Epidemiología lesional en actividades escolares y extraescolares en la Comunidad de Madrid (España) / Sport Injuries in School and Extracurricular Activities in the Community of Madrid (Spain)

Este estudio tuvo como objetivo analizar la epidemiología lesional deportiva de las actividades desarrolladas bajo responsabilidad docente (Educación Física, recreo y actividades extraescolares) en centros de Educación Secundaria Obligatoria (ESO). Participaron 1.050 estudiantes (edad media 13,9 ± 1,3 años) que cumplimentaron un cuestionario sobre lesiones deportivas. De las 848 lesiones registradas en total, 319 (172 en chicos y 147 en chicas) ocurrieron en actividades desarrolladas bajo responsabilidad docente (0,30 lesiones/estudiante). Las actividades extraescolares fueron el ámbito con mayor promedio de lesiones (0,12 por estudiante). Se observó una mayor incidencia lesional a los 13 años y una menor probabilidad de que las lesiones ocurriesen en los chicos (OR = 0,64 (0,49-0,85); p < 0,05). Los esguinces y las contusiones fueron las lesiones más frecuentes, especialmente en tobillo y rodilla. Un 27,3% de las lesiones impidieron al alumnado participar activamente en las sesiones de Educación Física durante más de tres días

This study aimed to analyse the epidemiology of sport injuries that occurred during activities performed under teacher supervision (Physical Education, break and extracurricular activities), at high school. A questionnaire regarding sport injuries were administered to 1050 students (mean age 13.9 ± 1.3 years). Out of the 848 sport injuries registered, 319 (172 in boys and 147 in girls) took place during activities performed under teacher supervision, (0.30 injuries/student). Extracurricular activities were the scenario in which the highest injury rate (0.12) was observed. There was a higher incidence of injury at age 13 and a lower likelihood of injuries occurring in boys (OR = 0.64 (0.49-0.85); p < 0.05). Sprains and contusions were the type of injury most frequently observed, especially in areas such as ankles and knees. A total of 27.3% of the injuries reported prevented the students from actively participating in the Physical Education sessions for more than three days

Urachal bladder in kidney transplanted patient with Prune Belly syndrome and patent urachus / Vejiga uracal postrasplante renal en paciente con síndrome de Prune Belly y uraco persistente

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Estudio comparativo del trasplante renal de donante vivo vs. cadáver en nuestro medio / Comparative study of living and deceased donor kidney graft among children from Hospital Universitario Virgen del Rocío

Introducción. El trasplante renal es, actualmete, la mejor opción terapéutica para la enfermedad renal crónica en estadios avanzados. En los últimos años un incremento de la donación procedente de vivo, que puede ofrecer importantes ventajas. Pacientes y métodos. Estudio analítico retrospectivo de pacientes sometidos a trasplante renal en un hospital de tercer nivel durante un período de 6 años, determinándose si hay o no diferencias en el grupo de pacientes con injertos de donante vivo frente a los de donante cadáver en relación a veriables de resultado. Resultados. De los 73 casos estudiados, 14 (19,2%) fueron de donante vivo. La supervivencia del injerto a lo largo de todo el seguimiento fue de 2,76 veces mayor en los receptores de donante vivo. La desviación estándar de la talla fue menor en el grupo de donante vivo, aunque esta diferencia no fue estadísticamente significativa. El filtrado glomerular medio estimado al final del seguimiento fue mayor en el grupo de los receptores de donante vivo (p=0,04). Conclusiones. La donación de vivo en el trasplante renal ofrece importantes ventajas frente a la donación de cadáver, siendo significativos los resultados en relación a la función renal (AU)

Background. Kidney transplantation is currently the best treatment option for chronic kidney disease in advanced stages. In recent years we have seen an increase in kidney donation living donors that may offer important benefits. Methods. A retrospective analytical study of patients undergoing renal transplantation in a tertiary hospital in a period of 6 years, determining whether there are differences in the group of patients with grafts from living donors compared with cadaveric donor regarding outcome. Results. Out of the 73 ptints with kidney transplantation, 14 (19,2%) were from livn donors. The graft survival throughout follow-up was 2.76 times higher in recipients of living donor. The standard deviation of the height was smaller in the living donor group, although this difference was not statistically significant. The mean estimated GFR at follow-up was higher in the roup of living donor recipients (p=0,04). Conclusions. Living donation in renal transplantation offer significant advantages over cadaveric donation, with significant results in relation to renal function (AU)

