Con esta guía de referencia rápida podrán reconocer con facilidad las enfermedades y efectos secundarios relacionados con el cambio climático, administrar los tratamientos adecuados y aconsejar a las poblaciones expuestas, presentar información actualizada sobre la relación entre los efectos s...ecundarios de ciertos medicamentos y la agravación de las dolencias sensibles al clima, y determinar las consecuencias posibles para los servicios de salud. En este libro se abordan los principales fenómenos meteorológicos, así como las afecciones en las que pueden tener incidencia, agrupados por áreas clínicas específicas.
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This brief summarizes current evidence and guidance for maintaining safe and effective care across the spectrum of maternal, newborn and infant care while protecting mother and child and health care providers during COVID-19. Furthermore, implications of the principle of “do no harm” are reviewe...d for maternal, newborn and infant care delivery during COVID-19, so that this information is conveniently and readily available to clinical and health system policy leaders and stakeholders in countries and communities. Additionally, considerations for safe oxygen delivery as well as key Infection Prevention and Control (IPC) measures at home and in healthcare facilities for pregnant women, newborns and children are described in detail in the brief.
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The manual has been designed in a comprehensive manner, the aim being to provide a holistic approach to the short-term development of human resources, with a focus on primary care physicians. This is a reference manual meant for primary care physicians who will provide care to older people in primar...y health care facilities. The information on old age care is meant to be incorporated into the everyday clinical practice of primary care physicians. This manual will help to enhance the knowledge and skills of physicians. It is expected that the use of the manual will improve the approach to issues of old age and promote holistic care of older people, which will ultimately improve their quality of life.
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As countries aim to progress towards the Sustainable Development Goals (SDGs) and achieving universal health coverage, health inequities driven by racial discrimination and intersecting factors remain pervasive. Inequities experienced by indigenous peoples as well as people of African descent, Roma ...and other ethnic minorities are of concern globally; they are unjust, preventable and remediable.
Health systems themselves are important determinants of health and health equity. They can perpetuate health inequities by reflecting structural racism and discriminatory practices of wider society. For instance, systemic racism, implicit bias, misinformed clinical practice, or discrimination by health professionals contributes to health inequities. However, health systems can also be a leading force for tackling the inequities faced by populations experiencing racial discrimination.
Primary health care (PHC) is the essential strategy for reorientating health systems and societies to become healthier, equitable, effective and sustainable. In 2018, on the 40th anniversary of the Declaration of Alma-Ata, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) renewed the emphasis on PHC with their strategy,
WHO outlines 14 strategic and operational levers for policy-makers to strengthen PHC. Within each lever, there are multiple potential entry points for targeted actions to address racial discrimination, foster intercultural care, and reduce health inequities experienced by indigenous peoples as well as people of African descent, Roma and other ethnic minorities.
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Violence against women and girls is widespread in the Region of the Americas, resulting in enormous consequences for the health and wellbeing of women and girls, their families and communities. These costs are unacceptable and they can be prevented through evidence-based action, including the health... sector through its policies and protocols, as well as in collaboration with other sectors. This report remains the first of its kind and is a major milestone for the Region. It is specifically informed by the commitments of Member States in the regional Strategy and Plan of Action on Strengthening the Health System to Address Violence against Women. The report provides an analysis of efforts to advance the prevention of violence against women through health policies, clinical protocols, multisectoral plans and related approaches across the Americas. Attention to this topic is timely, as the COVID-19 pandemic has created new visibility for this area of work. This report offers critical information on efforts in the Region that can be learned from and used to build upon in the future to prevent and respond to violence against all women and girls everywhere.
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Background
Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent hospitalization and death.
Methods
This review is based on articles retrieved by a selective search in PubMed, as well as on r...elevant guidelines.
Results
Evidence-based treatment options are available only for congestive heart failure with a low ejection fraction. Pharmacotherapy is based on neurohumoral inhibition of the renin-angiotensin-aldosterone system and the adrenergic system. The prognosis of patients with this condition has been further improved recently through the introduction of combined angiotensin receptor antagonists and neprilysin inhibitors. Modern implantable devices are a further component of treatment. Implantable defibrillators and special pacemakers for cardiac resynchronization are well established; the utility of alternative devices (baroreflex modulation or cardiac contractility modulation) needs to be investigated in further studies. It was recently shown that the catheter-based treatment of secondary mitral regurgitation with a MitraClip improves the outcome of selected patients.
