equipocesca

Despite evidence demonstrating the benefits of understanding patients, there is a paucity of information about how physicians address psychological and social concerns of patients. Patients cried in 157 encounters out of a total of 18,627 giving an incidence rate of 8.4 per thousand. More frequent reasons for encounters were: feeling depressed (12.7%), social handicap (mainly social isolation/living alone) (6.4%), relationship problem with partner (5.1%) and feeling anxious (3.2%). More frequent health problems were: depressive disorder (23.6%), anxiety disorder (8.3%), cerebrovascular disease (5.1%) and loss/death of partner (3.8%).

• Crying patients in general/family practice: incidence, reasons for encounter and health problems. Gérvas, J., Pastor-Sánchez, R., Pérez-Fernández, M. Rev Bras Med Fam Comunitaria (Florianópolis). 2012:7. Download article here.

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Influenza is a very common infection that spreads during winter time. In general flu is a lightly disease, but it may complicate the evolution of chronic patients, and even healthy ones. The best answer to stop the propagation is just to wash your hands. But official institutions and private organizations push to introduce influenza vaccine in children, elderly and health professionals, even asking for mandatory vaccination. There are no scientific bases for this proposal. See the text with links to the best evidence about this question, many from Cochrane Reviews.

• A few reasons to say no, thanks, to influenza vaccines. Gérvas, J. Madrid (Spain), September 2012. Download English text here.

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Health systems are social products, and as such they cannot being invented. They are expression of the final election between “freedom” and “equity”. Freedom means that each person may select and pay for the needed health services. Equity means solidarity, to help those in need even at the cost that are fit. Only the USA lacks an universal public health system; but countries as Germany, Japan and Switzerland, and others also favours “freedom”. “Equity” is important in countries like Denmark, Spain and the UK, and others, where primary health care is important.

• Primary health care oriented systems, for whom, why and how. Gérvas J. In: A symposium celebrating the scientific and policy legacy of Bárbara Starfield. Baltimore: Johns Hopkins Bloomberg School of Public Health. May 10th 2012. Download English text here.

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Quaternary prevention is the prevention of harms by medical interventions and as such a foundation block of medicine (primum non nocere). All services have adverse effects, all services might produce damage to health. A few services produce more benefits than harms in specific situations. Unnecessary and inappropriate services mainly produce harms, and few benefits if any.

• Quaternary prevention: a summary. Gérvas J. Windhoek (Namibia): School of Medicine; 15th March 2012. Download text in English here.

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In this review, we consider empirical studies from the United States and elsewhere, and we focus on how one aspect of health systems, clinical care, contributes to maintaining systematic differences in health across population groups characterized by social disadvantage. We consider inequities in clinical care and the policies that influence them. We develop a framework for considering the structural and behavioral components of clinical care and review the existing literature for evidence that is likely to be generalizable across health systems over time.

• Clinical care and health disparities. Starfield, B., Gérvas, J., Mangin, D. Annu Rev Public Health. 2012; 33: 89-106. Download English version here.

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We lack data about total mortality in the Swedish Two County Trial. After almost 30 years of follow-up, results are no definitive, and doubts persist about the efficacy of breast cancer screening. Problems are with overdiagnosis and overtreatment, and its mortality. So we need data about total mortality.

• Swedish Two County Trial: total mortality data are needed. Gérvas J. Radiology. 2012; 263: 307-8. Download English version here.

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A recent study concludes that mesenchymal stem cells (MSC) therapy provides the “same or better” relief for pain and disability, as current gold standard treatments for chronic unspecific low back pain (cLBP) caused by degenerative disc disease (DDD), namely spinal fusion and total disc replacement. This conclusion lacks scientific base, as pointe out in this letter to the Editor.

• Overenthusiastic interpretation of a nonetheless promising study. Kovacs S, Abraira V, Gérvas J et al. Transplantation. 2012; 93: e6-e7. Download English version here.

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