Vigilancia activa y control de enterobacterias productoras de carbapenemasas en un hospital de media/larga estancia de la Comunidad de Madrid / Active surveillance and control of carbapenemase-producing enterobacteriaceae in a non-acute rehabilitation hospital in Madrid

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Procedimentos de biossegurança adotados por profissionais de serviços de embelezamento / Biosafety procedures adopted by beauty professionals

O objetivo deste estudo foi investigar procedimentos de biossegurança adotados por profissionais de manicure, pedicure, tatuagem, piercing e maquiagem definitiva em Jacareí-SP. Utilizou-se abordagem descritiva e observacional de corte transversal. A pesquisa de campo foi realizada entre maio e junho de 2011. Foram feitas quarenta entrevistas com profissionais de estabelecimentos localizados no centro e nos dez bairros mais populosos. Utilizou-se questionário para avaliar conhecimentos e atitudes dos profissionais e um formulário para a observação de seus procedimentos e estrutura física dos estabelecimentos. Verificou-se falta de conhecimento sobre biossegurança pelos profissionais e deficiência na regulamentação desses serviços. Embora 55 por cento dos profissionais tenham realizado treinamento, seus procedimentos e a infraestrutura dos estabelecimentos foram favoráveis ​​à transmissão de doenças. Sobre os processos de limpeza, desinfecção e esterilização de instrumentais, nenhum dos entrevistados sabia o tempo e a temperatura ideal para a esterilização, 57,5 por cento tinham equipamento inadequado para sua realização e 80 por cento não tinham termostato ou termômetro no equipamento para a conferência da temperatura. Apenas 57,5 por cento acreditavam que poderiam transmitir doenças durante sua prática profissional. Quarenta e cinco por cento dos entrevistados relataram ter tido contato com sangue sem luvas. Outro problema observado foi a reutilização de materiais descartáveis. Somente 10 por cento possuíam área específica para a esterilização de instrumentais. Evidenciou-se a necessidade de formação de qualidade sobre boas práticas de biossegurança a esses profissionais, além de normas e diretrizes pormenorizadas para a prevenção de infecções nesses serviços, bem como a melhoria da vigilância nesses estabelecimentos.

The objective of this study was to investigate biosafety procedures adopted by manicure, pedicure, tattoo, piercing and permanent makeup professionals in Jacareí-SP. We used a descriptive, observational and cross-sectional approach. The field research was conducted between May and June 2011. Forty professionals were surveyed in the downtown area and in the ten most populated districts of the municipality. We used a questionnaire to assess knowledge and attitudes of professionals as well as a formulary for the observation of professional procedures and physical structure of establishments. It has been found that professionals lack knowledge on biosafety procedures, and that the regulation of these services was deficient. Although 55% of professionals have attended to training courses, their procedures and establishments' infrastructure were favorable to disease transmission. Regarding the processes for cleaning, disinfecting and sterilizing instruments, none of interviewed knew the ideal time and temperature for sterilization, 57.5% had inadequate equipment for it and 80% had no thermostat or thermometer in the equipment for checking the temperature. Only 57.5% believed they could transmit infectious diseases during their professional practice. Forty-five percent of respondents reported having had contact with blood without wearing gloves. Another problem observed was the reuse of disposable material. Only 10% had a specific area for sterilizing instruments. The results demonstrated the need for providing to these professionals quality training on good biosafety practices and standards, detailed guidelines for the prevention of infections in these services as well as improvement on these establishments' surveillance.

Reflexiones sobre los sistemas sanitarios del municipio de São Paulo y de Cataluña. Descripción del modelo sanitario de Brasil y São Paulo (I) / No disponible

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Seguridad de risperidona en el embarazo. A propósito de un caso / Risperidone safety in pregnancy. A case report

El uso de la risperidona y de otros antipsicóticos durante la gestación se hace, en ocasiones, imprescindible a pesar de la imposibilidad de diseñar ensayos clínicos que refrenden la seguridad de los mismos. El informe de casos clínicos es un modo de constatar la ausencia de hallazgos clínicos al nacimiento, pero puede ser insuficiente. Se presenta el caso de una mujer que padece un trastorno esquizofreniforme y se mantiene en tratamiento con risperidona durante todo el embarazo, que culmina con el nacimiento de un niño sano. Se repasa la evidencia científica respecto a la seguridad de la risperidona en la gestación y se apunta la necesidad de realizar estudios de seguimiento a largo plazo para valorar correctamente el riesgo que se corre a la hora de prescribir antipsicóticos en el embarazo (AU)

