lunes, 30 de noviembre de 2009

WHO | Arsenic in drinking water


Arsenic in drinking water
Arsenic may be found in water which has flowed through arsenic-rich rocks. Severe health effects have been observed in populations drinking arsenic-rich water over long periods in countries world-wide.


Source
Arsenic is widely distributed throughout the earth's crust.
Arsenic is introduced into water through the dissolution of minerals and ores, and concentrations in groundwater in some areas are elevated as a result of erosion from local rocks.
Industrial effluents also contribute arsenic to water in some areas.
Arsenic is also used commercially e.g. in alloying agents and wood preservatives.
Combustion of fossil fuels is a source of arsenic in the environment through disperse atmospheric deposition.
Inorganic arsenic can occur in the environment in several forms but in natural waters, and thus in drinking-water, it is mostly found as trivalent arsenite (As(III)) or pentavalent arsenate (As (V)). Organic arsenic species, abundant in seafood, are very much less harmful to health, and are readily eliminated by the body.
Drinking-water poses the greatest threat to public health from arsenic. Exposure at work and mining and industrial emissions may also be significant locally.

Effects
Chronic arsenic poisoning, as occurs after long-term exposure through drinking- water is very different to acute poisoning. Immediate symptoms on an acute poisoning typically include vomiting, oesophageal and abdominal pain, and bloody "rice water" diarrhoea. Chelation therapy may be effective in acute poisoning but should not be used against long-term poisoning.
The symptoms and signs that arsenic causes, appear to differ between individuals, population groups and geographic areas. Thus, there is no universal definition of the disease caused by arsenic. This complicates the assessment of the burden on health of arsenic. Similarly, there is no method to identify those cases of internal cancer that were caused by arsenic from cancers induced by other factors.
Long-term exposure to arsenic via drinking-water causes cancer of the skin, lungs, urinary bladder, and kidney, as well as other skin changes such as pigmentation changes and thickening (hyperkeratosis).
Increased risks of lung and bladder cancer and of arsenic-associated skin lesions have been observed at drinking-water arsenic concentrations of less than 0.05 mg/L.
Absorption of arsenic through the skin is minimal and thus hand-washing, bathing, laundry, etc. with water containing arsenic do not pose human health risk.
Following long-term exposure, the first changes are usually observed in the skin: pigmentation changes, and then hyperkeratosis. Cancer is a late phenomenon, and usually takes more than 10 years to develop.
The relationship between arsenic exposure and other health effects is not clear-cut. For example, some studies have reported hypertensive and cardiovascular disease, diabetes and reproductive effects.
Exposure to arsenic via drinking-water has been shown to cause a severe disease of blood vessels leading to gangrene in China (Province of Taiwan), known as 'black foot disease'. This disease has not been observed in other parts of the world, and it is possible that malnutrition contributes to its development. However, studies in several countries have demonstrated that arsenic causes other, less severe forms of peripheral vascular disease.
According to some estimates, arsenic in drinking-water will cause 200,000 -- 270,000 deaths from cancer in Bangladesh alone (NRC, 1998; Smith, et al, 2000).

Measurement
Accurate measurement of arsenic in drinking-water at levels relevant to health requires laboratory analysis, using sophisticated and expensive techniques and facilities as well as trained staff not easily available or affordable in many parts of the world.
Analytical quality control and external validation remain problematic.
Field test kits can detect high levels of arsenic but are typically unreliable at lower concentrations of concern for human health. Reliability of field methods is yet to be fully evaluated.

Prevention and control
The most important remedial action is prevention of further exposure by providing safe drinking- water. The cost and difficulty of reducing arsenic in drinking-water increases as the targeted concentration lowers. It varies with the arsenic concentration in the source water, the chemical matrix of the water including interfering solutes, availability of alternative sources of low arsenic water, mitigation technologies, amount of water to be treated, etc.

Control of arsenic is more complex where drinking-water is obtained from many individual sources (such as hand-pumps and wells) as is common in rural areas. Low arsenic water is only needed for drinking and cooking. Arsenic-rich water can be used safely for laundry and bathing. Discrimination between high-arsenic and low-arsenic sources by painting the hand-pumps (e.g. red and green) can be an effective and low cost means to rapidly reduce exposure to arsenic when accompanied by effective health education.

Alternative low-arsenic sources such as rain water and treated surface water may be available and appropriate in some circumstances. Where low arsenic water is not available, it is necessary to remove arsenic from drinking-water:

. The technology for arsenic removal for piped water supply is moderately costly and requires technical expertise. It is inapplicable in some urban areas of developing countries and in most rural areas world-wide.
. New types of treatment technologies, including co-precipitation, ion exchange and activated alumina filtration are being field-tested.
. There are no proven technologies for the removal of arsenic at water collection points such as wells, hand-pumps and springs.
. Simple technologies for household removal of arsenic from water are few and have to be adapted to, and proven sustainable in each different setting.
. Some studies have reported preliminary successes in using packets of chemicals for household treatment. Some mixtures combine arsenic removal with disinfection. One example, developed by the WHO/PAHO Pan American Center of Sanitary Engineering and Environmental Sciences in Lima, Peru (CEPIS), has proven successful in Latin America.

WHO's activities on arsenic
WHO's norms for drinking-water quality go back to 1958. The International Standards for Drinking-Water established 0.20 mg/L as an allowable concentration for arsenic in that year. In 1963 the standard was re-evaluated and reduced to 0.05 mg/L. In 1984, this was maintained as WHO's "Guideline Value"; and many countries have kept this as the national standard or as an interim target. According to the last edition of the WHO Guidelines for Drinking-Water Quality (1993):

* Inorganic arsenic is a documented human carcinogen.
* 0.01 mg/L was established as a provisional guideline value for arsenic.
* Based on health criteria, the guideline value for arsenic in drinking-water would be less than 0.01mg/L.
* Because the guideline value is restricted by measurement limitations, and 0.01 mg/L is the realistic limit to measurement, this is termed a provisional guideline value.

The WHO Guidelines for Drinking-water Quality is intended for use as a basis for the development of national standards in the context of local or national environmental, social, economic, and cultural conditions.

The summary of an updated International Programme on Chemical Safety Environmental Health Criteria Document on Arsenic published by WHO is available at http://www.who.int/pcs/pubs/pub_ehc_num.html. It addresses all aspects of risks to human health and the environment. The full text will be published in late 2001.

A UN report on arsenic in drinking-water has been prepared in cooperation with other UN agencies under the auspices of an inter-agency coordinating body (the Administrative Committee on Coordination's Sub-committee on Water Resources. It provides a synthesis of available information on chemical, toxicological, medical, epidemiological, nutritional and public health issues; develops a basic strategy to cope with the problem and advises on removal technologies and on water quality management. The draft of the report is available at http://www.who.int/water_sanitation_health/dwq/arsenic3/en/

Information on arsenic in drinking-water on a country-by-country basis is being collected and will be added to the UN report and made available on the web site.

As part of WHO's activities on the global burden of disease, an estimate of the disease burden associated with arsenic in drinking-water is in preparation. A report entitled "Towards an assessment of the socioeconomic impact of arsenic poisoning in Bangladesh" was released in 2000.

A United Nations Foundation grant for 2.5 million approved in July 2000, will enable UNICEF and WHO to support a project to provide clean drinking-water alternatives to 1.1 million people in three of the worst affected sub-districts in Bangladesh. The project utilizes an integrated approach involving communication, capacity building for arsenic mitigation of all stakeholders at subdistrict level and below, tube-well testing, patient management, and provision of alternative water supply options.

Urgent requirements
^Large-scale support to the management of the problem in developing countries with substantial, severely affected populations.
^Simple, reliable, low-cost equipment for field measurement.
^Increased availability and dissemination of relevant information.
^Robust affordable technologies for arsenic removal at wells and in households.

Global situation
The delayed health effects of exposure to arsenic, the lack of common definitions and of local awareness as well as poor reporting in affected areas are major problems in determining the extent of the arsenic-in-drinking-water problem.

Reliable data on exposure and health effects are rarely available, but it is clear that there are many countries in the world where arsenic in drinking-water has been detected at concentration greater than the Guideline Value, 0.01 mg/L or the prevailing national standard. These include Argentina, Australia, Bangladesh, Chile, China, Hungary, India, Mexico, Peru, Thailand, and the United States of America. Countries where adverse health effects have been documented include Bangladesh, China, India (West Bengal), and the United States of America. Examples are:

-Seven of 16 districts of West Bengal have been reported to have ground water arsenic concentrations above 0.05 mg/L; the total population in these seven districts is over 34 million (Mandal, et al, 1996) and it has been estimated that the population actually using arsenic-rich water is more than 1 million (above 0.05 mg/L) and is 1.3 million (above 0.01 mg/L) (Chowdhury, et al, 1997).
-According to a British Geological Survey study in 1998 on shallow tube-wells in 61 of the 64 districts in Bangladesh, 46% of the samples were above 0.010 mg/L and 27% were above 0.050 mg/L. When combined with the estimated 1999 population, it was estimated that the number of people exposed to arsenic concentrations above 0.05 mg/l is 28-35 million and the number of those exposed to more than 0.01 mg/l is 46-57 million (BGS, 2000).
-Environment Protection Agency of The United States of America has estimated that some 13 million of the population of USA, mostly in the western states, are exposed to arsenic in drinking- water at 0.01 mg/L, although concentrations appear to be typically much lower than those encountered in areas such as Bangladesh and West Bengal. (USEPA, 2001)

Arsenic in Bangladesh
In Bangladesh, West Bengal (India) and some other areas, most drinking-water used to be collected from open dug wells and ponds with little or no arsenic, but with contaminated water transmitting diseases such as diarrhoea, dysentery, typhoid, cholera and hepatitis. Programmes to provide "safe" drinking-water over the past 30 years have helped to control these diseases, but in some areas they have had the unexpected side-effect of exposing the population to another health problem - arsenic.

