressed, highlighting the need for immediate actions to conserve the genetic diversity of the crop’s wild relatives to attenuate the effect of extreme climates in a changing world. A plea is made to shift the focus to Middle America, stimulating and supporting local research and conservation efforts and the allocation of funds from this billion-dollar industry.
A Review of Breeding Systems in the Pineapple Family (Bromeliaceae, Poales)
(2023-07-05) Cascante Marín, Alfredo; Núñez Hidalgo, Stephanie María
Breeding systems play an essential role in plant sexual reproduction and influence speciation and extinction processes. However, our understanding of the breeding systems for particular neotropical angiosperm families is inadequate. The Pineapple family (Bromeliaceae) is one of the few indigenous and highly diverse plant lineages native to the American Continent and is a resource for the ornamental plant industry. Bromeliads have a remarkable history of adaptive radiation, yet the role of breeding systems in their evolution and ecology is still unknown. This review aims to establish the current state of knowledge on breeding systems in Bromeliaceae by identifying general patterns, data limitations, and information gaps. We compiled data on self-compatibility (SC), autonomous self-fertilization (selfing), and apomixis based on a thorough review of the scientific literature from 1990 to 2020. The final database included 177 entries, which represented 26 genera and 152 species (4.1% of the family). Two-thirds of the studies were conducted on species from highly diverse genera: Aechmea, Pitcairnia, Tillandsia, and Vriesea. Bromeliaceae exhibit a wide variety of breeding systems (SC and selfing). Subfamilies Pitcairnioideae (sensu stricto) and Tillandsioideae had higher values of SC and selfing, although some of the most investigated genera in each subfamily exhibited contradictory patterns and data for subfamilies considered ancestral were absent. Complete apomixis was rare, but it was more prevalent in Pitcairnioideae. The evolution of autofertility is likely the combined result of floral herkogamy as well as the species’ self-compatibility. Our present understanding of the evolutionary advantages of selfing in Bromeliaceae is limited and deserves further investigation.
Ácidos clorogénicos presentes en el café: capacidad antimicrobiana y antioxidante
(2019) Chaves Ulate, Evelyn Carolina; Esquivel Rodríguez, Patricia
Introducción. Los ácidos clorogénicos son componentes de relevancia presentes en las diferentes partes del fruto de café; son básicamente ésteres de ácido trans-cinámico que poseen actividad antioxidante, hipoglicemiante, antiviral, hepatoprotectora y nutraceútica, entre otras. Objetivo. El objetivo de este trabajo fue recopilar y analizar la información disponible en la literatura científica sobre la actividad antioxidante y antimicrobiana presente en el café, y algunos de los productos generados durante su procesamiento. Desarrollo. A lo largo del proceso que se lleva a cabo para la obtención de la bebida de café se generan una serie de productos derivados (broza, mucílago, pergamino, “silver skin”), que en muchas ocasiones son subutilizados, a pesar de que poseen cantidades importantes de ácidos clorogénicos, lo que potencialmente los convierte en elementos de interés para la industria farmacéutica, cosmética y alimentaria. Estos productos derivados exhiben importante actividad antioxidante y antimicrobiana, especialmente contra microorganismos gram positivos. En Costa Rica, la investigación referente a los derivados generados durante la producción del café es incipiente, sin embargo, los sectores productivos en conjunto con los investigadores podrían considerarlo como una alternativa novedosa y apta para revalorizar la operación productiva del grano de café. Conclusión. Existe evidencia científica que indica que, tanto los granos como los subproductos derivados del café poseen compuestos fenólicos que benefician la salud humana.