The use of risperidone and other antipsychotic drugs during pregnancy is sometimes essential, although it is impossible to design clinical trials to demonstrate the safety of these kinds of drugs. The common method to communicate the absence of drug-related events is through case reports, even though they might be insufficient. This is a case report of a woman with a schizophreniform disorder who continued treatment with risperidone during all her pregnancy, and who gave birth to a healthy baby. The scientific evidence regarding risperidone safety during pregnancy is reviewed and the need to conduct follow up studies evaluating the consequences of using antipsychotic drugs in pregnant women is stated (AU)

Necesidades de asistencia urgente a los inmigrantes ilegales recién llegados en cayuco a Tenerife / Nonhospital emergency care required by illegal immigrants arriving in small boats on Tenerife island

Objetivos: Determinar las características de la primera asistencia y las patologías atendidas de los inmigrantes que llegan de forma irregular por vía marítima a la Isla de Tenerife, en un nuevo tipo de embarcación, el cayuco. Método: Estudio transversal. Los puntos de asistencia de campaña fueron atendidos por personal del Servicio de Urgencias Canario (SUC) y Cruz Roja Española (CRE), y también por el equipo de Atención Primaria (AP) si el número de inmigrantes supera bala capacidad habitual de respuesta. Se incluyó a todos los inmigrantes que llegaron a la isla de Tenerife (Canarias, España) desde el 22 de octubre de 2005 al 21 de octubre de2006 (1 año). Se consignaron las patologías diagnosticadas al llegar a la isla, las derivaciones realizadas y su causa. Resultados: Se registró la llegada de 17.184 inmigrantes. Todos ellos se valoraron en el primer triaje, y precisaron de asistencia sanitaria 649 (3,7%). De ellos, 447 (68,9%)fueron tratados in situ y 202 (31,1%) tuvieron que ser trasladados a diferentes centros sanitarios. In situ se trataron 103 pacientes por hipotermia (23%), 79 por hipoglucemia(17,6%), 37 por erosiones (8,2%), 21 por traumatismos leves (4,6%), 15 por sarna(3,3%), y 14 por dolor abdominal (3,1%); no se registró el diagnóstico en 16 casos(3,5%). Los principales diagnósticos entre los trasladados fueron: la deshidratación en28 casos (13,8%), las heridas en extremidades en 22 (10,8%), las quemaduras en 18(8,9%), la hipotermia en 16 (7,9%), el dolor abdominal en 14 (6,9%), la hipoglucemia en 8 (3,9%), los vómitos en 8 (3,9%), el malestar general en 6 (2,9%), la hipotensión en 3 (1,4%) y el traumatismo torácico 3 (1,4%).Conclusiones: La llegada de inmigrantes en cayucos requiere un importante despliegue sanitario extrahospitalario, aunque la inmensa mayoría de los inmigrantes llegan en aparente buen estado de salud. De los que precisan atención sanitaria, la tercera parte han de ser trasladados a otros centros (AU)

Objectives: To determine the health problems of immigrants arriving on the coast of Tenerife (Canary Islands, Spain) in small boats, a new means of transport for this purpose, and to describe the type of first aid they require. Material and methods: Cross-sectional study. The first-aid field stations were attended by staff of the Canary Islands Emergency Service and the Spanish Red Cross. Additionally, if the number of arriving immigrants exceeded the ability of the staff to cope, they were joined by a team from a primary care clinic. All immigrants who arrived on Tenerife over a period of 1 year (October 22, 2005 through October 21, 2006) were studied. Data recorded included diagnoses made upon arrival, referrals, and reasons for referral. Results: A total of 17184 immigrants arrived. All were assessed in the initial triage and 649 (3.7%) were found to need medical care. Of those, 447 (68.9%) were treated at the point of arrival, and 202 (31.1%) had to be transferred to health-care facilities. One hundred three patients (23%) received on-site treatment for hypothermia, 79 (17.6%) for hypoglycemia, 37 for skin lesions (8.2%), 21 (4.6%) for minor injuries (4.6%), 15 (3.3%) for scabies, and 14 (3.1%) for abdominal pain. In 16 cases (3.5%) no diagnosis was recorded. The main reasons for transferring patients to health care facilities were dehydration in 28 cases (13.8%), cuts on extremities in 22 (10.8%), burns in 18 (8.9%), hypothermia in16 (7.9%), abdominal pain in 14 (6.9%), hypoglycemia in 8 (3.9%), vomiting in 8 (3.9%), nonspecific malaise in 6(2.9%), hypotension in 3 (1.4%), and chest trauma in 3 (1.4%).Conclusions: The arrival of immigrants in small boats requires considerable deployment of health-care providers outside the hospital setting, even though the great majority of immigrants are in apparently good health. A third of those in need of care must be transferred to health-care facilities (AU)

