The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and. Declaration from the International Conference on Primary Health Care, Alma-Ata, September , expressing the need for urgent national and international. "# $ "%&'! " " # $ % & # ' & (') * +) #& " ' $ % % ' () ' (" ', $ % & " -./// " ' % $ ' (0 # " ' " ('1 # $ ' (! 3' % $ 0 & (2.' 2 4'! 0 2 # 2 2 % 2 0 2 2 2 5' - # & % (& % 2 6'.
|Language:||English, Japanese, German|
|Genre:||Fiction & Literature|
|ePub File Size:||24.78 MB|
|PDF File Size:||18.22 MB|
|Distribution:||Free* [*Sign up for free]|
Esta definición se enriqueció con lo propuesto en la Declaración de. Alma-Ata, en , en donde se reconoció la salud como “un de- recho humano. Posteriormente, en el marco de la declaración regional sobre las nuevas orientaciones de la APS, se sostuvo que la Declaración de Alma-Ata seguía siendo. The Declaration of Alma-Ata was adopted at the International Conference on Primary Health . Print/export. Create a book · Download as PDF · Printable version.
Such clusters are likely to include the integrated management of childhood illnesses; maternal and reproductive health services; clinic and community based management of tuberculosis, HIV and AIDS, and other sexually transmitted infections; management of malaria; management of hypertension and other cardiovascular risk factors, stroke, and cardiovascular disease; mental illness and substance misuse. Outreach services may focus on individual preventive measures such as immunisation, vitamin A, or oral rehydration therapy or community-wide health promotion such as education on child nutrition or adult diet and exercise.
These services depend substantially on community support and mechanisms for identifying, training, and supporting village or community health workers. A community focused operational research agenda has been neglected in favour of research on individual interventions. Evaluations of new ways of organising primary healthcare services in specific settings are required.
Such research is complex because it is context specific and dependent on local capacity and commitment. Translation of the evidence into coherent, operational strategies at district level and below will be an equally big challenge. Affordability remains the over-riding and universal challenge.
What services can realistically be provided free at the first point of contact and what mix of financing mechanisms should be promoted to do so? The place of user charges for primary health care remains contested for they have repeatedly been shown to deter those most likely to benefit from preventive activities. Many countries are piloting schemes that give money or vouchers to increase access to particular services such as maternity care. How can independent providers be encouraged to deliver centrally determined priorities?
Many places, and particularly sub-Saharan Africa, have crippling shortfalls in human resources, partly as a result of international and internal migration; hence the renewed interest in the possible contribution of community workers. Ironically, poor countries that emulated training standards in industrialised countries have been most vulnerable to poaching by them.
They lack consistent managerial support and have grown accustomed to a norm of inadequate service. Only high level political commitment and adequate governance and funding will raise the status of primary care and attract suitable workers. For others, including the UK, the rhetoric of Alma Ata was of mostly symbolic importance.
Pivotal turning points in the postwar development of general practice—notably the Family Doctor Charter of —were already yielding benefits. The UK already boasted some of the best primary medical care in the developed world.
British general practice has been one of the main reasons for the relative efficiency of the National Health Service.
But moves under the current Labour government to create a market for these services threaten to fragment health care and erode the public support that holds the NHS together. Its power resides in linking different sectors and disciplines, integrating different elements of disease management, stressing early prevention, and the maintenance of health. A patient centred approach—a striking feature of family medicine in northern European countries but barely reflected in the medical curriculums of most developing countries—strives to tailor interventions to individual need.
Health professionals can be supported and rewarded for roles that promote social mobilisation. Support for intersectoral action should come from ministerial level downwards. Box 2 Essential components of effective primary health care Well trained, multidisciplinary workforce Properly equipped and maintained premises Appropriate technology, including essential drugs Capacity to offer comprehensive preventive and curative services at community level Institutionalised systems of quality assurance Sound management and governance systems Sustainable funding streams aiming at universal coverage Functional information management and technology Community participation in the planning and evaluation of services provided Collaboration across different sectors—for example, education, agriculture Continuity of care Equitable distribution of resources Health systems are part of the fabric of social and civic life.
The declaration of Alma Ata helped to entrench the idea of health care as a human right. This anniversary provides a salutary reminder of what we are placing at risk. Summary points The declaration of Alma Ata defined primary health care 30 years ago Although it had huge symbolic importance, its effect in practice was more limited Community participation and intersectoral action remain challenges for those working to reduce health inequalities The changing global burden of disease and workforce shortages make effective integration of existing vertical programmes essential Primary health care is key to providing good value for money and enhancing equity Alma Ata remains relevant for effective healthcare systems today Notes I thank Jennifer Amery for comments.
Contributors and sources: SG also works as a general practitioner. Competing interests: None declared. The primary concern was that it could be toxic to some individuals who appear to metabolize cyclamate to cyclohexylamine.
