Consenso para el diagnóstico y tratamiento de la esclerosis múltiple en pacientes del ISSSTE / Consensus for the diagnosis and treatment of multiple sclerosis in ISSSTE patients

Resumen: La esclerosis múltiple es una de las principales enfermedades desmielinizantes del sistema nervioso central, que repercute no solo en lo económico, sino también en lo social. El Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) dispone de la mayor parte de los tratamientos que modifican la evolución de esta enfermedad y para optimizar su uso, un grupo de neurólogos de la institución se reunió para la realización de un documento sobre aspectos generales de diagnóstico y tratamiento denominado Consenso para el Diagnóstico y Tratamiento de la Esclerosis múltiple en pacientes del ISSSTE. El objetivo de este documento es dar recomendaciones de las diferentes alternativas terapéuticas contra la esclerosis múltiple.

Abstract: Multiple sclerosis is one of the main demyelinating diseases of the central nervous system, which impacts not only economically but also socially. The Mexican Institute of Security and Social Services of State Workers (ISSSTE) has most of the disease modifying treatments for this disease and to optimize its use, a group of neurologists from the institution met to make a document on general aspects of diagnosis and treatment called: Consensus for the diagnosis and treatment of multiple sclerosis in ISSSTE patients. The objective of this consensus is to give recommendations on the different therapeutic alternatives against multiple scle- rosis for adults and children.

Infecciones respiratorias altas recurrentes en niños menores de 5 años: Jagüey Grande, 2008-2009 / Recurrent high respiratory infections in children aged less than 5 years old: Jaguey Grande-2008-2009

Las infecciones respiratorias altas constituyen una importante causa de morbilidad en los niños menores de 5 años. Por su magnitud en la población infantil, se realizó un estudio analítico retrospectivo, de casos y controles, para determinar los factores de riesgo en las infecciones respiratorias altas recurrentes en niños menores de 5 años del Policlínico Universitario 7 de Diciembre, Jagüey Grande, Matanzas, de mayo 2008 a mayo 2009. El universo fue de 352 niños con infecciones respiratorias altas que asistieron a la consulta de Alergia; la muestra fue de 85 niños para cada grupo. Se tuvo en cuenta las variables factores sociodemográficas, y ambientales. Se determinó que la atopia, la exposición al humo del tabaco, la no lactancia materna, la ablactación incorrecta, la baja escolaridad materna, vivir en área rural, las deficientes condiciones higiénicos sanitarias como presencia de animales, viviendas viejas, mala ventilación y factores ambientales como frío, cambios de temperatura y humedad constituyen los principales factores de riesgo.

The high respiratory infections are an important cause of morbidity in children aged less than 5 years old. For its magnitude among the infantile population, we carried out an analytical retrospective study of cases and controls, to determine the risk facts in the recurrent high respiratory infections in children less than 5 years old of the Teaching Policlinic 7 de Diciembre, Jaguey Grande, Matanzas, from May 2008 to May 2009. The universe were the 352 children with high respiratory infections who assisted the allergy consultation; the sample was formed by 85 children for each group. We took into account the variables socio-demographic and environmental factors. We determined that the main risk factors are the atopy, the exposition to the tobacco smoke, the lack of breastfeeding, the wrong ablactation, the low maternal scholarship, living in rural areas, the deficient hygienic-sanitary conditions like animals presence, old houses, bad ventilation and climatologic factors as cold, temperature and humidity changes.

Equidad, género y salud: retos para la acción / Equity, gender, and health: challenges for action

The Governing Bodies of the Pan American Health Organization (PAHO) have mandated that the Organization apply a gender perspective in all aspects of the Organization's activities and its technical cooperation in the area of health out the need to eradicate unjust gender differences that affect the right and access to health care that is appropriate for women. The piece explains the differences between equity and equality and between gender and sex, and how gender equity should come about in the state of health, in health care, and in all people's efforts to engender health. It is hoped the piece will contribute to a better understanding of the situation, thus helping to eliminate inequities that are due to sex, socioeconomic factors, and the distribution of power

Equidad de genero en las politicas de reforma del sector de la salud de America Latina y el Caribe / Gender equity in health sector reform policies in Latin America and the Caribbean

Gender equity is increasingly being acknowledged as an essential aspect of sustainable development and more specifically, of health development. The Pan American Health Organization's Program for Women, Health, and Development has been piloting for a year now a project known as Equidad de género en las políticas de reforma del sector de salud, whose objective is to promote gender equity in the health sector reform efforts in the Region. The first stage of the project is being conducted in Chile and Peru, along with some activities throughout the Region. The core of theproject is the production and use of information as a tool for introducing changes geared toward achieving greater gender equity in health, particularly in connection with malefemale disparities that are unnecessary, avoidable, and unfair in health status, access to health care, and participation in decision-making within the health system. We expect that in three years the project will have brought about changesin the production of information and knowledge, advocacy, and information dissemination, as well as in the development, appropriation, identification of intersectoral mechanisms that will make it possible for key figures in government and civil society to work together in setting and surveying policy on gender equity in health

Genero, equidad y acceso a los servicios de salud: una aproximación empirica / Gender, equity, and access to health services: an empirical approximation

