Alimentos sin finalidad nutricional en la terapéutica médica hospitalaria de la edad moderna en el Hospital de Santiago de Vitoria (Álava, España) / Food without nutritional purpose in the medical therapeutics in the modern age at Hospital de Santiago in Vitoria (Alava, Spain)

Introducción: con ser importante, la alimentación en los hospitales medievales y modernos distó de la excelencia y abundancia que sugierenalgunos historiadores, probablemente por una incorrecta valoración de la documentación hospitalaria al considerar como destinado a la alimentación todo gasto en alimentos, cuando buena parte tuvo como destino la botica.Objetivo/método: identificar los alimentos utilizados para una finalidad terapéutica no nutricional durante la edad moderna en el Hospital deSantiago Apóstol de Vitoria (Álava, España), describir su sistema de consignación y revisar la bibliografía del periodo para facilitar estrategias devaloración documental a los investigadores.Resultados: entre 1592 y 1813 se identifican 42 grupos de alimentos adquiridos para finalidades terapéuticas no nutritivas. El sistema deanotación en los libros de gastos no es sistemático ni homogéneo sino muy variable y dependiente de quien efectuara el asiento. Se identifican27 términos para el reconocimiento de que un determinado alimento tuviera por destino la botica y no la cocina. Se escogen 14 textos sanitariosdel periodo como bibliografía clarificadora, encontrándose de mayor utilidad para los fines propuestos los manuales enfermeros del siglo XVII.Conclusiones: la variedad y cantidad de alimentos destinados a la botica evidencia el riesgo de confusión en los investigadores no familiarizadosal analizar las dietas hospitalarias desde los libros de contabilidad. La propuesta de términos y estrategias de discriminación del uso nutricionalo no nutricional de los alimentos adquiridos, junto a la recomendación bibliográfica, resulta indispensable para una adecuada valoración de lasdietas hospitalarias históricas. (AU)

Introduction: although important, food in medieval and modern hospitals was far from the excellence and abundance suggested by somehistorians, probably due to an incorrect assessment of hospital documentation, considering all food expenditure to be for food when much of itwas destined for the apothecary’s shop.Aim/method: to identify the foodstuffs used for non-nutritional therapeutic purposes during the modern age at Hospital de Santiago in Vitoria(Alava, Spain), to describe the system of consignment, and to review the bibliography of the period in order to facilitate documentary assessmentstrategies for researchers.Results: between 1592 and 1813, 42 groups of foodstuffs acquired for non-nutritional therapeutic purposes were identified. The system of annotation in the expenditure books is neither systematic nor homogeneous, but highly variable and dependent on who made the entry. Twenty-seventerms were identified for the recognition that a given foodstuff was intended for the apothecary’s shop and not the kitchen. Fourteen sanitarytexts of the period were chosen as clarifying bibliography, finding the 17th century nursing manuals most useful for the proposed purposes.Conclusions: the variety and quantity of foodstuffs destined for the apothecary’s shop shows the risk of confusion in unfamiliar researcherswhen analysing hospital diets from account books. A proposal of terms and strategies for discriminating the nutritional or non-nutritional use ofthe food acquired, together with bibliographical recommendations, is essential for an adequate assessment of historical hospital diets. (AU)

Medical waste: the dark side of healthcare.

Hospitals and other health facilities generate an ever-increasing amount of waste, approximately 15% of which may be infectious, toxic, or radioactive. The World Health Organization has been addressing the issue since the 1980s. After initially focusing on high-income countries, it then focused on low-income countries, with unsafe disposal methods in landfills and inadequate incinerators as major concerns. Gradually, the understanding of the issue has undergone several shifts, including from a focus on the component of medical waste considered "hazardous" to all forms of waste, and from accepting medical waste as a necessary downside of high-quality healthcare to seeing the avoidance of healthcare waste as a component of high quality healthcare.

