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This paper specifies the areas and disorders that concern human communication medicine. The frequency of the diverse disorders is analyzed in relation to age and sex, and the distribution in group ages of several disabling diseases is also discussed.

This paper discusses the future strategies for the prevention of disease. The author presents three basic ideas. The first is that in public health it is increasingly important to evaluate critically the costs and benefits of different preventive strategies. Second, it is highly desirable to use new advances in biology to create more effective, safer, and possibly less expensive preventives. Third, it is increasingly important to utilize modern means of communication to reach the public to promote change toward healthier behaviours.

This paper briefly reviews the main features of the recent Mexican experience in demographic and economic development matters. It assesses the development pattern that prevailed between 1940 and 1970 and the ways and policies that were instrumental in accommodating the rapid population growth of the period. The author considers that by 1970 the relatively acceptable demo-economic system in place since 1940 entered a period of emerging tensions, and examines the responses to those difficulties, among them the change in population policy. It closes with a brief review of the tasks ahead considering future demographic and economic tendencies in Mexico.

In this paper the inherent characteristics of the demographic and epidemiological transitions are described. The main differences of the transitions between Western Europe of the 18th and 19th centuries and of the Latin American countries of the 20th century are pointed out. The demographic transition in Mexico is briefly described and the attributes that make it sui generis are indicated. It is emphasized that there has been a slowing of the rate of decline in fertility in Mexico since 1980 and some factors likely associated with this phenomenon are propounded. The different schools of thought regarding the changes of infant mortality during the transition are succinctly reviewed. The hypothesis that reductions of the birth rates induce reductions of infant mortality rates is supported by general theoretical results of the population dynamics of infectious diseases and some empirical evidences.

This paper discusses, on the basis of the Bruntland Report on development and environment, the relationship between population and development possibilities, and its consequences on natural and man made resources. The author emphasizes the need to design development policies in which the protection of the environment is a priority, specially in Latin American countries.

This paper presents some ideas on the relation between personal income and the quantity and quality of education and health. It is suggested that the high degree of inequality in income in Mexico could be attributed to ancestral differences in educative and health care opportunities. In the short run, the desirable decrease in educative and health inequities will not modify the income concentration rates. However it is a powerful tool in the struggle against poverty and a necessary condition for the gradual reduction of inequities in the long run.

This paper presents the results of an intradomiciliary procedure for arsenic removal from water, by means of flocculation with ferric sulphate. The reaction was carried out in a specifically designed tank with a manual agitator (reactor) installed in a vertical support. The salts to flocculate were handed in two small envelopes, whose contents were added independently, agitating the water and letting it settle for two to three hours. Water is decanted by opening a faucet connected to the inferior part of the recipient. Ten families of the states of Durango and Coahuila (the Comarca Lagunera) were selected. Samples of water were taken before and after the treatment. In 70 percent of these samples the arsenic removal was total, and in the remaining 30 percent the removal was superior to 93 percent. The arsenic removal of water in the domicile was very effective, for which it is suggested as a palliative method for those groups with higher levels of exposition.

The use of secondary sources of information such as the newspaper is necessary in order to do research on the degree of diffusion of public health issues. The problem of abortion in México has been scarcely studied due to several factors mentioned in this paper. Content analysis of articles published in the newspapers is a strategy that allows the study of the role of public opinion on this socio-political and health problem. A research based on content analysis was carried out in 771 newspaper articles on abortion found in seven national newspapers from 1974 to 1982. The results show a great inconsistency in the statistics on the numbers of abortions and the number of maternal deaths due to this cause. On the other hand, the information published on the characteristics of the women that have had an abortion in Mexico was found to be congruent. These elements point to the fact that the health sector has to produce and publish reliable statistics on abortion.

The main aim of this study was to assess the quality and quantity of the Mexican epidemiologic production published in two journals: Salud Pública de México (SPM) and Boletín de la Oficina Sanitaria Panamericana (BOSP). A previously accepted criterion was used to qualify a paper as an epidemiologic work. The period of study was eleven years (1975-1985) with 89 classified paper as "epidemiologic reports" (36 of BOSP and 53 of SPM). The variables included: original or revision's report; epidemiologic design; measures employed (frequency, association or potential impact); condition (contagious diseases, chronic-degenerative diseases or physiologic status); use of prevalent cases, incident cases or deaths; internal and external validity; bias' recognition; and number of references. Among the results that stand out are the proportion of cross-sectional designs (51.75), the weight for communicable diseases (36%), the detection of potential bias (65.7%) and the reports without references (30%). The discussion is centered in the main implications of these results when they are used to make decisions in the planning, operation and assessment of health services and in the generation of new epidemiologic knowledge.

