Soberanía alimentaria y cambios en la dieta en México 1961-2009. Una primera aproximación a partir de los datos sobre consumo aparente de la FAO

El trabajo que se desarrolla a continuación persigue un doble objetivo: por una parte, realizar una primera aproximación a los cambios que se han producido en la dieta de la población de México en los últimos 50 años. Unos cambios que se desarrollan en el contexto de la denominada transición nutricional, y que, como tendremos ocasión de constatar, adoptan en países en desarrollo como México unas características que no se ajustan totalmente al modelo de transición que en su momento determinaron las transformaciones experimentadas por los países de la Europa noroccidental. En segundo lugar, evaluar y analizar el proceso paralelo de progresiva pérdida de la soberanía alimentaria y de globalización de la dieta experimentada por México. Desde los años 1960 la dieta de las poblaciones centroamericanas se ha transformado de forma espectacular. En el marco de la llamada transición nutricional se ha producido un aumento del consumo de energía y nutrientes, a la vez que se ha modificado su procedencia tanto en lo que concierne a los productos como al lugar donde han sido producidos y la forma en que han sido procesados previamente. En concreto, se constata la reducción del consumo y aportación nutritiva de algunos integrantes tradicionales de la dieta, como los frijoles, en beneficio de otros productos vegetales como la patata, y especialmente de productos de origen animal como la carne de pollo, la leche o los huevos. Destacar la creciente importación directa e indirecta de alimentos básicos, como el maíz, componente importante de la dieta humana y de la alimentación de la creciente cabaña ganadera donde se destinan gran parte de las disponibilidades. Finalmente se analiza el impulso que desde la perspectiva de la oferta alimentaria disponible suponen en este proceso las medidas liberalizadoras que siguen a la crisis de la deuda externa de 1982 y la entrada en vigor del NAFTA en 1994.

Communication skills training in oncology: a position paper based on a consensus meeting among European experts in 2009.

BACKGROUND: Communication in cancer care has become a major topic of interest. Since there is evidence that ineffective communication affects both patients and oncology clinicians (physicians and nurses), so-called communication skills trainings (CSTs) have been developed over the last decade. While these trainings have been demonstrated to be effective, there is an important heterogeneity with regard to implementation and with regard to evidence of different aspects of CST. METHODS: In order to review and discuss the scientific literature on CST in oncology and to formulate recommendations, the Swiss Cancer League has organised a consensus meeting with European opinion leaders and experts in the field of CST, as well as oncology clinicians, representatives of oncology societies and patient organisations. On the basis of a systematic review and a meta-analysis, recommendations have been developed and agreed upon. RESULTS: Recommendations address (i) the setting, objectives and participants of CST, (ii) its content and pedagogic tools, (iii) organisational aspects, (iv) outcome and (v) future directions and research. CONCLUSION: This consensus meeting, on the basis of European expert opinions and a systematic review and meta-analysis, defines key elements for the current provision and future development and evaluation of CST in oncology.

Taking care of the most vulnerable : a descriptive study of patients with 12 attendances or more at a Swiss university hospital emergency department in 2009

