Revista de sanidad e higiene publica最新文献

The different Health Education (HE) models appeared in the scientific literature are analyzed, trying to eliminate the confusion produced by its great diversity, applying a general and systematic point of view. Due to the relevance of that topic in the activities of Health Promotion in Primary Health Care it is urgent a deep reappraisal due the heterogeneity of scientific papers dealing with that topic. The curriculum, as the confluence of thought and action in Health Education, is the basic concept thanks to which it is possible to integrate both scientific logic, the biological one and that pertaining to the social sciences. Of particular importance have been the different paradigms that have emerged in the field of HE from the beginning of the present century: a first generation with a "normative" point of view, a second one orientated from positivistic bases, and a third generation adopting an hermeneutic and critic nature. This third generation of paradigms in HE has taken distances from the behaviouristic and cognitive perspectives being more critical and participative. The principal scientific contributors in the field of HE, internationals as well as spaniards are studied and classified. The main conclusions obtained from this Health Education paradigm controversy are referred to both aspects: 1) planning, programming and evaluating activities, and 2) models, qualitative and quantitative methodologies. Emphasis is given to the need of including Community Participation in all phases of the process in critic methodologies of HE. It is postulated the critic paradigm as the only one able to integrate the rest of the scientific approaches in Health Education.

Background: We have shown the coverage of periodic health examinations made in children aged between 0 and 14 years old in Aragón during 1991, comparing with results obtained at national level and results obtained during 1990.

Methods: A descriptive transversal study was developed by reviewing clinic records of 9 primary health centers selected by systematic sampling. Sampling consisted on 436 histories.

Results: Main results were: age of child in the first visit: 83.5% below 1 month; metabolic disease screening: no data on 31.8%; DTP-polio: no data on 20.9%; triple viric: no data on 24.3%.

Conclusions: Obtained data showed better results than those at national level. We should improve the metabolic diseases screening and vaccinations recording system.

Background: Accidents in childhood are an important health problem, mainly in situations of social and environmental risk. Additionally, the lack of studies in primary health care, encouraged us to set up a study in order to establish the characteristics of accidents in childhood attended in a health center, their relation with the child's socio-familiar situation and medical care delivered.

Methods: We describe children's accidents occurred in our area (2,543 children 0-14 years old, 788 of them living in deprived neighbourhoods) during 1992 attended in the health center. Study data was collected from data included in emergencies and medical records of the health center. We included information on: age, sex, socio-familiar situation, accident, lesion, and health care delivered characteristics.

Results: We include 623 accidents: annual cumulated incidence = 245/1,000 children; males were more affected (58.4%); the accidents occurred mainly in the household (35.6%); the most frequent causes were blows (39.9%) and falls (30.5%); the most frequent lesions were injuries (29.7%) and blows (25.7%). Location of the lesions were the superior limbs (33.5%) and head and neck (25.98%). About 12.5% were delivered to the hospital, 17.8% of them required inpatient care, one died. Children of deprived boroughs have a relative risk of being attended for accident in our center of 4.2 (CI 95% = 3.64-4.84) compared with the rest of the area. 79 children have had repeated accidents, they occurred mainly in only 27 families, 92.6% of whom live in deprived areas.

Conclusions: Our health center is attending a high frequency of children's accidents, most of them can be treated in the health center, the cases are concentrated in deprived boroughs and in risk families.

The Law on Medicaments warns in its article 39, of the existence of immunological medicaments in the context of the so called "special", adapting the Directive 89/342/CEE to the Spanish Pharmaceutical Legislation. Under this perspective, immunological medicaments are regulated, adopting for that, the necessary measures to guarantee raw materials quality, and the necessary provisions are established for the observance of criteria on quality, reliability and efficiency of this kind of medicaments authorization, production and control. The most outstanding thing in the Royal Decree 288/91 of 8th March, is the faculty conferred to the Ministry of Health and Consumer Affairs to submit for previous authorization each lot of immunological medicaments before they are commercialized. Therefore, this is an innovatory Royal Decree regulating correctly this special kind of medicaments and collecting all tendencies dictated by the European Community.

The present article discuss briefly the different methods of economic assessment of drugs, how and where the methods can be included alongside clinical trials, and discuss their influence in the pharmaceutical industry and health care administration. There are several methodological limitations when adding the economic assessment into a clinical trial principally because they differs in the aims. Economic assessment is interested in efficiency and clinical trials in security and efficacy. Pharmaceutical industry have been developing pharmacoeconomic departments in order to increase the internal efficiency of the viability of new products and to generate studies for regulatory authorities. At the moment, for regulatory purposes in Spain, an economic assessment is nor required but is recommended. The standardization of the methodology of the economic assessment is a key issue that may produce the spread and adoption in health care decision making process.

