Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

Misiones sanitarias uruguayas en los terremotos de San Juan, Ambato y Managua / Uruguayan Sanitary Missions to assist victims of San Juan, Ambato and Managua earthquakes

La experiencia de la medicina nacional en este tipo de desastres naturales fue recogida por las misiones sanitarias de auxilio en los terremotos de San Juan (1944), Ambato (1949) y Managua (1972). Se relata en forma pormenorizada la preparación del grupo sanitario, el equipamiento que setransportó, así como la realidad de la zona del desastre, donde no había hospitales en condiciones de funcionar. Por lo tanto, el grupo de auxilio debió instalarse en ciudades vecinas al epicentro donde los hospitales estaban en condiciones normales, donde nofaltaban la electricidad ni el agua potable, lo que permitía ponerse a realizar la tarea asistencial de inmediato.Se destaca que la experiencia recogida en el primer terremoto en San Juan (Argentina) motivó la necesidad de tener un equipo médico coherente, con las mismas pautas terapéuticas y también que estuviera constituido fundamentalmente por traumatólogos, ya que la inmensa mayoría de los pacientes serían fracturados.De estas tres experiencias la escuela de traumatología uruguaya marcará las directivas para posibles misiones futuras y, a la vez, realizará investigación clínica que posteriormentepublicarán el Dr. José Luis Bado y colaboradores.

The Uruguayan Medical and Sanitation TeamsÆ experience with natural disasters is based on the earthquakes in San Juan (1944), Ambato (1949) and Managua (1972). A thoroughdescription of the sanitary team, the equipment transported and the conditions found in the earthquake disaster area, where hospitals were not operating is presented.The assistance team had to settle in nearby cities where hospitals were functioning under normal conditions, withnormal electricity and water supplies, enabling the first aid to be provided to the victims immediately. We stressthat the experience gained in the first earthquake, in San Juan (Argentina), calls for the need to have a constantmedical team, whose members would share the same therapeutic guidelines, and that would also be mainly trainedformed by traumatologists ûsince the majority of victims would have suffered fractures. Based on these three experiences, the Uruguayan School of Traumatology will draw out the guidelines for future missions, and conduct clinical research for to bepublished by Dr. José Luis Bado and others.

A experiência da medicina nacional neste tipo de desastres naturais foi registrada pelas missões sanitárias deauxilio nos terremotos de San Juan (1944), Ambato (1949) e Manágua (1972). Descreve-se detalhadamente a preparação da equipe de saúde, do equipamento e a realidade da zona de desastre, onde não havia hospitais em condições de funcionamento. Por essa razão o grupo de auxilio foi instalado emcidades próximas ao epicentro aonde os hospitais mantinham suas condições normais e não faltavam eletricidadenem água potável, o que possibilitou realizar imediatamente as ações assistenciais. A experiência adquirida no primeiro terremoto em San Juan, Argentina, demonstrou a necessidade de uma equipe médica coerente, com as mesmas pautas terapêuticas eque estivesse composto fundamentalmente por traumatologistas,pois a maioria dos pacientes apresentava fraturas. Com estas três experiências a traumatologia uruguaiadefiniu as diretrizes para outras possíveis missões e realizou pesquisa clínica que posteriormente foi publicadapelo Dr. José Luis Bado e seus colaboradores.