Introduction: Patients who repeatedly attend the Emergency Department (ED) often have a distinct and complex vulnerability profile that includes poor somatic, psychological, and social indicators. This profile has an impact on the patients' well-being as well as on hospital costs. The objective of the study was to specify the characteristics of hyper users (HU) and explore the connection with ED care and hospital costs. Methods: The study sample comprised all adult patients with 12 or more attendances at the ED of the Lausanne University Hospital in 2009. The data were collected by retrospectively searching internal databases to identify the patients concerned and then analysing the profiles of these patients. Information gathered included demographic, somatic, psychological, at-risk behaviour, and social indicators, and health system consumption including costs. Results: In 2009, 23 patients (0.1%) attended 12 times or more (425 attendances, 0.8%). The average age was about 43 years, 60.9% were female, and 47.8% single. Of these 95.7% had basic insurance, 87.0% had a general practitioner, and 30.4% were under legal guardianship. The majority attended in the evening or at night (67.1%), and almost one quarter of these attendances resulted in inpatient treatment (24.0%). Most HU had attended the ED in previous years too (95.7% in 2008). The most prevalent diagnoses concerned 'mental disorders' (87.0%). About 30.4% of patients had attempted suicide (all were female patients). Other frequent diagnoses concerned 'trauma' (65.2%), and the 'digestive' and the 'nervous system' (each 56.5%). At-risk behaviour such as severe alcohol consumption (34.8%), or excessive use of medicines (26.1%) was very frequent, and some patients used illicit drugs (21.7%). There was only a weak association between the number of ED attendances and the resulting costs. However, a reduction of one outpatient visit per patient would have decreased ED outpatient costs by 8.5%. Conclusions: HU often have a particularly vulnerable profile. Mental problems are prevalent among them, as are at-risk behaviour and severe somatic conditions. The complexity of the patients' profiles demands specific care that cannot be guaranteed within an everyday ED routine. The use of an interdisciplinary case management team might be a promising approach in diminishing the number of attendances and the associated costs, although the profiles of HU are such that they probably cannot completely give up ED attendance.

Rhumatologie [Rheumatoid arthritis and ankylosing spondylitis-rheumatologic highlights 2009]

In this year rheumatology highlights, we will especially note a new treatment, the tocilizumab, an interleukin-6 targeting therapy, effective and adequately safe for the treatment of rheumatoid arthritis. New classification criteria for axial spondylarthropathy have also been published, criteria that should facilitate earlier diagnosis, a diagnosis that should be pursue like a diagnosis of rheumatoid arthritis even in the absence of an inflammatory biological syndrome.

Representaciones de la mujer inmigrante en el cine español contemporáneo (1990-2009)

Este trabajo propone un proyecto de investigación cualitativa sobre las representaciones de la mujer inmigrante en el cine español contemporáneo (1990-2009) y establece un marco teórico que constituye la contextualización y el punto de partida del estudio propuesto a partir de un análisis del status quo de la inmigración femenina en nuestro país. En el marco de la creciente feminización del discurso sobre la inmigración, se efectúa un repaso a losprincipales datos estadísticos referentes a la mujer inmigrante y se realiza un recorrido por las representaciones y las imágenes sociales que de ella transmiten el cine -medio en el que se centrará específicamente la investigación- y los medios de comunicación, en susvertientes periodística y de ficción, a través del análisis de sus respectivos discursos por el impacto que éstos tienen en la opinión pública. Los resultados muestran una notable invisibilidad de la mujer inmigrante y una representación marginal y discriminatoria de la misma

Un pueblo silenciado: el movimiento nacionalista saharaui en la agenda de la prensa nacional española (1970-2009)

El Sáhara Occidental, el último territorio del mundo pendiente de descolonización, hasufrido durante treinta años el olvido de España y la invasión marroquí. Por ello, elmovimiento nacionalista saharaui ha intentado acceder a la agenda política ymediática española para obtener una solución política al conflicto y el apoyo de laopinión pública de nuestro país.El presente proyecto de investigación propone un acercamiento totalmente inédito; el conflicto saharaui desde el punto de vista comunicativo. A través de las teorías de la agenda-setting y el framing se propone analizar qué marcos políticos ha construido el movimiento saharaui a lo largo de los últimos treinta años y qué incidencia ha obtenido en la prensa nacional española a través de los marcos mediáticos.

Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS.