It is known that people metabolize cyclamate in different ways. Data on the extent to which individuals convert cyclamate to cyclohexylamine during longterm consumption were supported by the lack of an association between cyclamate and cyclohexylamine and male infertility in humans.
The relationship to infertility was of interest because high doses of cyclo-hexylamine caused testicular atrophy in rats. Stevioside was evaluated by the SCF Conservative estimates of steviol glycoside exposures both in adults and in children suggest that it is likely that the ADI would be exceeded at the maximum proposed use levels.
Stevia has a very low acute toxicity, and no allergic reactions to it seem to exist. However, several studies in animals have suggested that steviol glycosides may have adverse effects on the male reproductive system. These studies, some of which have never been published in English, were reviewed in detail by the European SCF, which declined to approve stevioside as a sweetener SCF, Of course, the mere fact that high doses of a substance can produce an adverse effect in experimental animals does not necessarily mean that the substance would be harmful when consumed in far smaller amounts by humans.
Currently the total calorie value of our diet has increased, physical activity has declined and most of the population is sedentary. The relationship between sugar and body weight is controversial. Barclay et al demonstrated that in the Australian population, there was a substantial decline in refined sugar intake over the same timeframe that obesity had increased.
Mattes et al concluded that the current evidence does not conclusively demonstrate that nutritive sweetened beverages have uniquely contributed to obesity or that reducing consumption will reduce BMI levels in general.
Low and no calorie sweeteners LNCS , otherwise referred to as non nutritive sweeteners NNS , artificial sweeteners or non caloric sweeteners, is the term used to describe compounds that taste sweet and provide few or no calories, or compounds that have such an intensely sweet taste that they can be used in food products at concentrations low enough to not contribute significantly to caloric content.
LNCS are used by adults to limit or reduce daily energy intake and are thus a tool in weight management. However earlier perceptions held that LNCS can increase hunger and possibly cause weight gain. Although excessive and disordered eating are factors in the development of obesity, there is no evidence that sugars or LNCS themselves trigger overeating. Several studies have examined the acute effects of low calorie sweeteners on hunger and food intake and they concluded that replacing sucrose sugar with low calorie sweeteners in foods or drinks does not increase food intake or hunger.
There is a proliferation of studies related to LNCS consumption and weight gain. Kanders et al. At one-year follow-up, sustained weight loss was associated with increased low calorie sweetener consumption, a decreased desire for sweets and increased physical activity levels. The results indicated that those who consumed low calorie sweeteners were more successful in keeping the weight off in the long term. Bellisle et al examined whether reducing the energy density of sweet drinks and foods through the introduction of low calorie sweeteners could be a useful aid for weight control.
Mattes and Popkin found that longer-term trials consistently indicate that the use of low calorie sweeteners results in slightly lower energy intakes and that if low calorie sweeteners are used as substitutes for higher energy-yielding sweeteners, they have the potential to aid in weight management.
In conclusion the bulk of epidemiologic studies, but not all, reported a positive association between body weight, weight gain and LNCS use.
However, it was noted that such findings do not prove causality. In addition, available intervention studies do not show that LNCS use increases body weight. In the "Workshop about LNCS, Appetite and Weight Control", they concluded that current knowledge in this area is modest at best and does not yet permit an informed view of how the ingestion of energy-containing sugars and LNCS affects overall mechanisms of energy balance and thus influences body weight. Non-caloric sweeteners and dental health; review Reina Garcia-Closas Dental caries and periodontal diseases constitute a Public Health problem due to their prevalence and socioeconomic consequences.
In Spain, In the last 10 years, caries indicators have not changed. In the period , periodontitis decreased by half.
Dental decay results from a complex interaction between host susceptibility, oral microflora and environmental factors diet, hygiene, use of fluorides. The caries process only takes place when dental plaque bacteria are capable of metabolising fermentable carbohydrates into organic acids.
The role of sugars in the etiopathogenesis of dental caries has been established in epidemiological studies. Sugar consumption frequency is more important than the quantity of sugar intake. The most cariogenic sugar is sacarose, and foods rich in processed starches and sugars are especially cariogenic. Sugars are frequently added to foods pastry, snacks, cookies, breakfast cereals, chewing-gum, milk products, sauces, bread, processed foods, etc and beverages.
Those hidden sugars are the main source of sugar intake in developed countries. Sugar consumption has increased during the last 50 years, especially from processed foods with low nutrient density, which contributes to dental caries and possibly obesity.
Sacarose, high-fructose corn syrup, fructose and maltose are the most common sugars added to foods and beverages. Non-nutritive sweeteners are non cariogenic since they cannot be metabolized by oral bacteria. To date, of these, aspartame is the most frequently added to non-caloric beverages, yogurts and snacks.