Conclusion
The treatment of chronic systolic heart failure as recommended in the relevant guidelines, with drugs and implanted devices if indicated, can significantly improve the clinical outcome.
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Objective: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and
middle-income countries.
Methods: We systematically searched medical databases and websites of medical societies and contacted international organizations.
Co...untry-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed
each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation).
We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of
guidelines and plans for dissemination to target audiences.
Findings: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries.
Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending
surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development;
breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and
middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines
encompassed detailed implementation plans and socioeconomic considerations.
Conclusion: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of
health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
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This is an update (third edition) of the BACPR Standards & Core Components and represents current evidence-based best practice and a pragmatic overview of the structure and function of Cardiovascular Prevention and Rehabilitation Programmes (CPRPs) in the UK. The previously described seven standards... have now been reduced to six but without sacrificing any of the key elements and with a greater emphasis placed on measurable clinical outcomes, audit and certification. Similarly, the second edition provided an overview of seven core components felt to be essential for the delivery of quality prevention and rehabilitation, and this too has been reduced to six. The interplay between cardio-protective therapies and medical risk factors is almost impossible to disentangle for the vast majority of patients and even if specific drug therapies are deployed exclusively for risk factor modulation, the indirect effect will also be cardio-protective. Thus, these have been combined into a single core component – medical risk management.
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This document updates the earlier version published in April 2020. In recent weeks, information on the potential use of chloroquine or hydroxychloroquine for the treatment of people with COVID-19 has been disseminated in academic journals and public media. Although there are now ongoing clinical tri...als testing the efficacy and safety of several medicines for COVID-19, as of the date of this document, there is a lack of quality evidence to demonstrate chloroquine and/or hydroxychloroquine are effective in the treatment of COVID-19. Evidence is recently emerging via small studies with sub-optimal methodologies that are conflicting.
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While many of the countries hit by the COVID-19 in the first few months of the year are now beginning to relax lockdown measures as infection and death rates fall, in the regions most affected by HIV, TB and malaria, such as Africa, South Asia and Latin America, the pandemic continues to accelerate.... In lower resource settings, lockdowns are less effective and hard to sustain, and clinical care facilities are extremely limited. In such environments, the response to COVID-19 must focus on containing the pandemic’s spread as far as possible through testing, contact tracing and isolation, protecting the health workforce through training and the provision of personal protective equipment (PPE) and minimizing the knock-on impact on other diseases through shoring up fragile health systems, and adapting existing disease programs.
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La Agencia Española de Medicamentos y Producto Sanitarios (AEMPS) está monitorizando de manera continua con los expertos de las agencias europeas, la EMA y el resto de agencias mundiales todos los datos relativos al uso de medicamentos para tratar la COVID-19. Se trata de... un escenario que puede ir cambiando por la enorme cantidad de datos, comunicaciones y publicaciones que se están generando a nivel mundial. El presente documento técnico tiene la finalidad de guiar el manejoclínicode los pacientes conCOVID-19 con un doble objetivo: lograr el mejor tratamiento del paciente que contribuya a su buena evolución clínica; y garantizar los niveles adecuados de prevención y control de la infección para la protección de los trabajadores sanitarios y de la población en su conjunto.
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El presente protocolo es una actualización del emitido el 24 de abril 2020 y contiene las
siguientes modificaciones:
• Definición de caso: Las definiciones de caso sospechoso y confirmado son dinámicas y secundarias a la situación epidemiológica vigente. En este contexto el Ministerio de
...
Salud de Nación ha modificado el criterio de caso sospechoso y de caso confirmado en pediatría. El Ministerio de Salud de Provincia de Buenos Aires acepta y adhiere a estos cambios.
• Manifestaciones clínicas: Se agregan manifestaciones clínicas en pediatría en base a la evidencia disponible y según la actualización realizada por el Ministerio de Salud de
Nación.