Complicaciones quirúrgicas precoces en el trasplante renal pediátrico / Early surgical complications in pediatric kidney transplantation

A pesar de los avances en la cirugía del trasplante renal, las complicaciones quirúrgicas continúan siendo una importante causa de morbilidad durante el periodo postrasplante inmediato. El objetivo de este estudio es analizar la incidencia, diagnóstico y tratamiento de dichas complicaciones en población pediátrica sometida a un trasplante renal y comparar los resultados con los de otras series descritas en la literatura. Revisamos de forma retrospectiva los trasplantes renales realizados en nuestro centro en pacientes menores de 18 años en los últimos 10 años. Analizamos el diagnóstico, cronología, tratamiento y evolución de las complicaciones quirúrgicas durante el primer mes postrasplante. En 120 trasplantes revisados se produjeron 35 complicaciones quirúrgicas en 27 pacientes (22,5%). Como consecuencia de estas perdieron el injerto 9 pacientes (7,5%) con una mortalidad asociada nula. La incidencia de complicaciones vasculares y urológicas fue de 8,3$ y 6,6% respectivamente. Entre estas destacan por su morbilidad asociada la trombosis del injerto (4,1%), la estenosis de la arterial renal (1,6%), el pseudoaneurisma arterial (0,8%) y la fístula urinaria (5,0%). Los resultados obtenidos en nuestra serie muestran una incidenica de complicaciones quirúrgicas, pronóstico y supervivencia del injerto asociada a las mismas similares a los publicados en otras series de pacientes pediátricos. El trasplante renal pediátrico presenta una tasa de complicaciones quirúrgicas equiparables al realizado en población adulta, siendo una opción terapéutica segura y eficaz (AU)

Despite advances in renal transplantation surgery, surgical complications still remain an important cause of morbidity in the early postransplant period. The objective of this study is to describe incidence, diagnosis and treatment of these complications in pediatric transplanted population and compare our results to published data. A retrospective review of pediatric transplantations (younger than 18 years old) performed in our institution during the last ten years was designed. We analysed diagnosis, chronology, treatment and prognosis of surgical complications during the first postransplant month. Among 120 transplantations reviewed, 35 surgical complications were described in 27 patients (22,5%). Nine patients (7,5%) lost their graft due these complications, although there was no patient associated mortality. Incidence of vascular and urological complications was 8,3% and 6,6% respectively. The higher morbidity was associated with thrombosis of the allograft (4,1%), renal artery stenosis (1,6%), arterial pseudoaneurysm (0,8%) and urinary leakage (5.0%). Our results show an incidence of surgical complications, prognosis and graft survival related to the complications similar to published data in other series of pediatric patients. Pediatric renal transplantation is a safe and effective therapeutic modality, with an associated surgical complications rate similar to that described in adult transplanted population (AU)

Hypertensive urgency and stunting. What is the diagnosis?

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Insuficiencia renal aguda tras consumo de setas / No disponible

La recolección y consumo de setas silvestres es una práctica frecuente en nuestro medio y puede dar lugar a intoxicaciones accidentales al ser confundidas con hongos comestibles. Describimos el caso de un niño de 9 años que tras la ingesta de un hongo tóxico comienza horas después con vómitos incoercibles y posterior afectación hepática, hematológica y renal, precisando hemodiálisis. El curso clínico, los hallazgos de laboratorio y la histología renal, donde se evidencia necrosis tubular con membrana basal conservada e infiltrado linfocitario intersticial, confirman el diagnóstico de un síndrome mixto grave. La evolución de la intoxicación fue favorable, recuperándose la función renal y hepática. Ante cualquier caso de insuficiencia renal aguda no filiada en niños, habría que descartarla exposición a tóxicos, ya que podría beneficiarse de un tratamiento precoz con hemoperfusión y así evitar el agravamiento de la función renal y resto de órganos. En nuestro paciente la hemoperfusión no fue realizada por el largo período de latencia que había ocurrido desde la ingesta del tóxico hasta su diagnóstico (AU)

