Adherence to treatment

28 08 2014

Both in the treatable and curable diseases it is essential that treatment is properly directed by the doctor and that her instructions are met by patients. If the diagnosis is correct and the treatment is successful, the expected benefits will be obtained. For this to happen, regularity on taking the medication required. This is one of the many factors involved in the broad concept called "adherence".

To analyze adherence to treatment (therapeutic adherence) you have to take into account not only the intervention of the patient (main beneficiary), but also the fulfillment of all the processes aimed at efficiency in the treatment of diseases, especially those that are chronic. There is no agreement on the definition of the term adhesion. Some authors say that it is equivalent to compliance with. Other, on the other hand, They claim that enforcement is part of the adhesion. The truth is that adherence to treatment is a dynamic process, resulting from agreements between physician and patient to achieve wellness. WHO defines it as "the degree in which the behavior of a person - taking the medication, follow a diet and lifestyle changes - run corresponds to the recommendations of the provider of health care". In this way patients are health professionals active partners in their own care.

In chronic treatments is estimated that the extent of global bond fluctuates between the 50% and 75%. For a good therapeutic results are considered acceptable upper grades to the 80%, with the exception of antiretroviral drugs that need a higher grade to the 95%. A poor adherence include not taking the correct dose, failure to observe the intervals between doses, forget a dose or stop treatment until instructed.

In this complex and dynamic process, health care providers (understand health care providers) we fulfill a role of great responsibility and fundamental. Not only the doctors as individuals able to communicate well and educate our patients, but also the health system and its institutions, required to provide a constant and regular medicines of the highest quality. In the process of adherence and efficient treatments do not fit the absence of medicines, replacement of which there's no "resemblance", the subdivisions and decreases in dose achieve until the next visit, or leave the free will of the patient to decide what to do. Anomalies as those raise the health cost and go against the effectiveness of the health system. Chronic diseases such as high blood pressure, diabetes, Hypothyroidism, Epilepsy, Parkinson's, multiple sclerosis, Alzheimer's, In addition to the infectious and rheumatic in general, they require a permanent supply of medicines and treatments are met on a regular basis. Patients need support, not that blame them when the treatment fails due to lack of adhesion.

As it expresses the PAHO: "Increasing the effectiveness of interventions in adherence may have more impact on the health of the population than any improvement of specific medical treatments".


By Rocio Santibáñez Vasquez [en línea] Quito (ECU):, 28 in August of 2014 [REF. 29 in July of 2014] Available on Internet: opinion/2014/07/29/Note/3291951/adherencia-tratamiento?src = menu

Approved the new model of core subjects that modifies the system of specialised health training

25 08 2014

The Council of Ministers on Friday approved the Royal Decree on the new model of core subjects which modifies the current system of specialized health training and incorporating important news. Medical students, contrary to this new model, they have warned that they will not cease in their claims and preparing new actions for September


The Council of Ministers approved last Friday, on the proposal of the Ministry of health, Social services and equality (MSSSI), the Royal Decree that regulates the core subjects of the health education, as well as the respec and specific training, with the objectives of promoting the evolution of the educational system and educational structures to adapt to new training programmes. It's a measure that modernizes the preparation of health professionals so they can learn to address the problems of health in a comprehensive manner from the earliest stages of their specialised training.

The core subjects, According to the Ministry of health in press release, enables skills common to several specialties in health sciences through a period of uniform training. In this way, residence training is structured in two consecutive cycles, one backbone, where he acquired the knowledge common to the specialities of the same trunk, and other specific where he acquired knowledge of each specialty. Both cycles will integrate the full formation of the specialties in health sciences.

This new educational model aims to health professionals “residents”, through the skills acquired in the period of core training, Learn to address the problems of health in a comprehensive manner and with an interdisciplinary and multidisciplinary approach that improves the quality of care of patients since the beginning of its specialized training.

On the other hand, represents the core subjects, According to the MSSSI a more flexible catalog of specialties in health sciences, that in many cases you have configured as watertight compartments isolated each other, resulting in an excessive typecasting professionals.