During his administration as Minister of Health, doctor Guillermo Soberón led one of the most important structural changes in health of this century in Mexico. All along the process, an ideological and doctrinal corpus was created. In this paper the main streams of this corpus are presented.

The use of a fixing solution (FAF) to preserve parasite specimens in routine coproparasitoscopy is considered in this paper as an essential tool in surveys and field work aimed at diagnosing intestinal parasitic disease. It increases the reliability of the analysis procedure when the samples have to be transported over long distances to a central laboratory.

This paper states some of the main problems associated with the collection and processing of the information about deaths in Mexico. The results reported are in relation to the integrity and transcription problems found in 23 municipalities of eight states of the Republic of Mexico. The main results were: lack of continuity in the flow of information; different criteria in the handling of the several existing formats; incomplete documentation (medical death certificates, official registration and special concentration forms 823-824) in 39 percent, with a variation range of 2 to 72 percent depending of the particular degree of development in each state or county; the forms used to make up the national death statistics (forms 823-824) were not found in 21.5 percent of the cases, and transcription problems of the main variables (age, sex and cause of death), using as common denominator (total deaths) those registered at least in 2 documents, occurred in 26 percent of the age registers, 22.4 percent in the case of sex, and 51.6 percent in the cause of death variable.

The evolution of the epidemiology of mortality in developing countries requires the use of indicators additional to cause specific mortality rates. This paper presents the leading causes of potential years of life lost in Mexico in 1983, by sex. Methodologic discussion focused on age limits and relative numbers. The indicator proved useful to assess the impact of infectious diseases, accidents and homicides as causes of premature death. It was also useful to identify years of potential life lost attributable to specific age and sex groups. The use of years of potential life lost provides valuable information to epidemiologic mortality analysis.

In this paper, the approach to the genesis of the acute hypertension of pregnancy, uses a conceptual and methodological perspective adjusted to its multifactorial nature; a set of questions with epidemiologic focus is proposed, in order to vinculate psychosocial factors with the biologic processes characteristic of this health problem.

Clinical observation shows that children with attention deficit disorder are insecure and have low levels of self-esteem. This paper analyzes the relationship of the disorder with self-esteem, measured with the Coopersmith Self-Esteem Inventory for children. Three groups were compared: 1) Children with attention deficit disorder without treatment (N = 20); 2) Children with attention deficit disorder who had received perceptual treatment for a period of six months to a year (N = 20), and 3) a control group of children without attention deficit disorder (N = 292). The results show significant differences among groups, and a tendency to find lower scores of self-esteem in children with attention deficit disorder without treatment. Therefore self-esteem is an important aspect to consider in the treatment programs for children with attention deficit disorder for better results in their rehabilitation.

The epidemiology profile of developing countries is in transition. While the prevalence of infectious and preventable diseases, malnutrition, and in general the health problems traditionally associated to the poor, is still high, the characteristic health profile of industrialized countries (i.e. chronic and degenerative diseases, accidents, violence, social pathology) is beginning to surface. This paper focuses on the need to consider organ transplantation as a health priority in developing countries, as an important element in the global strategy to cover both aspects of the health care demand.

Within the academic modernization strategy that the National School of Public Health developed as a result of its merging into the National Institute of Public Health, a set of different normative standards were established in order to review its academic programs. This paper shows the specific criteria to differentiate the three graduate academic levels (specialty, masters degree and doctoral degree) that are offered by the School. This set of criteria was needed because there were misunderstanding about the goals and the contents of each of these academic programs. The present proposal was done by the Academic Program Associated Dean's team during 1987, after reviewing the academic standards at the national level for graduate programs. On the other hand, a set of criteria is proposed for the graduate continuing-education programs. These courses are seen as strategic for the training of physicians in executive levels of the health sector in Mexico.

This paper presents a general picture of the relationship between health and borders, analyzing the particular case of Mexico. The concept of international health is discussed, and the role of the multinational organizations created to approach it -WHO, PHO, UNICEF, etcetera- is described.