The picking and consumption of wild mushrooms is a frequent practice in our region and may lead to accidental poisoning when confused with edible mushrooms. We describe the case of a 9-year-old boy who, following the ingestion of a poisonous mushroom, presented with uncontrollable vomiting and subsequent hepatic, haematological and renal failure some hours later. The patient required haemodialysis. The clinical course, laboratory findings and renal histology, which showed tubular necrosis with basal membrane preserved and lymphocytic interstitial infiltrate, confirmed the diagnosis of a severe mixed syndrome. The patient evolved favourably after the poisoning, recovering renal and liver function. In any case of acute renal failure of unknown cause in children, it would be necessary to rule out ingestion of mushrooms, since the patient could benefit from early treatment with haemoperfusion and thus prevent the deterioration of the renalfunction and other organs. In our patient, haemoperfusion was not carried out due to the lengthy period of latency since the ingestion of the toxic substance until diagnosis (AU)

[Acute renal failure after intake of mushrooms]. / Insuficiencia renal aguda tras consumo de setas.

The picking and consumption of wild mushrooms is a frequent practice in our region and may lead to accidental poisoning when confused with edible mushrooms. We describe the case of a 9-year-old boy who, following the ingestion of a poisonous mushroom, presented with uncontrollable vomiting and subsequent hepatic, haematological and renal failure some hours later. The patient required haemodialysis. The clinical course, laboratory findings and renal histology, which showed tubular necrosis with basal membrane preserved and lymphocytic interstitial infiltrate, confirmed the diagnosis of a severe mixed syndrome. The patient evolved favourably after the poisoning, recovering renal and liver function. In any case of acute renal failure of unknown cause in children, it would be necessary to rule out ingestion of mushrooms, since the patient could benefit from early treatment with haemoperfusion and thus prevent the deterioration of the renal function and other organs. In our patient, haemoperfusion was not carried out due to the lengthy period of latency since the ingestion of the toxic substance until diagnosis.

[Evaluation of therapeutic strategies in congenital nephrotic syndrome of the Finnish type]. / Evaluación de las estrategias terapéuticas en el síndrome nefrótico congénito tipo finlandés.

INTRODUCTION: Congenital nephrotic syndrome of the Finnish type (CNFS) is caused by mutations in the nephrin gene. This disease manifests as massive proteinuria, gross peripheral edema, and ascites during the first weeks of life. In the last few years the prognosis has improved due to new treatment strategies: antiproteinuria drugs, intensive nutrition, nephrectomy, dialysis, and renal transplantation. The aim of this study was to determine the impact of these therapeutic measures. PATIENTS AND METHOD: We performed a descriptive retrospective epidemiological study of 12 patients diagnosed with CNSF between January 1985 and August 2005. We included patients aged less than 14 years old with massive proteinuria and generalized edema during the neonatal period, a large placenta (> 25 % of birth weight), and normal glomerular filtration rate during the first 6 months of life, in whom other causes of congenital nephrotic syndrome were ruled out. RESULTS: The diagnosis was established after a median period of 17 days (range 6-30). The most commonly used treatments were albumin infusions (91.7 %), angiotensin-converting enzyme inhibitors (66.7 %), and indomethacin (58.3 %). Dialysis was started in 58.3 %, at a median age of 3.76 years (2.81-7.6). The main complication was acute peritonitis (85.7 %). Renal transplantation was performed in 58.3 % of the patients; of these, 71.4 % have normal renal function after a median follow-up of 3.73 years (0.8-6.3). The median plasma albumin level during the pretransplant period was 0.17 g/dL (0.12-0.28). Plasma cholesterol and triglyceride levels decreased significantly after renal transplantation (p = 0.043). Fifty percent of the patients achieved adequate height and weight for their age and gender. Mortality was 33.3 %. CONCLUSION: Antiproteinuria drugs and intensive nutritional therapy improve clinical control and delay the start of dialysis and renal transplantation, increasing the probability of success.