“The modifications that incorporates not only specialized health training project maintain the excellence of the system of residence, but to improve it, correcting detected deviations. In addition, the new model of core subjects brings us to the already developed countries models of specialized health training environment”, indicates the health administration.

Medical specialties, surgical and multidisciplinary, are structured in 5 groups or trunks: doctor, surgical, laboratory and clinical diagnosis, diagnostic imaging and Psychiatry. Specialties that have common competencies in its training programmes have been grouped in each of them, that it will be acquired in units accredited for a period of not less than two years.

The choice of square trunk and core teaching will be overcome once national entrance examination which annually convenes the Ministry of health, Social services and equality, According to the order obtained by the candidate. Once passed the evaluation of the core period, residents elect speciality and teaching among the offered, According to the order obtained in the entrance examination.



Healthcare professionals who provide or have provided services in the health care system will get a new title of specialist in another speciality of the same trunk. In this case, applicants must be out only the corresponding to the specialty training programme, being exempted from the first backbone cycle. This is required to have at least five years of professional experience.

This ability to respec will be a motivating element of professional, at the time that will allow greater adaptation of human resources to the most in-demand specialties, since they offer respec is to refer to loss-making specialties.

To avoid breaking the balance that must exist between vacancies offered by the ordinary procedure and the procedure of respec, limits are established so that the quota of seats for respec may not exceed to the 2% of the total. Also, which each community offers autonomous may not exceed of the 10% of the offered by the corresponding Community total.


New specialities

Modifies the current map of specialities in health through the creation science, change of name and fusion of certain titles of specialist.

Amendments which are incorporated in this map are of the utmost importance to the health system, they have scientific implications, organisational and social, to the extent that with these changes is intended to give an adequate response to the needs of the health system, the demands of scientific and technological progress and to the population in general that increasingly requires a more efficient health care, higher quality.

-Two new specialities are created: the medical specialty of “Child and adolescent psychiatry” and the multidisciplinary specialty of “Clinical Genetics”.

-Current specialty is changed from “Hospital pharmacy” which happens to be called “Hospital Pharmacy and primary care”.

-Merge the current titles of specialist in “Clinical analysis” and “Clinical Biochemistry” in a single title with the name of “Clinical analysis and Clinical Biochemistry”.


Specific training areas

Training in areas of specific training means enlargement or deepening the knowledge that specialists are already, enabling some professionals to delve into those facets that demands scientific progress in the area of one or more specialties in health sciences. This training shall be scheduled and will be held, also, by the system of residence.

The areas of infectious disease-specific training are created through Royal Decree, Advanced Hepatology, Neonatology,and accident and emergency.


Pfield-testing of access

It unifies and updated regulation of tests for access to specialized health training spaces, that has undergone partial modifications. It highlights the addition to the draft measures of positive action to be taken in the corresponding evidence of access for persons with disabilities (reserve a quota of seats in the 7%),

Intends that the State, making use of the powers granted in article 149.1. 16th of the Constitution in the scope of the general coordination of the health, ensuring specialized health training places offer to respond to needs of the set of health system planning parameters.


Students “they will continue with their demands”

For its part, the State Board of medicine students (CEEM) in a statement released after the decision of the Council of Ministers, considers that the adoption of the Royal Decree “is not the end of the road”, and ensure that they will not stop in their demands and that they will continue to defend its position regarding the core subjects.

In addition, They considered that the fact that the Government decides to approve a Royal Decree which has enjoyed so little consensus so complicated as these dates, where it is more difficult to organize properly, It is very little positive to improve dialogue and communication.

Medical students remember that, in the days that were held in Lleida in October of 2013, “Once their claims were not heard and after the knowledge that the draft Royal Decree was practically the final, they positioned themselves against the core subjects”.

In addition, so far of the year, they indicate that “they have undertaken a campaign of awareness and active claim, with the collection of more of 24.000 firms through the platform against the core subjects and a demonstration in Madrid and Barcelona with more of 9.000 students”.

