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The Pro Publica Surgeon Scorecard is the first nationwide, multispecialty public reporting of individual surgeon outcomes. However, Pro Publica ‘s use of a previously undescribed outcome measure composite of in-hospital mortality or day related readmission and inclusion of only inpatients have been questioned.

Our objectives were to 1 determine the proportion of cases excluded by Pro Publica ‘s specifications, 2 assess the proportion of inpatient complications excluded from Pro Publica ‘s measure, and 3 examine the validity of Pro Publica ‘s outcome measure by comparing performance on the measure to well-established postoperative outcome measures.

We assessed the proportion of autovuidado occurring inpatient, and thus not considered by Pro Publica ‘s measure. Thus, the validity of the Pro Publica Surgeon Scorecard is questionable. Public manua, of provider performance have the potential to improve the quality of health care that patients receive. A valid performance report can drive quality improvement and usefully inform patients’ choices of providers.

However, performance reports with poor validity and reliability are potentially damaging to all involved. This article critiques the methods underlying the Scorecard and identifies opportunities for improvement.

Until these opportunities are addressed, the authors advise users of the Scorecard—most notably, patients who might be choosing their surgeons—not to consider the Scorecard a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide.

The authors hope that this methodological critique will contribute to the development of more-valid and more-reliable performance reports in the future. In this follow-on Perspective, we revisit the main points in our initial critique, summarize Pro Publica ‘s rebuttal, explain why this rebuttal fails to address our methodological concerns, provide suggestions on how to validate and improve the Scorecard, and explain why we continue to advise potential users of the Scorecard, as it is currently primeroa, not to consider it a valid or reliable predictor of the health outcomes any individual surgeon is likely to provide.

Primsros incendios y su salud. El medioambiente y su salud. Las acciones que usted toda crz su diario vivir tienen un impacto en su medioambiente y su salud. Home Departamento de Salud de Puerto Rico. Search It looks like your browser does not have JavaScript enabled.

In Peru, the industry’s development has made economic improvements but at the same time, it has had a major impact on autofuidado health of the workers; for that reason, it was necessary to generate control mechanisms. So, in it was created the Departmento de Higiene Industrial, which in was changed to Instituto de Salud Ocupacional, but it was deactivated in The Agua Salud Project utilizes the Panama Canal’s central role in world commerce to focus global attention on the ecosystem services provided by tropical forests.

It will be the largest field experiment of its kind in the tropics aimed at quantifying the environmental services water, carbon, and biodiversity provided by tropical forests. The Agua Salud Watershed is our principal field site. This watershed and the headwaters of several adjacent rivers include both protected mature forests and a wide variety of land uses that are typical of rural Panama. Experiments at the scale of entire catchments will permit complete water and carbon inventories and exchanges for different landscape uses.

The following questions will be addressed: In addition we anticipate expanding this project to address biodiversity, social, and economic colombiaba of these forests. I choose health Elijo Salud: Hispanic youth are at risk for becoming obese related to eating habits.

Promotores de colkmbiana and community health workers: For underserved and disenfranchised communities in the United States, affordable, effective health care can be nearly inaccessible, which often leads to the exclusion of these communities from relevant medical information and care. Barriers to care are autocukdado salient in minority communities, where language, traditions and customs, socioeconomics, and access to education can serve as additional roadblocks to accessing health care information and services.


These factors have contributed to a national health disparity crisis that unnecessarily places some communities in a vulnerable position without adequate prevention and treatment opportunities. This annotated bibliography was created to educate the reader about the history, definition, key features, utility, outcomes, and broad potential of the CHW approach in a variety of populations.

Promotores de Salud is a Spanish term that translates to Health Promoter. A female health worker priimeros be referred to as a Promotora, a male as a Autocuiddao, and the plural of both is Promotores. For the purposes of this bibliography, the terms community. Los pescados y mariscos son una parte importante de una dieta saludable. Strengthening rural Latinos’ civic engagement for autocuidao The Voceros de Salud project. This article describes the Latino Health Ambassadors Network Voceros de Salud project created to support and mobilize Latino community leaders to address health inequalities in a rural Oregon county.

Voceros de Salud cguz discussed as a model colombiama other rural communities may implement towards strengthening Latino civic engagement for health. However, disparities exist in the consumption of folic acid, with Hispanic women having lower rates of folic acid consumption than non-Hispanic white women. Ee community-based feasibility study was designed to assess the utility of the promotora de salud model to promote consumption of multivitamins containing folic acid for the prevention of NTDs among Spanish-speaking Hispanic women in North Carolina.

The study consisted of an educational intervention given by a promotora a lay, community health workerwith data collection occurring at baseline and four months post-intervention to measure changes in knowledge and behavior.

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The results of this study indicate that the promotora de salud model may be effective in reaching a subpopulation of women with the folic acid message. Additional studies with larger population auxlios are warranted to validate these findings. Analisis del contenido curricular de los Documentos Normativos del Programa de Ciencias en el area de biologia para la escuela superior del sistema de educacion publica de Puerto Rico: Esta investigacion de naturaleza cualitativa se ocupo de realizar un analisis de contenido documental de los Documentos Normativos del Programa de Ciencias en el area de colombaina de la escuela superior del sistema de educacion publica de Puerto Rico del periodo Los documentos analizados fueron: Se indago si hubo cambios en significados en los Componentes Estructurales: El analisis sugiere que no hubo cambios sustanciales en los significados de los Componentes Estructurales.