Acknowledging extraordinary women in the history of medical entomology
(2022-03-31) Troyo Rodríguez, Adriana; González Sequeira, María Paula; Aguirre Salazar, Mónica; Cambronero Ortíz, Ian; Chaves González, Luis Enrique; Mejías Alpízar, María José; Alvarado Molina, Kendall; Calderón Arguedas, Ólger; Rojas Araya, Diana
Throughout history, women have been actively involved in the advancement of science, while struggling to overcome challenges to participate and a lack of recognition. Prior to 1950, most women were not included in the lists of “classical” descriptions of iconic scientific figures nor included in the most relevant historical accounts. Since the second half of the twentieth century, great efforts have been made to recognize the contributions of women to the advancement of science, especially since formal scientific careers have been dominated by men, with limited (or no) access to women. Despite these challenging social, political, and cultural contexts, many women have succeeded in making significant advancements, and their contributions are now being acknowledged. Such efforts have led to the publication of recent reviews and compilations on outstanding women in biological sciences. The field of medical entomology is inherently interdisciplinary, focusing on insects and other arthropods that affect human health, with input primarily from the biological and medical sciences and a strong public health perspective. Several reviews and book chapters describing the history of medical entomology have been published over the decades, but few women are mentioned in these publications, even though many women have contributed to this field. Much of the information on these women is currently scattered throughout the published literature and historical records on a wide range of topics, including activism, virology, vector control, and even acarology. Considering that there is no single available compilation of women contributors in the history of medical entomology, this review aims to provide a list of 22 women and their contributions to this field. The list includes women from diverse backgrounds, born in the late 1800s and before 1950, who directly impacted medical entomology in various ways and in different regions of the world. This compilation is far from exhaustive, but it aims to identify role models and examples of extraordinary women to motivate the evolving future of this field.
Acrylamide in foods: from regulation and registered levels to chromatographic analysis, nutritional relevance, exposure, mitigation approaches, and health effects
(2022-01) Quesada Valverde, Mónica; Artavia González, Graciela; Granados Chinchilla, Fabio; Cortés Herrera, Carolina
Herein we explore the latest research on a chemical compound resulting from food processing and during the Maillard reaction: Acrylamide (ACR). ACR is formed during high-temperature cooking processes (i.e. >120 °C), such as frying, roasting, and baking. Considering the relevance of ACR in the food industry, first, we briefly explored the nature of ACR and its mechanisms of formation and current available legislative framework (with especial emphasis on baked goods and cereals, potato-based products, and coffee). Special attention was given to which foods are more likely to contain considerable amounts of ACR and the particulars of chromatographic methodologies involved in its testing (including extraction). Additionally, health effects caused by ACR were addressed that include an introduction to eukaryotic and prokaryotic ACR metabolism, biotransformation, and fate. Risk assessment, including a margin of exposure (MOE) and tolerance levels for ACR, was highlighted. Finally, we concluded our review with a section regarding methods and strategies available to reduce ACR in foods; this includes the role of asparagine (Asn), operation units available to industry, and the addition of natural products. ACR is still a relevant compound regarding food safety, and still, research is ongoing to develop methods for accurate surveillance and strategies for quenching its formation at the processing stage.
Advances and Perspectives for Polyploidy Breeding in Orchids
(2021-05) Bolaños Villegas, Pablo Alberto; Chen, Fure-Chyi
The orchid market is a dynamic horticultural business in which novelty and beauty command high prices. The two main interests are the development of flowers, from the miniature to the large and showy, and their fragrance. Overall organ size might be modified by doubling the chromosome number, which can be accomplished by careful study of meiotic chromosome disjunction in hybrids or species. Meiosis is the process in which diploid (2n) pollen mother cells recombine their DNA sequences and then undergo two rounds of division to give rise to four haploid (n) cells. Thus, by interfering in chromosome segregation, one can induce the development of diploid recombinant cells, called unreduced gametes. These unreduced gametes may be used for breeding polyploid progenies with enhanced fertility and large flower size. This review provides an overview of developments in orchid polyploidy breeding placed in the large context of meiotic chromosome segregation in the model plants Arabidopsis thaliana and Brassica napus to facilitate molecular translational research and horticultural innovation.