At last, they have announced some extraordinary workshops in September to study in the best possible way the measures to take in the face two years of implementation, Since the core subjects is the theme that nowadays most concerned about medical students. [en línea] Bilbao (ESP):, 25 in August of 2014 [REF. 28 in July of 2014] Available on Internet: articles/troncalidad27714.html

Device helps sleep better for people with restless legs syndrome

21 08 2014

A novel non-pharmacological method for restless leg syndrome (SPI) It provides physical relief and allows you to stay in bed.


El dispositivo para el síndrome de las piernas inquietas, Relaxis (Fotografía cortesía de Sensory Medical).

The device for restless legs syndrome, Relaxis (Photo courtesy of Medical sensor).

The Relaxis device is based on a pad of low profile that patients placed on the site of his discomfort during a night attack of SPI during the night, usually in the calf or thigh. The patient then activates the pad, that is designed to automatically disconnect with a characteristic of deceleration ramp which completes the cycle after approximately 30 minutes. The vibration pad is essentially a form of contra-estimulacion that gradually decreases in intensity so that the patient will not wake up when it stops.


Relaxis Pad is only designed to be used in patients suffering from primary RLS. It is not intended for use by persons with disorders of the skin such as eczema, Psoriasis, cellulite, wounds that do not heal, or those who suffer from secondary SPI. The device must not used in patients who have been diagnosed with deep vein thrombosis (DVT) in any of their legs during the previous six months, due to a potential known drop or break up a clot and cause a pulmonary embolism. The Relaxis Pad is a product of Medical sensor (San Clemente, CA, USA) and it has been approved by the Directorate of food and drug administration of the United States (FDA).


"Relaxis represents the first alternative recipe, non-invasive, without drugs, to improve the quality of sleep in patients with primary restless legs syndrome, a major health problem that affects millions of people every year", said Fred Burbank, MD, Executive Director of Medical sensor and a patient of SPI. "So far", the only options for patients were, suffer, without help, "for life or face the potential side effects of long term therapies with drugs".


The SPI, also known as Willis-Ekbom disease (EWE) It is a neurological disorder characterized by an irresistible need to move the body to stop annoying or rare sensations. This condition affects most commonly the legs, but it can affect the arms, the torso the head, and even the phantom members. In the most serious cases, SPI attacks can occur several times per night, making, that repeatedly, the dream is interrupted and will affect performance during the day. Move the affected body part modulates the sensations, providing temporary relief.


The sensations tend to begin or escalate, Typically, during the quiet vigil, When the person is relaxed, Lee, studies or tries to sleep. Among the people most affected middle-aged or older are, Since the symptoms tend to increase in frequency and duration with age; It is two times more common in women. To relieve the symptoms of RLS, are frequently formulated drug therapy, including dopaminergic agents used to treat Parkinson's disease, anticonvulsant drugs, the opiate narcotics, muscle relaxants and benzodiazepines. [en línea] Hollywood, FL (USA):, 21 in August of 2014 [REF. 08 in July of 2014] Available on Internet: cuidados_de_pacientes/articles/294753426/dispositivo_ayuda_a_dormir_mejor_a_personas_con_sindrome_de_piernas_inquietas.html



They show that a single biopsy is insufficient to determine the treatment of lung cancer

18 08 2014

The results of the study represent a change in the development of the gene called MET inhibitor drugs, linked to worse prognosis of lung cancer.

A study of the Hospital del Mar, led by Edurne Arriola in the service of Oncology of the Hospital del Mar and coordinator of the functional unit of Lung Cancer has shown that a single biopsy is insufficient to accurately determine this gene and to establish the most appropriate treatment. These results represent a change in strategy that was used so far for the design of clinical trials with inhibitors MET and a step forward in knowledge of lung cancer and the personalization of your treatment.


The work has been presented at the 50th Congress of the American Society of Clinical Oncology (ASCO) with others 12 studies of researchers of the Hospital del Mar. The meeting being held in Chicago (United States) up the 3 June is one of the most important in the world and has met more of 25.000 specialists in Oncology.


Unlike chemotherapy, that attacks tumor cells, targeted therapies focus on block specific genes related to the development of tumors. The MET gene is a gene involved in proliferation and cell migration in a wide range of human cancers. The development of drugs to block it, as MET inhibitors, It is one of the therapies being considered to stop the carcinogenic process.