Medical waste: the dark side of healthcare / Resíduo hospitalar: o lado sombrio da assistência médica

Abstract Hospitals and other health facilities generate an ever-increasing amount of waste, approximately 15% of which may be infectious, toxic, or radioactive. The World Health Organization has been addressing the issue since the 1980s. After initially focusing on high-income countries, it then focused on low-income countries, with unsafe disposal methods in landfills and inadequate incinerators as major concerns. Gradually, the understanding of the issue has undergone several shifts, including from a focus on the component of medical waste considered "hazardous" to all forms of waste, and from accepting medical waste as a necessary downside of high-quality healthcare to seeing the avoidance of healthcare waste as a component of high quality healthcare.

Resumo Hospitais e outros centros de tratamento de saúde geram um volume de resíduos cada vez maior, dos quais cerca de 15% podem ser infecciosos, tóxicos ou radioativos. A Organização Mundial da Saúde começou a enfrentar o problema na década de 1980. Inicialmente, concentrou-se nos países ricos, depois mudou o foco para os países pobres, onde métodos de eliminação inseguros, como aterros sanitários e incineradores inadequados, preocupavam. Aos poucos, a compreensão do problema passou por mudanças, inclusive do enfoque no conteúdo do resíduo hospitalar considerado "perigoso", passando para todas as formas de resíduos, e da aceitação do resíduo médico como um inconveniente inerente aos cuidados de saúde de alta qualidade, até o conceito de que evitar a produção de resíduos hospitalares faz parte dos cuidados de saúde de alta qualidade.

O "retrato" do hospital da Misericórdia de Vila Viçosa (Portugal) em 1870 / The "portrait" of the hospital of the Misericórdia de Vila Viçosa (Portugal) in 1870

O nosso estudo analisa o hospital da Misericórdia de Vila Viçosa em 1870 com base na descrição elaborada pelo administrador do concelho nessa data. Os elementos fornecidos procuram conhecer a instituição a que está ligado -a Misericórdia-, e contribuir para uma melhor administração. Com base nesta fonte é possível conhecer o hospital, bem como a política seguida pela confraria no tocante à saúde. O seu estudo dá a conhecer o funcionamento da instituição, desde os seus espaços aos doentes, apresentando um hospital Municipal de traça quinhentista, embora adaptado às necessidades do século XIX. Integra ainda as sugestões do administrador do concelho, embora estas não sejam implementadas devido à escassez de receitas com que o hospital se debatia, as quais eram as responsáveis pelo estado de degradação em que alguns dos seus espaços se encontravam, mas sobretudo pelo corte no internamento de doentes e da assistência aos que se curavam em suas casas

Our study analyzes the hospital of the Misericórdia of Vila Viçosa in the 1870, based on the description made by the county administrator in that date. The elements given provided seek to know the institution in which is connected - the Misericórdia -, and to contribute to better administration. Based on this source is possible to know the hospital, as well as the politic pursued by the brotherhood in regards to the health. Its study makes known the functioning of the institution, from its spaces to the sick people, presenting a Municipal hospital of fifths hundred traces, although tailored to the needs of the XIX century. It also integrates the suggestions of the municipal administrator, although these are not implemented due to the lack of revenue that the hospital was debating, which were responsible for the state of degradation in which some of its spaces were located, but especially for the cut in hospitalization and the care of those who were cured in their homes

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Medical leadership and management in the United Kingdom.

OBJECTIVE: This article aims to outline the historical development of medical leadership in the United Kingdom (UK), present recent advances, and discuss professional development and future prospects. CONCLUSIONS: With increasing involvement of medical professionals in top managerial roles in the UK over the last 30 years, leadership development initiatives have been growing steadily and there is increasing recognition of the need for leadership and management skills for doctors. Such skills can help to greatly improve patient care as well as enhance organisational effectiveness and productivity. The central involvement of professional bodies such as the UK Faculty of Medical Leadership and Management, and the establishment of medical fellowship schemes, have provided a solid foundation for a new generation of aspiring medical leaders but there is still a long way to go to achieve a higher degree of professionalism for clinical leadership in the UK. The evidence base is weak such that integrated efforts by clinicians and management academics have much to offer in achieving the vision of socially responsible, clinically relevant and research informed medical leadership training.

