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Objective: During the ageing process the loss of family and social relationships is frequent which conditions loneliness, similarly the current COVID-19 pandemic has generated more social limitations in this age group and has increased the risk factors to trigger feelings of loneliness. This paper aimed to examine how loneliness among older people had been studied in Europe over the last ten years. Specific objectives were: i) to describe the methodological aspects; ii) to identify the scales or questions for the assessment of loneliness; iii) what were the main variables or dimensions that were related to loneliness in old age., Methods: A total of 1,591 articles were found in WoS and Scopus digital platforms. After initial assessment of titles and abstracts, full text reading and review of the established criteria, 42 scientific articles were finally included in the systematic review., Results: The countries that had carried out the most studies were the Netherlands and Spain. Most of the research was quantitative and uses the De Jong Gierveld Loneliness Scale (DJGLS) and the University of California at Los Angeles (UCLA) Loneliness Scale. The most analysed variables were: marital status, household structure, social support networks, social participation, depression, health problems, co-morbidity and physical functioning., Conclusions: The scientific interest in studying loneliness, with a focus on social support networks, in older people in Europe and strategically addressing loneliness as a public health problem is confirmed.

Introduction: Neuropsychiatric symptoms are common in patients with mild cognitive impairment and dementia. This symptomatology can appear or be exacerbated with changes in routine and in the patient's usual environment. The lockdown situation during the COVID-19 pandemic has meant a drastic and unexpected change in the daily life of the general population, with a particular impact on the most physically and mentally vulnerable groups, including patients with cognitive impairment., Aim: To know the impact of lockdown measures imposed due to the COVID-19 pandemic on neuropsychiatric symptomatology in people with mild cognitive impairment and dementia., Materials and Methods: Exploratory systematic review, in accordance with the PRISMA guidelines, of Pubmed and Psycinfo databases papers published from January 2020 to April 2021 which related confinement due to COVID-19 with the presentation or worsening of neuropsychiatric symptoms in patients with mild cognitive impairment mild or dementia., Results: Worsening of neuropsychiatric symptoms was observed in patients with dementia and mild cognitive impairment, especially agitation/aggression, anxiety, depression and apathy. Neuropsychiatric symptoms were more common in patients with dementia than in those with mild cognitive impairment, although their typology varied depending on the severity of dementia., Conclusions: During lockdown a worsening in the psychobehavioral area has been observed in people with mild cognitive impairment or dementia. Therefore, considerations arise on the need of promoting social contact in people with mild cognitive impairment and dementia, avoiding situations of isolation and low stimulation.

Prostate cancer (PCa) is the second leading cause of cancer-related mortality and the most frequently diagnosed male malignant disease among men. The manifestation of PCa ranges from indolent to highly aggressive disease and due to this high variation in PCa progression, the diagnosis and subsequent treatment planning can be challenging. The current diagnostic approach with PSA testing and digital rectal examination followed by transrectal ultrasound biopsies lack in both sensitivity and specificity in PCa detection and offers limited information about the aggressiveness and stage of the cancer. Scientific work supports the rapidly growing use of multiparametric magnetic resonance imaging as the most sensitive and specific imaging tool for detection, lesion characterization and staging of PCa. Therefore, we carried out an updated review of magnetic resonance imaging in the diagnostic PCa reviewing the latest papers published in PubMed., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

This paper shows an experience of the practical implementation of the Quadruple Helix-Based Innovation Model of Reference Sites of the European Commission through the Design Thinking method. This method establishes that, in order to successfully achieve the design of a digital solution, five unavoidable phases must be covered: empathize, define, ideate, prototype and test. The process was approached using the research action design. Qualitative data collection and analysis techniques were applied in each phase: qualitative meta-synthesis, focus groups, biographical interviews, professional and community forums and techniques of prototyping and testing with users. The systematic application of this method has facilitated the consolidation of a cooperative work model in which the main key agents in active and healthy ageing interact. Thus, products and services have been developed to better meet the needs of the users, making them an active part of the creation process., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travellers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicentre prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travellers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms., (Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.)

Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon countries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue.

The recent onset of epidemics caused by viruses such as Ebola, Marburg, Nipah, Lassa, coronavirus, West-Nile encephalitis, Saint Louis encephalitis, human immunodeficiency virus, dengue, yellow fever and Venezuelan hemorrhagic fever alerts about the risk these agents represent for the global health. Chikungunya virus represents a new threat. Surged from remote African regions, this virus has become endemic in the Indic ocean basin, the Indian subcontinent and the southeast of Asia, causing serious epidemics in Africa, Indic Ocean Islands, Asia and Europe. Due to their epidemiological and biological features and the global presence of their vectors, chikungunya represents a serious menace and could become endemic in the Americas. Although chikungunya infection has a low mortality rate, its high attack ratio may collapse the health system during epidemics affecting a sensitive population. In this paper, we review the clinical and epidemiological features of chikungunya fever as well as the risk of its introduction into the Americas. We remark the importance of the epidemiological control and mosquitoes fighting in order to prevent this disease from being introduced into the Americas., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

INTRODUCTION. Scientific collaboration is vital for to the advance of knowledge and is especially important in health sciences. The aim of this study is to identify scientific collaboration indicators and co-authorship networks of researchers and Spanish institutions that publish on multiple sclerosis (MS) during the period 1996-2010. MATERIALS AND METHODS. The analyzed papers were obtained from Web of Science and Scopus international databases, and IBECS and IME national databases, applying specific search profiles in each one of them. In order to identify collaboration networks all signed papers were quantified and co-authored measures were obtained, as the different indexes, degree, intermediation and closeness. RESULTS. 1,613 articles were published in the period 1996-2010, 92% of them in collaboration. With 10 or more works signed in collaboration, 20 Spanish research groups in MS were identified. 64.23% of the papers were published in collaboration between Spanish institutions, and 33.85% were in collaboration with foreign institutions. The institutional participation analysis has identified a large network of institutional partnerships that integrates 27 institutions, with the Hospital Vall d'Hebron in a central position. International collaboration is headed by the U.S. and European countries, most notably the UK and Italy. CONCLUSION. The most collaborative authors, institutions, and work groups in Spanish research in MS have been identified. Despite these indicators that characterize the collaboration in this area, it is necessary to enhance cooperation between them, since this collaboration is positively related to the quality and impact of research and publications.

The article explores and analyses the content of the Council of Europe's Additional Protocol to the Convention on Human Rights and Biomedicine concerning Biomedical Research regarding the standard legal instrument in biomedical research, issued by an international organization with leadership in bioethics. This implies ethics committees are mechanisms of protection of humans in biomedical research and not mere bureaucratic agencies and that a sound inescapable international regulatory framework exists for States to regulate biomedical research. The methodology used focuses on the analysis of the background, the context in which it is made and the nature and scope of the Protocol. It also identifies and analyses the characteristics and functions of ethics committees in biomedical research and, in particular, the information that should be provided to this bodies to develop their functions previously, during and at the end of research projects. This analysis will provide guidelines, suggestions and conclusions for the awareness and training of members of these committees in order to influence the daily practice. This paper may also be of interest to legal practitioners who work in different areas of biomedical research. From this practical perspective, the article examines the legal treatment of the Protocol to meet new challenges and classic issues in research: the treatment of human biological samples, the use of placebos, avoiding double standards, human vulnerability, undue influence and conflicts of interest, among others. Also, from a critical view, this work links the legal responses to develop work procedures that are required for an effective performance of the functions assigned of ethics committees in biomedical research. An existing international legal response that lacks doctrinal standards and provides little support should, however, serve as a guide and standard to develop actions that allow ethics committees -as key bodies for States- to advance in the protection of humans in biomedical research.