This personalised strategy requires a very precise knowledge of all mutations and abnormalities of the tumor at the molecular level.

In this study the researchers have analyzed 127 samples of 120 lung cancer patients, most (90%) adenocarcinomas, with an average age of 66 years. The samples came from different parts of the tumor and the researchers analyzed the expression and amplification - the amount of repetitions- The MET gene, aspects involved in tumor development. The results showed differences in terms of the characterization of the activity of the gene according to the origin of the biopsy.


These data imply that the determination of MET, required to design an appropriate therapy, It can be misleading if we rely on the study of a single biopsy, that is what we usually do with lung cancer. We need other tools that help us to predict the State of MET in a tumor, serum markers such as, more specific markers in tumors, or metabolic Imaging tests“, explains Edurne Arriola.


This conclusion can have an immediate impact on the design of clinical trials with drugs aimed at blocking the activity of MET, especially in the choice of the most appropriate patients to benefit from treatment.


They have recently failed two tests with MET inhibitors and this could be since the MET marker studies carried out with a single biopsy. Should re-evaluate the patient selection criteria to receive these therapies“, aims researcher.


In addition, This research could be applied to tumors located in other parts of the body.


In other tumors glioblastomas or gastric tumors also were are testing MET and therefore inhibitors, Although we do not have data on the heterogeneity of this tumor, It is very likely that the results will be similar to the lung cancer“, explains the researcher.


The challenge facing now researchers is “identify a biomarker that will allow us to know which patients benefit from a MET inhibitors and which are not, in order to better define and customize treatments, taking into account that a small biopsy does not represent the general condition of the tumor“, concludes Edurne Arriola.


Lung cancer is the most frequent in the world, with approximately 1.400.000 new cases per year. In Spain, represents the 16,6% of all tumors among men and the 7,6% among women. Between the 80-90% of lung cancers occur in smokers or in people who have quit smoking recently. Adenocarcinoma is a type of lung cancer that accounts for about the 40% of lung cancers and often appear more among women and locate in more peripheral areas of the lungs.

 [en línea] Barcelona (ESP):, 18 in August of 2014 [REF. 02 in June of 2014] Available on Internet: es_noticies/view.php?ID = 385

Some saturated fatty acids may present a bigger risk to diabetes than others

14 08 2014

The relationship between saturated fat and type 2 diabetes may be more complex than previously thought, according to the results of a large international study published today in the journal Lancet Diabetes and Endocrinology. The study found that saturated fatty acids can be associated with both an increased and decreased risk of developing the disease, depending on the type of fatty acids present in the blood.

The results add to the growing debate around the health consequences of fat, and could partially explain evidence from recent studies that suggests some foods high in saturated fats, such as dairy products, could actually lower the risk of type 2 Diabetes.


Saturated fat is typically found in foods with a high proportion of animal fat, such as butter, cheese and red meat, and in fried foods. It is made up of chains of individual fat molecules (fatty acids) that vary in length, depending on how many carbon atoms they contain. These saturated fatty acids have long been considered detrimental to health, and current recommendations suggest they should make up no more than 10 per cent of the calories we eat. However, the role of saturated fat in type 2 diabetes risk is unclear.


Our findings provide strong evidence that individual saturated fatty acids are not all the same

-Nita Forouhi


In the EPIC-InterAct Study, which was funded mainly by the European Commission under its Framework 6 programme, a team of researchers led by the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge set out to examine the relationship between blood levels of nine different saturated fatty acids and the risk of developing type 2 diabetes in later life.


The researchers looked at 12,403 people who developed type 2 diabetes from among a group of 340,234 adults across eight European countries. Using a sophisticated method of high-speed blood analysis, developed especially for the project by researchers at MRC Human Nutrition Research, they determined the proportion of each of the nine fatty acids in blood samples from the study participants and related this with later incidence of type 2 Diabetes.


They found that saturated fatty acids with an even number of carbon atoms in their chain (14, 16 and 18 carbon atoms) were associated with a higher risk of type 2 Diabetes, while saturated fatty acids with an odd number (15 and 17) were associated with a lower risk.


