La implantación de las gotas de leche en España (1902-1935): un estudio a partir de la prensa histórica / The establishment of milk depots in Spain (1902-1935): a study from the historical press

Las Gotas de Leche eran instituciones sanitarias que intervinieron en la reducción de la mortalidad infantil en España promoviendo la mejora en la higiene alimentaria de los recién nacidos. Este artículo reconstruye la trayectoria de su implantación hasta la Guerra Civil. Dada la limitada información estadística disponible, se ha empleado como base documental las hemerotecas históricas digitalizadas. El análisis de la misma y de otros estudios permite estimar que el despliegue de esta institución entre 1902 y 1935 involucró, al menos, a 79 localidades. Se establecieron mayoritariamente en capitales de provincia, en todas las regiones, incluido el protectorado español en Marruecos. Antes de 1936 tuvo lugar una secuencia completa de expansión y estabilización en la apertura de estos centros. La creación de Gotas de Leche parece que respondió más a la influencia de las instituciones médicas y benéficas existentes en una localidad que a los niveles de mortalidad infantil. El examen de las noticias de prensa muestra como la creación de una Gota de Leche no acostumbró a ser fruto de un proceso de decisión ágil ejecutado rápidamente. La gestión tampoco estuvo exenta de dificultades. Una parte relevante de las mismas eran de origen financiero o derivadas de una mayor demanda de sus servicios (AU)

Milk Depots were health care institutions involved in fighting against high levels of child mortality in Spain in the first third of 20th century. They promoted the improvement of food hygiene of the newborn. This article reconstructs the trajectory of its implementation until the Spanish Civil War. Given the limited number of statistical sources available, it has been used as documentary source digitized historical newspapers. Analysis of these documents and other published studies leads to the estimation that this institution was deployed in 79 cities between 1902 and 1935. Milk Depots were settled mostly in provincial capitals, in all regions, including the Spanish protectorate in Morocco. Before 1936, a complete sequence of expansion and stabilization took place in the opening of these centers. This opening seems to respond most to influence of existing medical and charitable institutions that infant mortality levels prevailing at that time. Examination of the news shows as setting up a Milk Depot was not the outcome of a simple decision process, implemented quickly. The management was not exempt from difficulties. They came mainly from the lack of financial support or they were consequence from greater demand for their services (AU)

El derecho de información en medicina curativa y satisfactiva / The right to information in curative and voluntary medicine

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Visual gut punch: persuasion, emotion, and the constitutional meaning of graphic disclosure.

The ability of government to "nudge" with information mandates, or merely to inform consumers of risks, is circumscribed by First Amendment interests that have been poorly articulated. New graphic cigarette warning labels supplied courts with the first opportunity to assess the informational interests attending novel forms of product disclosures. The D.C. Circuit enjoined them as unconstitutional, compelled by a narrative that the graphic labels converted government from objective informer to ideological persuader, shouting its warning to manipulate consumer decisions. This interpretation will leave little room for graphic disclosure and is already being used to challenge textual disclosure requirements (such as county-of-origin labeling) as unconstitutional. Graphic warning and the increasing reliance on regulation-by-disclosure present new free speech quandaries related to consumer autonomy, state normativity, and speaker liberty. This Article examines the distinct goals of product disclosure requirements and how those goals may serve to vindicate, or to frustrate, listener interests. I argue that many disclosures, and especially warnings, are necessarily both normative and informative, expressing value along with fact. It is not the existence of a norm that raises constitutional concern but rather the insistence on a controversial norm. Turning to the means of disclosure, this Article examines how emotional and graphic communication might change the constitutional calculus. Using autonomy theory and the communications research on speech processing, I conclude that disclosures do not bypass reason simply by reaching for the heart. If large graphic labels are unconstitutional, it will be because of undue burden on the speaker, not because they are emotionally powerful. This Article makes the following distinct contributions to the compelled commercial speech literature: critiques the leading precedent, Zauderer v. Office of Disciplinary Counsel, from a consumer autonomy standpoint; brings to bear empirical communications research on questions of facticity and rationality in emotional and graphic communications; and teases apart and distinguishes among various free speech dangers and contributions of commercial disclosure mandates with a view towards informing policy, law, and research.

How differently we should prepare for the next disaster?

Following the Great East Japan earthquake (the Big Quake) that hit the northeastern parts of Japan on March 11, 2011, aid was dispatched from multiple levels of organizations including the Japanese Nurses Association (JNA). Evidence indicates that the JNA did not play an effective role in the aid efforts, since the professional organization had pulled out and stopped sending nursing personnel from the end of April 2011. In view of the way that things were handled in terms of aid efforts immediately, a year, or two years after the Big Quake occurred, the authors of this paper have identified issues related to nurse's role at the time of the disaster. By looking back at what happened, we have gained insights into how to prepare for future disasters.

[Information hygiene and regulation of information for vulnerable groups of the population].