Evaluación de las estrategias terapéuticas en el síndrome nefrótico congénito tipo finlandés / Evaluation of therapeutic strategies in congenital nephrotic syndrome of the Finnish type

Introducción El síndrome nefrótico congénito tipo finlandés (SNCF) es una enfermedad causada por diferentes mutaciones en el gen de la nefrina. Se manifiesta con proteinuria masiva, edemas generalizados y ascitis en las primeras semanas de vida. En los últimos años su pronóstico ha mejorado gracias a nuevas estrategias de tratamiento: fármacos antiproteinúricos, nutrición intensa, nefrectomía, diálisis y trasplante renal. El objetivo del estudio es determinar la repercusión de estas medidas terapéuticas. Pacientes y método Estudio epidemiológico descriptivo retrospectivo de 12 pacientes diagnosticados de SNCF entre enero de 1985 y agosto de 2005. Se incluyeron menores de 14 años con proteinuria grave, edema generalizado, peso de la placenta superior al 25 % del peso al nacer, filtrado glomerular normal en los primeros 6 meses, y en los que se descartaron otras causas de síndrome nefrótico congénito. Resultados El diagnóstico se realizó en una mediana de 17 días (rango intercuartílico: 6-30). Los tratamientos más utilizados fueron las infusiones de albúmina (91,7 %), los inhibidores de la enzima conversora de la angiotensina (66,7 %) y la indometacina (58,3 %). El 58,3 % inició diálisis, a una edad mediana de 3,76 años (2,8-7,6). Su principal complicación fue la peritonitis aguda (85,7 %). El 58,3 % recibió un trasplante renal; de ellos, el 71,4 % tiene una función renal normal tras un período de seguimiento mediano de 3,73 años (0,8-6,3). La albuminemia durante el período pretrasplante fue de 0,17 g/dl (0,12-0,28). Las cifras de colesterol y triglicéridos plasmáticos descendieron de forma significativa tras el trasplante renal (p = 0,043). El 50 % de los pacientes alcanzó un peso y talla adecuados para su edad y género. La mortalidad fue del 33,3 %. Conclusión Los fármacos antiproteinúricos y el tratamiento nutricional intensivo permiten un mejor control clínico e iniciar la diálisis y el trasplante renal de forma más tardía y con mayores probabilidades de éxito

Introduction Congenital nephrotic syndrome of the Finnish type (CNFS) is caused by mutations in the nephrin gene. This disease manifests as massive proteinuria, gross peripheral edema, and ascites during the first weeks of life. In the last few years the prognosis has improved due to new treatment strategies: antiproteinuria drugs, intensive nutrition, nephrectomy, dialysis, and renal transplantation. The aim of this study was to determine the impact of these therapeutic measures. Patients and method We performed a descriptive retrospective epidemiological study of 12 patients diagnosed with CNSF between January 1985 and August 2005. We included patients aged less than 14 years old with massive proteinuria and generalized edema during the neonatal period, a large placenta (> 25 % of birth weight), and normal glomerular filtration rate during the first 6 months of life, in whom other causes of congenital nephrotic syndrome were ruled out. Results The diagnosis was established after a median period of 17 days (range 6-30). The most commonly used treatments were albumin infusions (91.7 %), angiotensin-converting enzyme inhibitors (66.7 %), and indomethacin (58.3 %). Dialysis was started in 58.3 %, at a median age of 3.76 years (2.81-7.6). The main complication was acute peritonitis (85.7 %). Renal transplantation was performed in 58.3 % of the patients; of these, 71.4 % have normal renal function after a median follow-up of 3.73 years (0.8-6.3). The median plasma albumin level during the pretransplant period was 0.17 g/dL (0.12-0.28). Plasma cholesterol and triglyceride levels decreased significantly after renal transplantation (p = 0.043). Fifty percent of the patients achieved adequate height and weight for their age and gender. Mortality was 33.3 %. Conclusion Antiproteinuria drugs and intensive nutritional therapy improve clinical control and delay the start of dialysis and renal transplantation, increasing the probability of success

[Guidelines of the Spanish Society of Nephrology. Clinical practice guidelines for peritoneal dialysis]. / Guías Sociedad Española de Nefrología. Guías de práctica clínica en diálisis peritoneal.