Arsenic in drinking-water in Bangladesh is attracting much attention for a number of reasons. It is a new, unfamiliar problem to the population, including concerned professionals. There are millions of people who may be affected by drinking arsenic-rich water. Last, but not least, fear for future adverse health effects as a result of water already consumed.

Background

.In recent years, extensive well drilling programme has contributed to a significant decrease in the incidence of diarrhoeal diseases.
.It has been suggested that there are between 8-12 million shallow tube-wells in Bangladesh. Up to 90% of the Bangladesh population of 130 million prefer to drink well water. Piped water supplies are available only to a little more than 10% of the total population living in the large agglomerations and some district towns.
.Until the discovery of arsenic in groundwater in 1993, well water was regarded as safe for drinking.
.It is now generally agreed that the arsenic contamination of groundwater in Bangladesh is of geological origin. The arsenic derives from the geological strata underlying Bangladesh.

Situation

* The most commonly manifested disease so far is skin lesions. Over the next decade, skin and internal cancers are likely to become the principal human health concern arising from arsenic.
* According to one estimate, at least 100,000 cases of skin lesions caused by arsenic have occurred and there may be many more (Smith, et al, 2000).
* The number of people drinking arsenic-rich water in Bangladesh has increased dramatically since the 1970s due to well-drilling and population growth.
* The impact of arsenic extends from immediate health effect to extensive social and economic hardship that effects especially the poor. Costs of health care, inability of affected persons to engage in productive activities and potential social exclusion are important factors.
* The national standard for drinking-water in Bangladesh is 0.05 mg/L, same as in India.
* District and sub-district health officials and workers lack sufficient knowledge as to the identification and prevention of arsenic poisoning.
* The poor availability of reliable information hinders action at all levels and may lead to panic, exacerbated if misleading reports are made. Effective information channels have yet to be established to those affected and concerned.

Remedial actions

- Within Bangladesh, a number of governmental technical and advisory committees have been formed and a co-ordinating mechanism established among the interested external support agencies. These committees include the Governmental Arsenic Co-ordinating Committee headed by the Minister of Health & Family Welfare (MHFW) and several technical committees. One of the positive outcomes of this collaboration (including work with local institutes) has been the testing of new types of treatment technologies.
- So far, many initiatives have focused on water quality testing and control with a view to supplying arsenic-free drinking-water, thereby reducing the risk of further arsenic-related disease. The amount of testing required and the need to provide effective feedback to those using well water, suggest use of field testing kits.
- Only a few proven sustainable options are available to provide safe drinking-water in Bangladesh. These include: obtaining low-arsenic groundwater through accessing safe shallow groundwater or deeper aquifers (greater than 200 m); rain water harvesting; pond-sand-filtration; household chemical treatment; and piped water supply from safe or treated sources.

For more information contact:


WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

abrir aquí:
WHO | Arsenic in drinking water

La desigualdad, principal lastre en la región más castigada - DiarioMedico.com


Diariomedico.com.
ESPAÑA
EN ÁFRICA SUBSAHARIANA SE CONCENTRAN DOS TERCIOS DE LA POBLACIÓN INFECTADA
La desigualdad, principal lastre en la región más castigada
Félicienne Zongo es la responsable del Programa de Asociaciones e Investigación para la lucha contra el VIH/Sida de Burkina Faso, en África subsahariana, el epicentro mundial de la enfermedad.


S. Moreno - Martes, 1 de Diciembre de 2009 - Actualizado a las 00:00h.

En África subsahariana se concentran dos tercios de las personas que viven con el VIH. En Burkina Faso son 130.000. A pesar de estas cifras, el informe de este año de Onusida destaca un dato positivo: el descenso de un 17 por ciento de las nuevas infecciones, que Félicienne Zongo recibe como una buena noticia: "Este descenso lo constatamos también en Burkina Faso, donde la prevalencia era del 7,1 por ciento en 2001, según Onusida; con los programas de sensibilización, la implicación del Gobierno y otras entidades que han financiado la carga médica y psicosocial de las personas infectadas, la prevalencia se redujo al 1,6 por ciento en 2008".

Uno de los hallazgos del informe de Onusida es que la respuesta al sida tiene gran impacto cuando los programas de prevención y tratamiento se integran en otros servicios de salud y bienestar. Por eso, en la lucha contra el sida en las sociedades menos favorecidas hay que atender a otros males, como la pobreza, el analfabetismo, la falta de independencia económica de las mujeres y su vulnerabilidad (sumisión total al marido), las guerras, los contactos sexuales no protegidos con el uso de preservativo masculino o femenino, las relaciones sexuales con diferentes compañeros sin protección, entre los que enumera Zongo.

Quizá el de las desigualdades entre sexos sea el obstáculo más evidente que impide frenar a la enfermedad. Las africanas de entre 15 y 19 años son especialmente vulnerables al VIH. En Kenia, las jóvenes son tres veces más propensas a contraer el VIH que los varones de su misma edad. "En mi etnia los hombres se consideran más que las mujeres. Habría que conseguir que chicos y chicas tuvieran las mismas posibilidades y recibieran el mismo trato, lo que parece lejos de ser una realidad en África".

La evolución del sida pide nuevos esfuerzos - DiarioMedico.com


Nuevas transmisiones según su vía de contagio en Europa occidental y Norteamérica (1977-2006)

Diariomedico.com
ESPAÑA
ADAPTACIÓN DE LOS PROGRAMAS DE PREVENCIÓN
La evolución del sida pide nuevos esfuerzos
La epidemia del sida ha cambiado en los últimos años. Por un lado, las vías de transmisión están variando, lo que exige una adaptación de los programas preventivos y para la detección precoz de la infección. Por otra parte, el perfeccionamiento de los tratamientos antirretrovirales ha logrado, sobre todo en las sociedades occidentales, que el paciente seropositivo sea un enfermo crónico, expuesto a las patologías propias de su edad.


Sonia Moreno - Martes, 1 de Diciembre de 2009 - Actualizado a las 00:00h.

llaves conceptuales:
1. Los factores de riesgo cardiovascular inciden en la población seropositiva con más fuerza que en la general, por lo que es clave evitarlos
2. Las nuevas familias farmacológicas y los estudios para reducir la terapia antirretroviral a un fármaco perfeccionarán el tratamiento
3. Uno de los problemas es que el 30 por ciento de la población en Europa occidental que está infectada por el virus del sida lo desconoce

La epidemia de sida en España se mantiene estable, con tasas de incidencia en la población general que han variado entre el 0,5 y el 0,8 por ciento en los últimos años. No obstante, la incidencia de los casos notificados de sida ha bajado; atendiendo al registro nacional, en 2008 se comunicaron 1.170, lo que supone un descenso del 80 por ciento con respecto a 1996, cuando se instauraron los tratamientos antirretrovirales de gran eficacia.

Estos datos indican que si bien no ha disminuido la incidencia de la transmisión del VIH en sí misma, la enfermedad aparece mucho más tarde, gracias a los tratamientos. De hecho, la edad media de los pacientes en el momento de recibir el diagnóstico de sida ha aumentado, alcanzando los 40 años, según comenta Juan González Lahoz, presidente de la Fundación de Investigación y Educación en Sida (IES) y jefe del Servicio de Enfermedades Infecciosas del Hospital Carlos III, de Madrid. Con motivo del Día Mundial del Sida, la Fundación IES organiza hoy un acto, con la Fundación del Colegio de Médicos de Madrid, donde se pondrá de relieve este cambio de la evolución de la enfermedad. "Gracias a los tratamientos antirretrovirales (TAR) las personas seropositivas tienen mayor esperanza de vida, pero eso conlleva la aparición de otras enfermedades, como las hepatitis víricas y los trastornos cardiovasculares". Respecto a los virus de la hepatitis, hay novedades terapéuticas que probablemente transformarán el tratamiento en los pacientes coinfectados.

"En cuanto al riesgo cardiovascular, la posibilidad de que un paciente con VIH muera de infarto, algo implanteable antes, se ha incrementado ahora. Los factores de riesgo de enfermedad cardiaca (tabaquismo, HTA, diabetes, hipercolesterolemia, etc.) inciden en los pacientes seropositivos con más fuerza que en la población general. Ello es debido primero a la propia infección por el virus del sida, que genera alteraciones en el endotelio vascular y, en parte, a ciertos antirretrovirales". González Lahoz explica que los análogos de nucleósidos son los que más riesgo aportan en cuanto a cardiotoxicidad, al igual que los inhibidores de la proteasa, debido a los trastornos metabólicos. "Plantean menos problemas desde el punto de vista cardiovascular los no análogos, así como los últimos antirretrovirales desarrollados: inhibidores de la integrasa e inhibidores de los correceptores". Con todo, el mayor peso en el riesgo cardiovascular lo tienen los factores comunes a toda la población general, por encima de la propia infección; de ahí la importancia de fomentar hábitos preventivos, tales como evitar el consumo del tabaco y controlar la hipertensión y el colesterol.Asimismo, según destaca González Lahoz, para favorecer el intercambio de conocimiento entre ambas áreas -sida y cardiovascular- se iniciará un proyecto en colaboración con Valentín Fuster, del Hospital Mount Sinai, en Nueva York, en el que gracias a los métodos de diagnóstico por imagen se podría adelantar la detección del riesgo cardiaco en los pacientes seropositivos.

