[Quality management of the SAMUR--Civil Protection Emergency Unit]. / Gestión de calidad del Servicio de Emergencias SAMUR-Protección Civil.

As in any sector, the focus of the health services must be directed towards the patient-client as the centre of the system, with organisation revolving around patient-client needs. Hence, the former must have objective and continuous information on both its clients' needs and their results, with quantitative and qualitative parameters. The application of these measures is complex in the field of pre-hospital emergency systems, since to their intrinsic variability is added geographic dispersion,the difficulty in controlling the direct quality of care and the fact that our care process ends up in different organisations. That is the challenge that was taken up five years ago in SAMUR with the aim of carry out a continuous analysis of the processes and results of the service. This article offers an overall vision of our quality system,which forms a basis of management essentially supported on the following pillars: certifications of quality management, process, performance evaluation, management based on indicators and productivity based on aims.

Gestión de calidad del Servicio de Emergencias SAMUR-Protección Civil / Quality management of the SAMUR-Civil Protection Emergency Unit

Como en cualquier sector, el enfoque de los serviciossanitarios debe dirigirse al paciente-cliente, girandola organización en torno a sus necesidades. Así,aquella debe tener información objetiva y continuatanto de las necesidades de sus clientes como de susresultados, con parámetros cuantitativos y cualitativos.En el ámbito de los sistemas de emergencias extrahospitalarios,la aplicación de esas medidas es complicada,pues a la variabilidad intrínseca de la urgenciase une, además, la dispersión geográfica, la dificultaddel control de calidad directo de las asistencias y elhecho de que nuestro proceso de asistencia acabe enorganizaciones diferentes.Éste es el reto que hace cinco años se acometió enSAMUR, persiguiendo realizar un análisis continuo delos procesos y resultados del servicio. En este artículose ofrece una visión global de nuestro sistema de calidad,que constituye una base de gestión sustentadafundamentalmente por los siguientes pilares: certificacionesde gestión de calidad, procedimentación de losprocesos, valoración del desempeño, gestión basada enindicadores y productividad basada en objetivos(AU)

As in any sector, the focus of the health servicesmust be directed towards the patient-client as the centreof the system, whit organisation revolving aroundpatient-client needs. Hence, the former must have objectiveand continuous information on both its clients’needs and their results, with quantitative and qualitativeparameters.The application of these measures is complex inthe field of pre-hospital emergency systems, since totheir intrinsic variability is added geographic dispersion,the difficulty in controlling the direct quality ofcare and the fact that our care process ends up in differentorganisations.That is the challenge that was taken up five yearsago in SAMUR with the aim of carry out a continuousanalysis of the processes and results of the service.This article offers an overall vision of our quality system,which forms a basis of management essentiallysupported on the following pillars: certifications ofquality management, process, performance evaluation,management based on indicators and productivity basedon aims(AU)

Glycolipids as the major autoantigens of cytoplasmatic islet cell antibodies.

It has been recently suggested that pancreatic glycolipidic extracts and acidic glycolipid fractions are able to block the binding of ICA to frozen sections of human pancreas. We study the prevalence of blocking effect by the upper-phase from human pancreatic glycolipid extracts (PGE) in thirty-eight sera ICA positive from seventeen IDDM patients and twenty-one first relatives of type 1 diabetics. Total inhibition was found in 82% and 76% insulin dependent diabetes mellitus patients and first relatives of type 1 diabetics respectively. Partial and no inhibition of ICA+ sera was seen in 6%, 12% of type 1 diabetics and 19%, 5% of the first degree relatives of type 1 diabetics respectively. Our study suggests that there is heterogeneity of cytoplasmatic islet cell antibodies and that glycolipids are the major autoantigen of ICA.

[Planning human of resources in health: a necessity to attain Health for All in the year 2000]. / Planificacion de recursos humanos en salud: una necesidad para el logro de SPT-2000.

PIP: This report assesses human resource needs in the Dominican Republic in light of the goal of health for all by the year 2000. The economic crisis that has deepened in the Dominican Republic since 1984 is aggravated by steps taken to pay off the external debt, including reduced public spending for health, education, and transportation. Per capita health expenditures declined from US $10.73 in 1983 to $4.48 in 1986, a 58% decline. The infant mortality rate is estimated at 75/1000 for upper socioeconomic strata to 83/1000 for lower strata. The proportion of children hospitalized with malnutrition declined from 1977-86, but the number of severe cases increased. The proportion of low birthweight infants more than doubled between 1977-86 from 6.2% to 14.3%. The lack of an adequate system of health statistics hampers analysis of health data, but the progressive deterioration of living conditions appears to have had a negative impact on health. The number of universities providing health education increased from only 1 in 1965 to 15 in 1983. Beginning in 1980, the proportion of medical students began to decline because of the severe economic crisis and high unemployment rates of medical graduates. The object of study in all current programs in illness, based on a biological and individual focus, ignoring the process of disease and its social and historic determinants. Little weight is given to epidemiology, prevention, scientific methods of investigation, or related areas. Most of the teachers were trained abroad and the curricular materials are almost exclusively foreign. Most learning is passive and occurs in classrooms. Most practices are demonstrations and hospital work is the only contact with the phenomena of health and illness. The current training program prepares personnel with fragmented knowledge, limited technical skills, and an orientation toward clinical practices and the terminal end of the health-disease continuum. Moreover, all medical schools accept students for essentially economic reasons or because of demand by potential students; there is not effective mechanism for balancing supply and demand of health workers. Existing health personnel are poorly distributed between the public and private sectors, geographically, and within specialties. Steps to take in preparing human resources to achieve health for all through primary health care include reorienting the type of manpower trained and the curriculum, redistributing existing personnel, strengthening programs of practical work for advanced medical students, and encouraging community participation and demand for quality health care.^ieng