Seminario Internacional de la APS, del 17 al 21 de Junio 2002, La Habana, Cuba

VIII Seminario Internacional de la Atención Primaria de Salud del 17 al 21 de Junio del año 2002, La Habana, Cuba

La Habana, Julio del 2001.

Estimado colega:

El desarrollo de la Atención Primaria de Salud (APS) es como una espiral en ascenso, que llega en el momento actual al punto más elevado; pero con una
complejidad mayor.

Desde el primer Seminario celebrado en Cuba en 1986; cuando teníamos 600 Médicos de Familia; la Atención Primaria de Salud y la Medicina Familiar se han ido desarrollando y avanzando con innovaciones y resultados beneficiosos para la Salud de nuestro pueblo y de otros pueblos del mundo; que nos permiten actualmente presentar, un modelo exitoso de Atención Primaria de Salud y Medicina Familiar, ejecutado por mas de 30 000 Médicos de Familia y 40 000 Enfermeras de Familia.

Cuba, ha logrado un avance extraordinario en el campo de la Salud, habiendo cumplido desde el año 1983 con los indicadores de la Organización Mundial de la Salud (OMS) que evalúan la estrategia de Salud para Todos (SPT) y ha ido introduciendo cambios estratégicos para ir perfeccionando su Sistema Nacional de Salud.

Cuba, ha venido desarrollando un intenso Programa Integral de Salud (PIS) de colaboración con numerosos países del Tercer Mundo y mediante el desarrollo de la Escuela Latinoamericana de Medicina, está contribuyendo a la formación de Médicos en esos países necesitados.

Por todas estas razones; la alta dirección del Ministerio de Salud Pública de Cuba, ha decidido trasladar la celebración del VIII Seminario Internacional de APS para celebrarlo del 17 al 21 de Junio del año 2002; con el propósito de promover una mayor participación de profesionales de la Salud y de la Medicina Familiar; para presentar nuestras experiencias nacionales e internacionales; que permitan contribuir al intercambio con otros países sobre las Lecciones del Siglo XX y los Desafíos del Siglo XXI.

Constituye un alto honor para nosotros convocar a este encuentro y tener la oportunidad de recibirlo cordialmente y agradecerle su atención y su participación,

Atentamente,

Dr. Carlos Dotres Martínez,
Ministro de Salud Pública de Cuba

Higher mortality in for-profit hospitals

P.J. Devereaux, Peter T.L. Choi, Christina Lacchetti, Bruce Weaver, Holger J. Schünemann, Ted Haines, John N. Lavis, Brydon J.B. Grant, David R.S. Haslam, Mohit Bhandari, Terrence Sullivan, Deborah J. Cook, Stephen D. Walter, Maureen Meade, Humaira Khan, Neera Bhatnagar and Gordon H. Guyatt

A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals

Canadian Medical Association Journal 2002;166(11): 1399-406

From the Departments of Medicine, Anesthesia, Clinical Epidemiology and Biostatistics, Psychiatry and Behavioral Neurosciences, and Surgery and the Health Sciences Library, McMaster University, Hamilton, Ont.; the Departments of Medicine, Social and Preventive Medicine, and Physiology and Biophysics, University at Buffalo, and the Veterans Affairs Medical Center, Buffalo, NY; the Institute for Work and Health and the Population Health Program, Canadian Institute for Advanced Research, Toronto, and the Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ont.

Correspondence to: Dr. P.J. Devereaux, Department of Clinical Epidemiology & Biostatistics, McMaster University, Rm. 2C12, 1200 Main St. W, Hamilton ON L8N 3Z5; fax 905 524-3841;

Abstract

Background: Canadians are engaged in an intense debate about the relative merits of private for-profit versus private not-for-profit health care delivery. To inform this debate, we undertook a systematic review and meta-analysis of studies comparing the mortality rates of private for-profit hospitals and those of private not-for-profit hospitals.

Methods: We identified studies through an electronic search of 11 bibliographical databases, our own files, consultation with experts, reference lists, PubMed and SciSearch. We masked the study results before determining study eligibility. Our eligibility criteria included observational studies or randomized controlled trials that compared private for-profit and private not-for-profit hospitals. We excluded studies that evaluated mortality rates in hospitals with a particular profit status that subsequently converted to the other profit status. For each study, we calculated a relative risk of mortality for private for-profit hospitals relative to private not-for-profit hospitals and pooled the studies of adult populations that included adjustment for potential confounders (e.g., teaching status, severity of illness) using a random effects model.