Pere Domingo, secretario del Grupo de Estudio de Sida (Gesida), de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (Seimc), entidad que agrupa a la mayoría de los médicos que atienden a personas con VIH/sida en España, también alude al desarrollo de los antirretrovirales alcanzado desde el punto de inflexión, en 1996: "El actual arsenal terapéutico, que incluye 25 fármacos, ha hecho que, convenientemente aplicados, la mayoría (un 90 por ciento) de pacientes que reciben tratamiento efectivo se hallen en buen estado de salud y activos desde el punto de vista social y laboral". La llegada de dos nuevas familias farmacológicas -los inhibidores de la integrasa y los antagonistas del CCR5- ha ayudado a aumentar las opciones para el paciente, así como los estudios encaminados a reducir la terapia a un solo fármaco, y que lideran los grupos españoles de Federico Pulido, en el Hospital 12 de Octubre, y de José Ramón Arribas, en el Hospital La Paz, ambos en Madrid, contribuyen a perfeccionar el régimen terapéutico.

A corto y medio plazo
Pero es obvio que existen retos no alcanzados, al menos uno a corto plazo y otro a largo plazo, continúa Pere Domingo. "A corto plazo, lo más importante sería identificar a la población que está infectada y que todavía no lo sabe (25-30 por ciento de los infectados en países occidentales). Con ello, y la aplicación de las medidas preventivas y terapéuticas adecuadas, se conseguiría que dichos pacientes no infecten a otros sujetos y también prevenir en ellos la progresión de la enfermedad. A medio-largo plazo, el reto es la consecución de una vacuna preventiva, para lo cual existe un enorme esfuerzo investigador que incluye también a nuestro país", en alusión al trabajo que dirige Mariano Esteban, del Centro Nacional de Biotecnología, con un prototipo de vacuna y que se concretó en un ensayo con voluntarios el pasado enero. Para González Lahoz, la consecución de la vacuna contra el VIH/sida es un reto difícil de alcanzar por la gran variabilidad del virus, aunque ve con más optimismo la llegada de vacunas terapéuticas. Mientras llegan, se concentran esfuerzos en la prevención y educación, como destaca González Lahoz de la labor de la fundación que preside.

Asimismo, Domingo alude a la importancia capital de detectar las personas infectadas que desconocen su situación y apuesta por una mayor oferta de pruebas de determinación del VIH, "como las de tipo opt-out (inclusión/exclusión voluntarias) a las mujeres que acuden a los servicios de obstetricia; a los pacientes que solicitan tratamiento de infecciones de transmisión sexual; a las mujeres que acuden a centros de interrupción voluntaria del embarazo; a los pacientes que efectúan programas de dependencia de drogas, y a los que reciben tratamiento para la tuberculosis, la hepatitis B y C o linfomas. Una opción similar, pero expandida, sería realizar la prueba a todos los ciudadanos cuando tengan contacto con el sistema público de salud. No obstante, se requieren estudios de coste/beneficio preliminares sobre estas estrategias e incluso podrían necesitar modificaciones en el actual marco legal".


CAMBIOS
El informe de Onusida muestra un cambio en el cariz de la epidemia que no se refleja en otro en la dirección de los esfuerzos para la prevención. Por ejemplo, en Europa oriental y Asia central la epidemia, que en algún momento se caracterizó por el uso de drogas inyectables, se está propagando a los compañeros sexuales de estos usuarios. En España, el Ministerio de Sanidad destaca que en 2008 la categoría de transmisión heterosexual fue la más frecuente, con un 41,8 por ciento de los casos, seguida de las relaciones homosexuales entre hombres (38,8 por ciento) y, por último, los casos de usuarios de drogas por vía parenteral (9,2 por ciento). Por otro lado, el cambio en la evolución de la enfermedad gracias a la TAR es un hecho en nuestro país, con el 80 por ciento de descenso de las notificaciones.

Research Activities, November 2009: Agency News and Notes: Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006


Agency News and Notes
Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

The number of Americans under care for depression and other mental illnesses nearly doubled between 1996 and 2006, and the overall cost of treating them jumped by nearly two-thirds, according to the Agency for Healthcare Research and Quality. The Agency's recent data analysis revealed that the number of patients treated for mental disorders, including depression and bipolar disease, increased from 19 million to 36 million. The overall treatment costs for mental disorders rose from $35 billion (in 2006 dollars) to nearly $58 billion, making it the costliest medical condition between 1996 and 2006. In addition, the study concluded that:

Heart disease, cancer, trauma-related disorders, and asthma joined mental disorders to comprise the five most costly conditions in both 1996 and 2006.
Overall spending for heart disease treatment increased the least, from $72 billion in 1996 to $78 billion in 2006.
Spending for cancer treatment went from $47 billion to $58 billion; asthma costs rose from $36 billion to $51 billion; and the cost to treat trauma-related disorders climbed from $46 billion to $68 billion.
In terms of average per-patient cost, cancer accounted for the highest, up slightly from $5,067 to $5,178, but treatment costs for trauma and asthma rose more steeply, increasing from $1,220 to $1,953 and from $863 to $1,059, respectively. In contrast, average per-patient spending for heart conditions and mental disorders fell from $4,333 to $3,964 and $1,825 to $1,591, respectively.
These findings were based on analysis of the Medical Expenditure Panel Survey (MEPS), a detailed source of information on the health services used by Americans, how often they are used, the cost of those services, and how they are paid. For more information, go to The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitionalized Population, at http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Statistical%20Brief&opt=2&id=910.

abrir aquí:
Research Activities, November 2009: Agency News and Notes: Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

WHO | Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents



30 November 2009
Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents


On the eve of World AIDS Day, the World Health Organization (WHO) is releasing new recommendations on treatment, prevention and infant feeding in the context of HIV, based on the latest scientific evidence.

WHO now recommends earlier initiation of antiretroviral therapy (ART) for adults and adolescents, the delivery of more patient-friendly antiretroviral drugs (ARVs), and prolonged use of ARVs to reduce the risk of mother-to-child transmission of HIV. For the first time, WHO recommends that HIV-positive mothers or their infants take ARVs while breastfeeding to prevent HIV transmission.

Rapid advice - English [pdf 306kb] 27 páginas [NEW]
http://www.who.int/hiv/pub/arv/rapid_advice_art.pdf


Key messages [NEW WHO RECOMMENDATIONS]- English [pdf 259kb] 5 páginas |
http://www.who.int/hiv/pub/arv/art_key_mess.pdf


Nouvelles recommandations de l’OMS :
Traitement antirétroviral de l’adulte et de l’adolescent

French [pdf 270kb] idem before
http://www.who.int/hiv/pub/arv/art_key_mess_fr.pdf

Related Rapid advice documents
Rapid advice: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants
http://www.who.int/hiv/pub/mtct/rapid_advice_mtct.pdf

Key
New WHO recommendation s:
Preventing mother-to-child transmission
http://www.who.int/hiv/pub/mtct/mtct_key_mess.pdf

French
http://www.who.int/hiv/pub/mtct/rapid_advice_mtct_fr.pdf

Nouvelles recommandations de l’OMS :
Prévenir la transmission mère enfant

http://www.who.int/hiv/pub/mtct/mtct_key_mess_fr.pdf

Rapid advice: infant feeding in the context of HIV
http://www.who.int/child_adolescent_health/documents/hiv_if_principles_recommendations_112009.pdf

ABRIR AQUÍ para acceder al documento general WHO:
WHO | Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents

Global status report on road safety [WHO/OMS]



Global status report on road safety

Approximately 1.3 million people die each year on the world's roads, and between 20 and 50 million sustain non-fatal injuries. The Global status report on road safety is the first broad assessment of the road safety situation in 178 countries, using data drawn from a standardized survey. The results show that road traffic injuries remain an important public health problem, particularly for low-income and middle-income countries. Pedestrians, cyclists and motorcyclists make up almost half of those killed on the roads, highlighting the need for these road users to be given more attention in road safety programmes. The results suggest that in many countries road safety laws need to be made more comprehensive while enforcement should be strengthened. The Global status report on road safety results clearly show that significantly more action is needed to make the world's roads safer.


abrir aquí (4.9MB / 301 páginas):
http://whqlibdoc.who.int/publications/2009/9789241563840_eng.pdf

DIRECTORIO DE DOCUMENTOS de NOVIEMBRE de 2009

DIRECTORIO DE DOCUMENTOS de NOVIEMBRE de 2009

DIRECTORIO de DOCUMENTOS EDITADOS DURANTE NOVIEMBRE de 2009
http://saludequitativa.blogspot.com
un blog del conjunto SALUD EQUITATIVA®
http://elbiruniblogspotcom.blogspot.com [CIENCIAS MÉDICAS NEWS]y
http://herenciageneticayenfermedad.blogspot.com

