RESUMO
In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.
Assuntos
Encéfalo , Certificação , Serviços de Saúde , Coração , Articulações , Melhoria de Qualidade , Acidente Vascular Cerebral , Ativador de Plasminogênio Tecidual , Estados Unidos , Senso de Humor e Humor como AssuntoRESUMO
En este artículo se analiza la realación entre migración y slaud tomando como caso el síndrome de inmunodeficiencia adquirida (SIDA) en las regiones fronterizas de México y Estados Unidos. Los autores sostienen que el carácter permanente de la migración entre estos dos países obliga al diseño de programas de salud binacionales, capaces de ofrecer educación y promoción en salud, y a una mayor interacción entre los sistemas de salud mexicano y estadounidense
This paper discusses the relationship between migration and health using as a case study the problem of Acquired Immunodeficiency Syndrome (AIDS) in the Mexican American border. The authors state that the permanent nature of migration between Mexico and the United States points to the need of binational health programs offering health education and promotion, and a greater interaction between the Mexican and the American health care systems.