Alojamiento de gallinas ponedoras con acceso a pastoreo, consideraciones generales
(2022-07) Chavarría Zamora, Sianny Valeria; WingChing Jones, Rodolfo
Los cuestionamientos de los consumidores en torno al bienestar animal han impulsado que los productores de huevo incursionen en sistemas alternativos. El objetivo de esta revisión fue describir las prácticas de alimentación y el bienestar animal de gallinas ponedoras en sistemas con acceso a pastoreo, así como el manejo forrajero y los costos de producción. Se consultaron 87 artículos científicos en bases de datos que se clasificaron en alimentación, comportamiento, características del área de pastoreo, bienestar animal y costos. Un sistema con acceso a pastoreo cuenta con un área externa al galpón cubierta de vegetación en la que las aves pueden estar durante al menos 6 h diarias durante todo el año, si las condiciones climáticas lo permiten. Estos sistemas tienen la necesidad de controlar y manejar las condiciones ambientales, las áreas de pastoreo, el bienestar animal, la sanidad de las aves y los costos de operación. La alimentación alcanza hasta 41% de los gastos, por lo que los productores desean sustituir parte de este con forrajes; con el agravante de que un exceso de forraje causa malnutrición, lo que afecta el bienestar animal y el rendimiento productivo de las mismas. Es fundamental que los empresarios de sistemas de producción de huevo con acceso a pastoreo conozcan el manejo adecuado de las aves y pasturas, con el fin de gestionar el sistema para garantizar la buena nutrición, la manifestación de comportamientos propios de la especie y la ausencia de estrés, miedo, dolor y enfermedad.
An Overview of Applications of the Modular Multilevel Matrix Converter
(2020-10-22) Díaz D., Matías; Cárdenas Dobson, Roberto; Ibaceta, Efraín; Mora, Andrés; Urrutia O., Matías; Espinoza Bolaños, Mauricio; Rojas, Félix; Wheeler, Patrick
The modular multilevel matrix converter is a relatively new power converter topology suitable for high-power alternating current (AC)-to-AC applications. Several publications in the literature have highlighted the converter capabilities, such as full modularity, fault-redundancy, control flexibility and input/output power quality. However, the topology and control of this converter are relatively complex to realise, considering that the converter has a large number of power-cells and floating capacitors. To the best of the authors’ knowledge, there are no review papers where the applications of the modular multilevel matrix converter are discussed. Hence, this paper aims to provide a comprehensive review of the state-of-the-art of the modular multilevel matrix converter, focusing on implementation issues and applications. Guidelines to dimensioning the key components of this converter are described and compared to other modular multilevel topologies, highlighting the versatility and controllability of the converter in high-power applications. Additionally, the most popular applications for the modular multilevel matrix converter, such as wind turbines, grid connection and motor drives, are discussed based on analyses of simulation and experimental results. Finally, future trends and new opportunities for the use of the modular multilevel matrix converter in high-power AC-to-AC applications are identified.
An Overview of Modelling Techniques and Control Strategies for Modular Multilevel Matrix Converters
(2020-09-08) Díaz D., Matías; Cárdenas Dobson, Roberto; Ibaceta, Efraín; Mora, Andrés; Urrutia O., Matías; Espinoza Bolaños, Mauricio; Rojas, Félix; Wheeler, Patrick
The Modular Multilevel Matrix Converter is a relatively new power converter topology appropriate for high-power Alternating Current (AC) to AC purposes. Several publications in the literature have highlighted the converter capabilities such as modularity, control flexibility, the possibility to include redundancy, and power quality. Nevertheless, the topology and control of this converter are relatively complex to design and implement, considering that the converter has a large number of cells and floating capacitors. Therefore multilayer nested control systems are required to maintain the capacitor voltage of each cell regulated within an acceptable range. There are no other review papers where the modelling, control systems and applications of the Modular Multilevel Matrix Converter are discussed. Hence, this paper aims to facilitate further research by presenting the technology related to the Modular Multilevel Matrix Converter, focusing on a comprehensive revision of the modelling and control strategies.