CONSULTAS ACUMULADAS POR EL GRUPO DE BLOGS DE SALUD EQUITATIVA®: 278.430

SALUD EQUITATIVA ©- GESTIÓN EN SALUD PÚBLICA©: DOCUMENTOS EDITADOS DURANTE Noviembre de 2009
Lunes 30 de NOVIEMBRE de 2009

El BLOG tomó entidad aunque tímidamente en el año 2008. Los registros de visitas cursan desde mediados de enero 2009. Los registros documentales se iniciaron hace tres meses, sin embargo todos los documentos editados permanecen completos en el archivo del BLOG.
La GESTIÓN en SALUD PÚBLICA suele ser despreciada y gracias a ello la SALUD PÚBLICA en el mundo está como está y enfrenta los problemas crecientes de una crisis económico-financiera temible. Este BLOG es un aporte al "despertar" de la necesidad de modificar el rumbo...
Desde el 10 de enero a la fecha el BLOG ha recibido aproximadamente 36.800 consultas.
Agradezco a los seguidores por su presencia como así también por los comentarios que me envían por vía privada, y por los que dejan en el mismo BLOG.
Muchas gracias a todas las FUENTES (Diariomedico.com de España; El Médico Interactivo de España; Médicos - Medicina Global; JANO.es/Elsevier de España; AHRQ-USA; FDA-USA; NCCN-USA; NIH-USA; CDC-USA; NQMC-USA; EMEA-EU; EURORDIS – EU; Diario LA NACIÓN de Argentina; agencia informativa Reuters; Hospital Italiano de Buenos Aires; Sociedades Médicas de Argentina; etc.) que nos aportan calidad y valor agregado diariamente para brindar información científica de calidad.-
Este BLOG se nutre de información en red que se distribuye gratuitamente y no monetiza los contenidos por respeto a las necesidades de los profesionales del equipo de la salud, a los pacientes y sus familias. Por dicho motivo, tenemos la libertad de administrar la información que recibimos sin emitir opinión (salvo excepciones de ética y/o bioética explícitas) y sin calificar como así tampoco descalificar a las fuentes. En lo personal entiendo que la información científico-médica así como la inherente a la gestión, debe ser de acceso libre y gratuito, siempre. Cerasale©. Noviembre 30, 2009.-


1. Argentina: 11.496 – 31,2 %
2. España: 7.527 – 20,4%
3. México: 3.628 - 9,8%
4. Perú: 2.751 - 7,5%
5. Colombia: 2.480 - 6,7%
6. Venezuela: 1.752 - 4,8 %
7. Estados Unidos: 1.349 - 3,7 %
8. Chile: 1.224 - 3,3 %
9. Ecuador: 587 - 1,6 %
10. Bolivia: 579 - 1,6%
El resto: 3.474 – 9,4 %
Total = 36.847 -100,0 %