Lead scientist Dr Nita Forouhi, from the MRC Epidemiology Unit at the University of Cambridge, said: “Our findings provide strong evidence that individual saturated fatty acids are not all the same. The challenge we face now is to work out how the levels of these fatty acids in our blood correspond to the different foods we eat.


“These odd-chain saturated fatty acids are well-established markers of eating dairy fats, which is consistent with several recent studies, including our own, that have indicated a protective effect against type 2 diabetes from eating yoghurt and other dairy products. In contrast, the situation for even-chain saturated fatty acids is more complex. As well as being consumed in fatty diets, these blood fatty acids can also be made within the body through a process which is stimulated by the intake of carbohydrates and alcohol.”


The authors therefore conclude that it is too early to make any direct dietary recommendations on the basis of this work.


Professor David Lomas, Chair of the MRC’s Population and Systems Medicine Board, added: “Type 2 diabetes has serious consequences for health and healthcare costs, and its numbers are rising in all world regions. Identifying new ways to not only treat, but prevent the condition are therefore vital. This research arising from 26 research institutions across Europe is an example of the power of international collaboration to generate larger and more reliable studies. By combining large-scale population data with advanced laboratory analysis, this research has delivered a compelling case to look more closely at the contribution of individual components of fat to health and disease.”
 [en línea] Cambridge (UK):, 14 de agosto de 2014 [REF. 06 in August of 2014] Available on Internet:

Curing arthritis in mice

11 08 2014

With a new therapeutic product, researchers have managed to cure arthritis in mice for the first time. The scientists are now planning to test the efficacy of the drug in humans.


Rheumatoid arthritis causes inflammation of multiple joints, such as the knee joint, as shown here. (Photo: / Raycat)

Rheumatoid arthritis causes inflammation of multiple joints, such as the knee joint, as shown here. (Photo: / Raycat)

Rheumatoid arthritis is a condition that causes painful inflammation of several joints in the body. The joint capsule becomes swollen, and the disease can also destroy cartilage and bone as it progresses. Rheumatoid arthritis affects 0.5% to 1% of the world’s population. Up to this point, doctors have used various drugs to slow or stop the progression of the disease. But now, ETH Zurich researchers have developed a therapy that takes the treatment of rheumatoid arthritis in mice to a new level: after receiving the medication, researchers consider the animals to be fully cured.


The drug is a biotechnologically produced active substance consisting of two fused components. One component is the body’s own immune messenger interleukin 4 (IL-4); previous studies have shown that this messenger protects mice with rheumatoid arthritis against cartilage and bone damage. ETH scientists have coupled an antibody to IL-4 that, based on the key-lock principle, binds to a form of a protein that is found only in inflamed tissue in certain diseases (and in tumour tissue).


Localised drug delivery

“As a result of combination with the antibody, IL-4 reaches the site of the disease when the fusion molecule is injected into the body,” says pharmacist Teresa Hemmerle, who has just completed her dissertation in the group of Dario Neri, a professor at the Institute of Pharmaceutical Sciences. Together with Fabia Doll, also a PhD pharmacist at ETH, she is the lead author of the study. “It allows us to concentrate the active substance at the site of the disease. The concentration in the rest of the body is minimal, which reduces side-effects,” she says.


The researchers tested the new fusion molecule, which they refer to as an ‘armed antibody’, in a CTI project together with the ETH spin-off Philochem. They used a mouse model in which the animals developed swollen, inflamed toes and paws within a few days. Among other things, the researchers studied the fusion molecule in combination with dexamethasone, a cortisone-like anti-inflammatory drug that is already used to treat rheumatoid arthritis in humans. The researchers started treating each mouse as soon as they began showing signs of the disease in the form of swollen extremities.


Clinical trials in the next year

When used separately, the new fusion molecule and dexamethasone managed only to slow the progression of the disease in the affected animals. In contrast, the typical signs of arthritis, such as swollen toes and paws, disappeared completely within a few days when both medications were administered at the same time. Concentrations of a whole range of immune messengers in blood and inflamed tissue, which are changed in rheumatoid arthritis, returned to their normal levels. “In our mouse model, this combined treatment creates a long-term cure,” says Hemmerle, who, since completing her dissertation, has been working at Philochem, where she continues the project.