Análisis de posibles peligros en leche materna donada. Revisión
(2023) Víquez Barrantes, Diana; Incer González, Ana Isabel; Acosta Montoya, Óscar Gerardo; Usaga Barrientos, Jessie
La leche materna donada es un recurso de alto valor que puede ser utilizado para la alimentación de neonatos hospitalizados y a término, por tanto, garantizar su inocuidad es imperativo. Esta revisión de literatura reúne los principales peligros de naturaleza física, química y microbiológica identificados en leche materna, con la intención de proveer una referencia que los consolide de tal forma que la información pueda ser utilizada por bancos de leche humana, gobiernos y agencias regulatorias para establecer mecanismos para su prevención y control. Se realizó una revisión de literatura entre agosto del 2021 y octubre del 2022, utilizando buscadores y descriptores específicos para peligros de transmisión alimentaria en leche materna. Se incluyeron estudios publicados en español o en inglés. Se identificaron 31 agentes biológicos patógenos incluyendo bacterias, virus y parásitos. Como peligros químicos se reportaron medicamentos, drogas, cafeína, infusiones herbales, micotoxinas, alérgenos, especias, suplementos nutricionales, contaminantes ambientales y desinfectantes. Se alerta sobre la presencia potencial de plástico y vidrio de tamaño menor a 7 mm proveniente del ambiente de extracción y recipientes. La presencia de peligros microbiológicos y químicos en leche materna puede darse por transmisión vertical, temperaturas inadecuadas durante el almacenamiento y contaminación en el proceso. La presencia de peligros físicos se relaciona con la manipulación de los implementos en etapas posteriores a la extracción. Se requiere prestar atención a los hábitos de la madre para prevenir peligros químicos, así como más investigación relacionada con micotoxinas en leche materna
Andinia chaoae
(2017) Vieira Uribe, Sebastian; Karremans Lok, Adam Philip
Descripción de Andinia chaoae
Andinia pseudocaulescens
(2018) Vieira Uribe, Sebastian; Karremans Lok, Adam Philip
Andinia pseudocaulescens has a wide distribution and has been found on all three Cordilleras in Colombia as well as in Ecuador. It frequently grows together with other species of Andinia subgen. Brachycladium (Luer) Karremans & S.Vieira-Uribe, but can be rec ognized by the small plants with elliptical leaves that are margin ally ciliate, the burgundy fowers almost as big as the leaves, borne on short inforescences, with ovate, acuminate sepals, and trans versally bilobed, pubescent petals with narrowly oblong lobes.
Antiagregantes plaquetarios: ¿En dónde se encuentran las diferencias?
(2017) Chaverri Fernández, José Miguel; Díaz Madriz, José Pablo; Cordero García, Ana Eugenia; Ramírez Medina, José Pablo; Villalta, Karina; Zavaleta Monestel, Esteban
Las guías de tratamiento apoyan el uso de antiagregantes plaquetarios como parte de la prevención y manejo de la enfermedad arterial coronaria, debido a la existencia de evidencia clínica que respalda el beneficio en la reducción de la morbimortalidad cardiovascular en pacientes post infartados que utilizan este tipo de tratamientos. Sin embargo, existe aún controversia sobre los parámetros requeridos para la elección e individualización de la terapia antiagregante plaquetaria en prevención secundaria. La presente revisión tiene como objetivo suministrar una guía al lector que le facilite la elección de la mejor estrategia antiagregante plaquetaria según las características individuales del paciente, la clínica y el medicamento, a fin de hacer una comparación aproximada entre los nuevos productos, debido a la escasa existencia de estudios clínicos.
Anticuerpos monoclonales para el tratamiento del COVID-19
(2022-04-20) Arce Rodríguez, Noelia; Bermúdez Vargas, Cristopher; Gamboa Campos, Gerson; Martínez Vargas, Ernesto; Molina Orlich, María José; Tencio Villalobos, Diana; Mora Román, Juan José
El COVID-19 es una enfermedad ocasionada por el virus SARS-CoV-2. Con el aumento explosivo de casos confirmados, la Organización Mundial de la Salud declaró este brote como emergencia de salud pública de interés internacional el 30 de enero de 2020, y como pandemia el 11 de marzo de ese mismo año. Desde ese momento, se han llevado a cabo investigaciones para hallar medicamentos contra este patógeno. Un ejemplo son los anticuerpos monoclonales, una herramienta poderosa para tratar una amplia gama de condiciones, tales como: cáncer, enfermedades autoinmunes, neuronales, infecciosas y metabólicas. En poco tiempo, algunos mostraron resultados alentadores en el mejoramiento de los síntomas clínicos de pacientes con dicha patología. Unos actúan de manera directa contra el virus y otros mediante mecanismos farmacológicos asociados a su fisiopatología. Su utilización representa una alternativa para reducir hospitalizaciones y muertes por la infección. Actualmente existe uno con aprobación completa (casirivimab e imdevimab, se administran en conjunto) y tres aprobados para uso de emergencia (bamlanivimab más etesevimab, se administran en conjunto; sotrovimab y tocilizumab) por parte de la Administración de Alimentos y Medicamentos de los Estados Unidos. Sin embargo, es indispensable el desarrollo de más estudios clínicos para evidenciar su eficacia y su seguridad en diversas poblaciones, así como el estudio de nuevas moléculas.