The prevention of HIV infection in school and university communities acquires great importance in adolescents and young adults where the risk of HIV infection is caused by age, occupation, location, and also adjoining relations with other groups of high incidence of infection, such as teachers and administrative employees. Adequate strategies for specific groups are needed. This paper focuses on the strategies developed at the National Autonomous University of Mexico. An interdisciplinary health commission for the prevention and control of AIDS was established to inform the student body. Other activities performed by this commission include providing medical and psychological attention for AIDS victims, as well as detecting and carrying out follow-up studies of infected students. Efforts in health education have also been made by training professors to include preventive measures against this disease as part of their subject matter. Specific, organized, and immediate action must be taken by health personnel and community organizations in order to prevent HIV infection in adolescents and young adults.

In this paper the main structural features of the dutch health system are described, together with a historical survey of its development in recent years. The basic elements of quality assurance in the country are also discussed.

In this paper, an overview of the quality of care activities undertaken at the General Direction of Medical Services of the Federal District Department is presented. The current standing of the medical services is briefly described, as well as the prevailing Reorientation Program, aimed at improving the quality of the care provided. The Departmental unit of Research on Health Services was created to generate, analyze, and integrate the information necessary to propose alternative ways to improve the quality of care. One of the main tasks of the Unit has been the implementation and operation of professional teams ("commitment circles"), advocated to the solution of specific quality problems. Once the initial goals are reached, these teams will constitute Quality Assurance Committees, under a program designed to identify and effectively correct the possible deviations.

Health care quality assurance is an increasing demand of our social environmental, regarding not only high medical technology centers but, even more so, the services given at the primary care level, that covers the greater part of the population. In this paper we describe a quality assurance program implemented through "quality circles" within the immunization program of a primary health care center. The study was done in several stages. In the first two steps (preliminary diagnosis of the local immunization program, and coverage evaluation) the main problems affecting the program's quality were identified. In turn, these results allowed the implementation of the next phases: integration of the quality circles, elaboration of a quality assurance manual, and actual operation of the quality circles. A methodology first developed in a third level care institution was applied in this quality assurance program, which, on the other hand, showed immediate benefits on the services rendered.

This article analyzes 33 risk indicators about problematic drugs use, based in epidemiological studies in representative student samples, carried out in Mexico since 1975. The indicators are distributed among the variation sources proposed by the classic epidemiological model (environment-agent-host), and are aimed to understand the phenomenon within a systemic paradigm where the multivaried nature of the phenomenon allows to establish functional relations among drug use, user characteristics and the social and family environment. The hypothetical construction sustained in this paper is: "the magnitude of the risk to fall in a problematical drug use, if someone belongs to the high school population in our country, depends on risk indicators coming from three sources: a facilitating environment, the drug use characteristics (use pattern and drug type) and the student characteristics (demographic, social and psychological)". This article describes the indicators (11 related to the facilitating environment, 8 to the drug use characteristics and 14 to the student), as well as the way to grade them, and the definition of a graphic profile that contemplates four areas. Also, the possible applications in field research and primary care are discussed. We conclude that it is important to have local preventive policies in schools.

The relationship between the socio-cultural characteristics of a population and their participation in immunization programs is described in this paper. An anthropological approach was utilized to study the reasons why certain population groups do not participate in the immunization programs or do so inadequately. The study was undertaken in a community south of Mexico City. The paper contains the description of the community's contextual elements, the organization of the medical care services and the participation of the population in the immunization programs. It was found that a wide millieu of socio-cultural factors are related with people's behavior toward vaccination, such as: lack of information about diseases and vaccines, lack of trust on modern health services, and the strong influence of traditional medicine. Clear implications can be derived from the analysis with regards to the need for revision and modification of strategies of the health education programs, in order to promote a wider participation in immunization programs.

The Head Office for Family Planning of the Mexican Ministry of Health implemented a program of sociodemographic research for the purpose of studying family planning. On the basis of the sociodemographic profile drawn up in 1983--the year in which said research program was initiated--research needs were gradually identified and then met by means of surveys and monographs for individual states in Mexico. This paper comments on the main features of the research projects that have been carried out. We order to show the data bank which the Head Office for Family Planning has at the present time for studying the phenomenon all of its activities are centered around.