Sucralose is progressively substituting other NCS, and the recently approved neotame is promising. Stevia is non-cariogenic and seems to inhibit bacterial metabolism. Xylitol has been widely used in chewing-gums and candies. Clinical studies have shown that xylitol is effective and safe as a sugar substitute for the control of dental decay. Frequent consumption of xylitol in chewing-gums and candies has shown to interfere in bacterial growth and to reduce dental caries incidence.
Xylitol is associated with the remineralization of caries lesions and it reduces cariogenic bacteria transmission from mother to children in comparison to clorhexidine and fluoride. Moreover, xylitol can prevent gingivitis and periodontitis. The combination of xylitol and erythritol could be specially anticariogenic. The deterrents of xylitol use are cost, caloric content x0. Other sugar alcohols sorbitol do not have an important effect on plaque mass and bacteria growth.
In conclusion, public health policies and dietary counselling should be oriented to reduce consumption of foods high in refined starches and sugars and in sugar sweetened beverages, particularly in high-risk population groups. The substitution of sugars by nonnutritive and non-cariogenic sweeteners or anticariogenic could be an important tool in the prevention of dental caries and should be included in preventive programmes based on fluoride use and hygiene. Low-calorie sweeteners, cancer and selected other diseases; epidemiological evidence Carlo La Vecchia The role of low-calorie sweeteners on cancer risk has been widely debated since the 70s, when animal studies found an excess bladder cancer risk in more than one generation of rodents treated with extremely high doses of saccharin, and a few earlier epidemiological studies found inconsistent associations with bladder cancer risk in humans.
This was however not confirmed in subsequent studies, and mechanistic data showed different saccharin metabolism in rodents and humans.
Primary health care eclipsed
To provide information on the role of low calorie sweeteners on the risk of cancer at several sites, we considered data from an integrated network of case-control studies that were conducted in Italy between and Cases were incident, histologically confirmed cancers of the oral cavity and pharynx, of the oesophagus, 1, of the colorectum, of the larynx, 2, of the breast, 1, of the ovary, 1, of the prostate, and of the kidney. Controls were 7, patients 3, men and 3, women admitted to the same network of general and teaching hospitals, for acute non-neoplastic diseases.
We also considered patients with cancers of the stomach and controls, of the pancreas and controls, and of the endometrium and controls.
ORs were obtained from multiple logistic regression analyses, including allowance for total energy, as well as major recognized risk factors for each neoplasm.
The ORs for an increase of one sachet-day of low calorie sweeteners were 0. There was no material difference in risk for saccharin vs other low calorie sweeteners. After allowance for various confounding factors, the ORs for ever users of sweeteners versus nonusers were 0.
Corresponding ORs for saccharin were 0. This is the first comprehensive dataset on the relation between sweeteners, digestive tract and selected other major cancers. Other data on brain and haematopoietic neoplasms also showed no association.
Thus, there is now convincing epidemiologic evidence of the absence of association between saccharin, aspartame and other sweeteners, and the risk of several common neoplasms. With reference to cardiovascular disease, the pooled RR from the two studies —obtained combining the study estimates by meta-analytic methods— was 1.
Alma Ata Declaration
Available epidemiologic data thus indicate that, while use of sugar-sweetened beverages appears to be related to increased risk of cardiovascular disease, consumption of low-calorie beverages is not significantly related. With reference to preterm delivery, when the main findings of the two studies were pooled, the RR was 1.
Thus, the two studies, Hall-dorsson et al. Identification and control of sweeteners in food products Eladia Franco Vargas Food additives are quite an unknown topic within the food consumption field, as well as being an issue that consumers are deeply concerned about.
Despite the fact that they are associated to modern times, food additives have been used for centuries. They have been used since mankind learned how to preserve food.
Thanks to the development that food science and technology have achieved in the past 50 years, several new substances providing some benefits have been discovered, such as certain sweeteners used in low-calorie products, non-cariogenic food, etc.
For the identification and control of table top sweeteners and those used in foodstuffs the European Union legal framework must be taken into account, which includes their conditions of use, specifications, authorization procedure, evaluation and re-evaluation programs.
In addition the Official Control food law must be taken in to account. The use of additives is strongly regulated, and the criteria used for their approval are: that there is a reasonable technological need, that they are safe, and that they do not mislead consumers.
All food additives must have a demonstrated useful purpose and must undergo a rigorous and comprehensive Scientific Assessment to assure their safety before their use is authorized. The European Union defines 26 functional classes according to the technological activity, and sweeteners are included as one of those.
For most of the additives that are authorized there is a minimum level necessary to achieve the desired effect. This level takes into account the acceptable daily intake from the Additive and from any other sources and the possible daily intake even for the most sensitive consumers. However, there is the possibility to use additives without complying with maximum levels and following the principle "quantum satis", which means the use of the minimum amount required to obtain the desired effect.