Aplicaciones terapéuticas del eculizumab
(2022-05) Campos González, Natalia; Ruiz Jiménez, Susana; Rodríguez Jiménez, Johanna; Chacón Jiménez, Luz María
Introducción: El eculizumab es un anticuerpo monoclonal de tipo IgG diseñado para el tratamiento de la hemoglobinuria paroxística nocturna (HPN), en el que su diana farmacológica forma parte del sistema del complemento. Su mecanismo de acción ha permitido implementarlo en el tratamiento de enfermedades huérfanas, como el síndrome urémico hemolítico atípico (SUHa), trastorno del espectro de la neuromielitis óptica (TENMO) y miastenia gravis, cuya incidencia, es baja. Asimismo, es viable en el tratamiento de Guillain Barré y el síndrome antifosfolípido catastrófico (CAPS). Objetivo: Evidenciar aplicaciones terapéuticas del eculizumab y beneficios más significativos en algunos padecimientos. Materiales y métodos: Se realizó búsqueda bibliográfica en el periodo 2010-2021, en bases de datos: Google Scholar, Science Direct, PubMed y Scielo, utilizando como palabra clave “eculizumab”. Posteriormente, se afinó la búsqueda utilizando palabras claves asociadas a enfermedades tratadas con este medicamento. Resultados: Se identificó el mecanismo de acción del fármaco y su efecto sobre la patogénesis de hemoglobinuria paroxística nocturna, síndrome urémico atípico, miastenia gravis generalizada refractaria, trastorno del espectro de la neuromielitis óptica, síndromes antifosfolípidos catastrófico y Guillain-Barré. Conclusiones: El eculizumab tiene una alta seguridad y capacidad para tratar y disminuir síntomas de diversas enfermedades que involucran el sistema del complemento.
Applications of single-molecule vibrational spectroscopic techniques for the structural investigation of amyloid oligomers
(2022-09-30) Vu, Katrin Ha Phuong; Blankenburg, Gerhard Heinrich; Lesser Rojas, Leonardo; Chou, Chia-Fu
Amyloid oligomeric species, formed during misfolding processes, are believed to play a major role in neurodegenerative and metabolic diseases. Deepening the knowledge about the structure of amyloid intermediates and their aggregation pathways is essential in understanding the underlying mechanisms of misfolding and cytotoxicity. However, structural investigations are challenging due to the low abundance and heterogeneity of those metastable intermediate species. Single-molecule techniques have the potential to overcome these difficulties. This review aims to report some of the recent advances and applications of vibrational spectroscopic techniques for the structural analysis of amyloid oligomers, with special focus on single-molecule studies.
Aprovechamiento integral de la Mosca Soldado Negra: Bioconversión, sostenibilidad y desafíos emergentes
(2023) Bermúdez Serrano, Ileana Maricruz; Sánchez Velásquez, Óscar Abel
The black soldier fly (BSF) has garnered the attention of the scientific community due to its outstanding efficiency in transforming organic waste into raw materials that can be incorporated into the value chain. A bibliometric and bibliographic review was conducted to elucidate the pivotal role played by the bioconversion of organic matter in shaping sustainable circular economy systems. The analysis revealed that black soldier fly larvae (BSFL) have proven effective in the bioconversion of common waste, such as household and livestock waste, yielding valuable biomass. Despite these advancements, the exploration of new sources of organic matter persists to mitigate its environmental impact. Emerging technologies enable the efficient processing of BSFL biomass, yielding substitutes for environmentally unfriendly materials. Although the literature emphasizes the advantages of BSF in constructing circular economy models, obstacles such as limited legislation and insufficient incentives for producers, concerns about pathogens and contaminants, and low public acceptance of this species are identified. However, the growing trend in scientific interest suggests that BSF could play a central role in building sustainable societies in the future.
