Nuevas capacidades estatales para una sociedad transformada : Instituciones y políticas sanitarias en la provincia de Santa Fe primera mitad del siglo XX

El presente trabajo indaga las dinámicas de transformación de las políticas sanitarias en la provincia de Santa Fe en la primera mitad del siglo XX, focalizando tres coyunturas: en primer lugar, el contexto previo y la sanción de la ley de sanidad en 1932; en segundo término, los cambios sostenidos durante la segunda mitad de la década de 1930 que darían lugar a la creación del Ministerio de Salud y Trabajo en 1941; finalmente las innovaciones proyectadas desde la intervención de 1943 y los posteriores gobiernos peronistas. A partir de los debates parlamentarios, las memorias ministeriales, la prensa y las publicaciones especializadas, nos proponemos dar cuenta de algunos aspectos de este proceso de transformación en las políticas sanitarias locales en diálogo con el plano nacional.

La profesionalización de la enfermería en Argentina : Disputas políticas e institucionales durante el peronismo

Nuestra investigación pretende visualizar el proceso de profesionalización de las enfermeras durante el peronismo desde dos ámbitos profundamente emparentados con espacios políticos peronistas: la Escuela de Enfermas de la Secretaría de Salud Pública (1947) y la Escuela de Enfermeras "7 de mayo" de la Fundación Eva Perón (1950). Conscientes de que este recorte excluye otras escuelas que funcionaron durante este período, los objetivos de este trabajo justifican el acotamiento dado que el interés está centrado en las disputas institucionales entre entidades embanderadas en las nuevas lógicas políticas peronistas

La profesionalización de la enfermería en Argentina : Disputas políticas e institucionales durante el peronismo

Nuestra investigación pretende visualizar el proceso de profesionalización de las enfermeras durante el peronismo desde dos ámbitos profundamente emparentados con espacios políticos peronistas: la Escuela de Enfermas de la Secretaría de Salud Pública (1947) y la Escuela de Enfermeras "7 de mayo" de la Fundación Eva Perón (1950). Conscientes de que este recorte excluye otras escuelas que funcionaron durante este período, los objetivos de este trabajo justifican el acotamiento dado que el interés está centrado en las disputas institucionales entre entidades embanderadas en las nuevas lógicas políticas peronistas

El género epistolar en la prensa como visión ciudadana de la esfera pública en Colombia

A partir de un análisis temático inductivo, este artículo explora la visión ciudadana sobre la esfera pública expresada en las cartas de los lectores de los diarios El Tiempo y El Heraldo de Colombia. Los resultados muestran cómo la identidad colectiva de los lectores apareció en forma transversal en las cartas, para dar cuenta de una comunidad de adultos que se autodefine como “colombianos de bien”. El análisis reveló dos unidades de significado: posturas sobre la administración de lo público y antagonismos en la esfera pública, centrada en el conflicto político con las guerrillas. A través de estas se pudieron hacer visibles los llamamientos vívidos de los lectores al gobierno, funcionarios públicos, actores al margen de la ley y a sus compatriotas, para movilizarse para exigir cambios sociales largamente esperados.

The U.N. convention on the rights of the child: Relevance and application to pediatric clinical bioethics

This article provides an overview of the relevance and import of the U.N. Convention on the Rights of the Child (CRC) to child health practice and pediatric bioethics. We discuss the four general principles of the CRC that apply to the implementation of all rights contained in the document, the right to health articulated in Article 24, and the important position ascribed to parents in fulfilling the rights of their children. We then examine how the CRC is implemented and monitored in law and practice. The CRC and associated principles of child rights provide strategies for rights-based approaches to clinical practice and health systems, as well as to policy design, professional training, and health services research. In light of the relevance of the CRC and principles of child rights to children’s health and child health practice, it follows that there is an intersection between child rights and pediatric bioethics. Pediatric bioethicists and child rights advocates should work together to define this intersection in all domains of pediatric practice.

