El proceso de institucionalización de la enfermera gestora de casos en España. Análisis comparativo entre los sistemas autonómicos de salud

Care of chronicity is a pressing issue for health systems because of its high prevalence and the organisational challenges that it generates. Different countries solve the complexity of the care of chronicity through case management by the nursing profession, obtaining good results.This paper analyses the status of institutionalisation of the case management nurse in Spain through the design of a reference standard to compare between the autonomous communities in their approach to chronicity. Thus, we sought to monitor the degree of progress of the institutional structure of the policies for the care of chronicity in our country through this healthcare professional. Our results showed that no autonomous community has reached the maximum standard of implementation and that the situation is very heterogeneous, confirming a weak and erratic degree of institutionalisation of the case management nurse in Spain despite the formal recognition of their role in patient care.     

加拿大电子健康档案建设新进展及其启示

阐述电子健康档案建设意义及加拿大电子健康档案建设最新进展，分析建设经验并提出对我国的启示，包括注重统筹规划设计、加强相关法律法规建设、引入认证机制等方面，以期为我国电子健康档案建设提供借鉴。     

Do interventions by allied health professionals discussing adherence to insulin improve this adherence?

It is assumed that interventions to improve the adherence to insulin by allied health professionals discussing adherence to insulin will improve this adherence. However, there is little evidence to support this, as interventions by a pharmacist or nurse educator have not been shown conclusively to improve adherence to insulin.     

Anesthetic gases and occupationally exposed workers

The aim of this study is to estimate whether the occupational exposure to low dose anesthetic gases could cause alterations of blood parameters in health care workers. 119 exposed subjects and 184 not exposed controls were included in the study. Each worker underwent the complete blood count test (CBC), proteinaemia, leukocyte count, serum lipids, liver and kidney blood markers.The liver blood markers show statistically significant differences in health care workers compared with controls (p < 0.05), a statistically significant decrease in neutrophils and an increase of lymphocytes in health care workers compared with controls (p < 0.05). The prevalence of values outside the range for GPT, GGT, total bilirubin, lymphocytes and neutrophils was statistically significant in health care workers compared with controls (p < 0.05). The results suggest that occupational exposure to low dose anesthetic gases could influence some haematochemical hepatic and hematopoietic parameters in exposed health care workers.     

Health Insurance and Chronic Conditions in Low-Income Urban Whites

Little is known about how health insurance contributes to the prevalence of chronic disease in the overlooked population of low-income urban whites. This study uses cross-sectional data on 491 low-income urban non-elderly non-Hispanic whites from the Exploring Health Disparities in Integrated Communities—Southwest Baltimore (EHDIC-SWB) study to examine the relationship between insurance status and chronic conditions (defined as participant report of ever being told by a doctor they had hypertension, diabetes, stroke, heart attack, anxiety or depression, asthma or emphysema, or cancer). In this sample, 45.8 % were uninsured, 28.3 % were publicly insured, and 25.9 % had private insurance. Insured participants had similar odds of having any chronic condition (odds ratios (OR) 1.06; 95 % confidence intervals (CI) 0.70–1.62) compared to uninsured participants. However, those who had public insurance had a higher odds of reporting any chronic condition compared to the privately insured (OR 2.29; 95 % CI 1.21–4.35). In low-income urban areas, the health of whites is not often considered. However, this is a significant population whose reported prevalence of chronic conditions has implications for the Medicaid expansion and the implementation of health insurance exchanges.