RESUMEN

A través de un recorrido histórico por la relación del Sistema Nacional de Salud español y la Salud Comunitaria, se describen las diferentes etapas de auge o declive de la Atención Primaria -y en concreto de su orientación comunitaria-, los acercamientos y distanciamientos en su relación con la Salud Pública y la influencia de las ideologías políticas dominantes. Considerando la salud comunitaria como parte esencial de la Atención Primaria, y de acuerdo con la estrategia de Alma Ata y los principios de la Carta de Ottawa, se defiende una reorientación comunitaria de los servicios de salud y se propone retomar la Atención Primaria como eje estratégico del Sistema Nacional de Salud, dada su capacidad para un abordaje integral de los procesos salud-enfermedad, sus posibilidades de reducir desigualdades y enfrentar determinantes sociales, así como de superar inequidades en salud, con la participación de la población y en coordinación con otros sectores. Los desafíos del futuro inmediato, así como las consecuencias de la crisis económica y de los recortes y debilitamiento del Estado de Bienestar, hacen evidente la necesidad de promover procesos participativos que impliquen al conjunto de actores sociales y, sobre todo, a la ciudadanía, considerada no como destinataria y 'usuaria' o consumidora, sino como sujeto activo y colaborativo. Se señala la imperiosa necesidad de incorporar procesos participativos dirigidos a crear una nueva cultura colectiva respecto a la sostenibilidad y universalidad de los recursos públicos de salud existentes

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and 'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources

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RESUMEN

In this article, we describe the different stages of the rise and decline of Primary Health Care and, in particular, its community approach; we do so by providing a historical journey of the relationship between the Spanish National Health System and community health, outlining the connections and disconnections with Public Health as well as the influence of dominant political ideologies. We defend a community reorientation of health services, considering community health as an essential part of Primary Health Care, and in accordance with the Alma Ata strategy and the principles of the Ottawa Charter. The Primary Health System is taken up as the strategic axis of the National Health System, given its capacity for an integral approach to health-disease processes, and the possibility it poses for reducing inequalities and confronting social determinants as well as overcoming inequities in health, with the participation of the population and in coordination with other sectors. The challenges of the immediate future, as well as the consequences of the economic crisis, the cuts, and the weakening of the Welfare State, make evident the need to promote participatory processes that involve all the social actors and, above all, the citizenship -considered not as a recipient and'user' or consumer, but as an active and collaborative subject. These participatory processes aim at creating a new collective culture regarding the sustainability and universality of existing public health resources.

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RESUMEN

The thymus undergoes an age-dependent degenerative process which is mainly characterized by a progressive loss of lymphoid tissue. Thymic involution is particularly important in relation to immunosenescence and its various associated diseases; this fact has prompted many studies aimed at understanding the causes and mechanisms of thymic degeneration which may, ultimately, lead to the possibility of manipulating it. In this sense, one of the aspects which has deserved most attention is the thymic microenvironment, and more precisely, the many growth factors to which the cells present in the organ are exposed. Thus, the levels of several of such factors have been reported to undergo age-dependent changes in the thymus, which may point at an influence on the regression of the organ. In this article we consider which growth factors and growth factor receptors occur in the vertebrate thymus. Then, focusing on those whose influences are better documented, i.e., neurotrophins, cytokines and IGFs, we discuss their potential role in the organ and the possibility of their being involved in thymic involution.

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RESUMEN

The neurotrophins are a family of polypeptide growth factors that are essential for the development and maintenance of the vertebrate nervous system. In recent years, data have emerged indicating that neurotrophins could have a broader role than their name might suggest. In particular, the putative role of NGF and its receptor TrkA in immune system homeostasis has become a much studied topic, whereas information on the other neurotrophins is scarce in this regard. This paper reviews what is known about the expression and possible functions of neurotrophins and their receptors in different immune tissues and cells, as well as recent data obtained from studies of transgenic mice in our laboratory. Results from studies to date support the idea that neurotrophins may regulate some immune functions. They also play an important role in the development of the thymus and in the survival of thymocytes.

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