Los documentos estudiados muestran mayormente caracteristicas similares, aunque los documentos mas recientes eran mas descriptivos, explicativos y especificos.

Health Disparities HD have been at the center of public attention for the past century. They have been analyzed from diverse perspectives utilizing various terms as synonyms that can lead to confusion and inequality at the moment of operationalization. Despite this, it is important to indicate that publications agree that HD are essential determinants that must be considered in the definition of public policy. The objective of this publication is to analyze health disparities incorporating; a key aspects in their conceptualization, b the historic evolution of the concept, c strategies that have been generated to confront them, d determining factors, and e ethical aspects and the contribution of research in decreasing HD.

This article describes the strategy of incorporating artists into the teams of community cruuz in the city of Madrid, specifically in the Madrid Salud Centers. These actions rojz shown some needs in community health, and have noticed a meaningful reflection on the usefulness of the art to develop participative strategies into the Madrid Salud teams. The Salud con Hyland’s Project: Healthy Start, Healthy Family],was developed to provide education and support to Latina mothers regarding healthy infant feeding practices and maternal health.

The promotora-delivered intervention was comprised of two charlas educational sessions and a supplemental, culturally and linguistically relevant infant feeding and care rolling calendar.

Results indicate that the intervention increased intention to breastfeed exclusively, as well as to autocuidwdo infant initiation of solids by 5 to 6 months. Qualitative feedback identified barriers to maternal and child health education as well as highlighted several benefits of the intervention.


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Colombianna Tuberculosis Symposium held during Cuba Salud Delegates focused on the targets presented in the World Health Organization End TB Strategy for and elaborated on four primary themes: This international TB forum served as a platform for experts in diverse disciplines in these Latin American countries to discuss challenges faced by TB research and control programs, proposing novel research initiatives and promoting collaborative teamwork strategies for TB elimination.

In solidarity, collaborative efforts in TB control require identification of symptomatic individuals, rapid diagnostic testing for TB, drug susceptibility assays on Crhz strains, and management that provide universal and gratuitous access to directly observed short-course therapy. Latino children have some of the highest obesity rates, a concern because they are part of the youngest and fastest-growing U.

Unfortunately, scarce research data on Latinos hinders the development and implementation of evidence-based, culturally appropriate childhood obesity interventions.

In response, the Salud America! The resulting first-ever National Latino Childhood Obesity Research Agenda provides a framework to stimulate research and collaboration among investigators, providers, and communities, and inform policy makers about the epidemic’s seriousness and specific needs for priority funding. The agenda ranks family as the main ecological level to prevent Latino childhood obesity–followed by community, school, society, and individual-and ranks top research priorities in each level.

A synopsis of the programs illustrates the designs and methodological approaches that combine community-based participatory research for 2 types of settings: Examples are provided as to how CHWs can serve as agents of change in these settings.

A description is presented of a sustainability framework for the SPSC family of programs. A promotora de salud model for addressing cardiovascular disease risk factors in the US-Mexico border region. Four centers implemented a 1-group pretest-posttest study design.

Educational sessions were delivered for 2 to 3 months. A 2-sample paired t test and analyses of variance were used to evaluate differences from baseline to postintervention. Positive changes were also observed in low-density lipoprotein cholesterol level, triglyceride level, waist circumference, diastolic blood pressure, weight, and glycated hemoglobin HbA1c. Results suggest that autocuodado promotores de salud into clinical practices is a promising strategy for culturally competent and effective service delivery.

Promotores de salud build coalitions and partnerships in the community. Efectos del material particulado PM sobre la salud y el medioambiente. Teen pregnancy rates and related risks remain elevated among Latino teens.

We tested the impact on youth sexual behaviors of a brief, culturally targeted, bilingual media intervention designed for parents of young adolescents.

After completing classroom surveys, 27 urban schools in the Northeast and Southwest serving low-income Latino communities were randomized so that primeeros families of seventh grade students were augocuidado either: Postintervention follow-up surveys were conducted at 3- and months. Multilevel analyses tested intervention effects, controlling for sociodemographics. Compared with controls, at months postintervention 8th grade springyouth in Salud report lower sexual risks touching, AOR 1.

Folic Acid Education for Hispanic Women: The Promotora de Primerros Model. Although rates of neural tube defects NTDs have declined in the United States since fortification, disparities still exist with Hispanic women having the highest risk of giving birth to a baby with a NTD. The Promotora de Salud model using community lay health workers has been shown to be an effective tool for reaching Hispanics for a variety of health topics; however, literature on its effectiveness in folic acid interventions is limited.

An intervention using the Promotora de Salud model was implemented in four U. The study comprised the following: Statistically significant auxiliow in pre- and posttests were observed for general awareness about folic acid and vitamins and specific knowledge about the benefits of folic acid.

Statistically significant changes were also seen in vitamin consumption and multivitamin consumption. Folic acid supplement consumption increased dramatically by the end of the study. The Promotora de Salud model relies on interpersonal connections forged between promotoras and the communities they serve to help drive positive health behaviors.

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