La medicina Xinesa a la Xina contempor��nia

La medicina occidental ��s la imperant a tot el planeta. Malgrat tot, a la Xina la medicina tradicional hi t�� un pes important. La conviv��ncia entre totes dues visions de la salut i la malaltia -l'occidental i l'oriental- no ��s senzilla. En aquest treball es fa un recorregut pel sistema de salut xin��s per a fer una aproximaci�� a la situaci�� de la medicina xinesa a la Xina contempor��nia.

��tica y muerte digna

This book is an study about the bill of Death with Dignity Act, written by the Andalusian Commission on Healthcare Ethics and Research. The aim of the Act would be to ���establish the criteria and conditions to be adopted by the health system to guarantee adequate healthcare during life���s final process based on the prevention of suffering and respect for each person���s dignity and free choice���.

Gu��a metodol��gica para la elaboraci��n de planes de igualdad en entidades del Sistema Sanitario P��blico de Andaluc��a (SSPA)

Currently equality plans are an effective tool to incorporate equal opportunities in human resource management of both companies and public administrations. They are also the appropriate mechanism to detect possible disparities and gender gaps in employment. Configured as an ordered set of actions and measures taken after a diagnosis of the situation and help organizations to promote equal treatment and opportunities between women and men in the workplace, and help eliminate discrimination based on sex. In this regard, the Directorate General of Health Planning and Innovation of the Ministry of Health, intends to promote and facilitate the development and implementation of equality plans in institutions and centers of the Andalusian Public Health System. This has raised the production and dissemination of a methodological guide that supports the design of equality plans in unison to allow both the completion of the monitoring process as the development and practical implementation of those plans.

Mapa de indicadores para integrar la perspectiva de g��nero en el Sistema Sanitario P��blico de Andaluc��a (SSPA)

Organizadores: AFOE (Asociaci��n para la Formaci��n, el Ocio y el Empleo)y Grupo MIDO (M��todos de Investigaci��n y Diagn��stico en Orientaci��n). Facultad de Ciencias de la Educaci��n. Universidad de Sevilla. Web del Congreso: http://www.empleoeigualdad.es/congreso/

Modernitzaci�� tecnol��gica, canvi organitzatiu i serveis als usuaris en el sistema de salut de Catalunya. Informe de recerca (volum III)

Aquest estudi va analitzar la interacci�� del canvi organitzatiu, els valors culturals i el canvi tecnol��gic en el sistema sanitari catal��. L'estudi se subdivideix en cinc parts diferents. La primera ��s una an��lisi de contingut de webs relacionats amb la salut a Catalunya. La segona ��s un estudi dels usos d'Internet en q��estions relacionades amb la salut entre la poblaci�� en general, les associacions de pacients i els professionals de la salut, i es basa en un sondeig per Internet adaptat a cada un d'aquests grups. La tercera part ��s un estudi de treball de camp dels programes experimentals duts a terme pel Govern catal�� en diverses ��rees i hospitals locals per a integrar electr��nicament la hist��ria cl��nica dels pacients. La quarta ��s un estudi de les implicacions organitzatives de la introducci�� de sistemes d'informaci�� en la gesti�� d'hospitals i centres d'assist��ncia prim��ria a l'Institut Catal�� de Salut, el principal prove��dor de salut p��blica a Catalunya, i es basa en un sondeig per Internet i entrevistes en profunditat. La cinquena part ��s un estudi de cas dels efectes organitzatius i socials de la introducci�� de les tecnologies de la informaci�� i la comunicaci�� en un dels principals hospitals de Catalunya, l'Hospital Cl��nic de Barcelona. L'estudi es va dur a terme entre el maig del 2005 i el juliol del 2007.

Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006

Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (~ 51.2%). When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9%) appeared at the top of the list, followed by candidiasis (30.2%), histoplasmosis (10.1%) and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

Situation et enjeux sanitaires aux Seychelles en 2012

Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have largely completed their demographic and epidemiologic transitions. Major investments in infrastructure and social services have fostered steady economic growth. Health care and education are free. The predominance of chronic non-communicable diseases and rapid aging of the population nonetheless present significant challenges for public health and the health system. Like the other small island states in the region, the Seychelles continue to be threatened by arbovirus outbreaks. Health indicators are good, but the geographic isolation, the small and aging population, and limited resources make a major challenge maintaining and sustaining an effective workforce of health professionals, a constantly evolving technical platform, and increasing amount of medications particularly in view of the increasing burden of chronic diseases.

