Adverse events in hospitals: the patient's point of view.

BACKGROUND: The publication of the report "To err is human: building a safer system" by the Institute of Medicine incited a profuse research addressing improvements in healthcare safety. However, there is still little acknowledgement of the key role of the patient in preventing adverse events of medical care. The aim of this review is to analyse and compare studies about patient's perception and opinion about care safety in hospitals. METHODS: We searched 10 databases (EMBASE, MEDLINE, PsychINFO, SCOPUS, Science Citation Index Expanded, Social Science Citation, IME, Sociological Abstracts, LILACS and The Cochrane Library) to identify articles and reports on patient's safety perception published between 1989 and 2006. RESULTS: From the 699 articles, 18 were selected: eight determined the frequency of experiences related to adverse events and the safety perception reported by patients, seven focused on the impact of the adverse events regarding the communication to the patient, and three included patient's opinions about the management and disclosure of adverse events and proposals to prevent them. CONCLUSIONS: The incidence of adverse events reported by patients was similar to that estimated by other procedures. The patient's concept of adverse events was different from that of the physician. The quality of communication from the physician influenced the patient's perception of adverse events, and the majority wanted adverse events to be disclosed. Patients emphasised emotional consequences of the adverse events. The majority supported system modifications to prevent adverse events and to sanction the physicians when an adverse event occurs.

History of health, a valuable tool in public health.

The aim of this article is to highlight the importance of the history of public health for public health research and practice itself. After summarily reviewing the current great vitality of the history of collective health oriented initiatives, we explain three particular features of the historical vantage point in public health, namely the importance of the context, the relevance of a diachronic attitude and the critical perspective. In order to illustrate those three topics, we bring up examples taken from three centuries of fight against malaria, the so called "re-emerging diseases" and the 1918 influenza epidemic. The historical approach enriches our critical perception of the social effects of initiatives undertaken in the name of public health, shows the shortcomings of public health interventions based on single factors and asks for a wider time scope in the assessment of current problems. The use of a historical perspective to examine the plurality of determinants in any particular health condition will help to solve the longlasting debate on the primacy of individual versus population factors, which has been particularly intense in recent times.

[Health and primary education in the regenerationist ideology at the open educational institution]. / Salud e instrucción primaria en el ideario regeneracionista de la Institución Libre de Enseñanza.

The objective of this work is to reconstruct the discourse of the authors who published about issues establishing links between health and primary education in the Boletin de la Institucion Libre de Ensenanza at the time of the Spanish colonial crisis in 1898. This source has been chosen due to its relevance to Spanish pedagogical renovation. Physical education was taken as a model for analysis for two reasons: firstly, it is the aspect that received the most attention; secondly, it became the engine for change in the renovation programme. In addition, its holistic nature was intended to lead to the new citizen that was needed by the country after the loss of the colonies.

[The Protomedicato Tribunal and popular healing]. / Protomedicato y curanderismo.

This brief article reviews the writings on popular healers which can be found in Spanish medical historiographical literature. Our knowledge of this topic is still clearly insufficient, and we note the possibilities that the Protomedicato could offer to increase it. Finally we review the ways in which the study of popular healing can enhance our knowledge of health care in the past.

Isocitrate lyase from Cephalosporium acremonium. Role of Mg2+ ions, kinetics, and evidence for a histidine residue in the active site of the enzyme.

Isocitrate lyase was purified from Cephalosporium acremonium CW-19 from cultures growing with poly(oxyethylene)sorbitan monopalmitate as the carbon source. Its subunit M(r) and native M(r) were 63,000 +/- 2000 and 250,000 +/- 5000, respectively. We found the Mg(2+)-isocitrate complex to be the true substrate and that Mg2+ ions act as a nonessential activator, according to the model reported by Giachetti et al. (1988) [Giachetti, E., Pinzauti, G., Bonaccorsi, R., & Vanni, P. (1988) Eur. J. Biochem. 172, 85-91], from which the kinetic parameters were calculated. The kinetic study is consistent with an ordered Uni-Bi mechanism, and the kinetic and rate constants of the model were calculated. pH dependence of the cleavage reaction indicated that the catalysis was dependent on two dissociable groups on the enzyme-substrate complex. The enzyme was inactivated by diethyl pyrocarbonate following first-order kinetics at all reagent concentrations used. The pseudo-first-order rate constant of inactivation increases with pH, suggesting participation of an amino acid residue with pK 6.0. Hydroxylamine added to the inactivated enzyme quickly restored the incremental absorption at 240 nm and most of the activity. Data analyses indicated that diethyl pyrocarbonate inactivation is a consequence of modification of 11 histidine residues per enzyme subunit, and from statistical analysis, we concluded that one is catalytically important. Mg(2+)-isocitrate protects the enzyme against diethyl pyrocarbonate inactivation with a Ks value of 26.8 +/- 2.1 microM, close to the Km value. Isocitrate protects the enzyme but a high concentration, suggesting its binding to the catalytic site of the nonactivated enzyme. Mg2+ ions also produced total competitive protection.