Archivo del blog
• ▼ 2009 (1911)
o ▼ noviembre (335)
 1905. Indoor Tanning: The Risks of Ultraviolet Rays
 1904. ▲OMS | Manual de seguimiento y evaluación de los re...
 1903. ▲ OMS | Informe sobre la salud en el mundo
 1902. INECO: Charlas a la Comunidad - ANSIEDAD
 1901. ▲ Physician Consortium for Performance Improvement®
 1900. H1N1 - gripe porcina - FRANCIA: grave mutación ide...
 1899. ♣ Adverse drug event rates in six community hospital...
 1898. ♣ An effectiveness analysis of healthcare systems us...
 1897. ♣ Effect of a weight-based prescribing method within...
 1896. ♣ Empowering frontline nurses: a structured interven...
 1895. ♣ Incorrect surgical procedures within and outside o...
 1894. ♣ Incidence, patterns, and prevention of wrong-site ...
 1893. ♣ Rapid response teams and continuous quality improv...
 1892. ♣ Uncomfortable prescribing decisions in hospitals: ...
 1891. ♣ Building Better Health Care Systems - AHRQ Patient...
 1890. ♣ Behaviors that undermine a culture of safety / AH...
 1889. ♣ Disruptive Physicians
 1888. ♣ Hidden Mistakes In Hospitals -- Courant.com
 1887. ♣ AHRQ Patient Safety Network
 1886. ♣ The New York Law Journal - Free With Registration:...
 1885. ♣ International Diabetes Federation calls for more e...
 1884. ► New International Diabetes Federation study reveal...
 1883. Cerrar las escuelas durante una posible pandemia r...
 1882. “Hospitales transformados en empresas”
 1881. "Es más fácil desmotivar que motivar; hay que sabe...
 1880. Respiratory Disease in Adults during Pandemic (H1N...
 1879. Infection Control and Epidemic Respiratory Virus |...
 1878. CDC H1N1 Flu |Q&A about CDC’s Guidance for Emergen...
 1877. ♠ Hospital Planning
 1876. ♣ CDC Guidance for Emergency Shelters for the 2009-2...
 1875. Los sonidos de la vida
 1874. La HCE no genera ahorros en los hospitales estadou...
 1873. La evaluación tecnológica debe utilizar más indica...
 1872. Siemens España: "El balance de 'Selene' en Madrid ...
 1871. FUNDACIÓN NOVARTIS
 1870. UNIVERSIDAD FAVALORO :: INSCRIPCIÓN CARRERAS DE GR...
 1869. ♣ Deaths in Acute Hospitals: Caring to the End? - AH...
 1868. Prevención y educación en diabetes
 1867. Los médicos cuidan de los pacientes, pero ¿quién s...
 1866. SOCIEDAD ARGENTINA de MEDICINA: próximas actividad...
 1865. ARGENTINA: Los medicamentos sólo en las farmacias
 1864. Experto chino advierte por mutación de gripe pandé...
 1863. proyecto GuíaSalud
 1862. Casi 173 millones de ciudadanos europeos disponen ...
 1861. INVESTIGACIÓN CARDIOVASCULAR - ESPAÑA
 1860. QuickStats: Age-Adjusted Death Rates* for the 10 L...
 1859. World AIDS Day --- December 1, 2009
 1858. ♠ Pseudo-Outbreak of Antimony Toxicity in Firefighte...
 1857. ♠ Acute HIV Infection --- New York City, 2008
 1856. ♠ HIV Infection Among Injection-Drug Users --- 34 St...
 1855. Sanidad Española recuerda que la vacuna inmoviliza...
 1854. ♠ Abortion Surveillance --- United States, 2006
 1853. Posible caso de transmisión entre humanos de virus...
 1852. SIDA expansivo
 1851. OMS investiga expansión de gripe H1N1 resistente a...
 1850. "Occidente reconoce que sus sistemas de salud hace...
 1849. "El médico no está preparado para tratar crónicos ...
 1848. Desigualdades Sociales y Enfermedades Infecciosas ...
 1847. Hispanic Diabetes Disparities Learning Network in ...
 1846. Las infecciones por SARM aumentan fuera del hospit...
 1845. Vol. 15, No. 12 Cover: "I think I could turn and l...
 1844. European Medicines Agency - Human Medicines - Medi...
 1843. El médico de AP puede asumir más terapias en ortop...
 1842. Canadá retira un lote de 172.000 vacunas de la gri...
 1841. 2007 UK national guideline on the management of vu...
 1840. CDC - Seasonal Influenza (Flu) - Weekly Report: In...
 1839. La Asociación Médica Mundial considera obligatorio...
 1838. Information for Healthcare Professionals: Peramivi...
 1837. Opioid Drugs and Risk Evaluation and Mitigation St...
 1836. * IntraMed - Artículos - El origen del almuerzo que ...
 1835. El gasto farmacéutico del SNS en octubre asciende ...
 1834. Recomendaciones sobre el manejo de la gripe en Ped...
 1833. "Las autoridades sanitarias subestiman la patologí...
 1832. ANESTHESIOLOGY/CRITICAL CARE (CRIT) // Algorithm f...
 1831. Physician Performance Measurement Set
 1830. Occupational exposure // Australian Council on Hea...
 1829. Neonatal infections // Australian Council on Healt...
 1828. Healthcare-associated MRSA // Australian Council o...
 1827. Haemodialysis-associated blood stream infection //...
o 1826. Patient Safety Conference 2010 - AHRQ Patient Safe...
 1825. Medication Safety in the Operating Room: Time for ...
 1824. No sólo es necesario estimular la presencia de la ...
 1823. Comportamiento de las importaciones de equipos de ...
 1822. Papel de la ecocardiografía - El Hospital: Informa...
 1821. piden más investigación científica en el sector de...
 1820. * IntraMed - Entrevistas - "El médico es medicina"
 1819. * IntraMed - Puntos de vista - ¿Y si al interrogator...
 1818. INECO: Charlas a la Comunidad - LA MEMORIA EN LA E...
 1817. Trazabilidad - Ley de trazabilidad de medicamentos...
 1816. ESPAÑA: Encuesta nacional sobre discapacidad
 1815. Obesidad. Las cifras de una epidemia mundial
 1814. Ending Health Care-Associated Infections
 1813. La mala salud de los médicos
 1812. "La duda de profesionales sanitarios en la vacunac...
 1811. Roche destina cuatro millones de euros al proyecto...
 1810. Los expertos aseguran que se hace necesaria una tr...
 1809. Safe Use Initiative Fact Sheet
 1808. LAS PATOLOGÍAS CRÓNICAS, EPIDEMIA DEL SIGLO XXI
 1807. El modelo sanitario, ¿colapsado por las patologías...
 1806. H1N1 - situation update in U.S.A.
 1805. FTC Warns Internet Peddlers that Marketing Unprove...
 1804. TAP 21-A Competencies for Substance Abuse Treatmen...
 1803. TAP 21 Addiction Counseling Competencies The Knowl...
 1802. TIP 46: Substance Abuse: Administrative Issues in ...
 1801. TAP 31: Implementing Change in Substance Abuse Tre...
 1800. Smoking: the percentage of patients with any or an...
 1799. Smoking: the percentage of patients with any or an...
 1798. Pharmacotherapy management of COPD exacerbation: p...
 1797. Pharmacotherapy management of COPD exacerbation: p...
 1796. Chronic obstructive pulmonary disease (COPD): the ...
 1795. Chronic obstructive pulmonary disease (COPD): the ...
 1794. Chronic obstructive pulmonary disease (COPD): the ...
 1793. Chronic obstructive pulmonary disease (COPD): the ...
 1792. Chronic obstructive pulmonary disease (COPD): perc...
 1791. Chronic obstructive pulmonary disease (COPD): hosp...
 1790. Ambulatory care sensitive conditions: age-standard...
 1789. NQMC - Expert Resources - Expert Commentary
 1788. * IntraMed - Entrevistas - El impacto de las condici...
 1787. Documentos editados hoy en CIENCIAS MÉDICAS NEWS
 1786. Neumonía, principal causa de muertes infantiles mu...
 1785. New Report Recommends Enhanced Food Tracing Guidel...
 1784. "África puede convertirte en un cínico"
 1783. "El investigador es una manera de ser"
 1782. "Viendo África no sé cómo dormimos"
 1781. FDA to Examine the Safety of Caffeinated Alcoholic...
 1780. INSTITUTO DE TECNOLOGÍA "JORGE A. SÁBATO"
 1779. * IntraMed - Puntos de vista - Un sacerdote jesuita ...
 1778. CDC H1N1 Flu | 2009-2010 Influenza Season: Informa...
 1777. sociedades que se debaten entre el alcohol y la di...
 1776. España registra más de 2.000 trasplantes de célula...
 1775. Research Activities, November 2009: Research Brief...
 1774. Research Activities, November 2009: Announcements:...
 1773. Research Activities, November 2009: Agency News an...
 1772. Research Activities, November 2009: Agency News an...
 1771. Research Activities, November 2009: Agency News an...
 1770. Research Activities, November 2009: Health Informa...
 1769. Research Activities, November 2009: Health Care Wo...
 1768. Research Activities, November 2009: Public Health ...
 1767. Research Activities, November 2009: Health Care Wo...
 1766. WHO | Pandemic (H1N1) 2009 - update 74
 1765. WHO: Interim Planning Considerations for Mass Gath...
 1764. CDC H1N1 Flu | Interim Additional Guidance for Inf...
 1763. Antiviral Treatment Options, including Intravenous...
 1762. CDC H1N1 Flu | Questions and Answers Regarding Res...
 1761. Quick Facts for Clinicians on Antiviral Treatments...
 1760. CDC H1N1 Flu | Questions and Answers about CDC’s I...
 1759. ▲ Interim Guidance on Infection Control Measures for...
 1758. Ampliar la Ley del Tabaco, una cuestión de salud
 1757. FDA Expands Approved Use of H1N1 Vaccines to Inclu...
 1756. En el país hay un millón de personas con diabetes ...
 1755. DIABETES: "La llegada de más terapias no evitará q...
 1754. Diabetes: Mejor control, pero una incidencia impar...
 1753. El número de pacientes infectados por bacterias re...
 1752. Laicidad y bioética: sobre algunos casos recientes...
 1751. La investigación en obesidad, protagonista del núm...
 1750. Atención primaria, prioridad y compromiso
 1749. ÁFRICA: 200 millones de menores de 5 años malnutri...
 1748. La diabetes se expande por toda África
 1747. Mumps Outbreak --- New York, New Jersey, Quebec, 2...
 1746. INECO: 17 de Noviembre de 2009
 1745. Announcement: World COPD Day --- November 18, 2009...
 1744. Announcement: Environmental Microbiology: Control ...
 1743. Great American Smokeout --- November 19, 2009
 1742. Cigarette Smoking Among Adults and Trends in Smoki...
 1741. State-Specific Secondhand Smoke Exposure and Curre...
 1740. Update: Influenza Activity --- United States, Augu...
 1739. CDC Novel H1N1 Flu | CDC Estimates of 2009 H1N1 In...
 1738. Órganos de gobierno en las entidades sanitarias
 1737. Retrato robot de una fundación sanitaria
 1736. Casi mil fármacos en I+D para mujeres
 1735. Secretary Sebelius Releases New Report on Health I...
 1734. Australian Council on Healthcare Standard: Surgica...
 1733. NQMC - Expert Resources - Expert Commentary
 1732. Patient Deaths in Hospitals Cost Nearly $20 Billio...
 1731. Barriers and Drivers of Health Information Technol...
 1730. AHRQ News and Numbers: One in Four Disabled Senior...
 1729. For whom the Bell Commission tolls: unintended eff...
 1728. Resident Duty Hours: Enhancing Sleep, Supervision,...
 1727. Building team and technical competency for obstetr...
 1726. Human factors in surgery: from Three Mile Island t...
 1725. Blame culture and defensive medicine. AHRQ
 1724. Integration of prospective and retrospective metho...
 1723. NEJM -- An Intervention to Decrease Catheter-Relat...
 1722. [2] - AHRQ Patient Safety Network - Patient Safety...
 1721. [1] - AHRQ Patient Safety Network - Patient Safety...
 1720. November 16-17, 2009: Blood Products Advisory Comm...
 1719. WHO | African Partnerships for Patient Safety
 1718. CDC - Seasonal Influenza (Flu) - Weekly Report: In...
 1717. nuevo Plan de Acción contra la Neumonía
 1716. INECO: primer taller de geronto-psiquiatría
 1715. Más de 6.000 muertos y medio millón de infectados ...
 1714. Las gripes A(H1N1) y estacional podrían causar 80....
 1713. ARGENTINA: Día Nacional del Donante de Sangre
 1712. vacuna para la leishmaniasis [Red de Investigación...
 1711. La ONU advierte de desplazamientos masivos en Soma...
 1710. Las mujeres reciben peor atención médica, según la...
 1709. Avoiding Medication Mistakes
 1708. DE LAS MIRADAS y SUS CIRCUNSTANCIAS
 1707. La medicina es una relación entre personas
 1706. ▲ MELANOMA (all about) from Clinical practice guidel...
 1705. Criteria for Determining Disability in Infants and...
 1704. Adjuvant systemic therapy of melanoma. In: Clinica...
 1703. Hispanic Diabetes Disparities Learning Network in ...
 1702. FDA Issues 2009 FDA Food Code
 1701. November 16-17, 2009: Blood Products Advisory Comm...
 1700. ► Human Fluid and Caloric Requirements by FDA
 1699. ► Dose Calculator by FDA
 1698. Humanizar y formar en la asistencia oncológica
 1697. Iniciativas útiles para que se puedan exportar
 1696. CDC H1N1 Flu | Interim guidance for use of 23-vale...
 1695. Vaccines: VPD-VAC/Pneumo/main page
 1694. Día del donante voluntario de sangre: Piden revisa...
 1693. H1N1 - Vaccination
 1692. La evolución del mal de Chagas, condicionada por l...
 1691. La productividad de la industria farmacéutica es u...
 1690. Empresas ávidas de proyectos buscan hospitales con...
 1689. El aumento de los crónicos impulsará la gestión cl...
 1688. Los niños representan ya uno de cada tres casos re...
 1687. Research Activities, November 2009: Announcements:...
 1686. Research Activities, November 2009: Announcements:...
 1685. Research Activities, November 2009: Announcements:...
 1684. Research Activities, November 2009: Agency News an...
 1683. Research Activities, November 2009: Agency News an...
 1682. Research Activities, October 2009: Agency News and...
 1681. Research Activities, October 2009: Agency News and...
 1680. Research Activities, October 2009: Elderly/Long-Te...
 1679. Research Activities, October 2009: Elderly/Long-Te...
 1678. Research Activities, November 2009: Agency News an...
 1677. Research Activities, September 2009: Mental Health...
 1676. National Survey on Drug Use and Health: National F...
 1675. Preventive Interventions Under Managed Care: Menta...
 1674. Revised Guidance Document for the Strategic Preven...
 1673. 137th APHA Annual Meeting (November 7-11, 2009): F...
 1672. 137th APHA Annual Meeting (November 7-11, 2009): I...
 1671. 137th APHA Annual Meeting (November 7-11, 2009): I...
 1670. 137th APHA Annual Meeting (November 7-11, 2009): A...
 1669. 137th APHA Annual Meeting (November 7-11, 2009): B...
 1668. INECO: DEPRESIÓN EN LA TERCERA EDAD
 1667. WHO | Pandemic (H1N1) 2009 - update 73
 1666. Evolution of pandemic H1N1 2009 in animals
 1665. WHO | Infection of farmed animals with the pandemi...
 1664. Cancer Network – NCCN Guidelines Update Webinar Se...
 1663. Healthcare-Associated Infection (HAI) Not on My Wa...
 1662. 2nd World HAI Forum: Experts Discuss Looming Threa...
 1661. Simposio Internacional Sobre Investigación en Célu...
 1660. ARGENTINA: Instituto Nacional de Enfermedades Trop...
 1659. INEQUIDADES: Sur de Sudán: 10 enfermeras para 8 mi...
 1658. Retrato de la enfermedad cardiovascular en España
 1657. “La Medicina Personalizada es el futuro de la inve...
 1655. El Banco de Datos Genéticos
 1654. About: Fifteenth Annual Maternal and Child Health ...
 1653. State Medicaid Coverage for Tobacco-Dependence Tre...
 1652. la industria farmacéutica es un sector crítico en ...
 1651. Paul Coverdell National Acute Stroke Registry Surv...
 1650. adecuada atención del paciente quemado - El Hospit...
 1649. Tecnología de la información - El Hospital: Inform...
 1648. CDC H1N1 Flu | Interim Guidance for People who hav...
 1647. H1N1 Flu Confirmed in Iowa Cat
 1646. * Humanidades medicas - Azucena Couceiro Vidal - Lai...
 1645. 2009 Meeting Materials of the Blood Products Advis...
 1644. PEDIDO ESPECIAL PARA DISPENSARIO MEDICO
 1643. NOT-HS-10-001: Technical Assistance Conference Cal...
 1642. Poor medication history plus slow symptom onset de...
 1641. Accuracy of medication documentation in hospital d...
 1640. Identification of patient information corruption i...
 1639. Safe & Sound: How to Prevent Medication Mishaps / ...
 1638. Another wrong-site surgery at RI Hospital / AHRQ ...
 1637. How could this happen? / AHRQ Patient Safety Netw...
 1636. Assessing Patient Safety Practices and Outcomes in...
 1635. Enhancing Patient Care: A Practical Guide to Impro...
 1634. Dosage Delivery Devices for OTC Liquid Drug Produc...
 1633. ESPAÑA: política farmacéutica
 1632. Cost-effectiveness analysis of hospital infection ...
 1631. CDC - Seasonal Influenza (Flu) - Weekly Report: In...
 1630. WHO | Experts advise WHO on pandemic vaccine polic...
 1629. - ViiV Healthcare
 1628. telemedicina y teleasistencia deben avanzar unidas...
 1627. La calidad como elemento integrador de la sanidad
 1626. I Jornada sobre Gestión de Calidad Total en el Sec...
 1625. La primaria británica 'is different'
 1624. FDA's MedWatch Safety Alerts: October 2009
 1623. Cuánto tiempo "protege" la vacuna contra la hepati...
 1622. Crearon una tela que repele a los mosquitos
 1621. H1N1 - gripe porcina - ARGENTINA: dos nuevas muert...
 1620. MALARIA: Casi un millón de personas mueren al año ...
 1619. La Red Iberoamericana de Bioinformática crea SoIBi...
 1618. Listas de espera en cirugía
 1617. 2009 Meeting Materials, Vaccines and Related Biolo...
 1616. Waivers for Conflicts of Interest for the November...
 1615. Tecnología y experiencia al servicio de la I+D
 1614. MEDICAMENTOS HUÉRFANOS designados en Octubre de 20...
 1613. Plan Nacional de enfermedades raras en Portugal (1...
 1612. Acceso a medicamentos huérfanos [III - COMUNICADO ...
 1611. Acceso a medicamentos huérfanos [II - COMUNICADO E...
 1610. Acceso a medicamentos huérfanos [COMUNICADO EURORD...
 1609. * IntraMed - Artículos - A usted..., ¿lo llaman Doct...
 1608. * IntraMed - Entrevistas - Los significados inconsci...
 1607. * IntraMed - Noticias médicas - Cada vez más gente p...
 1606. Plan de acción de la OMS y el UNICEF contra la neu...
 1605. Buscando el Acercamiento de los Jueces a las Cienc...
 1604. Tratamientos experimentales y financiación de la s...
 1603. La verdadera Pandemia - REVISTA MEDICOS | Medicina...
 1602. ESPAÑA: La prevención laboral empieza con el cuid...
 1601. ESPAÑA: Prioridad y compromiso, claves para volver...
 1600. ESPAÑA: Impulso científico en AP para colocar a Es...
 1599. ESPAÑA: Consenso sobre estrés e insomnio entre méd...
 1598. ESPAÑA: El médico de familia, piedra angular del s...
 1597. ESPAÑA: Más formación para los médicos de familia ...
 1596. ESPAÑA: Vacunas, antivirales y cautela: herramient...
 1595. ESPAÑA: AP y especializada, obligadas a entenderse...
 1594. Detectan riesgos en la autonomía de gestión
 1593. AHRQ Innovations Exchange | Oral Health Program Of...
 1592. AHRQ Innovations Exchange | Cross-Training of Medi...
 1591. AHRQ Innovations Exchange | At-Home, Internet-Enab...
 1590. AHRQ Innovations Exchange | Online Tools and Servi...
 1589. AHRQ Innovations Exchange | Team-Developed Care Pl...
 1588. AHRQ Innovations Exchange | Rehearsing Team Care f...
 1587. AHRQ Innovations Exchange | Providers Offer HIV Te...
 1586. AHRQ Innovations Exchange | Organization-Wide Adop...
 1585. AHRQ Innovations Exchange | Community Health Cente...
 1584. 10 years, 5 Voices, 1 Challenge
 1583. Four patients say Cedars-Sinai did not tell them t...
 1582. CT brain perfusion scans safety investigation: ini...
 1581. Universal Protocol for Preventing Wrong Site, Wron...
 1580. National Patient Safety | Joint Commission
 1579. Medication Reconciliation - AHRQ Patient Safety Ne...
 1578. Rate of undesirable events at beginning of academi...
 1577. Use of failure mode and effects analysis for proac...
 1576. Leadership WalkRound films- Patient Safety First C...
 1575. ESPECIAL SAMHSA: Selected Parenting and Homelessne...
 1574. INECO: INMERSIÓN EN GERONTOPSIQUIATRÍA
 1573. INECO: SIMPOSIO INTERNACIONAL de NEUROCIENCIAS COG...
 1572. SOCIEDAD ARGENTINA de MEDICINA: NEUQUÉN
 1571. SOCIEDAD ARGENTINA de MEDICINA: CONGRESO
o ► octubre (231)
o ► septiembre (291)
o ► agosto (211)
o ► julio (315)
o ► junio (202)
o ► mayo (85)
o ► abril (112)
o ► marzo (58)
o ► febrero (45)
o ► enero (26)
• ► 2008 (23)

