ABSTRACT
Introducción. A fin de 2019 se identificó una nueva variedad de coronavirus causante de COVID-19 que alcanzó categoría de pandemia. En Argentina, el área metropolitana de Buenos Aires (AMBA) concentra alrededor del 37 % de la población total y el mayor número de casos diagnosticados. El objetivo de este estudio fue describir las características clínico-epidemiológicas de los pacientes con COVID-19 y describir el impacto en el funcionamiento del Servicio de Pediatría de una institución privada de la zona. Métodos. Diseño retrospectivo, observacional, desarrollado en una institución de la zona oeste del AMBA entre el 12 de marzo y el 31 de agosto de 2020. Se incluyeron todos los menores de 16 años con diagnóstico de COVID-19. Se registraron características demográficas, epidemiológicas, clínicas, indicación de internación/control ambulatorio, número de consultas externas, internación por infecciones virales estacionales, licenciamiento del personal, modificación del número de camas y de las actividades de los profesionales. Resultados. Hubo 5454 consultas ambulatorias pediátricas totales, sospecha de COVID-19 en 753/5 454 (13,8 %), se confirmaron 152/753 (20,2 %). Mediana de edad 82 meses (rango intercuartílico: 20,5-147 m), el 50 % fueron varones. La fiebre fue el síntoma más frecuente. Se internaron 22/152 (14,5 %). Las consultas disminuyeron el 87 %, no hubo internación por infecciones virales estacionales y el 52,9 % (91/172) del personal fue licenciado. Conclusiones. La mayoría de los casos fueron leves y la fiebre fue el principal síntoma. Observamos un notable impacto en el funcionamiento del servicio en cuanto al recurso humano. Destacamos la necesidad de la organización logística del servicio para enfrentar esta contingencia.
Introduction. Towards the end of 2019, a novel coronavirus that causes COVID-19 was identified and became a pandemic. In Argentina, approximately 37 % of the total population lives in the Metropolitan Area of Buenos Aires (AMBA), where most cases have been diagnosed. The objective of this study was to describe the clinical and epidemiological characteristics of COVID-19 patients and the impact on the operations of the Department of Pediatrics of a private facility located in the AMBA. Methods. Retrospective, observational study conducted at a facility in the west of AMBA between March 12th and August 31st, 2020. All patients younger than 16 years diagnosed with COVID-19 were included. Demographic, epidemiological, and clinical characteristics; indication for hospitalization/outpatient follow-up; number of outpatient visits; hospitalization due to seasonal viral infections; staff on leave; changes in bed availability and health care providers' activities were recorded. Results. There were 5454 pediatric outpatient visits, COVID-19 was suspected in 753/5454 (13.8 %) and 152/753 (20.2 %) were confirmed cases. Their median age was 82 months (interquartile range: 20.5-147 months); 50 % were males. Fever was the most common symptom. In total, 22/152 (14.5 %) patients were hospitalized. Outpatients visits decreased by 87 %; there were no hospitalizations due to seasonal viral infections; and 52.9 % (91/172) of staff took a leave. Conclusions. Most cases were mild, and fever was the main symptom. The department operations were considerably affected in terms of human resources. It is worth noting the need for a logistic organization at the Department of Pediatrics to face such contingency.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Pediatrics , Burnout, Professional/epidemiology , COVID-19 , Communicable Disease Control , Surveys and Questionnaires , Retrospective Studies , Pandemics , Private Facilities , SARS-CoV-2ABSTRACT
Resumen Este artículo se propone, desde una perspectiva cualitativa, describir y analizar los tiempos durante el proceso de aborto en mujeres residentes en el Área Metropolitana de Buenos Aires, en base a cinco entrevistas en profundidad. Encontramos, en primer lugar, que el tiempo de gestación funciona como un cronómetro, que avanza de modo tan apremiante como la voluntad de interrumpirlo. En segundo lugar, identificamos el aborto como un proceso atravesado por los siguientes intervalos: 1) noticia del embarazo; 2) toma de la decisión de abortar; 3) búsqueda de información y establecimiento de vínculos; 4) obtención de la medicación; 5) toma de la medicación; y 6) expulsión y verificación del aborto. Las entrevistas dan cuenta de un escenario contradictorio, en el que la clandestinidad y la imposibilidad de nombrar el aborto en el entorno social se superponen con estrategias de resolución, individuales y colectivas.
Resumo A partir de uma perspectiva qualitativa, propomos descrever e analisar os tempos durante o processo de aborto entre mulheres residentes na Área Metropolitana de Buenos Aires, com base em cinco entrevistas em profundidade. Encontramos, em primeiro lugar, que o tempo de gestação funciona como um cronômetro que avança de modo tão coercivo como a vontade de interrompê-la. Em segundo lugar, identificamos o aborto como um processo atravessado pelos seguintes intervalos: 1) notícia da gravidez; 2) tomada da decisão de abortar; 3) busca de informação e estabelecimento de vínculos; 4) obtenção da medicação; 5) ingestão da medicação; 6) expulsão do feto e verificação do aborto. As entrevistas dão conta de um cenário contraditório em que a clandestinidade e a impossibilidade de nomear o aborto no entorno social se sobrepõem a estratégias de resolução, individuais e coletivas.
