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Summary: Out-of-hospital cardiac arrest is a serious public health problem worldwide. The annual incidence is estimated at around 400 000 cases in Europe and the United States, and survival rates scarcely reach 10%. However, there is considerable variation between countries and even between regions that share a similar health care system within a single country. Information recorded by the Out-of-Hospital Spanish Cardiac Arrest Registry (OHSCAR) provides information on care provided by emergency ambulance services, final health outcomes after cardiac arrest cases (including variations), the possibility of organ donation, and the impact of the COVID-19 pandemic. This paper presents the OHSCAR report for Spanish emergency services for the year 2022.

Drawing on a mixed-methods cross-cultural study undertaken in five locations in Argentina, Denmark, Hong Kong, England and the United States in 2018, this paper explores how children (aged five and seven) conceive of playfulness. Following a card-sorting task, 387 children selected familiar activities that they felt were most representative of play and not-play and explained their reasons. The children's justifications were fully transcribed, and five corpora were created (one per site). Lexicometry was applied, generating sets of the characteristic responses per age in each site. In-depth qualitative interpretation of these modal responses revealed nine dimensions across play and not-play: pleasure, social context, materials, movement, agency, risk, goal, time and focus. Commonalities revealed that children's ideas around play are not aligned with specific activities but with the sense of agency in a secure physical and social context when carrying out an activity experienced as an end in itself. Implications for playful pedagogies highlight the need to open up play with opportunities for children's choice and initiative, confident exploration and immersion in the activities in which they participate. [Spanish translation by Mercè Rius.]

Introduction: Critical congenital heart disease (CCHD) is a term that refers to ductus-dependent structural anomalies of the heart that may be fatal or require invasive management in the first month of life., Objective: To know the prevalence and distribution of CCHD among newborns in Argentina, compared to other countries, and the proportion of prenatal detection and perinatal mortality., Material and Methods: Data provided by the National Network of Congenital Anomalies (Red Nacional de Anomalías Congénitas de Argentina, RENAC) for the 2009-2018 period and by other surveillance systems in the United States, Europe, and Colombia were used. For Argentina, the proportion of prenatal detection, perinatal mortality, and CCHD prevalence in newborns by jurisdiction and health system subsector were analyzed., Results: The prevalence of CCHD was 11.46 (95% confidence interval: 11.02-11.92) every 10 000 births. Prenatal detection was possible in 43.93% of cases, and perinatal mortality was 25%. Tetralogy of Fallot was the most frequent specific defect. The prevalence of CCHD and percentage of prenatal detection was significantly lower in the public subsector, whereas perinatal mortality was higher in this subsector. The prevalence of CCHD was lower than in the United States (NBDPN) and European (EUROCAT) registries. The Bogotá Registry showed different specific prevalence values., Conclusion: The prevalence of CCHD is lower than what has been observed in other countries, and even lower in the public sector of Argentina. The need to improve prenatal detection and implement pulse oximetry among newborns as a mandatory and universal screening is emphasized.

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.

The role that environmental factors can play in preventing and controlling the Covid-19 epidemic was explored and compared to that of influenza. Papers cited by the U.S. National Academy of Sciences were discussed, which indicate that temperature and humidity in the environment can influence the intensity of the spread of the disease. The fact that influenza viruses and coronaviruses appeared seasonally, prevailing in the winter and declining in the summer, was illustrated. It was discussed that ultraviolet light in the environment can contribute to the control of the spread of the virus. A study was cited to suggest that particulate matter contributes to increased infection mortality, and that it increases in summer in some regions, countering the health effects of humidity and temperature. Data generated by online electronic tools was compared with surveillance reports generated by the U.S. Centers for Disease Control and Prevention. The epidemic began stronger in northern hemisphere countries during the northern winter. (Evidence that the epidemic intensified during the southern winter is not disputed.) The incidence declined in the northern hemisphere during the summer, except for the U.S., where cases doubled. Evidence suggests that the high degree of SARS-CoV-2 infection counteracts the role that environmental factors may play in Covid-19 control.