Indoor Tanning: The Risks of Ultraviolet Rays




Indoor Tanning: The Risks of Ultraviolet Rays

Printer-friendly PDF (295 KB)
http://www.blogger.com/posts.g?blogID=4376469832659547211

On this page:
Cancer Risk
Other Risks
Tanning in Children and Teens
FDA Regulation
The Riskiest Practices
Melanoma: One Woman's Story

Sunlamps and tanning beds promise consumers a bronzed body year-round, but the ultraviolet (UV) radiation from these devices poses serious health risks.

“Although some people think that a tan gives them a ‘healthy’ glow, any tan is a sign of skin damage,” says Sharon Miller, M.S.E.E., a Food and Drug Administration (FDA) scientist and international expert on UV radiation and tanning.

“A tan is the skin’s reaction to exposure to UV rays,” says Miller. “Recognizing exposure to the rays as an ‘insult,’ the skin acts in self-defense by producing more melanin, a pigment that darkens the skin. Over time, this damage will lead to prematurely aged skin and, in some cases, skin cancer.”

Two types of UV radiation that penetrate the skin are UV-B and UV-A rays.

UV-B rays penetrate the top layers of skin and are most responsible for sunburns.
UV-A rays penetrate to the deeper layers of the skin and are often associated with allergic reactions, such as a rash.
Both UV-B and UV-A rays damage the skin and can lead to skin cancer. Tanning salons use lamps that emit both UV-A and UV-B radiation.

Cancer Risk
Exposure to UV radiation—whether from the sun or from artificial sources such as sunlamps used in tanning beds—increases the risk of developing skin cancer, according to the National Cancer Institute (NCI). Melanoma, the deadliest form of skin cancer, is linked to getting severe sunburns, especially at a young age.

In July 2009, the International Agency for Research on Cancer (IARC), part of the World Health Organization, concluded that tanning devices that emit UV radiation are more dangerous than previously thought. IARC moved these devices into the highest cancer risk category: “carcinogenic to humans.” Previously, it had categorized the devices as “probably carcinogenic to humans.”

Development of cancer is a long process that may take decades. Therefore, IARC also recommended banning commercial indoor tanning for those younger than 18 years to protect them from the increased risk for melanoma and other skin cancers.