The day surgery experience from a service users perspective

Although health policy would suggest that day surgery is the best service for patients undergoing a surgical procedure, it is important to consider the patient and whether this type of service is what they want. This information can be generated through a service evaluation with the results used to inform local decision-making, changes to care delivery and improvements in patient care. This article describes the results of a service evaluation performed in a single-site day surgery unit.

Advances in the Diagnosis of Human Schistosomiasis

Schistosomiasis is a major neglected tropical disease that afflicts more than 240 million people, including many children and young adults, in the tropics and subtropics. The disease is characterized by chronic infections with significant residual morbidity and is of considerable public health importance, with substantial socioeconomic impacts on impoverished communities. Morbidity reduction and eventual elimination through integrated intervention measures are the focuses of current schistosomiasis control programs. Precise diagnosis of schistosome infections, in both mammalian and snail intermediate hosts, will play a pivotal role in achieving these goals. Nevertheless, despite extensive efforts over several decades, the search for sensitive and specific diagnostics for schistosomiasis is ongoing. Here we review the area, paying attention to earlier approaches but emphasizing recent developments in the search for new diagnostics for schistosomiasis with practical applications in the research laboratory, the clinic, and the field. Careful and rigorous validation of these assays and their cost-effectiveness will be needed, however, prior to their adoption in support of policy decisions for national public health programs aimed at the control and elimination of schistosomiasis.

Predictors of caregiver burden across the home-based palliative care trajectory in Ontario, Canada

Family caregivers of patients enrolled in home-based palliative care programmes provide unpaid care and assistance with daily activities to terminally ill family members. Caregivers often experience caregiver burden, which is an important predictor of anxiety and depression that can extend into bereavement. We conducted a longitudinal, prospective cohort study to comprehensively assess modifiable and non-modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory. Caregivers (n = 327) of patients with malignant neoplasm were recruited from two dedicated home-based palliative care programmes in Southern Ontario, Canada from 1 July 2010 to 31 August 2012. Data were obtained from bi-weekly telephone interviews with caregivers from study admission until death, and from palliative care programme and home-care agency databases. Information collected comprised patient and caregiver demographics, utilisation of privately and publicly financed resources, patient clinical status and caregiver burden. The average age of the caregivers was 59.0 years (SD: 13.2), and almost 70% were female. Caregiver burden increased over time in a non-linear fashion from study admission to patient death. Increased monthly unpaid care-giving time costs, monthly public personal support worker costs, emergency department visits and low patient functional status were associated with higher caregiver burden. Greater use of hospice care was associated with lower burden. Female caregivers tended to report more burden compared to men as death approached, and burden was higher when patients were male. Low patient functional status was the strongest predictor of burden. Understanding the influence of modifiable and non-modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden. Supporting caregivers can have benefits such as improved caregiver health outcomes, and enhancing their ability to meet care-giving demands, thereby potentially allowing for longer patient care in the home setting.

Sepsis: the LightCycler SeptiFast Test MGRADE®, SepsiTest™ and IRIDICA BAC BSI assay for rapidly identifying bloodstream bacteria and fungi – a systematic review and economic evaluation