Objective: this study examined scholarly output relating to nursing advocacy contributions toward influencing policy by authors in countries of the Pan American Health Organization., Method: the study utilizes a bibliographic analysis of papers indexed in Scopus authored by PAHO member state scholars. VOSviewer conducted coauthor and cooccurrence analysis to generate visualizations of the relationships between authors, countries of origin and keywords., Results: 7,773 papers with 21,523 authors met the inclusion criteria. An increase of publications on policy starting in 1962 was found. Co-authorship identified a fragile relationships structure with few authors bridging networks of collaboration. By country of origin, 22 of 35 member states contributed to policy literature; 17 in a connected network and 5 contributing but neither connected to peers nor other member states. Keyword analysis identified 20 specific data clusters., Conclusion: our findings are aligned with the Nursing Now Campaign. This bibliographic analysis provides an important benchmark into current policy advocacy activity in PAHO against which future progress in the region can be assessed. There is scope for greater collaboration amongst authors and this could be targeted toward engagement of nurses in member states not-yet or only partially active in this space.

Background: In the scientific literature, the impacts of plateletpheresis on leukogram parameters are not clear, with a high divergence in the studies that have evaluated changes in leukocytes. The objective of this paper was to meta-analyze the effect of plateletpheresis on the leukocyte count, based on studies published between 1980-2018., Methods: Systematic review with meta-analysis of random effects for the difference of means. The phases of the PRISMA guide were applied with 132 search strategies in Pubmed, Scielo, Science direct and Scopus. Reproducibility and evaluation of methodological quality were guaranteed. Heterogeneity was evaluated with Galbraith and Dersimonian and Laird's, publication bias with Funnel Plot and Begg; sensitivity analysis, accumulated meta-analysis and Forest Plot were carried out., Results: Nineteen studies were included with 2,358 donors, mostly from India, United States, Turkey, Germany and Austria. A mean difference of -0,80 x109⁄L (IC95%= -1,96; 0,36x109⁄L) between the predonation value and the value immediately after donation was founded; no publication bias was found and the conclusion presented good sensitivity since it does not vary with the elimination of studies in successive phases., Conclusions: The donation of platelets by apheresis does not affect the leukocyte count in the donors, in the last century there were reports of reductions in this parameter, explained by the blood loss in the cases used for the procedure and by effects produced in the blood cells by the biomaterials; however, at present the high safety of plateletpheresis for the white blood cell count is evidenced.

En: International guidelines recommend adapting military health care protocols to emergencies involving multiple intentional-injury victims in civilian environments. Adaptations can reflect similarities in types of injuries or issues of provider safety and that arise in military and some civilian emergencies. Because more experience with such incidents has been gained in the United States, most of the literature on this topic discusses emergency medical systems that differ from the ones operating in the autonomous communities of Spain, where varying resources and procedures are mandated by local authorities charged with preparing for emergencies. However, common elements are present, offering a framework and principles to apply when drafting evidence-based plans for effective, efficient response to multiple-victim emergencies. We think that participants at each point in the chain of survival must have clear missions and understand the roles they play in the various zones that comprise the scene of an emergency. Therefore this consensus paper attempts to define the relevant principles and roles for participants at all levels, from occasional first responders up to staff at trauma referral centers.

Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.

The high unemployment rates observed in the United States during the recent economic crisis, that moreover vary between ethnic groups, make it relevant to inquire into how this problem is linked to the mental health of employed and unemployed persons. Therefore, in this paper the relationship between unemployment and mental health among Mexican immigrants, Mexicans born in the US, and other Hispanics in comparison with non-Hispanic native whites and Afro-Americans in the US is analyzed. To achieve this objective prevalence, prevalence ratios and odds ratios for the population between 18 and 65 years of age in the labor force was calculated using data from the 1999 and 2009 National Health Interview Surveys. It was seen that in times of crisis the prevalence of Non-Specific Psychological Disorders (NSPD) in the labor force increased in all ethnic groups. The prevalence ratios indicate that the unemployed face a higher risk of suffering from NSPD than the employed, especially for the non-Mexican Hispanics. Mexican immigrants, in contrast, show the lowest risks.

Physicians have conducted research on syphilis for centuries, seeking to understand its etiology and the means of transmission as well as find ways to prevent and cure the disease. Their research practices often strayed from today's ethical standards. In this paper we review ethical aspects of the long history of research on syphilis with emphasis on the experiments performed in the 20th century. The description of research around the time of World War II covers medical experiments carried out in US prisons and in the experimentation centers established by Japanese doctors in occupied territory, as well as experiments in Nazi Germany and the treatment of syphilitics there., (Copyright © 2013 Elsevier España, S.L.U. and AEDV. All rights reserved.)

