Intervención didáctica para la enseñanza-aprendizaje de los fundamentos teóricos del método clínico 20 años de experiencia

Introducción: Dada la incuestionable importancia del método clínico en la labor asistencial, continua como tema medular en la docencia médica. Objetivo: Perfeccionar la enseñanza y el aprendizaje del método clínico en la educación médica superior. Métodos: Se transitó por un momento inicial de diagnóstico del estado de aprendizaje del método clínico en el contexto local, seguido de los momentos de concepción, diseño y aplicación de una intervención didáctica. Resultados: La intervención didáctica implementada está constituida por un sistema de conferencias orientadoras dirigidas a estudiantes de tercer año de la carrera de medicina, impartidas en las asignaturas propedéutica clínica y medicina interna, las cuales abordan áreas complejas de la enseñanza-aprendizaje del método clínico: el interrogatorio, el razonamiento diagnóstico y la toma de decisiones terapéuticas; todas las conferencias se acompañan de sus correspondientes materiales de apoyo a la docencia. Forman parte de la intervención, como diseñadas acciones complementarias dirigidas a estimular la participación de los profesores en la ejecución de la intervención, como cursos de capacitación, la elaboración de un modelo del pase de visita docente asistencial. Conclusiones: La intervención didáctica expuesta contribuyó a perfeccionar la "base orientadora de la acción" para la enseñanza y el aprendizaje del método clínico en sí, y de la mayoría de sus habilidades esenciales constituyentes, por lo que tributa al perfeccionamiento curricular en la carrera de medicina. La intervención didáctica diseñada puede ser aplicada, o servir de referente, en cualquiera de los centros de enseñanza médica superior del país.

Introduction: Given the unquestionable importance of the clinical method in health care work, it continues as a core theme in medical teaching. Objective: To improve the teaching and learning of the clinical method in higher medical education. Methods: There was an initial moment to diagnose the learning state of the clinical method in the local context, followed by the stages for conception, design and implementation of a didactic intervention. Results: The implemented didactic intervention is made up of a system of guiding lectures aimed at third-year students of the medical studies, taught in the clinical propaedeutic and internal medicine subjects, which address complex areas of the clinical method teaching-learning: questioning, diagnostic reasoning, and therapeutic decision-making. All the lectures are accompanied by their corresponding teaching support materials. They are part of the intervention, as designed complementary actions aimed at stimulating the participation of professors in the intervention operation, such as training courses, development of a model of medical rounds supporting teaching. Conclusions: The described didactic intervention contributed to perfecting the guiding basis of action for teaching and learning the clinical method itself, and most of its constituent essential skills, which is why it contributes to curricular improvement in the studies of medicine. The designed didactic intervention can be applied, or serve as a reference, in any of the higher medical education schools in the country.

Actitud y Conducta frente a la cuarta dosis de vacuna COVID-19 en personal de salud de la Región Lambayeque-2022

Introducción: Doce médicos y siete enfermeros murieron en la Región Lambayeque por COVID-19, aun así se observa negativa por vacunarse con la cuarta dosis. Objetivo: Determinar la actitud y conducta frente a la cuarta dosis de vacuna contra la COVID-19 en el personal de salud de Lambayeque. Materiales y métodos: Estudio descriptivo y transversal, en 371 trabajadores de salud, seleccionados a través de muestreo no probabilístico en bola de nieve, compartimos la encuesta virtual sobre actitud y conducta con respuestas en escala Likert continuo "acuerdo". Resultados: Edad promedio 40 años, 53,4% laboraban en EsSalud, 43,1% eran médicos, 27,7% con comorbilidades destacando la Hipertensión Arterial, Obesidad y Diabetes Mellitus; 74% rechazó vacunarse, el 51,8% tiene actitud neutra y el 48,3% conducta inestable frente a la vacunación. Conclusiones: La actitud y conducta a la vacunación es neutra e inestable respectivamente, se asocia al sexo y tienen una baja tasa de vacunación efectiva.

Introduction: Twelve doctors and seven nurses died in the Lambayeque Region due to COVID-19, even so, a refusal to be vaccinated with the fourth dose is observed. Objective: To determine the attitude and behavior towards the fourth dose of vaccine against COVID-19 in Lambayeque health personnel. Materials and methods: Descriptive and cross-sectional study, in 371 health workers, selected through non-probabilistic snowball sampling, we shared the virtual survey on attitude and behavior with responses on the continuous Likert scale "agree". Results: average age 40 years, 53.4% ​​worked in EsSalud, 43.1% were doctors, 27.7% with comorbidities, highlighting Arterial Hypertension, Obesity and Diabetes Mellitus. 74% refused to be vaccinated. 51.8% have a neutral attitude and 48.3% unstable conduct against vaccination. Conclusions: The attitude and behavior towards vaccination is neutral and unstable respectively, it is associated with sex and has a low effective vaccination rate.

