Thursday, July 16, 2009

Planning Resolution between The Surgeon General of Health and Human Services Richard Carmona and Governor Anibal Acevedo-Vila of Puerto Rico

Acuerdo entre Puerto Rico y el Departamento de Salud y Servicios Humanos de los EE. UU.

El 24 de marzo de 2006, el Director General de Salud Pública del HHS Richard Carmona y el Gobernador Anibal Acevedo-Vila firmaron una Resolución de Planificación que especifica las responsabilidades compartidas e individuales del HHS y de Puerto Rico en la planificación para una pandemia.


Whereas:

1.

Influenza pandemics have occurred three times in the last century, and history and science suggest that the country and the world could face one or more pandemics in this century;
2.

A pandemic can cause severe illness, death and disruption throughout the country and the world, and outbreaks can occur in many different locations all at the same time;
3.

Preparing for an influenza pandemic requires coordinated action at all levels of government - federal, state, local, tribal - and all sectors of society, including businesses, schools, faith-based and community organizations, families and individuals;
4.

The federal government has committed to taking a leadership role in creating a prepared Nation by monitoring international and domestic outbreaks, providing funding and technical assistance to foster local and state preparedness, stockpiling and distributing countermeasures, developing new treatments, and coordinating the national response;
5.

The Secretary of the United States Department of Health and Human Services (HHS) has committed to holding pandemic planning summits in all 50 states, assisting states to improve their level of preparedness;
6.

President George W. Bush asked Congress for emergency spending authority to prepare the United States against the possibility of a pandemic. The Congress has provided over $3 billion for that purpose in the Defense Appropriations Act for 2006, including funding for state and local planning purposes;
7.

States and local communities are responsible under their own authorities for responding to an outbreak within their jurisdictions and having comprehensive pandemic preparedness plans and measures in place to protect their citizens;
8.

Consistent with its authorities and availability of funding, HHS may provide additional resources for State and local influenza planning and preparedness activities, and require specific preparedness goals and achievement of these goals from States and localities as a condition of financial assistance;
9.

Preparedness plans must be continuously exercised and updated to make sure they work and to achieve a stronger level of preparedness; and
10.

Pandemic preparedness will help communities deal with any type of medical emergency and will have lasting benefits for the health of our Nation;
11.

HHS and Puerto Rico share common goals, and have shared and independent responsibilities for influenza planning and preparedness.

Be it resolved:

1. HHS will be responsible for:

1.

Continuing to provide substantial guidance and technical assistance to Puerto Rico as it prepares to respond to a possible influenza pandemic. Among other things, HHS, and its operating divisions, coordinates pandemic response activities with state, local and tribal public health and health care agencies; supports state pandemic planning efforts; communicates and disseminates timely influenza pandemic information and technical guidance to state and local public health departments and health care agencies; and provides direct support and technical guidance for epidemiological investigations and diagnostic services through the Centers for Disease Control and Prevention (CDC).
2.

Consistent with its statutory authorities, direction from Congress, and Departmental regulations and policy, and subject to available funding, providing States financial assistance through funds appropriated as part of the FY 2006 Defense Appropriations Act for the purposes of pandemic planning. Although a portion of those funds will be made available to the state immediately upon receipt of a self assessment of readiness, receipt by Puerto Rico of additional amounts will depend upon achievement of specific preparedness goals as agreed to by HHS and Puerto Rico.
3.

Within six months, reviewing Puerto Rico's plans for use, storage and distribution of antivirals and notifying Puerto Rico of its portion of the federal stockpile of pandemic influenza antiviral drugs.

2. Puerto Rico will be responsible for:

1.

Augmenting state and local planning with a State and Local Pandemic Preparedness Summit.
2.

Updating state pandemic influenza plans based on guidance given in the HHS Pandemic Influenza Plan and the National Strategy for Pandemic Influenza both released in November 2005 and any guidance the Secretary may provide concerning the use of countermeasures necessary to address a pandemic.
3.

Assuring that the operational plan for pandemic influenza response is an integral element of the overall state and local emergency response plan that will coordinate effectively with Emergency Support Function 8, Health and Medical Services, of the National Response Plan and the National Incident Management System.
4.