Background: Sepsis can lead to multiple organ failure and death. Timely and appropriate treatment can reduce in-hospital mortality and morbidity. Objectives: To determine the clinical effectiveness and cost-effectiveness of three tests [LightCycler SeptiFast Test MGRADE® (Roche Diagnostics, Risch-Rotkreuz, Switzerland); SepsiTest™ (Molzym Molecular Diagnostics, Bremen, Germany); and the IRIDICA BAC BSI assay (Abbott Diagnostics, Lake Forest, IL, USA)] for the rapid identification of bloodstream bacteria and fungi in patients with suspected sepsis compared with standard practice (blood culture with or without matrix-absorbed laser desorption/ionisation time-offlight mass spectrometry). Data sources: Thirteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from January 2006 to May 2015 and supplemented by hand-searching relevant articles. Review methods: A systematic review and meta-analysis of effectiveness studies were conducted. A review of published economic analyses was undertaken and a de novo health economic model was constructed. A decision tree was used to estimate the costs and quality-adjusted life-years (QALYs) associated with each test; all other parameters were estimated from published sources. The model was populated with evidence from the systematic review or individual studies, if this was considered more appropriate (base case 1). In a secondary analysis, estimates (based on experience and opinion) from seven clinicians regarding the benefits of earlier test results were sought (base case 2). A NHS and Personal Social Services perspective was taken, and costs and benefits were discounted at 3.5% per annum. Scenario analyses were used to assess uncertainty. Results: For the review of diagnostic test accuracy, 62 studies of varying methodological quality were included. A meta-analysis of 54 studies comparing SeptiFast with blood culture found that SeptiFast had an estimated summary specificity of 0.86 [95% credible interval (CrI) 0.84 to 0.89] and sensitivity of 0.65 (95% CrI 0.60 to 0.71). Four studies comparing SepsiTest with blood culture found that SepsiTest had an estimated summary specificity of 0.86 (95% CrI 0.78 to 0.92) and sensitivity of 0.48 (95% CrI 0.21 to 0.74), and four studies comparing IRIDICA with blood culture found that IRIDICA had an estimated summary specificity of 0.84 (95% CrI 0.71 to 0.92) and sensitivity of 0.81 (95% CrI 0.69 to 0.90). Owing to the deficiencies in study quality for all interventions, diagnostic accuracy data should be treated with caution. No randomised clinical trial evidence was identified that indicated that any of the tests significantly improved key patient outcomes, such as mortality or duration in an intensive care unit or hospital. Base case 1 estimated that none of the three tests provided a benefit to patients compared with standard practice and thus all tests were dominated. In contrast, in base case 2 it was estimated that all cost per QALY-gained values were below £20,000; the IRIDICA BAC BSI assay had the highest estimated incremental net benefit, but results from base case 2 should be treated with caution as these are not evidence based. Limitations: Robust data to accurately assess the clinical effectiveness and cost-effectiveness of the interventions are currently unavailable. Conclusions: The clinical effectiveness and cost-effectiveness of the interventions cannot be reliably determined with the current evidence base. Appropriate studies, which allow information from the tests to be implemented in clinical practice, are required.

When Patients Exit, What Happens to Solidarity?:Promoting Solidarity in the European Union

This chapter examines the EU healthcare regime under Hirschman's framework of Ext, Voice, and Loyalty in order to determine the impact of free movement on solidarity in health care.

La política sanitaria del peronismo en Jujuy (1946-1952) : Emilio Navea y la transformación del sistema de salud pública

Este artículo se inserta analiza el complejo proceso de estructuración de las políticas sanitarias en la Argentina. Procura examinar la transformación del sistema de salud pública durante el primer gobierno peronista en Jujuy (1946-1952). En esta tarea se presta atención a la labor del máximo responsable del área sanitaria en el distrito: Emilio Navea. Son objeto de estudio sus antecedentes académicos, sus relaciones políticas, así como las iniciativas y reformas realizadas al sistema de salud local. Esta intensa actividad contribuiría de gran modo a su designación como candidato a vicegobernador, para las elecciones de 1951, en representación del peronismo jujeño.

Continuidades y rupturas en el proceso de centralización de la administración sanitaria argentina (1880-1945)