Based on the promising results from the animal model, Philochem is currently preparing to test the new drug in clinical trials on people suffering from rheumatoid arthritis. According to the researchers, these tests will begin in the next year.


Literature reference

Hemmerle T, Doll F, Neri D: Antibody-based delivery of IL4 to the neovasculature cures mice with arthritis. PNAS, online publication 4 August 2014, DOI: 10.1073/pnas.1402783111
 [en línea] Zurich (SUI):, 11 de agosto de 2014 [REF. 06 in August of 2014] Available on Internet:

Antipsychotic drugs linked to slight decrease in brain volume

7 08 2014

A study published on 2014, Julio 18 has confirmed a link between antipsychotic medication and a slight, but measureable, decrease in brain volume in patients with schizophrenia. For the first time, researchers have been able to examine whether this decrease is harmful for patients’ cognitive function and symptoms, and noted that over a nine year follow-up, this decrease did not appear to have any effect.

As we age, our brains naturally lose some of their volume – in other words, brain cells and connections. This process, known as atrophy, typically begins in our thirties and continues into old age. Researchers have known for some time that patients with schizophrenia lose brain volume at a faster rate than healthy individuals, though the reason why is unclear.


“The loss of brain volume doesn’t appear to have any effect on people, and patients should not stop their medication on the basis of this research”

-Graham Murray

Now, in a study published in the open access journal PLOS ONE, a team of researchers from the University of Oulu, Finland, and the University of Cambridge has identified the rate of decrease in both healthy individuals and patients with schizophrenia. They also documented where in the brain schizophrenia patients have more atrophy, and have examined links between atrophy and antipsychotic medication.

By comparing brain scans of 33 patients with schizophrenia with 71 control subjects over a period of 9 years – from age 34 to 43 – the researchers were able to show that schizophrenia patients lost brain volume at a rate of 0.7% each year. The control participants lost brain volume at a rate of 0.5% per year.

Scientists have previously speculated that antipsychotic medication used to treat schizophrenia may be linked to this decrease in brain volume. Today’s research confirms this association, showing that the rate of decrease in volume was greater when the dose of medication was higher. However, the mechanisms behind this – and whether it was in fact the medication that was causing this greater loss of tissue – are not clear. Some researchers have previously argued that whilst older antipsychotic medications might cause brain volume decreases, newer antipsychotic medications may protect against these decreases. However, today’s research suggests that both classes of antipsychotic medication are associated with similar declines in brain volume.


The researchers also looked at whether there was any link between the volume of brain lost and the severity of symptoms or loss of cognitive function, but found no effect.


Professor Juha Veijola from the Department of Psychiatry at the University of Oulu, Finland says: “We all lose some brain tissue as we get older, but people with schizophrenia lose it at a faster rate. We’ve shown that this loss seems to be linked to the antipsychotic medication people are taking. Research like this where patients are studied for many years can help to develop guidelines about when clinicians can reduce the dosage of antipsychotic medication in the long term treatment of people with schizophrenia.”


“It’s important to stress that the loss of brain volume doesn’t appear to have any effect on people over the nine year follow-up we conducted, and patients should not stop their medication on the basis of this research, ” adds Dr Graham Murray from the Behavioural and Clinical Neuroscience Institute and the Department of Psychiatry at University of Cambridge. “A key question in future will be to examine whether there is any effect of this loss of brain volume later in life. We need more research in larger studies with longer follow-ups to evaluate the significance of these brain changes.”


The research was supported by the Academy of Finland, Medical Research Council, Sigrid Jusélius Foundation, and the Brain and Behavior Research Foundation.
 [en línea] Cambridge (UK):, 07 in August of 2014 [REF. 18 in July of 2014] Available on Internet:

First world atlas of the unmet palliative care needs

4 08 2014

Currently only one of each 10 people who need palliative care, This is, care to relieve pain, the symptoms and the stress caused by serious diseases, receive this attention. Unmet needs have been described for the first time in the Atlas of Palliative Care at the End of Life (World Atlas of care Palia-tivos at the end of life), published jointly by the World Health Organization (WHO) and the Worldwide Palliative Care Alliance (WPCA).