BACKGROUND: No data on long-term outcomes of survivors of 2009 influenza A(H1N1) (A[H1N1])-associated ARDS are available. The objective of this study was to compare the 1-year outcomes of survivors of A(H1N1)-associated ARDS, according to use or no use of extracorporeal lung assist (ECLA), using its need as an ARDS severity surrogate. METHODS: Survivors of ARDS (12 with ECLA use vs 25 without, corresponding to 75% and 54% of the eligible patients for each group, respectively) selected from the Réseau Européen de Ventilation Artificielle (REVA) registry had previously been healthy, with only pregnancy and/or moderate obesity (BMI ≤ 35 kg/m²) as known risk factors for A(H1N1) infection. Lung function and morphology, health-related quality of life (HRQoL), and psychologic impairment were evaluated. RESULTS: At 1 year post-ICU discharge for the ECLA and no-ECLA groups, respectively, 50% and 40% reported significant exertion dyspnea, 83% and 64% had returned to work, and 75% and 64% had decreased diffusion capacity across the blood-gas barrier, despite their near-normal and similar lung function test results. For both groups, exercise test results showed diminished but comparable exercise capacities, with similar alveolar-arterial oxygen gradients at peak exercise, and CT scans showed minor abnormal findings. HRQoL assessed by the 36-Item Short-Form Health Survey was poorer for both groups than for a sex- and age-matched general population group, but without between-group differences. ECLA and no-ECLA group patients, respectively, had symptoms of anxiety (50% and 56%) and depression (28% and 28%) and were at risk for posttraumatic stress disorder (41% and 44%). CONCLUSIONS: One year post-ICU discharge, a majority of survivors of A(H1N1)-associated ARDS had minor lung disabilities with diminished diffusion capacities across the blood-gas barrier, and most had psychologic impairment and poorer HRQoL than a sex- and age-matched general population group. ECLA and no-ECLA group patients had comparable outcomes. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01271842; URL: www.clinicaltrials.gov

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Relatório Estatístico 2009 Ministério de Saúde

A informação estatística que compõe este relatório é o resultado da recolha activa e da transmissão de dados produzidos pelas Delegacias de Saúde, pelos Serviço de Vigilância Epidemiológica, Programa Nacional de Saúde Reprodutiva e Programa Nacional de Luta contra a Tuberculose da Direcção Geral da Saúde, Hospitais Dr. Agostinho Neto e Dr. Baptista de Sousa, Hospitais Regionais de Santa Catarina, São Filipe e Ribeira Grande e Direcção Geral de Farmácia (DGF). Os dados de mortalidade e de outros recursos para a saúde são recolhidos e tratados pelo Serviço de Estatística do GEPC/MS. Várias informações foram incluídas em seis capítulos. O primeiro que apresenta dados demográficos com informações seleccionadas produzidas pelo Instituto Nacional de Estatística (INE). No segundo, as informações de Mortalidade do Serviço de Estatística do GEPC são apresentadas por local de residência e não por local do óbito. Para o capítulo do Programa de Saúde Reprodutiva - Cobertura de Serviços de Saúde apresentam-se resultados globais do inquérito de cobertura vacinal realizado pelo Ministério da Saúde em Abril de 2010. O capítulo quarto é semelhante aos relatórios anteriores que é composto com as informações da capacidade instalada da Rede Hospitalar do país e funcionamento. O quinto capítulo apresenta os recursos humanos disponíveis, a infra-estrutura de saúde, a assistência farmacêutica e os gastos com medicamentos e sua distribuição, seguido do capítulo que apresenta a série histórica dos Indicadores do Milénio para o Desenvolvimento. Para finalizar o anexo traz notas explicativas para as tabelas, gráficos, assim como a descrição dos principais indicadores. Tanto no capítulo da morbilidade como no do funcionamento de serviços foram incluídas informações provenientes do banco de dados sobre evacuações referentes a 2009. Sempre que foi possível apresentaram-se séries evolutivas referentes aos últimos dez anos. Espera-se que esse relatório seja útil para os responsáveis da saúde e comunidade sobre as decisões a serem tomadas. A leitura e análise das informações reportadas em tabelas e gráficos fornecem subsídios motivadores para acompanhar a Política Nacional de Saúde, a implementação do PNDS e o entendimento de que dados padronizados e ágeis também salvam vidas.