Impacto de las recomendaciones del Sistema Español de Farmacovigilancia en la publicación de casos de reacciones adversas a medicamentos / Impact of the spanish pharmacovigilance system recommendation son the publication of cases of adverse drug reactions

Objetivo. Evaluar el impacto de lasrecomendaciones que el Comité Técnico delSistema Español de Farmacovigilancia envióa los editores de revistas médicas españolasen el año 2004 sobre la información mínimaque deberían contener los casos publicadosde reacciones adversas a medicamentos.Diseño. Estudio observacional.Emplazamiento. Base de datos nacional desospechas de reacciones adversas (FEDRA).Participantes. Notificaciones de publicacionesde sospechas de reacciones adversasregistradas en FEDRA y publicadas enlos años previo (2003) y posterior (2005)al envío de las recomendaciones.Mediciones principales. Información en losapartados: sexo, edad, dosis, motivo de laprescripción, duraciones del tratamiento y dela reacción, secuencia temporal, efecto de laretirada y causas alternativas de laspublicaciones de sospechas de reaccionesadversas registradas en FEDRA. Secompararon los resultados de los 2 años.Resultados. No se observaron diferenciassignificativas en la información contenidaen las publicaciones de casos de reaccionesadversas entre los años 2003 y 2005.Los apartados que con mayor frecuenciapresentaban información incompleta eranlas dosis y duraciones de los tratamientosy de la reacción adversa. Sólo un tercio,aproximadamente, de las publicacionescontenían información completa.Conclusiones. Es necesario mejorarel contenido de la información de laspublicaciones de casos de reacciones adversasa medicamentos para que esta mejordocumentación contribuya a mejorarla evaluación de las señales de alerta

Objective. To assess the impact of therecommendations that, the TechnicalCommittee of the SpanishPharmacovigilance System sent, in 2004,to the editors of Spanish medical journalson the minimum information required forpublication of adverse drug reaction casereports.Design. Observational study.Setting. National suspected adverse drugreactions database (FEDRA).Participants. Published adverse drug reactionreports registered in FEDRA, publishedin the years before (2003) and after (2005)the recommendations were issued.Main measurements. The following dataelements were analysed: sex, age, dose,disease treated with the suspecteddrug, length of treatment and adverse drugreaction, temporal sequence, withdrawaleffect, and alternative causes. The resultsof the 2 years were compared.Results. The information in the case reportspublished between years 2003 and 2005was not significantly different. The dataelements more often incomplete were dose,length of treatment, as well as length ofadverse reaction. Approximately one thirdof the published case reports included fullinformation.Conclusions. There seems to be a needto improve the data elements contentof published adverse drug reactions casereports, so that such documentation can contribute to improve the assessment of alert signals (AU)

Antibióticos sin receta, ¿hasta cuándo? / Antibiotics without prescription. Until when?

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Enfermedades relacionadas con el trabajo: ¿un reto para la atención primaria? / Occupational related diseases. A challenge for primary care?