Background: Frailty is a syndrome with important epidemiological and clinical implications in older adults. One of the most accepted definitions of frailty is that of Fried and Walston, who operationalised it according to five well defined criteria. However, their criteria are not readily applicable in primary care, where practitioners need tools to identify patients who require priority access to more specialised resources. With that objective in mind, our research group published the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). The present paper reports the results of the Spanish sample., Methods: In the wave 1 of SHARE (2004), the Spanish sample was composed of 1,279 women and 933 men, all living in the community (mean age: 65.6 years). For each sex, a latent class analysis was used to summarise the five (adapted) frailty criteria into three incremental frailty classes. We tested the association of the frailty classes against a biopsychosocial range of wave 1 variables; the predictive validity of the frailty classes was tested using mortality data from the second wave of SHARE (2006-2007), which were available for 846 women and 660 men., Results: The frailty classes had the expected cross-sectional associations. The age-adjusted Odds ratio for mortality (with 95% confidence interval) associated with the frail class was 3.2 (1.0-10.2) for women and 8.3 (3.1-22.1) for men., Discussion: SHARE-FI is a valid and freely accessible instrument, which is intended to facilitate the adoption of the frailty paradigm in primary care., (Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.)

This paper describes how the Many-Facet Rasch Measurement (MFRM) can be applied to constructed-response items and rater analysis. The article provides an introduction to MFRM, a description of facet analysis procedures, and an illustrative example to examine the effects of various sources of variability on students' performance on a DELE (Diplomas in Spanish as a Foreign Language) test by means of the FACETS program. Results highlight the usefulness of the MFRM to detect raters that have extreme values on the continuum of severity. MFRM facilitates comprehension of the assessment process as well as providing objective measurement of facet elements.

As we move on to the second decade of the 21st century, many changes in education and, particularly, in training future surgeons, have come to pass. Several of these changes are the result of a natural evolution in teaching methods, but others have been dictated by global modifications in the educational and social systems reigning throughout the Western culture. The recent evolution to less aggressive therapy and, in particular, surgical techniques, attests to the desire to decrease patient harm. Laparoscopic surgery, based on less invasive parietal violation and insult, responding to the above-mentioned concerns, has rekindled the debate on patient safety but also has opened the debate on how to best teach the technique. This paper endeavors to describe the problems created by the social and economic changes in the last few decades, to assess the consequences on teaching and learning laparoscopic surgery for the surgeon and to review possible solutions.

Objective: To analyse Spanish scientific research output related to obesity during a 20-year period from 1988 to 2007 into context with the European Union productivity, Methods: The bibliometric study was based on research of the MEDLINE database in PubMed. Search terms were "obesity" appearing in MeSH. Linear regression was used to estimate trends in number of publications., Results: We retrieved 50,120 documents on obesity in the study period, and 1,407 were by Spanish authors (2.7% of the world production). Spain, accounting for 8.1% of scientific output in this area, was the fifth most productive country in the European Union; 932 (69.1%) of papers were published in English. The average yearly increase in publications was 15%, from 91 documents in the first five-year period to 702 in the last five-period. The most frequent specialty of first author was endocrinology (279 documents, or 22.8%), followed by physiology-nutrition-bromatology (203, or 16.6%), and biochemistry (161, or 13.2%). Journals publishing the largest numbers of papers on obesity were Medicina Clínica (83 or 6.1%), Obesity Surgery (79 or 5.8%), International Journal of Obesity (73) and Nutricion Hospitalaria (59). The most productive regions in Spain were Cataluña (338 or 24.9%), Madrid (286 or 20,6%), and Navarra (159 or 11,7%). The most productive institutions were hospitals, with 708 titles (52.1%), followed by universities, with 521 (38.5%)., Conclusions: Obesity research in Spain has increased over the last 20 years and accounted for a substantial proportion of European Union research in this field. Half of the papers by Spanish authors were published in international non-Spanish journals. Most of papers were carried out from hospital settings and universities., (Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.)