Nosocomial infections or infections related to health-care system have a great impact in the healthcare due to its high frequency and high morbidity and mortality they caused. Inside of them, there are the catheter-related bacteraemia. The paper of the nursing in the care and maintenance of the intravenous therapy is basic to avoid this type of infections. There has been demonstrated the efficacy of the implementation of catheter-related infections prevention programmes through a bundle of measures about the insertion, maintenance, surveillance and prevention of adverse events in the vascular access. The aim of this work is to show and emphasize the last updated recommendations collected in the 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections to nursing staff.

The Research Domain Criteria (RDoC) is an initiative of the National Institute of Mental Health of the United States of America, which based on research purposes consists of a new way of classifying mental disorders. His raison d'être is based on the conclusion that the knowledge progress of neurosciences does not seem to confirm the validity of the conventional psychiatric diagnoses. Furthermore, researching based on such diagnoses would weaken the progress in Psychiatry. Besides these scientific reasons, the Research Domain Criteria project is born within a political framework, giving raise to economic tensions. The objective of this paper is to discuss the first issue without avoiding the second one.

Since 2010 in the Autonomous Community of Andalusia passed into law ″derechos y garantías de la dignidad de las personas en el proceso de muerte″. At national level, in Spain, it's disputed the need to legalize this delicate aspect therefore already been made some projects for legalization. This advised to review the pros and cons of some legislative implementation experiences and case mix in countries where it has already occurred. This paper undertakes the study of the implementation of the Death with Dignity Act in Oregon and highlight is what were the immediate consequences and risks that has produced a law of this nature.

The study was aimed at identifying Latin-American countries' public policy which has been related to the social determinants of health. A topic review was thus made of papers kept in the 22 Latin-American countries' databases and official documents issued by their multilateral organisations and ministries of health. The World Health Organization's concept of the social determinants of health has been summarised and a history given of the pertinent work developed worldwide in regions such as Europe and Latin-America. Public policy regarding the field of study in Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, México and Venezuela has been described. It was concluded that Latin-America provides a panorama of inequality regarding the application of policy concerning the social determinants of health and that there was segmented intervention, mainly regarding intermediate determinants of health, without taking an integrated approach from different entrance points into account, according to the stated conceptual framework.

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.

Skin histopathology reports of melanoma routinely include important prognostic information used in the staging system of the American Joint Committee on Cancer (AJCC). This information, which influences disease management, includes tumor depth, presence of ulceration, number of mitotic figures, and presence or absence of microsatellites. However, numerous studies have found many other factors that are not included in the AJCC classification but that are nevertheless of prognostic significance. We discuss these factors in this paper., (Copyright © 2010 Elsevier España, S.L. y AEDV. All rights reserved.)

In public health services, the interest in sexuality seems to turning from traditional topics such as potential treatments for male erectile dysfunction, psychosomatic disorders, the control of premature ejaculation and contraception. Instead, an increasingly prominent role is being given to prevention strategies carried out by means of campaigns or through sexual health programme sin schools. The different teaching strategies that underlie these programmes, which in many cases lack social consensus but are often promoted by international organizations such as WHO or UNESCO, reveal not only divergent ethical conceptions and worldviews on the meaning of sexuality, but also conflicting starting points, means and goals, focusing either on barrier-contraceptive methods or on sexual abstinence and personal responsibility. There is therefore a pressing need to understand the scientific evidence underlying each educational approach and the ethical postulates of each pedagogical proposal. This paper presents an outline of a six-point adolescent sexuality education program, which is respectful of individuals' ethical convictions. Given that few works on preventive medicine issues include an ethical evaluation of the steps followed in their development, this article also proposes a systematic evaluation of strategies for sexual health in the community that is developed through four steps verifying the following aspects: 1) the accuracy of information, 2) the level of evidence, 3) efficiency and 4) non-maleficence about the target population of each health program. The methodology used in these sexual health programs is another aspect that will verify their ethical consistence or, conversely, their absence of ethical values. We emphasize the duty of designers of programme for children not to carry then out against the will of their parents or tutors, and not conceal sensitive and relevant information.