The prevalence of schistosomiasis in school-aged children as an appropriate indicator of its prevalence in the community

School-aged children (6-15 years) from the endemic area of Pernambuco were evaluated both as a target group for and an indicator of schistosomiasis control in the community. Parasitological data were drawn from baseline stool surveys of whole populations that were obtained to diagnose Schistosoma mansoni infection. Nineteen representative localities were selected for assessing the prevalence of schistosomiasis among individuals in the following age groups: 0-5, 6-15, 16-25, 26-40 and 41-80 years. For each locality, the prevalence in each age group was compared to that of the overall population using contingency table analysis. To select a reference group, the operational difficulties of conducting residential surveys were considered. School-aged children may be considered to be the group of choice as the reference group for the overall population for the following reasons: (i) the prevalence of schistosomiasis in this age group had the highest correlation with the prevalence in the overall population (r = 0.967), (ii) this age group is particularly vulnerable to infection and plays an important role in parasite transmission and (iii) school-aged children are the main target of the World Health Organization in terms of helminth control. The Schistosomiasis Control Program should consider school-aged children both as a reference group for assessing the need for intervention at the community level and as a target group for integrated health care actions of the Unified Health System that are focused on high-risk groups.

La transition des soins p��diatriques aux soins adultes des adolescents souffrant d'affections chroniques. [The transition from pediatric to adult care of chronically ill adolescents]

Bien que la transition des soins p��diatriques aux soins adultes soit extr��mement importante pour les adolescents souffrant de maladies chroniques, celle-ci se limite le plus souvent �� un simple transfert. L'objectif de cet article est de d��crire les barri��res au bon d��roulement de la transition du point de vue du patient et de sa famille, des professionnels de la sant�� et du syst��me de soins; de d��tailler les ��l��ments cl��s pour que la transition soit la moins traumatique possible; et d'��noncer les diff��rentes approches propos��es dans la litt��rature. [Abstract] The transition from pediatric to adult care of chronically ill adolescents Even though the transition from pediatric to adult health care is extremely important for chronically ill adolescents, most of the times it is limited to a simple transfer The objective of this paper is to describe the barriers to a smooth transition from the point of view of the patient and his/her family, the health professionals and the health system, to review the key elements for a smooth transition, and to address the different approaches proposed in the literature.

Is a Virtual Library cost effective?

The Andalusian Public Health System Virtual Library (Biblioteca Virtual del Sistema Sanitario P��blico de Andaluc��a, BV-SSPA), was created in June 2006. In this paper an evaluation is made to see whether the investment made by the Andalusian Government has been worthwhile. The cost-effectiveness and efficiency of the project together with the management criteria are explored.

Aggravation of chronic stress effects on hippocampal neurogenesis and spatial memory in LPA��� receptor knockout mice.

BACKGROUND The lysophosphatidic acid LPA��� receptor regulates plasticity and neurogenesis in the adult hippocampus. Here, we studied whether absence of the LPA��� receptor modulated the detrimental effects of chronic stress on hippocampal neurogenesis and spatial memory. METHODOLOGY/PRINCIPAL FINDINGS Male LPA���-null (NULL) and wild-type (WT) mice were assigned to control or chronic stress conditions (21 days of restraint, 3 h/day). Immunohistochemistry for bromodeoxyuridine and endogenous markers was performed to examine hippocampal cell proliferation, survival, number and maturation of young neurons, hippocampal structure and apoptosis in the hippocampus. Corticosterone levels were measured in another a separate cohort of mice. Finally, the hole-board test assessed spatial reference and working memory. Under control conditions, NULL mice showed reduced cell proliferation, a defective population of young neurons, reduced hippocampal volume and moderate spatial memory deficits. However, the primary result is that chronic stress impaired hippocampal neurogenesis in NULLs more severely than in WT mice in terms of cell proliferation; apoptosis; the number and maturation of young neurons; and both the volume and neuronal density in the granular zone. Only stressed NULLs presented hypocortisolemia. Moreover, a dramatic deficit in spatial reference memory consolidation was observed in chronically stressed NULL mice, which was in contrast to the minor effect observed in stressed WT mice. CONCLUSIONS/SIGNIFICANCE These results reveal that the absence of the LPA��� receptor aggravates the chronic stress-induced impairment to hippocampal neurogenesis and its dependent functions. Thus, modulation of the LPA��� receptor pathway may be of interest with respect to the treatment of stress-induced hippocampal pathology.