IARC’s conclusions and recommendations were based on its 2006 review of 19 studies conducted over 25 years on the use of indoor tanning equipment. The review found evidence of

. an association between indoor tanning and two types of skin cancer: squamous cell carcinoma and melanoma
.. an association between UV-emitting tanning devices and cancer of the eye (ocular melanoma)
... both UV-A and UV-B rays causing DNA damage, which can lead to skin cancer in laboratory animals and humans
... the risk of melanoma of the skin increasing by 75 percent when tanning bed use started before age 35

IARC’s review had some limitations, says Ron Kaczmarek, M.D., M.P.H., an FDA epidemiologist who analyzed the review. Limitations include possible inaccuracy of people’s memories of their tanning experiences, not knowing the amount of UV radiation emitted by each tanning device, and the inability to separate the effects of individuals’ indoor and outdoor exposure. Nevertheless, IARC concluded that there is convincing evidence of an association between the use of indoor tanning equipment and melanoma risk, and that the use of tanning beds should be discouraged.

“It’s well established that UV radiation from the sun causes skin cancer,” says Miller. “Since lamps used in tanning beds emit UV radiation, the use of indoor tanning devices also increases your risk of skin cancer.”


Other Risks
In addition to the serious risk of skin cancer, tanning can cause:


* Premature aging. Tanning causes the skin to lose elasticity and wrinkle prematurely. This leathery look may not show up until many years after you’ve had a tan or sunburn.
* Immune suppression. UV-B radiation may suppress proper functioning of the body’s immune system and the skin’s natural defenses, leaving you more vulnerable to diseases, including skin cancer.
* Eye damage. Exposure to UV radiation can cause irreversible damage to the eyes.
* Allergic reaction. Some people who are especially sensitive to UV radiation may develop an itchy red rash and other adverse effects.

Advocates of tanning devices sometimes argue that using these devices is less dangerous than sun tanning because the intensity of UV radiation and the time spent tanning can be controlled. But there is no evidence to support these claims. In fact, sunlamps may be more dangerous than the sun because they can be used at the same high intensity every day of the year—unlike the sun whose intensity varies with the time of day, the season, and cloud cover.


Tanning in Children and Teens
FDA is particularly concerned about children and teens being exposed to UV rays. Intermittent exposures to intense UV radiation leading to sunburns, especially in childhood and teen years, increase the risk of melanoma, according to NCI.

FDA believes that limiting sun exposure and using sunscreen or sunblock are particularly important for children since these measures can prevent sunburn at a young age.

NCI reports that women who use tanning beds more than once a month are 55 percent more likely to develop melanoma. Teenage girls and young women make up a growing number of tanning bed customers.

“Young people may not think they are vulnerable to skin cancer,” says Kaczmarek. “They have difficulty thinking about their own mortality.” Yet of the more than 68,000 people in the United States who will learn they have melanoma this year, one out of eight will die from it, according to NCI estimates. In addition, the American Academy of Dermatology reports that melanoma is the second most common cancer in women 20 to 29 years old.

Some states are considering laws to ban those under age 18 from using tanning beds. And many states now have laws that require minors to have a parent’s consent or be accompanied by a parent to the tanning facility.

FDA’s current performance standard requires that a sunlamp product’s label include a recommended exposure schedule. FDA has advised manufacturers that this schedule should provide for exposures of no more than three sessions in the first week.

In an NCI-sponsored study published in September 2009 in the Archives of Dermatology, the study researchers hired and trained college students to pose as 15-year-old, fair-skinned girls who had never tanned before. By telephone, the students asked more than 3,600 tanning facilities in all 50 states about their practices.

Less than 11 percent of the facilities followed FDA’s recommended exposure schedule of three or fewer sessions the first week. About 71 percent said they would allow a teen to tan all seven days the first week, and many promoted frequent tanning with “unlimited tanning” discount price packages.

About 87 percent of the facilities required parental consent, leading the researchers to conclude that “many parents are allowing their teens to tan and are providing written consent or accompaniment.”

“Parents should carefully consider the risks before allowing their children under 18 to tan,” says Miller.


FDA Regulation
FDA regulates radiation-emitting products, including sunlamps and products that contain them, such as tanning beds and booths and portable home units. Manufacturers of sunlamps must comply with FDA regulations, including the performance standard for sunlamp products.

FDA requires sunlamp products to carry a warning label with specific information. Based on the results of consumer testing, FDA is considering amending the warning label requirements to
- strengthen the warnings about skin cancer and irreversible eye damage
- make the warning easier for consumers to read and understand
In a December 2008 Report to Congress, FDA noted that FDA/NCI studies found that the UV exposures typically provided by sunlamp products are excessive, and that comparable cosmetic effects can be produced with exposures that are only one-third or even one-fourth the levels currently used. FDA is evaluating the results of this research and considering whether those results warrant changes to its performance standard for sunlamp products.

The Riskiest Practices
FDA, NCI, the American Academy of Dermatology, and other health organizations advise limiting exposure to natural UV radiation from the sun and avoiding artificial UV sources such as tanning beds entirely.

All use of tanning beds increases the risk of skin cancer. Certain practices are especially dangerous. These include:

.Failing to wear the goggles provided, which can lead to short- and long-term eye injury.
..Starting with long exposures (close to the maximum time for the particular tanning bed), which can lead to burning. Because sunburn takes 6 to 48 hours to develop, you may not realize your skin is burned until it’s too late.
...Failing to follow manufacturer-recommended exposure times on the label for your skin type.
....Tanning while using certain medications or cosmetics that may make you more sensitive to UV rays. Talk to your doctor or pharmacist first.


Melanoma: One Woman's Story
Brittany Lietz Cicala of Chesapeake Beach, Md., began tanning indoors at age 17. She stopped at age 20 when she was diagnosed with melanoma, the deadliest form of skin cancer. The former Miss Maryland says she used tanning beds at least four times a week, and sometimes every day.

"Growing up, until I started using tanning beds, my parents were very strict about me wearing sunscreen," says Cicala. Although she also tanned in the summer sun during her 3 years of tanning bed use, Cicala estimates that 90 percent of her UV exposure was in tanning beds during this period.

In the 4 years since she was diagnosed with melanoma, Cicala’s surgeries have left her with about 25 scars. Cicala gets a head-to-toe skin exam every 3 months, which usually results in removal of a suspicious growth.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

Date Posted: November 30, 2009

abrir aquí:
Indoor Tanning: The Risks of Ultraviolet Rays

OMS | Manual de seguimiento y evaluación de los recursos humanos para la salud


Manual de seguimiento y evaluación de los recursos humanos para la salud
Esta publicación es fruto de una iniciativa conjunta de la Agencia de los Estados Unidos para el Desarrollo Internacional, el Banco Mundial y la Organización Mundial de la Salud (OMS) dirigida a documentar métodos e intercambiar experiencias en el terreno de la medición y el seguimiento de los RHS, alentar a los países y los asociados a sacar partido de dichas experiencias, y compilar recomendaciones sobre seguimiento y evaluación del personal sanitario destinadas a los ministerios de salud y otros interesados directos.

abrir aquí para acceder al documento PDF (212 PÁGINAS / 3.25MB)
http://whqlibdoc.who.int/publications/2009/9789243547701_spa.pdf

ABRIR AQUÍ para acceder al documento WHO general:
OMS | Manual de seguimiento y evaluación de los recursos humanos para la salud

OMS | Informe sobre la salud en el mundo


El Informe sobre la salud en el mundo, publicado por vez primera en 1995, es la principal publicación de la OMS. Cada año el informe combina una evaluación de la salud mundial a cargo de expertos, incluidas estadísticas sobre todos los países, con el análisis de un tema concreto. La finalidad principal del informe es proporcionar a los países, los organismos donantes, las organizaciones internacionales y otras entidades la información que necesitan para ayudarles a tomar decisiones de política y de financiación. El informe se hace llegar también a un público más amplio, desde universidades, hospitales docentes y escuelas, pasando por los periodistas, hasta el público general, en definitiva, a cualquier persona interesada profesional o personalmente en la salud internacional.


Informe actual
pdf: 4.22MB / 154 PÁGINAS
http://www.who.int/whr/2008/08_report_es.pdf

¿Por qué renovar la atención primaria de salud (APS), y por qué ahora más que nunca? La respuesta inmediata es que los Estados Miembros lo están pidiendo claramente, y no sólo los profesionales de la salud, sino también los responsables políticos. La globalización está afectando a la cohesión social de muchos países, y no cabe duda de que los sistemas de salud, elementos fundamentales de la estructura de las sociedades contemporáneas, no están funcionando todo lo bien que podrían y deberían. La gente está cada vez más descontenta ante la incapacidad de los servicios de salud para proporcionar un nivel de cobertura nacional que satisfaga la demanda y las nuevas necesidades, y ante el hecho de que los servicios prestados no sean acordes con sus expectativas. Es difícilmente rebatible que los sistemas de salud tienen que responder mejor y con mayor rapidez a los desafíos de un mundo en transformación. Y la APS puede afrontar esos desafíos.