Dengue and dengue hemorrhagic fever in the Americas have been on the rise throughout the 1990s, with the highest number -over one million cases- reported in 2002. This paper analyzed the situation of dengue in the region and discussed the determining factors that account for the rise of the disease, making emphasis on socioeconomic factors, such as poverty, inequality, migrations and the lack of access to basic services, which are the most influential in perpetuating this disease in most countries. Considering that a safe and accessible vaccine is now unavailable, basic principles of vector control combined with political willingness, inter-sectoral involvement, active community participation and the tightening of health legislation were also examined as the only viable solution at present.

At the present time, care the patients safety during across the process of health is a priority target and determine the urgent necessity, to guarantee the satisfaction of their health needs, on best conditions as possible as it is, without complications for adverse events occurring in the medical attention. This paper purpose definition of different concepts like medical error, medical criteria, adverse and sentinel event, in order to define these concepts. Also try to show the sequence of events for a correct or incorrect medical decision, the consequent mistake and the possibility to produce an adverse event, with patient's damage. An important goal is that the medical practice is immersing in a biological paradigm, define like unpredictable, suitable, reactive and creative; very different to the exact science that has a predictable and structured paradigm, supported in mathematical rules. In the medical practice, each patient is an inedited situation and required all the knowledge, skills and experience in order to satisfy specific health needs, particularly in critical moments. The way for protect from the occurrence of medical error include the clinical practices guidelines, evidence-based medicine, the maintenance of professional competences by the continuous training, the close medical-patient relationship, integral approach of the illness and scrupulous data at the clinical record. In consequence, very often medical errors produce adverse events with damage of patients, or sentinel events with serious consequences of health, integrity or patient's life. Is important to say that the adverse events could be appear even without a medical error, just for failures in structural and systems issues, including resources and it's maintaining, organizational variables, communication, human resources, training programs, process without standardization, failures an supervision or control phases. This paper shows current adverse and sentinel events, and distinguish between the possibility of its measurement with good and standardized register systems.

Dentists who treat children must be alert to the possibility of finding diseases of the oral mucosa, especially in younger children. The present study aimed to review the most updated information and the experience of our group in order to yield epidemiological data that assist diagnosis of the most common diseases of the oral mucosa in children. Recent epidemiologic studies have shown a wide variability in the prevalence of oral mucosal lesions in different regions of the world and have led researchers to draw disparate conclusions. Moreover, studies have not been designed using standard criteria, further explaining the wide variability in the percentage of different groups of children with oral lesions, which ranges from 4.1 to 52.6%. The lesions most frequently considered by authors and that most often appear in the different studies are: recurrent aphthous stomatitis (0.9-10.8%), labial herpes (0.78-5.2%), fissured tongue (1.49-23%), geographic tongue (0.60-9.8%), oral candidiasis (0.01-37%) and traumatic injury (0.09%-22.15%). Dentists must be able to detect any of the numerous possible disorders and perform the correct differential diagnosis, key to the treatment plan. The aim of this paper, based on a review of the different national and international studies, is to contribute data on the most important oral mucosal diseases in the paediatric population in terms of prevalence and differential diagnosis.

Cardiovacular disease is the main cause of morbidity and mortality in hemodialysis (HD) patients. However, there are no reliable data neither on the prevalence of cardiovacular disease nor its risk factors in Spain. The Morbidity and mortality Anemia Renal study (MAR) is a two-year multicenter, open-label, prospective cohorts study. Its main objective is to assess the general morbidity and mortality, particularly of a cardiovascular cause, and its relationship with the degree of anemia. Secondary objectives are: a/ the description of current clinical practices in anemia, dialysis, vascular access, and CV risk factor management; and b/ the description of hospitalization and mortality causes. This paper describes the prevalence of cardiovascular disease and risk factors of the HD population in Spain. A total of 1.710 patients were included (60% male, aged 64.4 years, 16.2 months on HD). The mean co-morbidity Charlson index was 6.5 +/- 2.3. Cardiovascular disease was the most prevalent comorbidity, 16.7% had a coronary disease, and 13.9% had different degrees of heart failure, while 11.6% had arrhythmia, 1.7% stroke and 5.5% peripheral artery disease. The prevalence of hypertension was 75.8%, 74.4% of patients received antihypertensive drugs, and still 40% of patients had an inadequate blood pressure control. The investigators considered as dyslipidemic 34.1% of patients, and prescribed treatment to 69.5% of them, while the remaining 30.5% (10.4% of the total) had hyperlipidemia with no drug therapy. Eleven percent was active smoker, and 26.6% former smoker. There was 47.4% of patients with a corporal mass index above 25. Secondary hyperparathyroidism with PTH above of 300 pg/ml was present in 22.2% of patients. Despite the EBPG and K-DOQI recommendations, only 68.8% of prevalent hemodialysis patients attained a hemoglobin (Hb) above 11 g/dl, 89.4% ferritin levels above 100 ng/ml, 66.5 degrees/a a transferrin saturation index (TSI) above 20%, and 61.1% met all three objectives. In summary, this first cross-sectional analysis has allowed us to know in detail the standard practice in multiple aspects of management of HD population in Spain. It has also established clear differences in the prevalence of cardiovascular disease and risk factors from the US registries. Last but not least we have identified therapeutic opportunities to improve the course and prognosis of our patients.