Establishing a Pandemic Preparedness Coordinating Committee that represents all relevant stakeholders in the jurisdiction (including governmental, public health, healthcare, emergency response, agriculture, education, business, communication, community based, and faith-based sectors, as well as private citizens) and that will assist the State in articulating strategic priorities and overseeing the development and execution of the jurisdiction's operational pandemic plan.
5.

No later than July 1, 2006 notifying HHS of the amount, if any, of additional pandemic influenza antiviral drugs that Puerto Rico will plan to purchase in coordination with HHS, subject to the availability of funding.
6.

Exercising the state's preparedness plan within six months of the date of the state planning summit between the HHS Secretary and the Governor of Puerto Rico, and participating in a nationwide pandemic planning exercise within twelve months of that date. These planning and response exercises should enable public health and law enforcement officials to establish procedures and locations for quarantine, surge capacity, diagnostics, and communication.
7.

Providing CDC a self-assessment of readiness on the part of Puerto Rico to receive a portion of funds referenced in 1.b) immediately.
8.

Achieving specific preparedness goals, targets, and timelines as agreed to by HHS, CDC and Puerto Rico in order to receive additional funds referenced in 1.b).


/s/ Anibal Acevedo-Vila /s/ Richard Carmona

Wednesday, July 1, 2009

Los médicos le corean consignas a Obama

http://www.elnuevodia.com/losmedicoslecoreanconsignasaobama-586976.html

Llevan su reclamo por plan universal hasta Casa Blanca
Por José A. Delgado / jdelgado@elnuevodía.com
WASHINGTON – Con batas blancas, la bandera boricua y cartelones a favor de un plan de salud universal, dos docenas de médicos de la Isla llamaron ayer la atención de los turistas y los empleados de la Casa Blanca que entraban y salían de sus oficinas.
“El cuidado médico tiene que ser un derecho humano”, le indicó el doctor Héctor Rivera a una joven que cruzaba por el Parque Lafayette, justo al frente de la mansión presidencial, y a la que le entregó una hoja informativa.
Convocados por el Colegio de Médicos Cirujanos, los galenos –que pocas veces son vistos, como grupo, en protestas públicas- tomaron el espacio que hasta 2003 fue símbolo de las manifestaciones en Washington en contra de las maniobras militares en la isla de Vieques.
Se acercaron a los portones de la Casa Blanca, pero fueron advertidos de que la manifestación debía tener lugar en la calle que separa el parque de los terrenos que albergan la oficina del presidente Barack Obama.
No será sino hasta agosto que la Casa Blanca les extienda una invitación formal para sentarse dialogar.
Pero, bajo un intenso calor, estuvieron por más de una hora coreando consignas: “Obama, queremos seguro universal ahora”; “Sí se puede”; “ No a las aseguradoras”.
“La situación es tal que hay que tirarse a la calle”, dijo Sara Huertas, doctora en el Departamento de Siquiatría del Centro Médico de Río Piedras.
Gisela Negrón, directora del Departamento de Trabajo Social de la Universidad de Puerto Rico, representó en el evento al Colegio de Trabajadores Sociales. “Estamos muy cerca de los problemas de salud”, dijo Negrón.
Al terminar la manifestación, el presidente del Colegio de Médicos Cirujanos, Eduardo Ibarra, comenzó una serie de reuniones con funcionarios del Congreso, donde está a punto de conocerse el contenido de los proyectos de ley que guiarán el debate de este verano y el otoño próximo en torno a una posible reforma federal de salud.
Los primeros encuentros fueron con representantes de los demócratas John Conyers (Michigan) y Dennis Kucinich (Ohio).
Para Ibarra, mientras el Congreso debate diferentes iniciativas, cobra fuerza un verdadero movimiento social en reclamo del derecho a la salud y de una reforma que garantice un plan de salud universal que le permita tener un seguro a los más de 400,000 que ahora no lo tienen en Puerto Rico.
“Se repetirá la historia de lo que ocurrió con la educación pública. Tuvo tanto éxito que se expandió inmediatamente”, dijo Ibarra.
Agregó que aunque el Congreso no se plantee ahora la puesta en marcha de un plan que tenga al Gobierno como principal pagador, esa alternativa seguirá ganando terreno.