Development of information society engenders the problem of hygienic regulation of information load for the population, first of all for vulnerable groups. There are presented international and Russian normative legal documents and experience in this area, there are described the negative effects of information (such as stress, depression, suicidal ideations). There are considered social-psychological characteristics of vulnerable groups that requires their best protection from loads of information, doing harm, particularly in terms of reproductive health, family relationships, children, etc. There was noted the desirability of improvement of sanitary, legislation on the regulation of the information load on the population, especially in vulnerable groups, in terms of optimization of parameters of the signal-carriers on volume, brightness and the adequacy of the volume and content of information in radio and television broadcasting, in an urban environment and at the plant to preserve the health and well-being of the population.

For whom the bell tolls: Silver Alerts raise concerns regarding individual rights and governmental interests.

The Silver Alert system was initially created to help protect missing persons who have cognitive impairments, particularly the elderly. The Silver Alert is modeled after the Amber Alert, created to help locate and safeguard missing children. Unlike the Amber Alert, however, in most states the Silver Alert applies to the elderly, adults with a mental impairment, or both, depending on the state. The goal of the Silver Alert system is the quick dissemination of information about missing persons to law enforcement personnel as well as to the general public. Previously, states notified law enforcement personnel of missing persons through teletype to other public safety jurisdictions to enlist their assistance in the retrieval of the missing person. Silver Alert programs substantially expand the notification to include the general public, who receive information through radio and television broadcasts as well as highway billboards. The programs serve a legitimate governmental interest by protecting a vulnerable population from possible harm. Yet, the implementation of these alerts can have unintended consequences, including the possible violation of an individual's right to privacy. Such consequences require careful consideration.

[The national plan for orphan rare diseases: nearly 10 years on]. / Le plan national maladies rares--bientôt 10 ans.

The management of orphan rare diseases has been the goal of two successive government plans since 2004. They allowed the management of these diseases to be handled initially through reference centers, then by specialized centers that were specifically created. The resulting benefits to patients, standardization of management protocols, dissemination of information through ORPHANET, and the development of both fundamental and clinical research have clearly justified the setting up of these plans. Other associated plans are expected to follow in the years to come.

Online professional networks for physicians: risk management.

BACKGROUND: The rapidly developing array of online physician-only communities represents a potential extraordinary advance in the availability of educational and informational resources to physicians. These online communities provide physicians with a new range of controls over the information they process, but use of this social media technology carries some risk. QUESTIONS/PURPOSES: The purpose of this review was to help physicians manage the risks of online professional networking and discuss the potential benefits that may come with such networks. This article explores the risks and benefits of physicians engaging in online professional networking with peers and provides suggestions on risk management. METHODS: Through an Internet search and literature review, we scrutinized available case law, federal regulatory code, and guidelines of conduct from professional organizations and consultants. We reviewed the OrthoMind.com site as a case example because it is currently the only online social network exclusively for orthopaedic surgeons. RESULTS: Existing case law suggests potential liability for orthopaedic surgeons who engage with patients on openly accessible social network platforms. Current society guidelines in both the United States and Britain provide sensible rules that may mitigate such risks. However, the overall lack of a strong body of legal opinions, government regulations as well as practical experience for most surgeons limit the suitability of such platforms. Closed platforms that are restricted to validated orthopaedic surgeons may limit these downside risks and hence allow surgeons to collaborate with one another both as clinicians and practice owners. CONCLUSIONS: Educating surgeons about the pros and cons of participating in these networking platforms is helping them more astutely manage risks and optimize benefits. This evolving online environment of professional interaction is one of few precedents, but the application of risk management strategies that physicians use in daily practice carries over into the online community. This participation should foster ongoing dialogue as new guidelines emerge. This will allow today's orthopaedic surgeon to feel more comfortable with online professional networks and better understand how to make an informed decision regarding their proper use.

Prosocial behavior on the Net.

Volunteers and charitable organizations contribute significantly to community welfare through their prosocial behavior: that is, discretionary behavior such as assisting, comforting, sharing, and cooperating intended to help worthy beneficiaries. This essay focuses on prosocial behavior on the Internet. It describes how offline charitable organizations are using the Net to become more efficient and effective. It also considers entirely new models of Net-based volunteer behavior directed at creating socially beneficial information goods and services. After exploring the scope and diversity of online prosocial behavior, the essay focuses on ways to encourage this kind of behavior through appropriate task and social structures, motivational signals, and trust indicators. It concludes by asking how local offline communities ultimately could be diminished or strengthened as prosocial behavior increases online.

Architecture of a consent management suite and integration into IHE-based Regional Health Information Networks.