The health sector is particularly vulnerable to naturally occurring events. The vulnerability of the health infrastructure (hospitals and clinics) is of particular concern. Not only are such facilities vulnerable structurally, but their ability to continue to provide essential functions may be severely compromised, thus leaving the stricken population without essential services. This paper summarizes a more detailed document, Guidelines for Vulnerability Reduction in the Design of New Health Facilities published by the Pan-American Health Organization (PAHO)/ World Health Organization (WHO). The current document summarizes these Guidelines emphasizing how they may be used, by whom, and for what purpose. Potential users of the Guidelines include, but are not limited to: (1) initiators of health facility construction projects; (2) executors and supervisors of health facility construction projects; and (3) financing bodies in charge of funding health facility construction projects. The Guidelines include: (1) implications of natural phenomena upon the health infrastructure; (2) guidelines for vulnerability reduction for incorporation into development project cycles; (3) definitive phases and stages within the phases for development projects including: (I) Projects Assessment (needs assessment; assessment of options, the preliminary project); (II) Investment (project design, construction); and (III) Operational Activities (operations and maintenance). In addition, investment in damage reduction measures, policies and regulations, training and education, and the role of international organizations in the promotion and funding of mitigation strategies are addressed.

Science is a complex human activity that is modeled by a myriad of factors beyond the researcher's control, especially in the medical sciences, where human and economic resources, as well as bioethical and regulatory factors play an important role. Bioethical and regulatory factors are similar between the US, Canada and Mexico, however these countries differ markedly in their economic and human resources: In Canada and the US there are government institutions (CIHR and NIH, respectively) to specifically provide funding to health research, while in Mexico the principal source of funding for all sciences is the National Council for Science and Technology (CONACYT). The NIH budget for clinical research alone during 2002 was over 7 US billion dollars; the CIHR funding for health research projects was approximately 300 US million dollars, while the support from CONACYT for research and infrastructure in health was aproximately 70 US million dollars. In the year 2000, the US had 8.17 researchers in all areas per 1,000 habitants--of the economically active population (EAP)--, Canada had 5.78 and Mexico 0.55 researchers. These factors impact greatly the scientific productivity: While Canada and the US contributed in 1991-1998 with 31.4% of the world's scientific productivity--measured as the number of articles published--, Latin America contributed with only 2.4% of the world's productivity. This paper also discusses other factors that model science, scientific inquiry, and scientific activity such as, the role of the industry, the media and scientific journals. How these factors influence the Medical Sciences in North America is exemplified herein.

From 1927 on, a series of technological innovations revolutionized the study of yellow fever, leading to a re-conceptualization of the disease. The Rockefeller Foundation (RF) was at the vanguard of these developments, which made specialized laboratories an imperative. This paper explores the activities of the RF yellow fever cooperative programme in Colombia and their consequences, and shows how the RF constructed yellow fever as a continental problem and a public health priority for the American republics, investing heavily in basic research - its primary interest-, thus deviating attention and resources from other pressing health needs. At the same time, Colombian health authorities gained legitimacy through the prestige and resources of the programme, and were in a better position to advocate the role of research in national public health.