[Early decentralization of health services in Argentina: the construction of the health system in Córdoba, 1930-1955]. / La temprana descentralización de los servicios de salud en la Argentina: la construcción del sistema sanitario en Córdoba, 1930-1955.

This paper analyzes the process of construction of the Argentine public health system, highlighting the limitations that occurred in the proposed nationalization of health policy in the postwar period and the central role played by subnational jurisdictions, making the provision of services rendered on a provincial basis. More precisely, in this respect it is seen how the expansion of health services in some provinces shows us how, in the second quarter of the twentieth century, it was primarily the result of the action of local rather than national departments. In order to better elucidate this process, the trajectory of public healthcare facilities in the province of Córdoba between 1930 and 1955 was studied.

La temprana descentralización de los servicios de salud en la Argentina: la construcción del sistema sanitario en Córdoba, 1930-1955 / Early decentralization of health services in Argentina: the construction of the health system in Córdoba, 1930-1955

Este trabajo analiza el proceso de construcción del sistema público de salud argentino, poniendo en evidencia las limitaciones que se produjeron en el proyecto de nacionalización de las políticas sanitarias en la postguerra y el papel central que tuvieron las jurisdicciones subnacionales, provincializando la provisión de los servicios. Más precisamente se visibiliza cómo, en el segundo cuarto del siglo XX, la ampliación de los servicios de salud en algunas provincias fue principalmente el resultado de la acción de las reparticiones locales antes que nacionales. Con el propósito de dilucidar mejor ese proceso, estudiamos la trayectoria de los dispositivos sanitarios públicos en la provincia de Córdoba entre 1930 y 1955.

This paper analyzes the process of construction of the Argentine public health system, highlighting the limitations that occurred in the proposed nationalization of health policy in the postwar period and the central role played by subnational jurisdictions, making the provision of services rendered on a provincial basis. More precisely, in this respect it is seen how the expansion of health services in some provinces shows us how, in the second quarter of the twentieth century, it was primarily the result of the action of local rather than national departments. In order to better elucidate this process, the trajectory of public healthcare facilities in the province of Córdoba between 1930 and 1955 was studied.

Desarrollo histórico de la enseñanza médica superior en Cuba de 1959 a 1989 / Historical development of higher medical education in Cuba from 1959 to 1989

El triunfo de la Revolución marcó una serie de transformaciones en el sistema de salud. De ahí que el periodo revolucionario se considere la etapa superior de la enseñanza de la Medicina en Cuba. Este trabajo pretende analizar el desarrollo de la Enseñanza Médica Superior en Cuba en el periodo comprendido de 1959 a 1989. Para ello se tomó como punto de partida la situación en la que se encontraba el país al inicio de la Revolución en el poder. Se abordaron aspectos relacionados con el desarrollo alcanzado en la formación de los profesionales de las ciencias médicas, las modalidades de enseñanza, planes de estudios y con la red de centros docentes a lo largo del país. El periodo analizado fue el escenario de grandes cambios y pasos de avance en función de lograr la integración docente, asistencial e investigativa, fundamentada en los problemas y necesidades comunitarias(AU)

The triumph of the Revolution led to a series of changes in the health system. Hence, the revolutionary period is considered the upper stage of medical teaching in Cuba. This paper analyzes the development of Higher Medical Education in Cuba from 1959 to 1989. The situation in the country at the beginning of the Revolution was taken as a starting point. Aspects related to the achievements in health professional training, teaching methods, curricula and the network of medical schools throughout the country are discussed. The period analyzed was the scene of major changes and steps forward to achieve teaching, practical and research integration based on the community problems and needs(AU)