• Criterio de Alta: Los criterios de alta para el manejo de casos son dinámicos y se
adecúan conforme con las actualizaciones de la evidencia disponible y las recomendaciones de la Organización Mundial de la Salud. En este marco, el Ministerio de Salud de Nación ha modificado el criterio de alta del aislamiento para un caso
confirmado de COVID-19 el 24 de junio. El Ministerio de Salud de Provincia de Buenos
Aires acepta y se adhiere a este cambio.
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La presente publicación tiene como objetivo facilitar herramientas para garantizar el abordaje integral del suicidio en la adolescencia, partiendo de la comprensión de que esta problemática trasciende las fronteras de la Salud Mental: requiere de una articulación basada en los principios de inte...rdisciplina, intersectorialidad y corresponsabilidad del conjunto de las políticas públicas destinadas a esta población.
Por ello, el material incluye herramientas para el proceso de atención clínica y, al mismo tiempo, prioriza el abordaje integral y comunitario. En este sentido, se propone como un insumo tanto para las acciones quedesarrollan los equipos de salud de atención primaria como también para la articulación y el trabajo en red con todos los efectores del Sistema de Promoción y Protección Integral de Derechos de Niñas, Niños y Adolescentes.
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Mientras los países se esfuerzan por avanzar hacia los Objetivos de Desarrollo Sostenible (ODS) y lograr la cobertura sanitaria universal, las desigualdades sanitarias provocadas por la discriminación racial y los factores interrelacionados siguen estando omnipresentes. Las desigualdades que sufre...n los pueblos indígenas, los afrodescendientes, los romaníes y otras minorías étnicas son preocupantes a nivel mundial; son injustas, prevenibles y remediables
Los propios sistemas de salud son determinantes importantes de la salud y la equidad sanitaria. Pueden perpetuar las desigualdades sanitarias al reflejar el racismo estructural y las prácticas discriminatorias de la sociedad en general. En este sentido, el racismo sistémico (por ejemplo, relacionado con la ubicación de los servicios o los requisitos para acceder a ellos), los prejuicios implícitos, la práctica clínica mal informada o la discriminación por parte de los profesionales de la salud contribuyen a las desigualdades sanitarias. Ahora bien, los sistemas de salud también pueden convertirse en una de las principales fuerzas para combatir las desigualdades a las que se enfrentan las poblaciones que sufren discriminación racial.
La atención primaria de salud (APS) representa la estrategia esencial que permite reorientar los sistemas de salud y las sociedades para que sean más saludables, equitativos, eficaces y sostenibles. En 2018, al cumplirse el 40.º aniversario de la Declaración de Alma-Ata, la Organización Mundial de la Salud (OMS) y el Fondo de las Naciones Unidas para la Infancia (UNICEF) renovaron el énfasis en la atención primaria de salud con su estrategia sobre la atención primaria de salud en el siglo XXI.
La OMS ha señalado 14 mecanismos estratégicos y operacionales con los que los responsables políticos pueden reforzar la atención primaria de salud. Cada mecanismo dispone de múltiples puntos de partida posibles para emprender acciones específicas dirigidas a combatir la discriminación racial, fomentar la atención de salud intercultural y reducir las desigualdades sanitarias que sufren los pueblos indígenas, los afrodescendientes, los romaníes y otras minorías étnicas
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The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the... disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
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Q 4: Is behavioural activation better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?brief, structured psychological treatment in non-specialist health care settings better (more effective than/as safe as) than treatment as usual in people with de...pressive episode/disorder?
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Q 2: How long should treatment with antidepressants continue in adults with depressive episode/disorder?
Q 3: Is brief, structured psychological treatment in non-specialist health care settings better (more effective than/as safe as) than treatment as usual in people with depressive episode/disorder?
This Handbook, an updated edition of the Management of Severe Malaria, provides new and revised practical guidance on the diagnosis and management of severe malaria.
This booklet is recommended for all health workers who diagnose and treat leprosy, especially those at the first referral level such as a health centre. It contains more detail than the WHO Guide to Eliminate Leprosy as a Public Health Problem. The Guide gives practical advice on how to diagnose lep...rosy and how to give the correct treatment, and basic information on how to recognise and manage leprosy reactions.e
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