This paper presents the results of an ecologic study of the trends of ischemic heart diseases (IHD) (ICD 9th 410-414) from 1950 to 1985 in Mexico. The mortality rates area strongly related with age and sex. Among those aged 30 to 59 years old, the male-female ratio (MFR) was 2.5 whereas in those aged 60 or more the ratio was 1.2. The mortality rates for IHD increase over time, particularly when converted in logarithms (r = 0.89). There were important differences in the regional mortality patterns by age and gender. Among males the northern region showed a mortality risk 2.5 times higher than the southern region; this risk increases (3.0) in those older than 60 years old. The increasing risk modifiable risk factors such as smoking, cholesterol and hypertension.

In this paper the authors stated the performance of the National System of Charges for Medical Services of the Mexican Ministry of Health. The study focus the analysis on 1,776 charges on hospitals at a secondary level of attention. It includes a presentation of the background of the System, and it's regulations, major problems and irregularities. The main founding were: a) irregularities on the classification for payment of the patients according to social class. The 67 per cent of users were classified in the upper class section; b) additional charges of 109 per cent on deconcentrated states; c) fees don't established on information on costs. The authors recommended: 1) Establishment of cost units on regional basis; 2) standarization of procedures of socioeconomic classification, exemption o payment and disminution of discretional procedures; 3) programmed adjustment on fees; 4) Monitoring of the system; 5) integration to the System of the third level of attention and the descentralized states and; 6) solution to budget problems.

Infant mortality is usually accepted as a sensitive indicator of living conditions, and of the coverage and quality of health care in a specific country. However, the validity of this indicator in middle-income countries presents some important limitations. First, underegistration of infant deaths is a common feature. In second place, the national figures hide the great inequalities that may exist among different social sectors and regions. In this paper, the limitations of Mexico's infant mortality rate are analyzed. Underegistration is demonstrated by comparing infant mortality rates obtained from vital statistics data and national health surveys. Differences among social sectors are evident when specific infant mortality rates are compared. Inequalities have been increasing in the last years.

Epidemiological and health system research projects are often delayed due to the difficulties to build validated data basis in personal computers. This papers presents a new computer interactive program for handling numeric data from a given questionnaire to a structured archive. The questionnaire includes the basic variables of the dwelling and of the members of the household. A list of sociodemographic and health variables are selected, although other variables can be easily added, according to special needs. All the intermediate steps regularly needed to construct a data base are included in the package: capture, verification, validation and record linkage. The package is equipped with the basic procedures needed to produce tabulations and basic statistical analysis.

The life habits of 358 males abstemious (ABS) and 248 male risky or with harmful alcohol consumption (BRD) are compared; selected from the patients attending to a clinic of familiar medicine, of the Instituto Mexicano del Seguro Social (IMSS) and to General Hospital of the Secretaria de Salubridad y Asistencia (SSA). BRD are different from ABS because of a sedentary life, tobacco consumption, higher frequency of other drug use, poor nutrition, over weighted and poor physical condition. The difference between ABS and BRD is not only due to the alcohol consumption and related problems, but two groups of individuals with different ways of life. The present paper shows the first Mexican results of an International Multicentric Investigation coordinated by World Health Organization (WHO).

The problem of population aging and its consequences for health has not been analysed in depth in Mexico. This paper is a critical review of available data on the epidemiology of aging in Mexico. Available data, even though incomplete serves us to identify the main problems afflicting the elderly population: poverty, absence of specialized services, high prevalence of disabilities and multiple pathology and weakening of the family and social support network. throughout the analysis of this information, a proposal is made towards the development of a gerontological services network.

In this article it is outlined the work of doctor Bustamante in fighting against diseases such as yellow fever, typhus, malaria, and smallpox; and the development and impel that this professional gave to preventive and social medicine is pointed out. It is established that health care professionals currently must not only highly studied and prepared, as they should manage all features related with public health, but also change-men-and-women who are capable to influence future generations, which will be the responsible in relocating men at the equilibrium point concerned to their health. Said equilibrium point is not only modified in its biopsychosocial aspect, but also its essence is deeply affected. This paper is a warning to physicians to fight together in response to humanity, that has set their confidence in them, as the current problem of drugs and dependence to drugs unhinges everything wholeness. To doctor Suarez is intolerable that, in spite of technological advances in the world, yet exist deaths caused by pneumonia or diarrhea. The hazards of the century are frightened: nuclear war and AIDS; but the characteristics that have distinguished human species and allowed its survival and superation are trusted: mental activity, ability of judgement, and consciousness; which are valuable for a deep philosophic discussion that allows us to continue our advance. An enumeration of the medicine achievements in this century is made.