In Spain and in each of its autonomous communities, the dialysis treatment of chronic renal disease stage 5 is totally covered by public health. Peritoneal dialysis, in any of its modalities, is established as the preferred home dialysis technique and is chosen by high percentage of patients as their choice in dialysis treatment. The Spanish Society of Nephrology has promoted a project of creation of performance guides in the field of peritoneal dialysis, entrusting a work group composed of members of the Spanish Society of Nephrology a with the development of these guides. The information offered is based on levels of evidence, opinion and clinical experience of the most relevant publications of the topic. In these guides, after defining the concept of << peritoneal dialysis>>, the obligations and responsibilities of the sanitation team of the peritoneal dialysis unit are determined, and protocols and performance procedures that try to include all the aspects that concern the patient with chronic renal disease in substitute treatment with this technique are developed. They propose prescription objectives based on available clinical evidence and, lacking this, on the consensus of the experts' opinions. The final aim is to improve the care and quality of the of the patient in peritoneal dialysis, optimizing in this way the survival of the patient and of the technique. In Spain, as in other neighbouring countries, peritoneal dialysis has an incidence and prevalence that is much lower than that of hemodialysis, ranging in the last evaluation by the Spanish Society of Nephrology between 5 and 24% in the different autonomous communities. The great majority of peritoneal dialysis units form part of the public network of the Spanish state, with special representation as a Satellite Unit or Concerted Center related to the public hospital of reference, on which it must depend.

Trasplante renal y crisis epilépticas en la infancia / Renal transplantation and epileptic episode in childhood

La semiología clínica neurológica que puede presentarse en el contexto de un trasplante renal, comprende un amplio y variado abanico de enfermedades neurológicas. Y una gran parte de las complicaciones neurológicas del trasplante renal pueden desarrollar crisis convulsivas. Objetivo: Se pretende analizar la incidencia de las crisis convulsivas en niños que tras el diagnóstico de insuficiencia renal terminal han recibido un trasplante renal, estudiando las características semiológicas de los episodios convulsivos, su posterior evolución y la presencia de posibles secuelas. Se han relacionado los distintos factores desencadenantes de las crisis, con su evolución y con su tratamiento. Material y métodos: Durante un período de 20 años, se revisan de forma retrospectiva 42 pacientes que ingresados en el hospital han sido sometidos a un trasplante renal. El estudio informático de las 18 variables médicas recogidas se realiza con el programa SPSS versión 9.0.1. Resultados: Del total de enfermos, 13 habían sufrido algún tipo de crisis convulsiva (30,95 por ciento), con una edad media de aparición de la primera crisis de 69 meses. Como factor desencadenante, hubo un desequilibrio hidroelectrolítico en 8 casos, hipertensión en 2, y otras causas no bien determinadas en los restantes. sólo en 3 casos que correspondían a epilepsias previas al fallo renal, se mantenían las manifestaciones críticas. Comentarios: Las crisis epilépticas del trasplante renal en la infancia pueden ser consideradas como crisis ocasionales, que no suelen cronificarse ni dejar secuelas deficitarias. El manejo de las crisis en cualquier fallo renal debe ser divulgado entre los profesionales que atienden enfermedades sistémicas (AU)

Insuficiencia renal como factor desencadenante de crisis epilépticas / Renal failure as a factor leading to epileptic seizures

Objetivo: Se pretende analizar la incidencia de las crisis convulsivas en la insuficiencia renal, estudiando las características semiológicas de los episodios convulsivos, su posterior evolución y la presencia de posibles secuelas. Se han relacionado los distintos factores desencadenantes de las crisis, con su evolución y con su tratamiento. Material y métodos: Estudio retrospectivo por revisión de historias clínicas. Durante un período de 20 años se revisan de forma retrospectiva 108 pacientes ingresados en el hospital con el diagnóstico de insuficiencia renal: 55 con prediálisis, 42 con trasplante renal, 7 con diálisis peritoneal, y 3, hemodiálisis. Un caso se desechó por no cumplir los criterios de selección. Se analizaron 18 variables cuantitativas y cualitativas, utilizando las medidas de tendencia central o de localización en las variables cuantitativas, y los porcentajes en las cualitativas. El test de chi cuadrado ( 2) se usó al comparar dos proporciones. Resultados: Del total de enfermos, 16 habían sufrido algún tipo de crisis convulsiva (14,95%), y de ellos ninguno se encontraba en el grupo de prediálisis. Como factor desencadenante, hubo un desequilibrio hidroelectrolítico en 8 casos, hipertensión en cuatro, y otras causas no bien determinadas en los restantes. Sólo en 3 casos que correspondían a epilepsias previas a la insuficiencia renal, se mantenían las manifestaciones críticas. Conclusiones: Las crisis epilépticas de la insuficiencia renal en la infancia pueden considerarse crisis ocasionales, que no suelen cronificarse ni dejar secuelas deficitarias. El tratamiento de las crisis en la insuficiencia renal debe ser divulgado entre los profesionales que atienden enfermedades sistémicas (AU)