This paper will contribute to the scientific development of a new approach on the pishtaco in Peru by means of medical anthropological analysis. The model emphasizes presentation and analysis of historical, pharmaceutical, and anthropological evidence supporting use of human tissues with specific medical goals in Peruvian and European regions. We can find the origin of this phenomenon around the sixteen and seventeen centuries in Europe: The pishtaco has no an Andean origin. The methodology and main conclusions of this paper could provide to the scientific community an alternative perspective to the conventional anthropological and ethnological research, as an example of a medical anthropological analysis of the pishtaco character. Professionals involved in intercultural health projects could have a new insight on this issue thanks to these results. They will obtain an adequate historical-cultural context for the interpretation and understanding of people and native communities' beliefs about health, body and medical systems.

In this paper, I analyze risks and limits of the current psychopharmacology and how both are promoting a new social interpretation of health concept. Besides, I show how such interpretation can be detected in four issues related to safety, equality, psychiatrization of human condition, and autonomy. In the conclusions, I defend, first, the obligation of physician to inform patients about the important long-term uncertainties around psychopharmacology. Second, I justify the necessity of promote more prolonged monitoring of patients treated with such kind of drugs. Third, I insist in the relevance of increasing research about drugs ' adverse effects extended over a long time. And forth, I bring up the utility of health concept to avoid the subjective stigmatization of cognitive or affective traits, to prevent potential problems of inequality and coercion, and to keep from mental disorders caused by attempts of getting psychical states supposedly optimized.

The aim of this paper is twofold: first, to examine the relationships between antecedents and consequences of bridge employment activity; second, to analyze the mediator role both of quality and quantity of bridge employment activities in the relationship between antecedents and consequences. First wave panel data from the SHARE (Survey of Health, Ageing and Retirement in Europe) were obtained from 1190 men and women in Europe, using structured interviews and questionnaires. Structural equation modeling analyses, including the sample without missing values (N=650), showed that both quantity and quality of bridge employment participation are predictors of job satisfaction, life satisfaction, and quality of life in retirement. These results validate and expand the previous research on bridge employment activities and partial retirement.

The paper comments on present and future scenarios for the pharmaceutical sector in Spain, framed a highly regulated system. So far the drug industry has evolved under the short term public financial constraints for additional health care spending and the long term efforts to innovate. This has not proved to offer a stable setting for the relationship between the industry and Health Authorities. The author offers from the economic analysis and a subjective appraisal from his experience some recommendations for regulatory changes in order to better align the incentives of the parts for improving the health system as a whole. The basic point is that 'consumption levels' (quantities) and not <> (unit costs) are the main challenge to tackle today in our Public Health Care system, and for this the decentralisation of financial responsibility is not in itself 'the' problem but it may well be a part of the solution.