The presence of additives in intermediate products is also permitted. The dossier shall include the documentation required in the regulation that is mandatory for both the risk and management assessment. The European Commission established a Re-evaluation of Additives program for the additives approved before The priority for re-evaluation takes into account: exposure assessment to consumers, the elapsed time since the last risk assessment, the availability of new scientific evidences and the level of use of the additive.
Dyes, which had old SCF assessments, were prioritized. The evaluation of sweeteners that is the most recent and will be revaluated at the end of the program. Official Control covers companies and products. The companies in the additives sector are considered in the categories of A and B of lower risk given the conformity of the official controls obtained during past years.
Sweeteners, nutrition and medicine; what do we do in primary care?
Is the declaration of Alma Ata still relevant to primary health care?
In the International Congress on Primary Health Care of Alma-Ata, health was defined as a state of complete physical, social and mental well-being, and not just simply a lack of illness.
The fundamental pillars of primary care are prevention and health promotion, as well as the way to manage any health problem subject to being attended to within the primary care setting. Health education is a process that approaches not only how health information is transmitted, but also helps to foment motivation, personal abilities and the self-esteem necessary to adopt measures destined to improve health.
Through the Service Portfolio and a series of periodic recommendations, preventive methods are put into action based on scientific evidence. Of all the services that it encompasses we will refer to: Pregnant women care, The promotion of childhood health habits, Overweight children care, The promotion of health in adolescence, Childhood oral hygiene and The promotion of healthy lifestyles for adults.
There is vast evidence of the correlation between specific health lifestyles and the decrease of the main chronic diseases.
This model has limitations when it comes to complex behaviours physical activity or eating behaviour. With the SWOT analysis we can reach the following conclusions: 1. Training health professionals.
Commitment with the Administration. There are few solid studies based on humans that confirm their possible benefits weakness. Patient training. The use and abuse of "evidence" provided by the media leads to lack of information for the patient threat.
In the Community of Madrid the prevalence of obesity in those aged years is 7. According to other communities the Community of Madrid is situated at a medium-low level. The significant observed increase in the consumption of sugar sweetened beverages may contribute to obesity. For these reasons, the aim of the administration in the Autonomous Community of Madrid was to improve the professional knowledge of Primary Care professionals and citizens in relation to sweeteners and food.
The results are shown in table III. In conclusion, the following recommendations can be made: - The actions should improve the influence of food and nutrition knowledge on health and cover it throughout all of the life cycle. References 1. Assessment of the carcinogenicity of the nonnutritive sweetener cyclamate. Crit Rev Toxicol ; Alonso JR.
Edulcorantes Naturales. La Granja.
American Academy of Family Physicians. Periodic Health Examinations. Dietary guidelines for the Spanish population. Public Health Nutr ; 4 6A : We also promote country-level engagement with diverse stakeholders from non-governmental and private sector partners to enhance shared ownership and accountability. In doing so, we will promote a focus on fragile and conflict- affected settings to ensure UHC financing in such settings.
We also commit to investing in building a sound foundation for healthy societies with equitable access to social services such as water, sanitation, nutrition, housing, and education, and mainstreaming gender throughout policies and programmes. It is also critical for countries to mobilise citizen and community platforms, strengthening their budgetary processes, tracking expenditures to achieve value and equity of health spending, and enhancing the efficiency of health expenditures.
Declaración Del Alma Ata
In order to further promote financing for UHC, we will explore holding a high-level dialogue with Health and Finance Ministries by This commitment recognises the need for countries to articulate their local priorities for UHC and share best practices.
We commit to stimulate learning on innovation for UHC by accelerating the generation and sharing of critical knowledge by building on and enhancing coordination of existing and future networks. We extend our deep appreciation to the Government of Japan for its commitment to supporting the continuation of the UHC Fora in the future.In this environment, Primary Health Care as originally conceived in a generous and radical way, became a flag for resistance.
Support for intersectoral action should come from ministerial level downwards. Sugars are frequently added to foods pastry, snacks, cookies, breakfast cereals, chewing-gum, milk products, sauces, bread, processed foods, etc and beverages.
DuBois GE. The preferred level of sweetness is determined first by age and only thereafter by culture. In general, benefits of LNCS have been traditionally neglected in comparison with the tendency for emphasising unexisting or unproven possible risks.
Selective Primary Health Care, as one knows, was introduced into the debate by the Rockefeller Foundation initiative as a competition with other international agencies. Patient training.
As a whole, this set of formulations and proposals share a broad spectrum of terms and notions, as well as much of the expectations for change and tensions that existed in the classic period of development during the later years of the post-war era.