Background: To compare information on the deaths detected by the register of AIDS cases and the register of deaths due to AIDS in residents of Barcelona, with the objective to determine the differences between the two.

Methods: Mortality data were obtained from the register of AIDS cases and the mortality register during 1991 and 1992. The two registers were linked and concordant cases were identified.

Results: During 1991-92 there were 582 deaths on the case-register and 525 on the mortality register. It was possible to link 458 cases. The 67 cases not detected by the register of cases of AIDS were due to the fact that some had not been reported (35.9%), some were not AIDS cases (28.3%), some lacked information that qualified them as AIDS cases (28.3%), or were from a different residence (7.5%). The 124 cases that were not detected in the mortality register were due to their having another underlying cause of death (60.5%), a different residence (21.8%) and a lack of information since 22 deaths could not be identified in the mortality register, therefore, the cause of death could not be identified (17.7%).

Conclusions: To do a correct epidemiological surveillance of AIDS, a good coordination between the case and the mortality register is necessary.

Background: In 1992, a breast cancer screening program was implemented by the General Directorate of Health of the Autonomous Government of Valencia. This program was aimed to decrease the mortality caused by breast cancer in a 30% on those women submitted to the program. The program was implemented, in 1992 and 1993, and with this purpose five units of breast cancer screening were set up in five Health Areas. This paper presents our preliminary results of this program, from april 1992 to december 1993.

Methods: The program target population consisted on 125,000 healthy women aged from 45 to 65 years. Each woman recruited, a two-view (cranio-caudal and medio-lateral oblique) screen-film mammograms were performed as the primary and only film-screening examination with two years interval. Additionally and according to the criteria of the physician charged to inform the mammography a physical examination could be practised.

Results: 52,843 women were invited to participate. The participation rate was of 70.78%. The number of breast cancer detected was of 141, corresponding to a rate of 3.90/1000 women under screening program.

Conclusions: The objectives stated, in relation to participation rate, methods applied and early time of detection, were achieved in this period of assessment.

Background: The objective of this paper is to study whether the Contrato Programa-based management formula between INSALUD and Primary Care Managerships (CP) is known by INSALUD-Madrid primary care physicians and nurses, as well as which factors are influencing its acceptability.

Methods: Qualitative-based analysis and interpretation of the discussion had in five health personnel groups was used.

Results: The Health Service Contract is known by primary care health personnel as "self-management". This word induces them to think in the management of teams by their physicians themselves. Based on this self-management, physicians would plan staffs with minimal representation of nurses personnel, in exchange for increasing medical and administrative personnel, which in fact would solve their main problems, i.e. attendance pressure and bureaucracy, in addition to relationships with nurses. Determinants of this response relate to the satisfaction level with the Primary Care Reform attained by these collectives. This Reform has produced a "subjective equality" in both collectives, conditioned by fault in authority by physicians, which is desired by nurses and rejected by physicians.

Conclusions: Health Service Contract in Primary Care is generally accepted by physicians, except for pediatricians, and rejected by nurses. Reasons are related to the ability from both collectives to recuperate the difference between them.

Background: The epidemiological patron of hepatitis A has changed in the last few years and a decrease of the anti-hepatitis A antibodies IgG (Anti-HVA) have been observed at early ages, which will accompany in the future an increase of symptomatic hepatitis. The prevention of hepatitis A requires a strict application of the norms of personal and environmental hygiene and the administration of vaccines or immunoglobulins. In order to determine the convenience of immunization actively or passively with or without the previous detection of Anti-HVA, requires the knowledge of with strategy is more efficient.

Methods: An analysis is carried out to determine the threshold of prevalence, where the reason of efficiency is established by comparing the unit cost of immunization either actively or passively of the population, with a cost of immunizing only the negative Anti-HVA by previous screening, with the formula: the unit cost of the active or passive immunization (unit cost of screening + cost of active or passive (in specific immunoglobuline) immunization in the negative Anti-HVA). The results correlate with the prevalence of Anti-HVA in age group founded in sero-epidemiological studies published by Salleras (1992 and Pérez-Trallero (1994).

Results: The threshold of prevalence, the reason of efficiency equals 1, it's situated in 18% and 65% respectively for the active and passive immunization, which corresponds to the age group of 10-19 years and 20-29 years based on sero-epidemiological studies used.

Conclusions: With prevalence of Anti-HVA equal to or above 18% of the population the most efficient strategy is to determine the Anti-HVA before the active immunization; This threshold of prevalence move to up to 65% with passive immunization. Beneath these prevalence it's more efficient to immunize actively or passively without prior screening.