Informe sobre la salud en el mundo 2008 - La atención primaria de salud: Más necesaria que nunca

abrir aquí para acceder al documento WHO, o bien (VER ARRIBA):
OMS | Informe sobre la salud en el mundo

INECO: Charlas a la Comunidad - ANSIEDAD

domingo, 29 de noviembre de 2009

Physician Consortium for Performance Improvement®


Physician Consortium for Performance Improvement®

- Radiology: percentage of final reports for carotid imaging studies (neck MR angiography [MRA], neck CT angiography [CTA], neck duplex ultrasound, carotid angiogram) performed that include direct or indirect reference to measurements of distal internal carotid diameter as the denominator for stenosis measurement. This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14298


-- Radiology: percentage of final reports for CT examinations performed with documentation of use of appropriate radiation dose reduction devices OR manual techniques for appropriate moderation of exposure. This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14304


--- Radiology: percentage of final reports for procedures using fluoroscopy that include documentation of radiation exposure or exposure time. This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14305


---- Radiology: percentage of final reports for screening mammograms that are classified "probably benign." This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14300


----- Radiology: percentage of patients aged 40 years and older undergoing a screening mammogram whose information is entered into a reminder system with a target due date for the next mammogram. This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14303


------ Radiology: percentage of patients undergoing diagnostic mammograms that are classified as "suspicious" or "highly suggestive of malignancy" with documentation of direct communication of findings from the diagnostic mammogram to the patient within 5 business days of exam interpretation. This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14302


------- Radiology: percentage of patients undergoing diagnostic mammograms that are classified as "suspicious" or "highly suggestive of malignancy" with documentation of direct communication of findings from the diagnostic mammogram to the practice that manages the patient's on-going care within 3 business days of exam interpretation. This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14301


-------- Radiology: percentage of patients undergoing screening mammograms whose assessment category (e.g., Mammography Quality Standards Act [MQSA], Breast Imaging Reporting and Data System [BI-RADS®], or FDA approved equivalent categories) is entered into an internal database that will, at a minimum, allow analysis of abnormal interpretation (recall) rate. This updates a previously published measure summary.
abrir aquí:
http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=14299

H1N1 - gripe porcina - FRANCIA: grave mutación identificada


29 NOV 09 | Confiere al virus mayor penetración en las vías respiratorias
Una grave mutación del H1N1 se detecta en Francia
Dos fallecidos tenían la misma variante del virus que apareció en Noruega y otros países.
El País, Madrid
EMILIO DE BENITO


Esta vez ha sido en Francia. Dos de las personas que han fallecido por la nueva gripe en el país tenían la misma mutación que se identificó el pasado día 20 en tres enfermos de Noruega (dos de ellos fallecidos), y que, según la Organización Mundial de la Salud (OMS, ya había sido detectada en pacientes de otros países (Brasil, China, Japón, México, Ucrania y EE UU).

La mutación confiere al virus la capacidad de penetrar más profundamente en las vías respiratorias, lo que lo hace más peligroso. Pero, hasta ahora, no hay evidencias de que se transmita entre personas. Parece, más bien, que es un cambio relativamente frecuente si se tiene en cuenta la cantidad de veces que se ha identificado, y grave.

Mientras no haya un contagio de la forma mutada entre personas, no aumentará el riesgo relativo de la enfermedad. Que la gripe causa complicaciones que suponen el fallecimiento de algunas personas ya se sabía; y que los virus mutan cuando comienzan su ciclo de proliferación dentro de una persona también. Es un puro proceso adaptativo: estos patógenos necesitan de los mecanismos intracelulares de sus anfitriones para reproducirse, y, por tanto, es ahí donde pueden ensayar cambios. El hecho de que esta mutación se haya identificado ya en la menos seis países sólo indica que es una de las que resulta viable para el microorganismo. Pero mientras no se contagie, no aumenta el riesgo de la enfermedad para la población en general (sí que se está demostrando que es un peligro para las personas que la sufren).

Ya cuando se supo del caso noruego hace una semana, la OMS comentó que era "difícil determinar" el impacto de este cambio, y apuntó a que, dado que el número de personas infectadas en el mundo es ya de millones, y que en cada una de ellas se pueden producir millones de mutaciones, la probabilidad de que la variante se repite aumenta.

Hasta ahora en Francia la gripe A ha causado la muerte a 76 personas, según el Ministerio de Sanidad francés.


Descubierta una mutación del H1N1 que agrava la enfermedad

El Instituto de Salud Pública noruego afirma que la variante no se propaga - Dos de las tres personas en las que se ha detectado el virus han muerto.

EMILIO DE BENITO - Madrid

Una escueta nota del Instituto de Salud Pública de Noruega publicada en su web a las 15.36 de ayer ha venido a alterar lo que estaba siendo un desarrollo casi normal de la pandemia de gripe. En ella, los científicos comunican que han hallado en tres pacientes un virus H1N1 con una mutación "de especial interés". Y, a continuación, explican por qué: "Se ha encontrado en dos pacientes que murieron de la nueva gripe A(H1N1) y en otro con una gripe grave".
Hasta aquí, el asunto parece extremadamente peligroso. El H1N1 ya tiene una gran capacidad para transmitirse (las tasas de infectados en Europa en estas fechas corresponden ya a la del pleno apogeo de una epidemia de gripe invernal de las consideradas fuertes), y si a esa propiedad se añade la de causar una enfermedad letal, el resultado sería la pandemia perfecta: rápida y mortal.

Pero en la breve nota, a continuación, las autoridades sanitarias noruegas añaden información tranquilizadora. La primera es que los dos muertos en los que han encontrado esta mutación son, precisamente, las dos primeras víctimas mortales asociadas a la nueva gripe del país. Después de ellos ha habido, al menos, otros 19 fallecimientos atribuidos al H1N1, según los datos remitidos al Centro Europeo de Control de Enfermedades (ECDC), que tiene su sede muy cerca, en Estocolmo (Suecia), y en ninguno se ha detectado la mutación.

70 análisis

La segunda es que "parece que el virus mutado no está circulando entre la población". "Hemos analizado unos 70 virus de casos confirmados en Noruega, pero sólo hemos encontrado la mutación en esos tres", ha dicho el director general del instituto, Geir Stene-Larsen.

La suma de estas dos condiciones parece apuntar a que la mutación ocurrió, pero no se ha propagado. Esto no es algo extraño en los virus. Estos microorganismos son tan aparentemente sencillos (apenas tienen una decena de genes) que cambian con facilidad. Eso los convierte en los parásitos perfectos. Lógicamente, la inmensa mayoría de los cambios son inviables, y ahí acaba la propagación del virus. Pero si la mutación es demasiado agresiva -y ésta parece que lo es- ellos mismos mueren de éxito: acaban demasiado pronto con el huésped, y no les da tiempo a completar su ciclo infeccioso y a trasladarse a otro.

Ésta podría ser la explicación de lo que ha pasado en Noruega: el virus mutó -no una, sino tres veces-, pero lo que resulta de este cambio es que "infecta las vías respiratorias más profundamente, y, por lo tanto, causa una enfermedad más grave".

Ésta es la tercera causa que, de momento, permite estar tranquilos. Según las autoridades noruegas, lo más probable es que la mutación se haya producido "espontáneamente dentro de los tres pacientes". Este proceso tampoco es excepcional: el virus no se mantiene inalterado una vez que entra en su huésped, sino que, por un puro proceso de selección natural, en su periplo sólo sobreviven las mutaciones que le hacen adaptarse mejor al organismo que está infectando.

La ministra de Sanidad española, Trinidad Jiménez, descartó ayer que haya habido posibilidad de que la mutación encontrada en Noruega se haya transmitido a España. "El Centro de Microbiología del Instituto de Salud Carlos III ha revisado la información sobre este virus, y aquí no se ha encontrado nada parecido", redundó una portavoz del ministerio. "Aun así hay que mantener la vigilancia y nunca bajamos la guardia porque estamos ante un virus nuevo y la actitud de las autoridades sanitarias tiene que ser muy vigilante", insistió la ministra.

La información que empezó a circular ayer por la tarde contiene un añadido en la nota difundida por el Instituto de Salud Pública noruego que no está directamente relacionada con la amenaza que podría suponer una mutación del virus hacia una forma más letal. "No hay indicios de que este cambio en el virus tenga ninguna importancia para el efecto de la vacuna o del tratamiento antiviral", concluye Stene-Larsen.

Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention - AHRQ PSNET


Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention.
Hug BL, Witkowski DJ, Sox CM, et al. J Gen Intern Med. 2009 Nov 6; [Epub ahead of print].

This study used chart review with trigger tools to estimate the incidence of medication errors in community hospitals. A high proportion of errors occurred at the prescribing stage, and therefore could have been prevented by a computerized provider order entry system.


abrir aquí para acceder al documento AHRQ completo:
AHRQ Patient Safety Network

abrir aquí para acceder al original:
http://www.springerlink.com/content/h263745568p25380/

An effectiveness analysis of healthcare systems using a systems theoretic approach - AHRQ Patient Safety Network


An effectiveness analysis of healthcare systems using a systems theoretic approach.
Chuang S, Inder K. BMC Health Serv Res. 2009;9:195.

This study describes a theoretical systems approach to integrating quality measurement and reporting systems with accreditation activities


abrir aquí para acceder al documento AHRQ completo:
AHRQ Patient Safety Network

abrir aquí para acceder al full-text:
http://www.biomedcentral.com/1472-6963/9/195

Effect of a weight-based prescribing method within an electronic health record on prescribing errors - AHRQ Patient Safety Network


Effect of a weight-based prescribing method within an electronic health record on prescribing errors.
Ginzburg R, Barr WB, Harris M, Munshi S. Am J Health Syst Pharm. 2009;66:2037-2041.

An automated weight-based calculator within a computerized provider order entry system reduced prescribing errors for pediatric patients.


abrir aquí para acceder al documento AHRQ completo:
AHRQ Patient Safety Network

abrir aquí para acceder al abstract:
http://www.ajhp.org/cgi/content/abstract/66/22/2037