Abstract Adopting a qualitative perspective, five abortion experiences of women living in the Metropolitan Area of Buenos Aires are described and analysed through in-depth interviews. We found that the time of gestation is like a chronometer progressing as urgently as the willingness to interrupt the pregnancy. We also identified abortion as a process punctuated by the following intervals: 1) knowing about the pregnancy; 2) deciding to have the abortion; 3) searching for information and the establishment of networks; 4) obtaining the medication; 5) taking the medication; and 6) the expulsion of the fetus and the verification of the abortion. Interviews showed a contradictory scenario in which secrecy and the impossibility to name abortion in the social environment overlap with strategies both individual and collective to solve the issue.
Subject(s)
Humans , Female , Pregnancy , Argentina/ethnology , Pregnancy , Public Health , Misoprostol , Abortion, Induced/methods , Decision Making , Qualitative Research , Ethics, MedicalABSTRACT
La satisfacción que los pacientes tienen con respecto a sus tratamientos es un indicador de la calidad de los mismos y un importante predictor de sus posibles resultados. Se analizaron los niveles de tal satisfacción en una muestra de pacientes con problemáticas de abuso de sustancias, tratados en instituciones del Área Metropolitana de Buenos Aires (AMBA). Los grados de satisfacción fueron a su vez analizados en relación con las características diferenciales de las instituciones (tipo de institución, ubicación geográfica, género de los pacientes aceptados, presencia de cualidades atípicas en las instituciones) y la evolución de los tratamientos (duración y cantidad de interrupciones del proceso). A partir de un muestreo aleatorio por conglomerados y estratificado, se convocó una muestra de 216 participantes pertenecientes a 22 centros, que completaron un cuestionario de satisfacción, diseñado para este estudio. Los resultados mostraron niveles elevados de satisfacción en las distintas áreas exploradas, observando características distintivas de las instituciones asociadas a diferentes niveles de satisfacción, como es el caso del tipo de institución y el género de los participantes aceptados. No obstante, no se encontraron diferencias en los grados de satisfacción en función del tiempo de desarrollo del tratamiento y la cantidad de interrupciones del mismo. Los resultados obtenidos son discutidos en relación a los alcances del estudio, a la vez que se presentan sus limitaciones y se proponen futuras investigaciones para avanzar sobre esta temática.
The client satisfaction about his treatments it is an important indicator of its quality, but also a fundamental predictor of treatment outcome. Specifically, in patients with drug abuse disorders, the degrees of satisfaction with their treatments have presented lineal correlations with the amount of therapeutic change and the continuity in treatment (prevention of drop-out). Thus, the analysis of clients' satisfaction with their treatments is presented as an indirect and alternative strategy to analyze the effects of therapy for drug abuse disorders, a main health, social, and political problem in the world wide. In this exploratory study we analyzed the levels of satisfaction about their treatment in a sample of client's with substance abuse disorders, treated in institutions of the Buenos Aires Metropolitan Area (AMBA). Then we explored the relationship among the levels of satisfaction with the specific features of the institutions where the treatments were conducted (type of institution, geographic location, genre of the clients accepted, and the presence of atypical characteristics) and with characteristics of the evolution of those treatments (treatments length and amount of interruptions during the therapeutic process). Based on a stratified cluster random sampling strategy, using the above-described characteristics of the institutions analyzed in this study to create the clusters, we designed a sample of 216 subjects that were treated in 22 institutions with treatments subsidized by the Argentine National Secretary for the Prevention of Drug Abuse and the Fight against Drug Trafficking (SEDRONAR by its acronym in Spanish). All the participants of this research completed a questionnaire developed ad hoc and based on previous developments, to explore patient's levels of satisfaction in six areas: Admission, General environment (divided into the sub-areas Human and physical context and Mistreatment), Satisfaction with food, Staff evaluation (divided into the sub-areas Overall staff assessment and Specific staff assessment), Satisfaction with treatment (divided into the sub-areas Treatment features, Treatments results, and Complementary therapeutic devices), and General treatment evaluation. Results showed that there were same features of the institutions related to different levels of satisfaction in the participants of the study. Regarding the type of institution, patients of the psychiatric clinics presented the lowest degrees of satisfaction while the patients of the day hospitals had the highest levels of satisfaction. Also different levels of satisfactions were observed based on the genre of the patients accepted in the institutions. Patients of the institutions that only accept male clients have greater degrees of satisfaction than patients in mixed institutions. No significant differences were found in patient's satisfaction due to institution geographical location. Also, we have not found a significant association between patient's satisfaction and treatment length or between treatment satisfaction and amount of interruptions in the therapy. The results are discussed in the context of the scopes of the study, while further research is suggested to move forward in the exploration of this issue. The differences in satisfaction due to the type of institution might be explained by the degree of openness and flexibility of the setting, but also by the severity of the patients that are included in eacht type of institutions. As well, the differences in satisfaction based on the genre of the patients accepted by the institution could be explained by the predominance of male patients in the population (85%) and the possible lack of adaptation of treatment characteristics to female specific necessities. However, the results of this research must be interpreted extremely cautious because of limitations of the study related to the sample method and the unknown psychometric properties (in terms of validity and reliability) of the instrument used.