The Dialysis Outcomes and Practice Pattern Study (DOPPS) is an international observational study of treatment conditions and medical outcomes in hemodialysis patients. Prospective sampling has yielded long-term observational data from randomly selected groups of patients receiving treatment at representative, randomly selected hemodialysis units in each country. The data shown were collected at 20 hemodialysis units/centers in Spain. The data pertaining to Spain--Sp--refers to 575 patients and their comparison with those of the Euro-DOPPS countries--Eu--(Germany, France, United Kingdom, Italy and Spain), which encompass 3,038 patients, represent the formal goal of this paper. Diabetes mellitus, at 21.5% in Eu and 21.7% in Sp, was the most common cause of renal insufficiency in dialysis and coronariopathy, as a concomitant disease, was present in 67.8% in Eu as opposed to 75.8% in Sp. Differences were observed in the incident of hypertension (73.4% in Eu vs 77.4% in Sp), hepatitis C (11.6% vs 19.5%), depression (12.7 vs 16.2%) and left ventricular hypertrophy (54.9% vs 62.3%). The patterns of vascular access were similar (79% vs 81% AV fistulas in Eu and Sp, and 10% synthetic grafts for both) and the mean applied dose of dialysis--Kt/V--smaller (1.19) in Sp than in Eu (1.24); likewise the duration of the dialysis (in minutes) was shorter (234 in Eu vs 217 in Sp) and the % of synthetic membranes used was smaller (60% in Eu vs 52% in Sp). There were no differences between the groups in the figures for urea, creatinine, albumin, nPCR, calcium, phosphate or PTH. There were also no differences in the mean values of Hb (10.7 for Eu vs 10.8 for Sp), given that the values of ferritin were noticeably lower in Sp (288 vs 355) and the dose of EPO/kg/week was higher to in Sp (115 vs 102); s.c. route was used in similar proportions (69% in Eu vs 67% in Sp). The level of medical care, understood as contact with the physician at all or almost all treatments, was noticeably better in Sp (90%) that in Eu (66%), whereas the number of patients per hour of specialized personnel and % of specialized staff, were smaller. Mortality (death/100 patients-years) was one point lower in Sp than in Eu (15.4 vs 16.3). These data suggest that an increment in dialysis time and in the percentage of synthetic membranes used, as well as in the supply of intravenous iron, would be justified.

Objective: In this paper we review the main studies on teratogenicity related to epilepsy and especially use of anti epileptic drugs (AED), with special emphasis on recently acquired knowledge regarding the new AED., Development: When considering the teratogenic effects of epilepsy and the anti epileptic drugs it should be remembered that there are a series of premises and considerations which undoubtedly play an important part in causing possible damage to the foetus. These factors include changes caused during pregnancy, the passage of drugs across the placenta barrier , malformations occurring in the children and relations of women with epilepsy and finally the effect of seizures on the foetus. We then review the mechanisms of the teratogenicity of the classical AED and the new AED. Little is known about the adverse effects of the new AED, and many are used together as polytherapy. Multicenter studies involving large numbers of participants are therefore necessary to obtain results which can be extrapolated to the whole population. Unfortunately, at present, this is not yet so and there are no clear recommendations for their use during pregnancy. The EURAP was designed for this reason. It is one of the multicenter studies being carried out in Europe at present with many Spanish specialists participating., Conclusions: Multicenter studies with many participants are necessary to obtain reliable data on the teratogenicity of the various AED, used as monotherapy and bitherapy, particularly regarding the new AED. We conclude by considering measures to try to reduce, as far as possible, the teratogenic effects in pregnant women.

This paper deals with the scientific origins of the electroconvulsive therapy, particularly between 1938 and 1945. The most interesting and imaginative research on ECT occurred in this period. An analysis of a host of social, moral and scientific factors to understand its history is offered, focusing on several european countries.

This paper explores the relation between ideology and efficiency of the health care systems. In order to achieve this goal, this study: analyzes the relation between ideology and health care system organization, defines the concept of health care system efficiency, and reviews the relation between health care organization and efficiency. The last part of the paper is devoted to discuss the relevance of the conclusions of the above mentioned analyses to the debate on the reform of the Spanish National Health Care System.

This paper deals with the way in which the pre-existence of germs was defended in the face of experimental conclusions regarding animal regeneration in the period between the turn of the seventeenth century and the 1760's. From the experiments of Claude Perrault (1680), Antoine de Réaumur (1712), Abraham Trembley (1740-44) and Charles Bonnet (1740), it became clear that pre-existence delimited its objective so narrowly as to make it invulnerable to all possible experimental refutation. Moreover, we shall argue that this construction of the objective was linked with a renewed definition of the "community of Practitioners" built upon the notion of "scientific exclusion".

This paper intends to signify the utilization of the iconographic resources of the language in the construction and diffusion of the rhetorical elements of the scientific language, with special attention to the XVIIth and XVIIIth centuries, as historic outstanding times in the configuration of the so-called modern science.