Objective: To develop a neuropsychological test battery in Spanish for the cognitive evaluation of HIV 1 infected patients., Development: Departing from the suggestions presented by the work group of the National Institute of Mental Health (USA), a neuropsychological assessment battery was developed. It was named HUMANS (HIV/University of Miami Annotated Neuropsychological test battery in Spanish). This battery includes the following domains: 1) attention and speed of processing information, 2) memory, 3) executive function, 4) language, 5) visuospacial/visuoconstructive abilities, and 6) motor abilities. Administration takes about 3 4 hours. The English parallel version of this battery has been successfully used in English for over a decade with HIV 1 infected patients. In the paper the development and adaptation to Spanish language of the HUMANS neuropsychology section is presented., Conclusions: HUMANS neuropsychological test battery fulfill the recommendations presented by the work group of the National Institute of Mental Health for evaluating HIV 1 infected patients. Studies regarding validity and reliability are still required.

For a decade, state and federal agencies have worked jointly with communities throughout the USA, with the objective of measuring the health-risk from lead pollution in residential zones. Often these communities have been linked with facilities previously associated with activities like mining and metallurgy; nevertheless, there are other industries like paint manufacturing and battery recycling, that have also been identified as lead pollution sources. The vast experience in cleaning up the contaminated sites has shown that ample programs designed to identify and handle the exposure routes can help, in an effective manner, to diminish blood lead levels (BLL) in susceptible populations, such as in young children. Environmental intervention programs are more effective when the affected communities carry out health education/intervention programs, geared towards the development of individualized strategies for handling the risk implied by the presence of lead in the atmosphere. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Lead regulations and standards have resulted in a lower exposure to lead in the general population of the United States of America. This paper highlights some of the know-how developed through lead-containing experiences, particularly regarding lead content in air and water. The availability of a solid and clear scientific knowledge is central to the success of these policies. Collateral effects of some air-related standards show the extent to which problem-oriented efforts may be beneficial in other areas, inasmuch as they may have untoward consequences if careful planning and evaluation are not considered. Finally, this paper presents a discussion of the differences between centralized and decentralized approaches to lead exposure control. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Art and Medicine, in some occasions have singular contact points. An example of this is the life of the North American writer Pearl S. Buck, a Litterature Nobel Prize winner in 1938, and her relation with phenylketonuria and mental retardation. The present paper is a biographical sketch of this brilliant writer, whose only daughter had phenylketonuria, an inborn error of metabolism of low frequency. If this disease is not treated, it may cause mental retardation. At the same time, we point out some of the highlights of the discovery of this disorder in Norway in 1934, and the description of its first treatment in 1953. At the present time, the mental retardation that this disease causes, can be prevented by means of the neonatal screening.

It exists controversies about if the effects and benefits of the esterified estrogens could be similar to those informed for equines, because its chemical composition and bioavailability are different. Esterified estrogens has not delta 8,9 dehydroestrone, and its absorption and level of maximum plasmatic concentrations are reached very fast. In United States of America and another countries, esterified estrogens has been marketed and using for treatment of climacteric syndrome and prevention of postmenopausal osteoporosis, based on the pharmacopoiea of that country, but the Food and Drug administration (FDA) has not yet authorized up today, a generic version of conjugated estrogens. In Instituto Mexicano del Seguro Social (IMSS) and another institutions of health sector in Mexico, starting in year 2000, it has been used esterified estrogens for medical treatment of climacteric and menopausal conditions. For this reason, in this paper we revised the most recent information about pharmacology, chemical composition, clinical use and costs of the conjugated estrogens with the purpose to guide the decisions to purchase this kind of drugs in Mexican heath institutions.

Conflicting results have been published during the past three decades regarding the cut points for the diagnosis of diabetes and glucose intolerance. Two major consensus changed the diagnostic values; the last revision occurred in 1997. After the publication of the new criteria, the controversy grew. New evidence was published demonstrating that the new cut points were inappropriate. The purpose of this review paper is to summarize the currently available information useful to evaluate the sensibility and specificity of the diagnostic criteria and to discuss the difficulties to define properly the cut-points for the diagnosis of diabetes and glucose intolerance.

Health care professionals, specially physicians, are frequently exposed to end of life situations that interfere with the traditional processes patient care. The right to die has become an important movement that calls for self-determination with outcomes related to the legalization of physician assisted suicide in various countries. In this paper the 1997 resolution approved by the American Medical Student Association is examined in relation to the criteria to be considered in situations of legal assisted suicide. Some arguments regarding the legalization of physician-assisted suicide as well as its impact in the contemporary practice of medicine are also identified. A description of current legislation in the area is exposed. Presently there is no legislation regarding physician-assisted suicide in Puerto Rico.