BACKGROUND: The University Hospital Heidelberg is implementing a Regional Health Information Network (RHIN) in the Rhine-Neckar-Region in order to establish a shared-care environment, which is based on established Health IT standards and in particular Integrating the Healthcare Enterprise (IHE). Similar to all other Electronic Health Record (EHR) and Personal Health Record (PHR) approaches the chosen Personal Electronic Health Record (PEHR) architecture relies on the patient's consent in order to share documents and medical data with other care delivery organizations, with the additional requirement that the German legislation explicitly demands a patients' opt-in and does not allow opt-out solutions. This creates two issues: firstly the current IHE consent profile does not address this approach properly and secondly none of the employed intra- and inter-institutional information systems, like almost all systems on the market, offers consent management solutions at all. Hence, the objective of our work is to develop and introduce an extensible architecture for creating, managing and querying patient consents in an IHE-based environment. METHODS: Based on the features offered by the IHE profile Basic Patient Privacy Consent (BPPC) and literature, the functionalities and components to meet the requirements of a centralized opt-in consent management solution compliant with German legislation have been analyzed. Two services have been developed and integrated into the Heidelberg PEHR. RESULTS: The standard-based Consent Management Suite consists of two services. The Consent Management Service is able to receive and store consent documents. It can receive queries concerning a dedicated patient consent, process it and return an answer. It represents a centralized policy enforcement point. The Consent Creator Service allows patients to create their consents electronically. Interfaces to a Master Patient Index (MPI) and a provider index allow to dynamically generate XACML-based policies which are stored in a CDA document to be transferred to the first service. Three workflows have to be considered to integrate the suite into the PEHR: recording the consent, publishing documents and viewing documents. CONCLUSIONS: Our approach solves the consent issue when using IHE profiles for regional health information networks. It is highly interoperable due to the use of international standards and can hence be used in any other region to leverage consent issues and substantially promote the use of IHE for regional health information networks in general.

The right to know about chemical hazards in Canada, 1982-2006.

Traditionally in Canada, there are three health and safety rights: the right to participate (joint workplace health and safety committees); the right to refuse unsafe and unhealthy work; and the right to know about workplace hazards. By the end of the 1970s, the right to know had been established in law across Canada, but it was not enough to cover workplace chemical hazards in particular. The Workplace Hazardous Materials Information System (WHMIS) was a project set up by the Canadian federal government in 1982 to address the issue. This article tells the story of how labor got the progressive WHMIS agreement(1985) and how the agreement has been implemented in the following years.

Integración de la información para las intervenciones sanitarias: de los datos a la información; de la información a la acción. Informe SESPAS 2008 / Integration of information for health interventions: from data to information and from information to action. 2008 SESPAS Report

Nuestros sistemas de información (SI) de salud pública y delos servicios de salud han mejorado, pero están fragmentadospor áreas de interés y han evolucionado de forma independiente.Su formato, estructura e integridad y la calidad delos datos son heterogéneos, como los programas, plataformasy bases de datos que los sustentan. Las innovaciones introducidasabordan SI aislados y parten lastradas por modelos,registros, herramientas y funcionalidades obsoletos, y por unademanda inercial de información. La transferencia de competencias,realizada sin acuerdos sobre mínimos, ha mermadola cohesión de los SI, lo cual, junto con la ausencia de espaciospara compartir experiencias en la informatización, nos debilitaante la oferta de aplicaciones informáticas inmaduras.La integración debe gobernar la evolución de los SI. Hemosde redefinir sus objetivos (estratégicos y operativos), revisar losdatos y la información disponibles, establecer la identificaciónúnica de personas y pacientes, ordenar y homogeneizar las variables,los indicadores, las prestaciones y los servicios, y redefinirlos cuadros de mandos mediante una nomenclatura única,así como unificar como fuentes de información primarias lashistorias clínicas, las bases de datos administrativas y las deactividad de servicios y de salud pública. Debe redefinirse larecogida, la mecanización, el registro y la explotación de datos,y su depuración y mantenimiento periódicos, con independenciade su ámbito. Urge alcanzar un compromiso nacional sobre lasfuncionalidades mínimas que debe reunir cualquier SI, que respetesu naturaleza técnica y asuma su gestión autonómica(AU)

Spanish public health and health services information systems(HIS) have improved, but are still fragmented by areasof interest and have evolved independently from one another.Their format, structure, integrity and data quality vary widely,as do the programs, platforms and databases that support them.The latest innovations focus on isolated HIS and are hamperedby obsolete models, tools, functionalities, and the inertialdemand of information. Transfer of responsibilities without minimalagreements on HIS has eroded their national cohesionand, along with the absence of exchanges on experiences ofcomputerization on a national basis, has weakened us, giventhe supply of immature computer applications.The evolution of HIS must be governed by integration. Wehave to redefine their strategic and operational objectives, reviewexisting data and information, and determine the singleidentification of specific persons and patients. Variables, indicators,services and control panels should be reviewed andsystematized through a single shared nomenclature. Personalhealth records and administrative and clinical registriesshould become the primary sources of health information data.Data collection, mechanization, registration and exploitation,and their quality control and maintenance, should be redefinedregardless of setting. A national agreement is urgently requiredon the minimal functionalities of HIS, while respectingtheir technical nature and management by autonomous governments(AU)