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Los Servicios de Salud Pública de Área de la Comunidad de Madrid: una experiencia de más de tres quinquenios / The implementation of district Public Health Services in the Autonomous Community of Madrid. An experience of more than fifteen years

El objetivo de este artículo es la descripción y análisis de los Servicios de Salud Pública de Áreaque se implantaron en la Comunidad de Madrid al principio de los años noventa. Se describen lasestructuras, dispositivos y funciones de la salud pública desde 1989 hasta la situación actual, con ladescripción y análisis de las reestructuraciones que se han llevado a cabo. Se realiza una valoracióncrítica de los logros y las limitaciones presentadas; entre los primeros: ordenación y especialización delas funciones, mejora en la gestión de los problemas y demandas en salud pública, y entre los segundos:escasez de recursos humanos, desequilibrio numérico de profesionales y escasa coordinación conlas corporaciones locales.El artículo termina con unas propuestas para el futuro: cartera de servicios, coordinación con otrossectores asistenciales y no asistenciales, especialización profesional e innovación de la gestión de los servicios

This article has aimed to describe and analyze the District Public Health Services that were implementedin the Autonomous Community of Madrid in the early nineties. It also describes and analyzesthe evolution of former structures, devices and functions of the public health services from the 1989until the present day, making a description and analysis of the restructuring carried out. A criticalanalysis is made of the achievements and limitations presented among them: in the first place, organizationand the specialization of the tasks, improvement in the management of public health issuesand demands in public health. In the second place there are limitations such as shortage of human resources,lack of public health professionals and insufficient coordination with local public health authorities.The article ends with some recommendations for the future, such as implementation of service portfolioin public health, general coordination and collaboration with other non-health sectors and innovationin management of health services (AU)

Vacuna contra el virus del papiloma humano. No es oro todo lo que reluce. Respuesta / Vaccination against the human papilloma virus. All that glitters is not gold. Reply

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Aportaciones de la atención primaria y la salud pública al desarrollo de la salud comunitaria / Contributions of primary care and public health to the development of community health

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La Ley General de Sanidad: el impulso necesario / The General Law of Health: the necessary impulse

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El ejercicio de la autoridad sanitaria: los principios, lo reglamentado y la incertidumbre / On the exercise of health authority: principles, regulations and uncertainty

El ejercicio de la autoridad sanitaria es un servicio básico de la salud pública. Parte de la responsabilidad de los gestores de la salud pública es hacer cumplir normas. Éstas se desarrollan cuando se dan circunstancias que llevan a considerar inadmisibles ciertos riesgos. El grueso del ejercicio de la autoridad sanitaria se basa en la aplicación relativamente sistemática de normativas detalladas de referencia, aunque siempre hay cierta incertidumbre, ejemplificada en la frecuente adopción de medidas cautelares por un inspector sanitario aplicando el principio de precaución. Pero la vigilancia epidemiológica plantea de forma intermitente situaciones de afectación de la salud humana sin normas de referencia, en las que la autoridad sanitaria debe actuar según su criterio, contrapesando los riesgos de intervenir con los de no actuar. En este manuscrito presentamos 3 casos de este tipo: la coerción en el tratamiento de enfermos con tuberculosis bacilífera; la regulación de actividades con haba de soja que plantean riesgos de asma; y la limitación del ejercicio profesional de un médico infectado por el virus de la inmunodeficiencia humana

Implementing health authority is a basic public health service. Part of the responsibility of public health managers is to ensure compliance with regulations. These are developed when certain risks are considered inadmissible. Mostly, the exercise of health authority deals with the routine application of detailed norms, although there is always some uncertainty, as shown by the frequent use of cautionary measures by health officers during inspections. However, epidemiologic surveillance periodically involves situations in which human health is damaged and there is no reference regulation; in these situations, health authorities must act according to their own criteria, weighing the risks of intervention against those of nonintervention. In this article, we present 3 such scenarios: using coercion in the treatment of patients with smear-positive tuberculosis, regulation of activities with soy beans posing asthma risks, and setting limits to the professional activity of an HIV-positive physician

Situación actual y futuro del sistema sanitario público / Current and future situation of the Public Health Care System

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Los profesionales sanitarios titulados como elemento de cohesión: nuevo reto del Sistema Nacional de Salud / Health care professionals with degree as cohesion element: new challenge of the Spanish National Health Service

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Vigilância em Saúde / Vigilância em Saúde

Este tomo II apresenta a Vigilância Sanitária. Como ela se organiza, sob quais preceitos foi criada e como está sendo desenvolvida no País e proporciona ao leitor a visão de como esta área está inserida no Sistema Estadual de Saúde. As ações de prevenção e proteção da saúde são de caráter público e indelegável ao privado, premissa ideológica da construção do SUS. Um dos meios para desempenhar esse papel constitucional é a vigilância sanitária,função típica do Estado, para a busca da proteção à saúde e a melhoria a qualidade de vida da população