This work stems from a brief visit in 1993 to the Canadian health services as part of the PAHO International Health Training Program and the subsequent research, discussion, and analysis relating to that experience. By no means is this paper an exhaustive account of the system, but rather a close look at one of its aspects: financing. The main objective is to identify some of the virtues and limitations of a health system that is considered one of the most efficient, effective, and equitable in the world. Although the Canadian health system is financed by the federal government and the provincial governments, cost containment is a constant concern, since factors such as the growing use of highly complex technologies, hospital care, and long-term treatment of chronic and degenerative illnesses tend to increase costs. The progressive reduction in the federal budget has lead to more efficient use of resources and the rationalization of installed capacity. At the same time, the relative simplicity of the system's operation has permitted administrative costs to be kept low. In addition, alternative forms of care, such as local centers for community-based care, care at home and in special institutions to promote the maximum level of self-sufficiency, and the use of volunteers, have been devised in order to partially control cost increases. The people's participation in planning and decision-making permit them to guide the development of the health services. Nevertheless, given the current situations, it is essential that the system be modified to prepare it for the challenges the twenty-first century will bring.

The three countries that have signed the North American Free Trade Agreement (NAFTA) have focused particular interest and concern on the potential impact that this agreement will have on the environmental health, based on the premise that economical development should not detriment neither the environment nor the human health. In this paper, the NAFTA is presented as an opportunity to improve environmental and occupational health in Mexico and assumes that the study of the potential impact of NAFTA could help to find the solutions of the former and actual environmental health problems. From this perspective, the north-border maquila industry is analyzed as a case study for the purpose of identifying and predicting the impact of NAFTA on environmental and the occupational health. Preventive as well as control measurements are suggested. The general characteristics of the U.S.-Mexico border and the maquila industry are presented. The lack of both social investment and urban planning along with population and economical growth are described. An explanation of the impact that these factors have had on the environmental and occupational problems is discussed. Special emphasis is given to the human health problems including that of water, air and soil contamination by industrial toxic residues. Also, some possible health impact of NAFTA are outlined. Finally a sustainable developmental intervention is suggested, based on NAFTA as an opportunity to take advantage of coming structural changes that will improve the environmental health conditions at the northern-border and in the entire country.

In this paper are discussed essential issues about the concept, characteristics and general functions of sanitary regulation, as well as the principles and main lines of action contained in the Program of Modernization of the Sanitary Regulation, which is being implemented by the Ministry of Health of Mexico. In addition, some considerations are offered regarding the supporting role of such a program, in the context of the free trade era that Mexico is undergoing. After 40 years of an outdated sanitary regulation based in a non-functional licensing concept, the new and improved scheme relies on several ammendments to the General Health Law. Thus, the present approach, focuses on a set of flexible, simple and efficient rules, strengthened by proven scientific and technical procedures.

This paper discusses recent trends concerning the commercialization of pesticides in Mexico and focuses on organophosphates and their potential health risk impact. It points out the existing lack of knowledge on health effects associated to chronic exposure to organophosphate pesticides. A need for both toxicological and epidemiologic studies of chronic exposure is identified. Regulatory programs for pesticides in Mexico and the United States are also compared. The paper also addresses the possibility of effective enforcement of environmental and health regulations in Mexico as a result of more rigorous surveillance under NAFTA.

In this paper we study the general mortality trends by cancer in Spain (1951-1987), and also by sex and age groups. We focus on lung cancer, establishing comparisons with USA, England and Wales. We appreciate on the general mortality trend that only young age groups show a higher decrease, while in other countries this decrease was also in old age groups. We observed a lower mortality trend in Spain by lung cancer than in the other countries, however increasing the rates in both sexes and more in males. That evolution could be related with the evolution of cancer risk factors and especially lung cancer. On concluded that the general mortality trend in Spain is the same than other developed countries but with some delay in the evolution, when comparing lung cancer. Spain is now in an increasing phase and USA, England and Wales have stabilized their rates and begin to decrease their trends.