This article presents a general view of the evolution of the conceptual approach to equity in health and its current meaning. The analysis of equity from the standpoint of distribution-accesibility, use and outcome of health services is proposed. Every point of view is addressed to an operational and policy-making position. This paper concludes with a proposal of perspectives for research development in this field.

This paper surveys the health care personnel's knowledge and opinion about the physiology of the mother milk production and the issues that occur when it is stopped at an earlier moment. From an inquire carried out in 1984 on 155 doctors and nurses and 48 midwives that render their services to the rural population of Mexico, it was found that the majority of the health care personnel recognized breast-feeding as the best nurture for the child. Nevertheless, this personnel is against having a long breast-feeding period. More than half of the doctors and nurses commented that the breast-feeding period must be stopped when the child has diarrhea, which is contrary to the international health agencies opinion. The majority of the health care personnel recommends the introduction of complementary food to children under three months old and suggests a quick stop of the breast-feeding period. From these data it is shown that the health care personnel has little knowledge about the breast-feeding role as an element that increases the period of amenorrhea and its value as a natural contraceptive. The relation between breast-feeding and amenorrhea and infertility is inaccurate, that is why it is concluded that it is necessary to have training for the health care personnel in some physiological aspects of breast-feeding that are of prime importance. If the health care personnel has a better knowledge about breast-feeding, these influencing agents to decrease the incidence and value of breast-feeding will turn into strong promoters of such a healthy practice.

The goal of this paper is to show the paralelism between the objectives of both, neurosciences and philosophy. First, a historical review of the common works on both fields of study is made; next, the implications of the brain-mind relationship and how the use of a cerebral function theory that help us to solve the problem are discussed. Finally, the social implications of cooperation between neurosciences and philosophy are analyzed.

The purpose of this paper is to discuss the historical evolution of the concept and activities that have come under the rubric of international health during its modern "formative" years in the 20th century. The analysis seeks to illuminate the changing objectives and key players, the achievements and failures, and the challenges that lie ahead. The emphasis is placed on its institutional component, particularly as it relates to the countries of the American continents.

This paper discusses the role that the international agencies have played in financing health programs. The different types of organisms are identified and classified according to the support they offer, the nature of their relationship with the recipient countries and their public or private character. The main problems associated with external financing of health problems are also discussed and the case of the W.K. Kellogg Foundation is presented to illustrate some of the issues previously analyzed.

This paper shows a general scope of migration and border health in the US-Mexico border. Project CONSENSO's methodology and the results founded by the local and state health personnel are presented. This activity enabled health personnel from both countries to identify the most relevant health problems at the Northern and Southern US and Mexico border.

This paper discusses the relationship between migration and health using as a case study the problem of Acquired Immunodeficiency Syndrome (AIDS) in the Mexican-American border. The authors state that the permanent nature of migration between Mexico and the United States points to the need of binational health programs offering health education and promotion, and a greater interaction between the Mexican and the American health care systems.

This paper discusses the main points of a proposal for the modernization of the sanitary regulation in Mexico. The basic goal of the Program for the Modernization of the Sanitary Regulation is to promote the free and easy circulation of goods and services guaranteeing the protection and promotion of the health of the population.

This paper discusses the conditions that force the countries in Latin America and the Caribbean to design and produce vaccines for the most common infectious diseases in the Region on a regional basis. The authors discuss as well the goals and strategies of the Regional System for the Production of Vaccines in Latin America, its possible structure and economic feasibility.

This paper discusses the comparative analysis of health systems, its relative low level of development, its great importance for training health sector leaders and some of the difficulties and limitations for implementing it transnationally. The appropriate understanding of the sociohistorical conditions and the economic and political context are of germane importance for comparative analyses. Moreover, analysis of the financial aspects of health systems, as well as that of the physical or technological infrastructure, of the human resources, or the organizational structure and also of the health levels bring about particular difficulties which need adequate methodological developments.

This paper discusses the conditions in which the Commission on Health Research for Development was born. The main purpose of this Commission is to promote research as a mean to achieve better health conditions.

This paper discusses the main characteristics of the Program on International Health of the Pan American Health Organization that started in 1985. It describes the dynamics of the formative process in which the students are involved as well as the results of their academic work both as individuals and as a group. Emphasis is placed on the contribution of the Program to the discussion of the concept and practice of international health, and specifically to one of its basic areas: technical cooperation in health. Based on this analysis a main conclusion is presented: the need to strengthen the study of international health in the training programs in the schools of public health.