[Renal failure as a factor leading to epileptic seizures]. / Insuficiencia renal como factor desencadenante de crisis epilépticas.

OBJECTIVE: To analyze the incidence of convulsive seizures in renal failure by studying the semiological characteristics of the convulsive episodes, their subsequent evolution and the presence of possible sequelae. The relationship between the different potential causes of the seizures and their evolution and treatment was also analyzed. MATERIAL AND METHODS: We retrospectively reviewed the clinical histories of 108 patients admitted to the hospital over a 20-year period with a diagnosis of renal failure: 55 were undergoing predialysis, 42 renal transplantation, 7 peritoneal dialysis and 3 hemodialysis. One patient was excluded for not fulfilling the selection criteria. Computer study of the 18 quantitative and qualitative variables was carried out with the SPSS 9.0.1 program. RESULTS: Of the 107 patients, 16 (14.95 %) had suffered some type of convulsive seizure. None was in the predialysis group. As triggering factors, hydroelectrolyte imbalance was found in eight patients and hypertension was found in four. In the remaining patients the causes were not well-defined. Only three patients with epilepsy prior to renal failure presented sequelae. CONCLUSIONS: Epileptic seizures in renal failure in childhood can be considered as occasional seizures that do not usually become chronic or produce sequelae. Information on the management of seizures in renal failure should be disseminated among professionals treating systemic diseases.

[The outlook for Spanish primary care starting with a bibliometric analysis of its scientific production (1971-1994)]. / Perspectiva de la atención primaria española a partir del análisis bibliométrico de su producción científica (1971-1994).

OBJECTIVE: To establish the relative weight of the various kinds of primary health care (PHC) research collected in the IME (Spanish medical index), In order to determine their possible relationships with Spain's PHC model. DESIGN: Bibliometric analysis. PARTICIPANTS: PHC documents (1971-1994) from the IME data base (CD-ROM), subdivided by years, journals, themes and Autonomous Communities (AC). RESULTS: 3,015 studies were published, with a first phase (1970s) of under 10 documents per year, a second (1980s) with a big increase and a third (1990s) of stagnation. Of the 117 journals containing studies, Atención Primaria gave a home to almost 58% (60% after 1984). CONCLUSIONS: PHC research production has stagnated recently, though the journal Atención Primaria has maintained its undisputed leadership position. The clinical model predominant in Spanish medicine is generally followed.

[Study of tuberculosis in Huelva prison]. / Estudio de tuberculosis en la prisión de Huelva.

OBJECTIVES: Knowing about the rate of tuberculous infection and disease in prison population and workers in Huelva prison, and the association of tuberculosis with the sociosanitary risk factors. EQUIPMENT AND METHODS: Descriptive research for a year in 141 male prisoners at the age of 20 to 52 years old, from the 1sT of February in 1994 to the 1sT in 1995. RESULTS: The prevalence on tuberculous infection is 46.4% (accumulative incidence); and tuberculous disease 3.5% (accumulative incidence 1.4%) on the prisoners and the prevalence on tuberculous infection on the prison officers is 18.8% (there wasn't incidence) and the was no disease. CONCLUSIONS: It's perceived a high rate of tuberculous disease on the prisoners at the expense of people with infection by HIV and drugs addicts by parenteral way. The socio-cultural variables affect the tuberculous infection and disease tuberculous.

[Rational structures in health education models: basics and systematization]. / Estructuras de racionalidad en educación para la salud: fundamentos y sistematización.

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.