In this paper, the first one in a series of three complementary papers on dementias, we introduce the concept and evaluate the methods for diagnostic and the data provided by modern epidemiology. The current clinic criteria for the diagnosis of dementias are based on international instructions such as those included in the DSM-III-R (1987), and the ICD-10 (1992), and the criteria developed by the NINCDS-ADRDA or the CERAD. Such a disparity makes even more difficult the transcultural reliability of epidemiological information. The differentiation with pseudodementias, being the depressive one the most frequent of them (75%), the inclusion of the denominated dementia-AIDS complex, or those dementias related with the alcoholic illness have special relevance. In Europe the more solid studies proceed from the EURODEM group, and their results are consistent with the North American and Asiatic ones, pointing all of them out an exponential growing of dementia with age, which is very similar in the different continents. The risk factors for the Alzheimer's disease and other dementias are discussed and contrasted with the contributions of the different reliable documental sources existing.

"This paper examines the decline of mortality in Vizcaya [Spain]...the first Basque province to be industrialised at the beginning of the demographic transition. Making use of both the death and municipal population registers we analyse its diverse trajectory in two differentiated economic environments: those municipalities which played an important role in the industrial process and those rural municipalities which remained on the sidelines." The author compares life expectancies, causes of death, and sanitary conditions, and discusses some social consequences of industrialization. (SUMMARY IN ENG AND FRE), (excerpt)

"This paper provides a conceptual framework of elderly migration according to the decision making process. The migration is presented as a complete spatial and social system related to migratory behaviours and residential strategies. A typology of movements in Spain is proposed; it emphasizes several topics (decision maker, personal characteristics, reasons for moving, destination, housing, etc.)." (SUMMARY IN ENG AND FRE), (excerpt)

"This work reminds us [of] the need to approach the study of mortality as a whole and insists upon the many factors having an influence upon its etiology. At the same time it suggests that more attention should be paid to the subjects of morbidity and the synchronical connections between illnesses.... The paper displays some results...based upon the death registries of Geneva [Switzerland] (1685-1844). Using the data for the years 1740-1759, the work studies the deaths and main death causes from the viewpoint of their gradual development [over] time, their periodicity and their distribution by age groups." (SUMMARY IN ENG AND FRE), (excerpt)

"During the last few years, Spain has become a host country for Maghreb emigrants that cross the Straits of Gibraltar hoping to find a better life. This article evaluates the importance of this migratory trend, its evolution, location and characteristics. At the same time, this paper sets forth new data about the recent Official Registration process of alien residents." (SUMMARY IN ENG AND FRE), (excerpt)

This paper discusses some of the proposals regarding the improvement of the efficiency in the delivery of health care services. Several countries have implemented different strategies based on the experience of the Health Maintenance Organizations, which have used the market to stimulate competition between providers and insurance companies. One of the proposals includes the creation of agencies that would compete in quality and in price. Another one implies the creation of a National Health Service capable of hiring public or private services from local agencies. The ideal strategy would enable a consumer to choose between insurance companies and public and private providers, and would hopefully create cost conditions reasonably correlated with the efficiency and quality of the rendered services.

The aim of this paper is to review the current state of breast cancer screening in our country, as well as to discuss the most appropriate approaches for its development. Firstly, the impact of breast cancer in Spain is presented, as well as the current evidence about the efficacy of the screening. The major programs and initiatives addressed to promote screening are described. Finally, a few recommendations are given in order to achieve that breast cancer screening be, not only efficacious, but also effective. It is concluded that it is necessary that health and professional authorities coordinate and monitor breast cancer screening programs.

The purpose of this paper is to present the basic principles needed to implement a national strategy for quality assurance in medical care in Mexico. The first part is devoted to a review of the basic concepts of quality of care with the aim of analyzing the evolution of the discussion of the concept of "quality assurance". This review constitutes the reference frame of the description of the historical evolution of quality assurance in different parts of the world. Finally, the experiences regarding quality assurance in Mexico are discussed and several basic proposals for the design of a national quality assurance strategy are presented.

