[Morbidity and mortality of osteoporotic proximal femoral fracture after one year follow-up]. / Morbilidad y mortalidad de la fractura osteoporótica de la extremidad proximal del fémur tras un año de seguimiento.

BACKGROUND: The aim of the present study was to follow for a year all the osteoporotic proximal femoral fractures that happened in the island of Gran Canaria during 1990 and to analyze: a) mortality; b) the degree of functional capacity; c) their destination after being attended from the fracture. METHODS: Personal interviews were performed in almost every patient (68%), either directly to them or the relatives who were at their care (23.5%), after excluding those patients who died during the acute phase (7.6%) a year after the fracture. Two patients were missed (0.9%). We had the collaboration of every public and private center in the island. 209 patients (154 women and 55 men) were interviewed. Age mean of the patients was 77.1 +/- 10.9 years. The degree of functional capacity was determined by Karnofsky scale. RESULTS: Mortality within the acute phase was 7.6%, rising to 20.8% 6 months later and to 30.7% after a year. There was an important disability in 30.7% of the remainder living patients. In the postsurgical period, 18% of the patients were transferred to a center for chronic care and 25% to a rehabilitation center. Although 48.9% of the patients are discharged to their homes from the hospital, surprisingly, when they die, only 15% do so in their homes, while 59% of the patients die in a center for chronic care. CONCLUSIONS: Osteoporotic proximal femoral fracture produces an important mortality within the first year after fracture, and also an important deterioration of functional capacity. Most of the patients are admitted later on and die in a center for chronic care.

[The community health technician and alternative in the training of health manpower]. / El técnico en salud comunitaria: una alternativa en la formación de recursos humanos para la salud.

This paper describes the general conditions of the social and economic dynamics of the rural area, with emphasis on the development of the factors that affect health in Mexico, and briefly analyzes the system for the education and training of manpower for health care. The author presents arguments in support of an alternative proposal for the training of the "community health technician" as a professional produced by four years of study following graduation from secondary school, and trained to take measures that contribute to the integral development of the community by acting upon the factors involved in the occurrence of pathological states, and to be the first contact for persons with medical problems. The course of training is described in terms of its ultimate purpose, which is improvement of the health status of a rural community, and of the general objectives in the "community development" and "medical care" areas. The course is administered in 25 modules as follows: four introductory modules to acquaint the student with the requirements for dealing with the areas, 11 modules on community development, eight modules on first-contact medical care, and the last two for practical exercises and community work, in which the student is required to bring all his knowledge to bear on a given community. Lastly, the course content of each semester is described together with the distribution of the theoretical and practical work in each module, and the outlook for its success, which points to the possibility of incorporating this resource into programs for extending coverage to rural areas.

El técnico en salud comunitaria: una alternativa en la formación de recursos humanos para la salud / The community health technician and alternative in the training of health manpower

This paper describes the general conditions of the social and economic dynamics of the rural area, with emphasis on the development of the factors that affect health in Mexico, and briefly analyzes the system for the education and training of manpower for health care. The author presents arguments in support of an alternative proposal for the training of the «community health technician» as a professional produced by four years of study following graduation from secondary school, and trained to take measures that contribute to the integral development of the community by acting upon the factors involved in the occurrence of pathological states, and to be the first contact for persons with medical problems. The course of training is described in terms of its ultimate purpose, which is improvement of the health status of a rural community, and of the general objectives in the «community development» and «medical care» areas. The course is administered in 25 modules as follows: four introductory modules to acquaint the student with the requirements for dealing with the areas, 11 modules on community development, eight modules on first-contact medical care, and the last two for practical exercises and community work, in which the student is required to bring all his knowledge to bear on a given community. Lastly, the course content of each semester is described together with the distribution of the theoretical and practical work in each module, and the outlook for its success, which points to the possibility of incorporating this resource into programs for extending coverage to rural areas (Au)