Dos visiones sobre la reforma de salud

http://www.elnuevodia.com/dosvisionessobrelareformadesalud-586940.html

Pierluisi favorece una opción pública bien diseñada

Por José A. Delgado / jdelgado@elnuevodía.com
WASHINGTON – Contrario a lo que opina el gobernador Luis Fortuño, su compañero de boleta electoral, Pedro Pierluisi, ha defendido en el Congreso que la reforma federal de salud incluya la creación de un nuevo plan médico que sea administrado por el Gobierno federal.
“Apoyo la posición de la mayoría (demócrata) de la Cámara de Representantes, que se cree una opción pública bien diseñada y que sea justa”, indicó Pierluisi, después de conocer las expresiones del Gobernador.
Durante su visita de la semana pasada a Washington, Fortuño expresó a la cadena C-SPAN que rechaza la opción pública que promueven sectores del Congreso como parte de la reforma federal de salud, pues considera que las iniciativas para proveerle un seguro médico a todos los residentes de Estados Unidos, Puerto Rico y los demás territorios deben surgir de la empresa privada.
Pierluisi, quien se identifica aquí con los demócratas pero fue elegido por el Partido Nuevo Progresista (PNP) que preside Fortuño -quien a su vez es republicano-, se distanció de la posición del Gobernador.
“El propósito de una opción pública es que disciplinen las ofertas privadas”, sostuvo Pierluisi.
Para el Comisionado Residente, la posición del gobernador Fortuño es la que muestran los republicanos y que puede tener peso dentro del Senado federal, pero que en este momento no tiene apoyo dentro de la Cámara baja.
El presidente del Colegio de Médicos Cirujanos de Puerto Rico, Eduardo Ibarra, ha advertido que tradicionalmente cualquier plan universal de salud ha incluido una opción pública, que le permite al Gobierno asegurar un costo adecuado de los servicios de salud.
Ibarra sostuvo que, como norma, en los países que existe un plan universal de salud el Gobierno está involucrado. “Debe ser un derecho humano equivalente a ofrecerle educación pública a todos los niños”, dijo el galeno.

Incidencia de VIH en Puerto Rico doble de EEUU en 2006

Incidence and Diagnoses of HIV Infection — Puerto Rico, 2006 (MMWR Published 6-05-09)

In 2006, 33 U.S. states and five territories had confidential, name-based, human immunodeficiency virus (HIV) infection reporting; among territories, Puerto Rico had the second highest rate of HIV infection (1). To characterize the HIV epidemic in Puerto Rico in 2006 (the year with the most recent available data), the Puerto Rico Department of Health and CDC analyzed data on diagnoses of HIV infection (including infections that occurred in 2006 and in previous years) and used a stratified extrapolation approach developed by CDC (2) to generate HIV incidence estimates (the number of persons newly infected with HIV in 2006). The results indicated that, in 2006, an estimated 1,440 persons aged >13 years were newly infected with HIV in Puerto Rico, resulting in an estimated incidence rate of 45.0 cases per 100,000 population, twice the rate for the 50 U.S. states and District of Columbia (DC). Males accounted for 65% of new HIV infections in Puerto Rico, and 38% of new HIV infections occurred among persons aged 30–39 years; 39% of new infections were associated with injection-drug use, and 37% with high-risk heterosexual contact. The results provide insight into HIV transmission patterns in Puerto Rico that can help guide allocation of resources and the planning, implementation, and evaluation of HIV prevention programs and other services.