The aim is not only to relieve pain and alleviate suffering

The goal of palliative care is not just relieve the pain, but also to alleviate physical suffering, psychosocial and emotional diseases patients serious at an advanced stage and help the families of these people to take care of their loved.

Approximately one-third of those who need palliative care have cancer. The rest suffer from degenerative diseases that affect the heart, the lungs, the liver, the kidneys or brain, disease or chronic or fatal poten-cially, as HIV infection and TB.

It is estimated that every year more than 20 millions of patients need palliative end of life care, of which about one 6% they are children. If you include all persons who could receive palliative care at an earlier stage of their disease, the corresponding figure would be at least a 40 million. Palliative care and Terminal often include some type of support to the fami - family of the patient, which means that care needs multiply by more than two.


80% the world needs corresponds to low and middle income countries

In 2011, some three million patients, most of these terminals, they received palliative care. Although much of this type of assistance is provided in high income countries, almost the 80% the global needs of palliative assistance corresponds to low and middle income countries. Only 20 countries around the world have properly integrated palliative care sanitaria1 systems.

«The Atlas shows that», the vast majority, World care terminal needs are related to non-communicable diseases, as cancer, heart disease, Lung diseases and cerebrovascular accident», He said Dr. Oleg Chestnov, Who Assistant Director-General for noncommunicable diseases and Mental health. «While we strengthen efforts to reduce the burden of diseases that currently cause more deaths in the world», We must alleviate the suffering of those who suffer from degenerative diseases and do not respond to the healing treatments.»


An essential component of all health care systems

Atlas urges all countries to include palliative care as the essential component of all health care systems, in line with efforts to achieve universal health coverage, which means tackling problems such as:

  • the lack of policies that recognize palliative care and the need for care of terminal patients and those who suffer from degenerative diseases;
  • the lack of resources to establish the appropriate services, among other things, to ensure access to essential medicines, especially pain relievers;
  • the lack of knowledge of health professionals, volunteers from the communities and the general public about the benefits of palliative care.


«Our efforts to expand palliative care should focus on alleviating the suffering of people with less resources and make it possible that these will be-neficien of palliative care», added David Praill, Co-Chair of WPCA. «You will need courage and creativity in the process of collective learning on how to integrate palliative care into systems of care with very few resources».

Last week, the Executive Board of the who urged countries to strengthen palliative care and to integrate it into their health care systems. Are scientists-to that this issue is examined in the 67.º World Health Assembly which will be held in May of 2014.

The importance of palliative care has been highlighted in the plan of ac-tion world who for the prevention and control of diseases not trans-misibles 2013-2020 and the last who model list of essential medicines, that includes a specific section on drugs for palliative care.

1 Germany, Australia, Austria, Belgium, Canada, United States of America, France, Ireland, Iceland, Italy, Japan, Norway, Poland, Hong Kong Special Administrative Region, United Kingdom of Great Britain and Northern Ireland, Romania, Singapore, Sweden, Switzerland and Uganda.


The Worldwide Palliative Care Alliance (WPCA) is a network of global action, focused exclusively on the development of terminal care and palliative worldwide. It is integrated by national and regional organizations involved in such care and affiliated organizations that support this type of assistance. The WPCA maintains official relations with who, and this publication is the result of this relationship. The Alliance is the international counterpart of, an international service of information and news about palliative care; also, It organizes the world day of the palliative care. For more information on the WPCA, see:


For more information please contact with:

Glenn Thomas official communications and spokesperson, WHO Tel.: +41 22 791 3983Mobile: +41 79 509 0677Email:

Dr Stephen Connor senior researcher, WPCA Tel.: + 1 703 980 8737Email: [en línea] Geneva (SUI):, 04 in August of 2014 [REF. 28 in January of 2014] Available on Internet: mediacentre/news/releases/2014/palliative-care-20140128/en /