Self-assessment of all the health centres of a public health service through the European Model of total quality management.

The Basque Country Public Health Service has moved in the last years from considering quality as an attribute of patient care to thinking that all management can be subject to improvement. Consequently, its general management team has promoted and supported a self-assessment experience of all their centres by means of the European Quality Model. This strategy has been facilitated by the Basque Country Government, which has strongly encouraged total quality management in companies, and has created the Basque Foundation for Quality Promotion, a key institution in this whole process. A total of 26 centres of the Public Health Service concluded a self-assessment process. As the main result of this, different improvement areas were detected, and various necessary actions were implemented in the centres assessed. Advantages, troubles and future work lines to extend and improve the use of the EFQM model in the health sector are discussed.

[Immunologic changes in sickle-cell anemia]. / Alteraciones inmunológicas en la anemia drepanocítica.

In order to assess the status of their immunologic system, a study was carried out in 38 adults with sickle-cell anaemia. Fifty healthy blood donors were used as control group. Significant decrease of serum albumin (p less than 0.02) and increase of alpha-globulins (p less than 0.01) and gamma-globulins (p less than 0.001) were present in the patients. They showed also significantly decreased percentage of spontaneous rosette-forming lymphocytes (p less than 0.01) and of lymphocytes responding to anti-CD3 monoclonal antibody (p less than 0.05) with respect to the control group. Such relative T-cell decrease in peripheral blood seemingly took place by means of decreasing CD4-positive subpopulations, whose percentage was significantly lower (p less than 0.001) in the patients than in the control subjects. Functional studies showed a significant decrease (p less than 0.001) of the activity of natural cytotoxic cells. None of the patients had antibodies against human immunodeficiency viruses type 1 and type 2, and 60% of them were positive to cytomegalovirus test. No statistical correlation was found between the immunological findings and the presence of antibodies against such virus, neither such alterations correlated with the number of blood units received by the patients.