Background: Physicians' legal liability regarding malpractice has reached a previously unknown importance in Spain. This paper brings forward some statistical data on judicial claims presented by patients and their relatives., Methods: The whole of resolutions of the First and Second Court of the Supreme Court were collected between 1870 and 1992. In Madrid, the number of lawsuits in proceedings were obtained from a sample of the Courts at the Plaza de Castilla in April 1990, and figures on legal complaints, accusations and demands were obtained through consultations at the Medical College., Results: The great majority of verdicts, both in Civil and Penal Jurisprudence, correspond to the last 13 years. In Madrid, the average of penal cases in proceedings was 3.8 per Court, and an appreciable increase of claims can be noticed, with an annual rate of about 0.4 per 100 physicians., Conclusions: Appealing to Justice in order to accuse a practitioner for presumed malpractice is no longer an unusual event. Various reasons contribute in this respect. However, other reasons exist to consider the Spanish situation very far from the level in the United States of America.

The assessment of skinfold thickness has been used to estimate protein reserve through arm muscle area (AMA) and through arm fat area (AFA) it can assess caloric reserve. The aim of this paper is to compare trends of AMA in pre-school children living in Tijuana with american children of the same ages. This study has been accomplish in pre-school children attending to the Federal Education System. Through a randomly sample it was chosen 30 school, afterwards in systematic was done to assess 900 children aged 48 to 78 months old. This studied variables were: weight, height, arm circumference and triceps skinfold thickness, obtained according to accepted techniques at the international literature. From which were created AMA and AFA, according to formulas already described. A multiple regression model was obtained from AMB to height, between expected and experimental values. Using analysis of variance to determined differences between slopes and intercepts. In this paper are shown the statistics and distributions for AMA and AFA. Correlations for reference and experimental values were linear and no significant differences were observed between the slopes and intercepts of the set of data. These results suggest that form the point of view considering AMA, growth rate between Tijuana children and American similars are apparently the same at this ages.

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.

In this paper the role of efficiency in health care delivery is discussed. In the first part several definitions of efficiency are presented and the most common efficiency analysis are described. In the second part of the paper some experiences aimed at improving the efficiency of health care delivery in England, Latin America and Mexico are discussed. Finally, the author presents four proposals for the improvement of efficiency of health care delivery in Mexico: monetary reward associated to performance, alternative organization of health services, investment in management training for health manpower, and operational research in the health systems.

The present paper reviews the epidemiology of peptic ulcer in the United States based on national statistics available through the National Center for Health Statistics and other federal or private institutions. About 5 million people currently have a peptic ulcer disease. More than 95 percent ever saw a physician for their disease, 65 percent visited their physician during the past year and 65 percent were currently under treatment for peptic ulcer disease. On the average, the ulcer led to 2.5 weeks of restricted activity per patient. About one week per patient was spent in bed due to the ulcer disease. The total number of physician visits for peptic ulcer ranged between 2 and 5 million per year. About 600,000 persons were discharged annually from hospitals with the diagnosis of peptic ulcer. In half of these discharges peptic ulcer was listed as primary diagnoses leading to 2.2 million hospital days or one week per case. Peptic ulcer was the primary cause of death in 6,700 subjects per year corresponding to a death rate of 28 per million living population. It was mentioned as secondary diagnosis on the death certificate of additional 11,000 people. Almost all US statistics revealed a marked decline in the occurrence of peptic ulcer during the past three decades. The decline affected all ulcer types, both sexes, and all races. It did not appear to be markedly influenced by any major medical improvements achieved in treating peptic ulcer disease.(ABSTRACT TRUNCATED AT 250 WORDS)

This paper compares the normative point count of the Parenting Inventory for Adults and Adolescents (PIAA) with the points of the fathers of a family (n = 336) and adolescents (n = 357) in the city of Guadalajara. The comparisons were studied in the four dimensions of paternity which have proven clinically and experimentally valid for detection of child abuse and maltreatment. An analysis of the points obtained by fathers of children in private and public schools, as well as the points acquired by Mexican female adolescents were compared with white and black adolescents (in USA), as well as pregnant and non-pregnant ones. The object of the study was to know the point count of Mexican females on the PIAA, and contrast the count with those considered normative and those of pregnant adolescents, who are considered a high risk due to paternal abuse. The results show the Mexican fathers acquire less points with respect to the adolescents, when compared with the respective normative tables. The significance of these facts of low point count is discussed in terms of identifying child abuse and maltreatment in the Mexican child population of different social and economic strata as compared with other risk groups.