Impactia: automating the study of the scientific production

Introduction The Andalusian Public Health System Virtual Library (Biblioteca Virtual del Sistema Sanitario P��blico de Andaluc��a, BV-SSPA) was set up in June 2006. It consists of a regional government action with the aim of democratizing the health professional access to quality scientific information, regardless of the professional workplace. Andalusia is a region with more than 8 million inhabitants, with 100,000 health professionals for 41 hospitals, 1,500 primary healthcare centres, and 28 centres for non-medical attention purposes (research, management, and educational centres). Objectives The Department of Development, Research and Investigation (R+D+i) of the Andalusian Regional Government has, among its duties, the task of evaluating the hospitals and centres of the Andalusian Public Health System (SSPA) in order to distribute its funding. Among the criteria used is the evaluation of the scientific output, which is measured using bibliometry. It is well-known that the bibliometry has a series of limitations and problems that should be taken into account, especially when it is used for non-information sciences, such us career, funding, etc. A few years ago, the bibliometric reports were done separately in each centre, but without using preset and well-defined criteria, elements which are basic when we need to compare the results of the reports. It was possible to find some hospitals which were including Meeting Abstracts in their figures, while others do not, and the same was happening with Erratum and many other differences. Therefore, the main problem that the Department of R+D+i had to deal with, when they were evaluating the health system, was that bibliometric data was not accurate and reports were not comparable. With the aim of having an unified criteria for the whole system, the Department of R+D+i ordered the BV-SSPA to do the year analysis of the scientific output of the system, using some well defined criteria and indicators, among whichstands out the Impact Factor. Materials and Methods As the Impact Factor is the bibliometric indicator that the virtual library is asked to consider, it is necessary to use the database Web of Science (WoS), since it is its owner and editor. The WoS includes the databases Science Citation Index (SCI), Social Sciences Citation Index (SSCI) and Arts & Humanities Citation Index. To gather all the documents, SCI and SSCI are used; to obtain the Impact Factor and quartils, it is used the Journal Citation Reports, JCR. Unlike other bibliographic databases, such us MEDLINE, the bibliometric database WoS includes the address of all the authors. In order to retrieve all the scientific output of the SSPA, we have done general searches, which are afterwards processed by a tool developed by our library. We have done nine different searches using the field ���address���; eight of them including ���Spain��� and each one of the eight Andalusian Regions, and the other one combining ���Spain��� with all those cities where there are health centres, since we have detected that there are some authors that do not use the region in their signatures. These are some of the search strategies: AD=Malaga and AD=Spain AD=Sevill* and AD=Spain AD=SPAIN AND (AD=GUADIX OR AD=BAZA OR AD=MOTRIL) Further more, the field ���year��� is used to determine the period. To exploit the data, the BV-SSPA has developed a tool called Impactia. It is a web application which uses a database to store the information of the documents generated by the SSPA. Impactia allows the user to automatically process the retrieved documents, assigning them to their correspondent centres. In order to do the classification of documents automaticaly, it was necessary to detect the huge variability of names of the centres that the authors use in their signatures. Therefore, Impactia knows that if an author signs as ���Hospital Universitario Virgen Macarena���, ���HVM��� or ���Hosp. Virgin Macarena���, he belongs to the same centre. The figure attached shows the variability found for the Empresa Publica Hospital de Poniente. Besides the documents from WoS, Impactia includes the documents indexed in Scopus and in other databases, where we do bibliographic searches using similar strategies to the later ones. Aware that in the health centres and hospitals there is a lot of grey literature that is not gathered in databases, Impactia allows the centres to feed the application with these documents, so that all the SSPA scientific output is gathered and organised in a centralized place. The ones responsible of localizing this gray literature are the librarians of each one of the centres. They can also do statements to the documents and indicators that are collected and calculated by Impactia. The bulk upload of documents from WoS and Scopus into Impactia is monthly done. One of the main issues that we found during the development of Impactia was the need of dealing with duplicated documents obtained from different sources. Taking into account that sometimes titles might be written differently, with slashes, comas, and so on, Impactia detects the duplicates using the field ���DOI��� if it is available or comparing the fields: page start, page end and ISSN. Therefore it is possible to guarantee the absence of duplicates. Results The data gathered in Impactia becomes available to the administrative teams and hospitals managers, through an easy web page that allows them to know at any moment, and with just one click, the detailed information of the scientific output of their hospitals, including useful graphs such as percentage of document types, journals where their scientists usually publish, annual comparatives, bibliometric indicators and so on. They can also compare the different centres of the SSPA. Impactia allows the user to download the data from the application, so that he can work with this information or include them in their centres��� reports. This application saves the health system many working hours. It was previously done manually by forty one librarians, while now it is done by only one person in the BV-SSPA during two days a month. To sum up, the benefits of Impactia are: It has shown its effectiveness in the automatic classification, treatment and analysis of the data. It has become an essential tool for all managers to evaluate quickly and easily the scientific production of their centers. It optimizes the human resources of the SSPA, saving time and money. It is the reference point for the Department of R+D+i to do the scientific health staff evaluation.