El objetivo del trabajo es presentar el proceso de centralización administrativa de la repartición sanitaria nacional. Para ello se analizan, en primer lugar y con la intención de situar el problema en un plazo más largo, los límites que debió afrontar el Departamento Nacional de Higiene desde el momento de su creación, en 1880, para avanzar en sus intenciones centralizadoras. Entre ellos se encuentran su escasa autonomía administrativa, las superposiciones jurisdiccionales con otras dependencias del Estado, las indefiniciones respecto de su supremacía jerárquica, la resistencia de las provincias, los municipios fuertes y las asociaciones benéficas y los conflictos de proyectos al interior mismo de la repartición. En segundo lugar se muestra cómo los sucesivos presidentes del Departamento Nacional de Higiene asumieron ese límite para su gestión y apostaron a la organización interna de la repartición antes que al desafío de la centralización de la asistencia sanitaria. Su estrategia fue el fortalecimiento de nuevas áreas de incumbencia que constituyeron una agenda que sirvió como base de la definitiva centralización de la administración sanitaria. En esta tarea contaron con el apoyo parlamentario, fundamentalmente de la bancada socialista, que logró convertir en ley durante los años 30 a una serie de nuevas atribuciones del Departamento en aspectos que ligaban la salud con la asistencia social. Por último se analiza un momento clave de este proceso, el primer ensayo de centralización sanitaria a través de la creación, en 1943, de la Dirección Nacional de Salud Pública y Asistencia Social.

Nuevas capacidades estatales para una sociedad transformada : Instituciones y políticas sanitarias en la provincia de Santa Fe primera mitad del siglo XX

El presente trabajo indaga las dinámicas de transformación de las políticas sanitarias en la provincia de Santa Fe en la primera mitad del siglo XX, focalizando tres coyunturas: en primer lugar, el contexto previo y la sanción de la ley de sanidad en 1932; en segundo término, los cambios sostenidos durante la segunda mitad de la década de 1930 que darían lugar a la creación del Ministerio de Salud y Trabajo en 1941; finalmente las innovaciones proyectadas desde la intervención de 1943 y los posteriores gobiernos peronistas. A partir de los debates parlamentarios, las memorias ministeriales, la prensa y las publicaciones especializadas, nos proponemos dar cuenta de algunos aspectos de este proceso de transformación en las políticas sanitarias locales en diálogo con el plano nacional.

Promoção da saúde e trabalho: um ensaio analítico

CAVALCANTE,Cleonice Andréa Alves, NÓBREGA, Jussara Azevedo Bezerra da, ENDERS,Bertha Cruz, MEDERIROS, Soraya Maria de. Promoção da saúde e trabalho: um ensaio analítico. Revista Eletrônica de Enfermagem. v.10,n.1 p.241-248.2008. Disponível em :.

Self-harm, suicide and risk: helping people who self-harm. Final report of a working group.

The focus of this report is to enquire into and report on why people harm and kill themselves and to consider the role (including the limits of the role) that psychiatrists and other mental healthcare professionals play in their care and treatment. The experiences and views of people who harm themselves as well as those of their carers, health professionals and third-sector workers are central to this enquiry. As there is much policy and guidance on self-harm and suicide prevention, the report does not attempt to retrace this same ground but rather examines the evidence of practice on the ground, including the implementation of the National Institute for Health and Clinical Excellence (NICE) guidelines on self-harm (National Collaborating Centre for Mental Health, 2004). This report is the second in the Royal College of Psychiatristsââ,¬â"¢ programme of work on the broad issue of risk. The College report Rethinking Risk to Others was published in July 2008 (Royal College of Psychiatrists, 2008a) and a new Working Group was set up under the chairmanship of John, Lord Alderdice, to examine risk, self-harm and suicide. This clinical issue is an integral part of the role of the psychiatrist in ensuring the good care and treatment of patients. Our central theme is that the needs, care, well-being and individual human dilemma of the person who harms themselves should be at the heart of what we as clinicians do. Public health policy has a vital role to play and psychiatrists must be involved and not leave these crucial political and managerial decisions to those who are not professionally equipped to appreciate the complexities of self-harm and suicide. But we must never forget that we are not just dealing with social phenomena but with people who are often at, and beyond the limit of what they can emotionally endure. Their aggressive acts towards themselves can be difficult to understand and frustrating to address, but this is precisely why psychiatrists need to be involved to bring clarity to the differing causes for the self-destructive ways in which people act and to assist in managing the problems for the people concerned, including family, friends and professional carers, who sometimes find themselves at the end of their tether in the face of such puzzling and destructive behaviour.