A sensible and rational approach is necessary in order to match the growing requirements of information on the ambulatory care sector characterised by a big deal of complexity and variability. This must be applied to any initiative attempting to obtain any degree of harmonization in ambulatory care data sets. This paper summarises a conceptual aspect of the work undertaken by the project Measurement Characterization and Control of Ambulatory Care in Europe (McACE) sponsored by the Commission of the European Communities under the exploratory phase of the Advanced Informatics in Medicine (AIM) programme. Our approach places in the first priority the efficiency when assessing the information needs of the different actors trying to make a balanced approach between the costs of collecting and processing a specific item and its use. For this we performed a conceptual validation of the term Minimum Basic Data Set and its potential application to the Ambulatory Care Sector. It is suggested its substitution by the term Minimum Data Set as a part of a practical tool for promoting the harmonization of the information in ambulatory care.

This paper describes a provisional framework that could be used to help compare and evaluate activities concerned with reducing the demand for illicit drugs in the European Community. It provides a background to European concern in this field, and comments on some methodological problems that arise regarding evaluation. The overall goal of demand reduction may be attempted through a diverse range of activities--treatment and rehabilitation, reduction of secondary harm arising from drug use, primary prevention, and suppression of drug availability and use--each of which may involve different interventions at different levels of generality and with different subsidiary objectives. Thus it is essential that data for evaluation are collected in terms of a framework where demand reduction activities and their objectives are clearly specified, together with criteria for success or failure, appropriate measures for those criteria and suitable methods to obtain those measures. The paper provides some examples of how this framework could be applied to evaluating attempts to reduce demand for drug through treating addicts, and comments on the use of global measures (indicators) of trends in the demand for drugs. A possible administrative structure for comparing drug demand activities in different countries through a European network on health data is suggested.

"The paper refers to the amount and some characteristics of the Spanish, Italian and Portuguese immigration to Chile during the period 1860-1930. It is compared with [movements to] Argentina, Brazil, Cuba and Uruguay.... Different information sources are used and in spite of data weakness, the low preference for Chile of the European migratory flows is ratified as compared with those to Argentina.... It is pointed out that the migratory flows to Latin America, in particular to Chile, are associated, on the one hand, with the favourable... European [immigration] policy in this country and on the other hand with the huge European emigration overseas during that period." (SUMMARY IN ENG), (excerpt)

This paper analyzes the changes in Argentine laws regarding migration, mainly in the hundred years since the Argentine Constitution was passed until the 1950s. The different subsequent laws and the debates they caused are related by the author to the political and ideological trends dominating Argentina in that period as to the characteristics and oscillations of the migratory afflux. Further the paper considers Italian laws and migration policies during the same period. The author concludes that after a liberal migration policy in the 19th century, growing legal restrictions and passionate discussion on the role of immigrants followed in this century, particularly between the 2 World Wars.

This paper makes a socio-historical analysis of the determinants of health on the basis of the different ideas that are held about it. It examines the methodological and practical part played by these different ideas in the past and in the present, and the conclusion is reached that health is a sociobiological process historically determined. With the foregoing definition as a starting point, the author reviews the validity of primary care as a "key" strategy for attaining the goal of health for all by the year 2000.

The relationship between adult mortality and the proportion of orphans in France in the eighteenth and nineteenth centuries is analyzed. Data are from a research project developed at the Institut National d'Etudes Demographiques [INED] and concern data for some 400 communes, together with life tables developed for the periods 1740-1749 and 1820-1829. "This paper is divided in two chapters. The first chapter examines the different proportions of orphans, observed in the above mentioned periods. The second one confronts these proportions with comparable values derived from mortality tables." Consideration is given to the relationship between parents' death and timing of marriage of, (excerpt)