Calculation of diagnoses of HIV infection (i.e., HIV diagnosed with or without a concurrent or later acquired immunodeficiency syndrome [AIDS] diagnosis) was based on the 1,021 diagnoses in 2006 among persons aged >13 years reported to CDC by the Puerto Rico Department of Health through June 2007. Data were categorized by sex, age group, and mode of HIV transmission. The following hierarchy was used for HIV transmission categories: 1) male-to-male sexual contact, 2) injection-drug use, 3) male-to-male sexual contact and injection-drug use, and 4) high-risk heterosexual contact (i.e., with a sex partner known to have or to be at high risk for HIV infection). The number of reported diagnoses was adjusted for reporting delay using a previously reported procedure (3). In addition, for diagnosed cases missing transmission category (32%), a multiple imputation procedure was used (4). Percentages were calculated for sex, age group, and transmission categories. HIV diagnosis rates per 100,000 population were calculated for sex and age group using post census estimates for 2006 (5). HIV incidence for Puerto Rico was calculated using the stratified extrapolation approach (2,6). Remnant diagnostic serum specimens from persons aged >13 years and diagnosed with HIV infection in 2006 in Puerto Rico were tested with the BED HIV-1 capture enzyme immunoassay (BED) to classify infections as recent or long-standing. In addition to the BED result, the estimation method requires HIV testing history, demographic data, and behavioral information for persons with HIV infection diagnosed in 2006. HIV incidence was calculated from cases based on the 1,021 diagnoses of HIV infection, adjusted to 1,460 for reporting delays in 2006. Percentages were calculated for sex, age group, and transmission categories. HIV incidence rates per 100,000 population were calculated for sex and age group using official post census estimates for 2006 (5).

In 2006, after adjustment for reporting delays, 1,460 persons aged >13 years were diagnosed with HIV infection in Puerto Rico (Table 1). Of these, 1,036 (71%) were males and 424 (29%) were females. By age group, the greatest number of diagnoses of HIV infection occurred among those aged 30–39 years, followed by those aged 40–49 years. Among males, the most common mode of HIV transmission was injection-drug use (40%), followed by male-to-male sexual contact (30%). Among females, the most common mode of HIV transmission was high-risk heterosexual contact (73%), followed by injection-drug use (27%). The rate of diagnosis of HIV infection in Puerto Rico in 2006 was 45.5 per 100,000 population.

An estimated 1,440 persons (45.0 per 100,000 population) were newly infected with HIV in 2006. The HIV incidence rate among males (62.0) was twice that among females (29.8). The highest rate of incident HIV infections, among persons aged 30–39 years (103.6), was 1.7 times that of the age group

To view source documentclick below, "Para ver documento orginal, haga click abajo.

http://www.cdc.gov/mmwr/PDF/wk/mm5821.pdf

Retiran nombramiento de Rivera Dueño

domingo, 28 de junio de 2009
Actualizado hace 1 días (07:04 p.m. )
Prensa Asociada

El secretario de Estado, Kenneth McClintock -quien funge como gobernador interino-, solicitó el domingo al presidente del Senado, Thomas Rivera Schatz, el retiro del nombramiento del Secretario de Salud.
Ello, luego de que el ahora ex designado secretario de Salud, Jaime Rivera Dueño, solicitara un día antes al gobernador Luis Fortuño que retirara su nominación.
"Le notifico el retiro del nombramiento del doctor Jaime Rivera Dueño para el cargo de Secretario del Departamento de Salud de Puerto Rico, efectivo el día de hoy (domingo)", reza la escueta misiva enviada por McClintock al Presidente senatorial.

En una carta enviada a La Fortaleza el sábado, Rivera Dueño solicitó el retiro de su nombramiento refiriéndose a la negativa del Senado para aprobarla.

"Luego de evaluar la situación suscitada en el Senado de Puerto Rico con motivo de mi designación como Secretario de Salud, he decidido solicitar de usted (Fortuño), respetuosamente, que retire mi nombramiento a dicho puesto", reza la carta de una página firmada por Rivera Dueño.

"Creo que no es justo ni adecuado, para usted o para mí, continuar con ese esfuerzo", agregó.

El ahora ex funcionario lamentó la controversia sobre su designación.

"Acepté esta designación por entender que podía volver a poner a la disposición de mi pueblo el conocimiento, mi experiencia y deseo de servir. Lamentablemente, por las razones que sean, esta meta no ha podido ser posible alcanzarla", indicó Rivera Dueño.

Desde que fue nombrado como Secretario de Salud, varios sectores se opusieron a que ocupara ese cargo por su relación con el Instituto del Sida -que dirigió cuando se produjo un esquema millonario de corrupción- y luego confrontó la oposición de la mayoría novoprogresista