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts, the specification of a framework on the determinants of health status, the analysis of the mechanisms through which changes in health occur in populations, the characterization of the attributes that allow us to identify different transition models, and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time, an attempt is made to provide them with the necessary specificity to account for different national experiences, thus opening a space for future comparative research efforts. Through the systematization exercise presented in this paper, we hope to contribute to the progress of a topic that has gained growing importance during recent years. Such importance is due to the enormous potential that health transition theory has for understanding and transforming the growing complexity of our times.

The treatment and control of onchocerciasis in Mexico has been supported only on the administration of diethylcarbamazine and the removal of adult worms, which are in the onchocercomata. These actions seems to have diminished the prevalence and incidence of blindness in those individuals who are affected by this parasitosis. However, there has not been an important impact on onchocerciasis transmission. The objective of this paper is to critically analyze and discuss subjects related to diagnosis, treatment and control of onchocerciasis transmission in Mexico. Chemical vector control has been successfully achieved in other world regions; however, in Mexico, it has not been fully accepted as part of the integral onchocerciasis control due to several causes. Moreover, there has been few scientific research activities toward the search of new options for vector control. Recently, results of research on ivermectin (a microfilaricide agent) have indicated that this drug is effective and safe for the treatment of onchocerciasis. Additionally, it has been reported that ivermectin has an effect on the onchocerciasis transmission. However, there are several unanswered questions about the efficacy of ivermectin in stopping onchocerciasis transmission. In this report, the main efforts carried out in Mexico against onchocerciasis are analysed and problems related with diagnosis, treatment and control are also discussed. Some parameters for the correct evaluation of onchocerciasis control, with entomological emphasis, are proposed.

This paper discusses the results of the research work on medical technology in several countries by research teams whose goals are to prompt the exchange of information and support practical cooperation. Emphasis is placed on the work developed by the Pan American Health Organization, which has supported 45 research proposals on medical technology and stimulated the association of academic groups, national institutions and international agencies. The authors also describe the research activities of the team devoted to medical technology research at the National Institute of Public Health in Mexico.

To improve the procedures for cardiovascular health care in Mexico it is necessary to be able to perform accurate measurements of the cardiovascular parameters with appropriate equipment and to count with standard values for the Mexican population at the primary health level. Cardiac frequency (CF), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were analyzed in O2 consenting volunteers under resting (seated) and standing conditions as well as during exercise (30 sitting), and again after exercise under resurge conditions. A direct relation was found between CF, SAP and DAP with body surface and age. The orthostatic reflex (OR) diminished with age. Exercise increased FC, PAS and PAD, which decreased four-eight minutes after completing the exercise in those subjects under 30 years of age, where as in those aged 30 to 50 years these parameters did not return to their previous values. The RO decrement is more pronounced in men, although arterial pressure values are higher in women aged 30 to 50 years. Data followed a normal distribution curve, agreeing with the data reported for altitudes lower than that of Mexico City. Implementing the measurement systems described in this paper will allow early detection of pathology that might affect cardiac activity and arterial pressure that could be related to environmental pollution at the first level of medical attention.

This paper discusses the need to create specific programs for the training of researchers in epidemiology, a field that has traditionally been ignored by the graduate programs in public health. This is due, in part, to the emphasis that has been placed on the training of professionals in other areas of public health. The paper also includes the results of a consensus exercise developed during the curricular design of the Masters Program in Epidemiology of the School of Medicine of the National Autonomous University of Mexico. The technique used during the consensus exercise was the TKJ, which allows the presentation of ideas and possible solutions for a specific problem. This is probably the first published experience in the use of such a technique for the design of an academic curriculum. Taking as a base the general characteristics of the students, the substantive, disciplinary and methodological subjects were chosen. The results showed a need for a multidisciplinary approach based on modern methodologies of statistics and epidemiology. The usefulness of the results of the curricular design and the superiority of this method to reach consensus is also discussed.

In the last 25 years we have witnessed revolutionary changes in the field of health, particularly in the low and middle income countries. This paper discusses some of the new problems which need to be solved and some of the challenges which lie ahead. Among the former we can mention the financing of health care services and the provision of health care to an aging population. Among the latter we include the need for improvement of the quality of health services and the training of appropriate health manpower.