Results: Fifteen observational studies, involving more than 26 000 hospitals and 38 million patients, fulfilled the eligibility criteria. In the studies of adult populations, with adjustment for potential confounders, private for-profit hospitals were associated with an increased risk of death (relative risk)

Mortality between for profit & not-for profit centres

P. J. Devereaux, MD; Holger J. Sch?nemann, MD, PhD; Nikila Ravindran, BSc; Mohit Bhandari, MD, MSc; Amit X. Garg, MD; Peter T.-L. Choi, MD, MSc; Brydon J. B. Grant, MD; Ted Haines, MD; Christina Lacchetti, MHSc; Bruce Weaver, MSc; John N. Lavis, MD, PhD; Deborah J. Cook, MD, MSc; David R. S. Haslam, MD, MSc; Terrence Sullivan, PhD; Gordon H. Guyatt, MD, MSc

Comparison of Mortality Between Private For-Profit and Private Not-For-Profit Hemodialysis Centers. A Systematic Review and Meta-analysis
JAMA. 2002;288:2449-2457

Context Private for-profit and private not-for-profit dialysis facilities provide the majority of hemodialysis care in the United States. There has been extensive debate about whether the profit status of these facilities influences patient mortality.

Objective To determine whether a difference in adjusted mortality rates exists between hemodialysis patients receiving care in private for-profit vs private not-for-profit dialysis centers.

Data Sources We searched 11 bibliographic databases, reviewed our own files, and contacted experts in June 2001�January 2002. In June 2002, we also searched PubMed using the “related articles” feature, SciSearch, and the reference lists of all studies that fulfilled our eligibility criteria.

Study Selection We included published and unpublished observational studies that directly compared the mortality rates of hemodialysis patients in private for-profit and private not-for-profit dialysis centers and provided adjusted mortality rates. We masked the study results prior to determining study eligibility, and teams of 2 reviewers independently evaluated the eligibility of all studies. Eight observational studies that included more than 500 000 patient-years of data fulfilled our eligibility criteria.

Data Extraction Teams of 2 reviewers independently abstracted data on study characteristics, sampling method, data sources, and factors controlled for in the analyses. Reviewers resolved disagreements by consensus.

Data Synthesis The studies reported data from January 1, 1973, through December 31, 1997, and included a median of 1342 facilities per study. Six of the 8 studies showed a statistically significant increase in adjusted mortality in for-profit facilities, 1 showed a nonsignificant trend toward increased mortality in for-profit facilities, and 1 showed a nonsignificant trend toward decreased mortality in for-profit facilities. The pooled estimate, using a random-effects model, demonstrated that private for-profit dialysis centers were associated with an increased risk of death (relative risk, 1.08; 95% confidence interval, 1.04-1.13; P

Conclusions Hemodialysis care in private not-for-profit centers is associated with a lower risk of mortality compared with care in private for-profit centers.

Palestinian Urgent Appeal – July 16, 2002

THIS IS AN URGENT CALL FOR ALL HUMANITARIAN ORGANIZATIONS WORLWIDE TO INTERVENE IMMEDIATELY

The Union of Palestinian Medical Relief Committees
Urgent Appeal- July 16, 2002

Continuing Curfew Creates Humanitarian Disaster

For nearly a month, two million residents of the West Bank have been under almost constant curfew. This deliberate policy by the Israeli government has created a humanitarian disaster throughout the West Bank. Hospitals, schools, universities as well as civil and governmental institutions have been completely paralyzed. Furthermore, the Israeli-imposed curfew has decimated the economy leaving a considerable percentage of Palestinians under the poverty line and nearing levels of starvation.

The Israeli government’s curfews are intended to, and have succeeded in destroying the socio-economic infrastructure of Palestine. Its collective punishment measures represent a severe violation of international law, and have no justification as security measures.

As such, we are astounded and deeply concerned by the weak response of the international community in denouncing Israel’s creation of this ever-increasing humanitarian crisis.

For more information, please contact Dr. Mustafa Barghouthi at: Medical
Relief – 00972-59-254-218 or consult our new website

Private finance & “value for money”, by A. Pollock et al.

Pollock AM, Shaoul J, Vickers N.

Private finance and “value for money” in NHS hospitals: a policy in search of a rationale?

British Medical Journal, 2002; 324: 1205-1209

Summary points:

The private finance initiative (PFI) brings no new capital investment into public services and is a debt which has to be serviced by future generations.

The government’s case for using PFI rests on a value for money assessment skewed in favour of private finance

The higher costs of PFI are due to financing costs which would not be incurred under public financing

Many hospital PFI schemes show value for money only after risk transfer, but the large risks said to be transferred are not justified

PFI more than doubles the cost of capital as a percentage of trusts’ annual operating income

2002 IAHP/FADSP Mallorca Conference papers

…other papers will be gradually added

13 women flogged in Qom Iran

The state-run daily, Seday-e Edalat, reported yesterday that 13 women were flogged in the city of Qom. Among them were three pairs of sisters. They were each sentenced to 180 lashes.

Flogging women for “prostitution” and “drinking alcohol” and issuing these kinds of barbaric sentences against women come from mullahs who themselves run prostitution and drug trafficking rings and are involved in smuggling women and girls to neighboring countries. The Iranian Resistance has revealed the names of some of these mullahs.

The Women’s Committee of the National Council of Resistance of Iran calls on international human rights and women’s rights organizations to urge the United Nations High Commissioner for Human Rights and the coming session of the General Assembly of the United Nations and other relevant international forums and organizations to take  effective measures and adopt resolutions condemning evil crimes of the mullahs against Iranian women.