Arnaldo Moya Gutiérrez, Arquitectura, historia y poder bajo el régimen de Porfirio Díaz. Ciudad de México, 1876-1911 (México: CONACULTA, 2012)
(2013) Fumero Vargas, Patricia
Por lo general, los historiadores costarricenses se especializan en el estudio de su propio país y, a lo sumo, del resto de Centroamérica. Sin embargo, algunos pocos han traspasado los límites de las fronteras nacionales y regionales. Este es el caso de Arnaldo Moya, cuyo libro más reciente ha sido publicado por el prestigioso Colegio de México, prologado por el insigne y respetado historiador mexicano, Enrique Florescano. En esta obra, Moya estudia el Porfiriato (1876-1911), nombre con el que se designa un período de la historia mexicana dominado por la figura de Porfirio Díaz.
Assessment of Different Lactic Acid Bacteria Isolated from Agro-Industrial Residues: First Report of the Potential Role of Weissella soli for Lactic Acid Production from Milk Whey
(2022) Montero Zamora, Jéssica Pamela; Fernández Fernández, Silvia; Redondo Solano, Mauricio; Mazón Villegas, Beatriz; Mora Villalobos, José Anibal; Barboza Vargas, Natalia María
Abstract: The production of lactic acid (LA) through the microbial conversion of agro-industrial residuals is an important process in the biotechnology industry. The growth kinetics of 30 strains of lactic acid bacteria (LAB) isolated from agro-industrial residues were determined and nine strains were selected for microbioreactor fermentation. Lactiplantibacillus pentosus_70-1 (1.662) and L. pentosus_ 19-2 (1.563) showed the highest OD600 values, whereas the highest growth rates were observed for L. pentosus_19-2 (0.267 h−1) and Weissella soli_31 (0.256 h−1). The production of LA and acetic acid (AA), glucose consumption, and metabolic profiles were determined, without finding significant differences in the production of LA; however, W. soli_29 produced the highest amount of LA (20.833 gL−1) and was able to metabolize most of the studied carbohydrates. Based on these results, W. soli_29 was chosen for a 20 h fermentation in a 7 L bioreactor using both standard medium and milk whey supplemented medium. W. soli_29 produced 16.27 gL−1 and 7.21 gL−1 of LA in each of these mediums, respectively. These results show the underlying potential of Weissella strains for biotechnological applications. Additional analysis which should contemplate different agro-industrial residues and other conditions in bioreactors must be carried out.
Cáncer de cérvix en Costa Rica, barreras según las dimensiones de la asistencia sanitaria: una revisión sistemática cualitativa
(2022-07) Rivera Chavarría, Ana Leonor; Calderón Céspedes, Alejandro
Introducción: de las muertes de mujeres en el mundo por algún tipo de cáncer, el de cérvix es responsable del 7 % del total. En Costa Rica, cada año se diagnostican en promedio 320 casos y fallecen 140 mujeres por esta enfermedad.Objetivo: identificar barreras para el diagnóstico y el tratamientodel cáncer cérvico-uterino, según la disponibilidad de la asistencia sanitaria en Costa Rica. Metodología: se realizó una revisión sistemática cualitativa de literaturaentre mayo y setiembre de 2021. Se examinaron estudios publicados de enero de 2010 a junio de 2021 con diseño cuantitativo, cualitativo o ambos, de fuente primaria o secundaria, que identificaran limitaciones para acceder a la atención según población general, usuarios o personal de salud en Costa Rica. Resultados: se seleccionaron9 artículos científicos. Se identificaron5 dimensiones del modelo de Tanahashi y 26 barreras correspondientes a cada una: 12 de disponibilidad, 5 de accesibilidad, 3 de aceptabilidad, 2 de contacto con el servicio y 4 de cobertura efectiva.Conclusiones: las dificultades en torno al servicio médico son múltiples y están presentes en todas las dimensiones descritas en el modelo de Tanahashi. Los hallazgos deeste estudio destacan la importancia de abordarlas, lo cual, en algunas podría ser complejo. No obstante, otras variables son relativamente simples de solucionar a nivel de sistema, política o práctica.

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