This piece describes the conceptual framework and the objectives that guided a research initiative in the Region of the Americas that was called "Gender, Equity, and Access to Health Services" and that was sponsored in 2001 by the Pan American Health Organization. The piece does not summarize the results of the six projects that were carried under the initiative, whose analyses have not all been completed. Instead, the piece discusses some of the foundations of the initiative and provides a general introduction to the country studies that were done. The six studies were done in Barbados/Jamaica, Brazil, Chile, Colombia, Ecuador, and Peru. The primary objective of the initiative was to stimulate the use of existing quantitative information in the countries, with the goal of starting a process of systematically documenting two things: 1) the unfair, unnecessary, and avoidable inequalities between men and women in their access to health care and 2) the linkages between those inequalities and other socioeconomic factors. The concept of gender equity that guided this examination of health care was not the usual one calling for the equal distribution of resources. Rather, it was the notion that resources should be allocated differentially, according to the particular needs of men and of women, and that persons should pay for health services according to their economic ability rather than their risk level. The starting point for the initiative was the premise that gender inequities in utilizing and paying for health care result from gender differences in the macroeconomic and microeconomic distribution of resources. The piece concludes that achieving equity in health care access will require a better understanding of the gender needs and gender barriers that are linked to social structures and health systems

Género, mujer y salud en las Américas / Gender, women, and health in the Americas

En este artículo se presenta en primer lugar una breve descripción de las nuevas técnicas de reproducción asistida a modo de actualización técnica. Se plantean luego las principales inquietudes que surgen al analizar la aplicación no regulada de estas técnicas desde la perspectiva de la mujer. Por último, a modo de observaciones finales se hace un breve recuento de la experiencia legislativa en materia de maternidad subrogada en Australia, los Estados Unidos y Gran Bretaña, con el fin de ofrecer puntos de referencia para aquellos países que decidan regular el uso de las nuevas técnicas de reproducción asistida en América Latina y el Caribe mediante la expedición de leyes, decretos o reglamentos sobre el tema

Género, mujer y salud en las Américas

Determinantes de saúde materna em países da América Latina e Caribe. O fator sócio-econômico, e as medidas de melhoria no acesso e atendimento à saúde para minimizar as ocorrências. A diminuiçäo da mortalidade infantil tem sido mais acentuada que a mortalidade materna, em funçäo das políticas de saúde infantil. As condiçöes sociais, somam-se mecanismos biológicos e individuais que determinam a morbidade e mortalidade materna. A qualidade das informaçöes sobre registros e causas de óbito contribui para uma melhor definiçäo da situaçäo de mortalidade. A estreita ligaçäo entre a mortalidade materna e qualidade dos serviços de saúde. As tendências da mortalidade materna a partir de dados. Estudos de mortalidade materna decorrente de fatores sociais, condiçäo sócio-econômica, desenvolvimento etnia, e idade. Causas obstétricas diretas e indiretas da mortalidade materna, aborto, toxemia, hemorragia, complicaçöes pós-parto. Serviços de planejamento familiar e a falta de quantificaçäo dos custos para serviços de prevençäo da mortalidade materna (MC)

Género, mujer y salud en las Americas

Perfil sócio-demográfico do trabalho feminino na área da saúde, no Brasil. A tendência de ocupar cargos de pouca competitividade e acúmulo de jornadas de trabalho é mais verificada em países do terceiro mundo. Como característica brasileira a maior parte do trabalho feminino está no setor terciário da economia com baixos salários em relaçäo aos masculinos, e com predomínio numérico. Na saúde, é crescente e predominante o número de mulheres; e na medicina o que se observa é que certas especialidades parecem näo fazer parte das funçöes femininas, como ortopedia, neuro-cirurgia, medicina nuclear, etc. No Brasil, a oferta de empregos para médicos (1977-1983) foi maior do que para enfermeiros (MC)

Control serológico prenatal del síndrome STORCH en un grupo de gestantes en la ciudad de Bogotá

Se tomaron 112 gestantes, con edades gestacionales de 10-30 semanas. Se determinó edad, antecedentes gestacionales, paridad, abortos, contacto con gatos, consumo de carnes semicrudas, labores de jardinería, antecedentes de rubéola enfermedad y vacunación, antecedentes de herpes oral y genital. Se practicó IFI-IgG para toxoplasma, ELISA IgG para Rubeóla, herpes I y II y citomegalovirus, VDRL, FTA, ABS y TPHA para lúes. Se encontró que 60.7 por ciento fueron negativas para Acs antitoxoplasma y 14.3 por ciento para rubéola, 5.4 por ciento fueron negativas para CMV, 99.1 por ciento positivas para herpes I y 46.4 por ciento para herpes II, 0.9 fueron positivas para lúes. La anamnesis para rubéola no es confiable y sólo 0.9 por ciento han sido vacunadas para rubéola. Se considera haber contribuido a actualizar el conocimiento epidemiológico de este síndrome en nuestro medio.

Sensibilización alérgica a los alimentos tropicales usados en la ablactación

Se estudiaron 160 individuos sanos menores de dos años mediante la técnica de Inmunodot para determinar la presencia de Ig E sérica específica frente a los 10 alimentos tropicales de mayor consumo. Se encontró que el 23.12 por ciento de los pacientes presentaron sensibilización a dichos alimentos, siendo los más frecuentes maíz, banano y guayaba. Esta sensibilización tiende a disminuir hacia los 24 meses. Se sugiere que la introducción temprana de estos alimentos debe considerarse como factor predisponente a la posterior presentación de alergia