Women’s Committee of the National Council of Resistance of Iran.

Legal boost for Dutch abortion ship

The Dutch Government has given the go-ahead to the Women on Waves group to offer the abortion pill to pregnant women on board their boat, Aurora. The Aurora is due to set sail again for countries where abortion is forbidden.

It will dock in international waters and members of Women on Waves will offer advice and treatment to women who come on board.

The group sparked a storm of protest from pro-life activists last year when they docked off the coast of Ireland, where the practice of abortion is illegal. The first stop for the Aurora – sometimes known as the Sea of Change – will probably be back to Ireland, from where 6,000 women travel to England for abortions each year. The Dutch Health Minister, Els Borst, said the decision to allow Women on Waves to give out the abortion pill was in line with government policy regarding the sexual independence of women. Women on Waves are allowed to offer the drug to terminate pregnancies of up to six weeks, provided a gynaecologist is present. However the group say they will appeal against the decision in the hope of being able to offer clinical abortions to women who are up to three months pregnant. The World Health Organization estimates that 100,000 women die each year from illegal back-street abortions.

UPMRC International Voluntary Work Camp in Palestine

UPMRC International Voluntary Work Camp in Palestine

During the current Intifada, the Israeli government’s policies have led to devastation and destruction in all areas of Palestinian life. From September 29, 2000- June 12, 2002, 1,588 Palestinians have been killed, and more than 20,000 injured. In conjunction with its excessive use of force against civilians, the Israeli government has imposed various collective punishment measures that have served to choke the physical, economic, social and political life of Palestinians. These measures include invasions, curfews, strict internal and external closure and the destruction of houses, agriculture and industry. The current crisis emphasizes the need for international support of and solidarity with the Palestinian people. There is much that international volunteers can do to help Palestine. Thus, the Union of Palestinian Medical Relief Committees is sponsoring a weeklong summer work camp for international and local volunteers.

The purpose of the camp is to improve community resources in Palestine and provide an opportunity for internationals to show solidarity with the Palestinian people, while learning about and experiencing life in Palestine under occupation. UPMRC is a grassroots, community-based Palestinian health organization. It is non-profit, voluntary, and one of the largest health NGOs in Palestine. UPMRC’s national health programs emphasize prevention, education, community participation, and empowerment of the Palestinian people.
We are seeking 200 internationals interested in:

a.. Showing solidarity with Palestinians

b.. Participating in voluntary projects that support public institutions in different Palestinian cities, villages and refugee camps

c.. Supporting the Palestinian cause and participating in advocacy for Palestinian rights


The work camp will also have 300 local Palestinian youth volunteers,
as well as 150 Palestinian youth living in Israel.
Through this camp, you will:
a.. Work in solidarity with the Palestinian People
b.. Participate in the restoration of public institutions, schools
and other buildings destroyed during recent Israeli military incursions
c.. Participate in voluntary work in refugee camps such as clearing
rubble and aiding in reconstruction
d.. Help provide access to villages and cities isolated by the
Israeli closure
e.. Meet and work closely with Palestinian youth
f.. At the end of your visit, we hope that you will be able to
educate people in your communities about Palestine and promote international solidarity for the Palestinian people

Location
The camp will primarily be based in El Bireh, which is a suburb of
Ramallah, and volunteers will work both in Ramallah and El Bireh. There will also be options to volunteer for short periods in Nablus and Jenin, as well as in rural areas isolated by Israeli closure.

Duration: August 3-10, 2002

Activities:
Voluntary work
a.. Reconstruction, repair and maintenance in public schools and
public parks, including mural painting, gardening and light construction
b.. Voluntary days in Jenin Refugee camp and Nablus Old City (two
of the areas hit the hardest during the latest Israeli invasion) clearing
rubble and helping to rebuild
Cultural and informative activities
a.. Documentaries
b.. Lectures on political situation
c.. Field visits
d.. Social activities

Entertainment
a.. Musical evenings
b.. Films
c.. Sports
d.. Photo/art exhibit
Transportation:
Participants should fly into Ben Gurion Airport in Tel Aviv.
Expenses:
Work camp fees: $50
Approximate Airfare: US: $800-$1,200
Europe: $500-$800
Requirements:
Participants must be at least 18 years old.

Please fill out the Registration form “Summer Work Camp” and submit it by July 20.

If you have any questions, please contact Ghadeer

More information on UPMRC

For more information on Palestine, please visit

Defending freedom of health services research

Defending independence and freedom of health services research

The work of Prof Allyson Pollock and her team is well known internationally. Her scientifically sound and politically sharp work especially analysing and unmasking the privatisation tactics used by the british government (Private Finance Initiative & Public Private Partnership) produced an unbelievable assault against her by the Commons Health Select Committee.

A debate is ongoing these days with written reactions against the Commons Health Select Committee’s assault on Prof Allyson Pollock’s credibility and on the integrity of her research and findings.