El futuro de la sanidad ambiental en Andaluc��a: oportunidades de mejora.

In the present article is presented a portrait of the situation of the environmental health in the administration of Andalusian Goverment; are analyzed implanted management formulations and we believe a reflection space on the professional exercise and the course begun with the organizational process in the Andalusian public health. The public health system has not undergone reconstruction from the process of transferences from the State towards the autonomous Communities. We identified the extrapolation of the model clinicalassistance management to the public health structures without delving what is sufficient in their organization and objectives. Setting of business process management (BMP) has got worse the administrative bureaucracy and the teamwork has not been preceded of alliances and agreements that generate feeling of ownership the same organization to avoid professional conflicts. We bet on strengthening the paper of the environmental health technicians as referring in the identification of this performances within public health system. For this propose we need the implication of all the professionals in the reform of the organization and management of the health public, to evolve in the professional exercise creating a regulated academic specialty and to define the competences maps in their different capabilites areas.

Recepci��n, clasi���caci��n seg��n escala Manchester y atenci��n sanitaria inicial al paciente que acude a un Dispositivo de Cuidados Cr��ticos y Urgencias (DCCU) con motivo de consulta ���Diabetes���: Posibilidad de intervenci��n ���nalista de la enfermera en la consulta de triage (Triage Avanzado) ante la hipoglucemia. Colaboraci��n multidisciplinar y criterios de derivaci��n

The Andalusian Public Health System (SSPA) is considering the last time an attempt urgent process management through triage consultation, both hospital and primary care environment and tables situations in which the nurse responsible for these consultations can carry out a ���nal statement of which only she is directly responsible through their independent intervention and referral (Triage Advanced). Pose, at once and consistently to the idea of teamwork, where they can be the limits to that intervention ���nalist and the circuits to follow. This paper proposes a de���nition line of one of those situations through triage concepts universally tested, and takes full advantage of advanced practice pro���le offered by nurses Device Critical Care (DCCU) of the SSPA and any the emerging legal and regulatory framework in terms of standardized collaborative prescription, us know legitimate receivers. This work stems from the vision of professionals and our contribution to that line of institutional work that must be consensus.

Assessment of the treatment of chronic hepatitis C in the state of Mato Grosso, central Brazil

In Brazil, the treatment of hepatitis C virus (HCV) infection is funded by the national public health system (SUS). To evaluate treatment results in the state of Mato Grosso, central Brazil, we have consulted the files of the office of the State Department of Health responsible for supplying such medications. We obtained information on 232 treatments of 201 patients who underwent treatment in or prior to 2008. The study was conducted by reviewing medical records, making telephone calls and interviewing the assistant physicians. Thirty-nine patients (19.4%) had cirrhosis and HCV genotype 1 predominated (64.3%). Excluding patients with comorbidities or treatment without ribavirin we analysed 175 treatments (sustained virologic response occurred in 32.6% of cases). Twenty-six of these 175 were retreatments and the sustained virological response (SVR) rate among them was 30.8%; the SVR rate was 32.9% among those receiving treatment for the first time. The SVR rate of genotype 1 patients was 27.8%, whereas it was 37.5% in non-1 genotype patients. The adjusted multivariate analysis showed association of SVR with the absence of cirrhosis [odds ratio (OR): 7.7; confidence interval (CI) 95%: 2.5, 33.3], the use of pegylated interferon (OR: 5.8; CI 95%: 1.5, 21.4), non-1 genotype (OR: 5.3; CI 95%: 1.7, 16.7) and uninterrupted treatment (OR: 9.0; CI 95%: 3.3, 45.4). The SVR rates were similar to those found in other Brazilian studies about HCV, but lower than those found in national and international clinical trials. These data suggest that the treatments of chronic hepatitis C that are made available by SUS does not, under normal conditions, work as well as the original controlled studies indicated.