Coalizão partidária, aporte financeiro e desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras / Party coalitions, budget outlay, and performance of medical and dental care in two health regions of Brazil / Coalición partidaria, aporte financiero y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas

Coalizações de governo distintas encontram limites para produzir mudanças na orientação de políticas. O objetivo foi descrever a orientação política dos partidos de coalização, o aporte financeiro, a estrutura e o desempenho da assistência médica e odontológica em duas regiões de saúde brasileiras distintas socioeconomicamente e na oferta de serviços. Utilizaram-se indicadores a partir de dados oficiais relativos ao período de 2007 a 2014 e caraterísticas da coalização partidária definidas pelas preferências eleitorais municipais e de intensidade da competição eleitoral em cada estado da respectiva região. Maior aporte financeiro per capita e maior porcentagem de população potencialmente coberta pela atenção básica e pelas equipes de saúde bucal da Estratégia Saúde da Família estavam relacionados com o município-polo da região de coalização partidária mais à esquerda, ao passo que o município-polo da região de coalização partidária mais à direita mostrou aumento expressivo na porcentagem de população potencialmente coberta por médicos. Em ambos os municípios-polo, a efetividade melhorou. Os achados confirmaram a noção de que as coalizações mais à esquerda aportam mais recursos em políticas sociais, mas encontram limites para superar desigualdades estruturais e converter suas preferências programáticas em políticas efetivas.

Various government coalitions encounter limits when attempting to implement policy changes. The study aimed to describe the policy orientation of party coalitions, budget outlay, and the structure and performance of medical and dental care in two health regions of Brazil with different socioeconomic conditions and supplies of services. The indicators used were based on official data from 2007 and 2014 and characteristics of the party coalition defined by municipal electoral preferences and the intensity of electoral competition in each state of the respective major geographic region. Higher per capita budget outlay and higher percentage of the population potentially covered by primary care and by the oral health teams under the Family Health Strategy were related to the regional hub municipality with a more left-leaning party coalition, while the regional hub municipality with the more right-leaning party coalition showed an important increase in the percentage of the population potentially covered by physicians. The effectiveness improved in both hub municipalities. The findings confirmed the notion that more left-leaning coalitions tend to earmark more budget resources for social policies but encounter limits for overcoming structural inequalities and for converting their platform preferences into actual policies.

Coaliciones de gobierno distintas encuentran límites para producir cambios en la orientación de políticas. El objetivo fue describir la orientación política de los partidos de coalición, el aporte financiero, la estructura y desempeño de la asistencia médica y odontológica en dos regiones de salud brasileñas, distintas socioeconómicamente y en la oferta de servicios. Se utilizaron indicadores a partir de datos oficiales relacionados con el período de 2007 a 2014 y características de la coalición partidaria, definidas por las preferencias electorales municipales y de intensidad en la competición electoral en cada estado de la respectiva región. Mayor aporte financiero per cápita y mayor porcentaje de población potencialmente cubierta por la atención básica y por los equipos de salud bucal de la Estrategia Salud de la Familia estaban relacionados con el municipio polo de la región de la coalición partidaria más a la izquierda, mientras que el municipio polo de la región de coalición partidaria más a la derecha mostró un aumento expresivo en el porcentaje de población potencialmente cubierta por médicos. En ambos municipios polo, la efectividad mejoró. Los resultados confirmaron la noción de que las coaliciones más a la izquierda aportan más recursos en políticas sociales, pero encuentran límites para superar desigualdades estructurales y convertir sus preferencias programáticas en políticas efectivas.

Emergency Medical Service (EMS) Belt

Background:Emergency medical service has been a well-know n subject of discussion in India where the population is vast and the health care system is inadequate. Essential drugs are a category of drugs that are needed during the golden hour of saving a patient’s life. It becomes necessary that time, when a simple drug can save the life of a patient, a competent health care provider, is needed to administer the drug to the patient. In such a situation, any health care provider in the vicinity of the person who needs medical assistance must get an alert so that the health care provider can reach the site of the emergency and provide assistance. EMS belt is a system in which with the help of a mobile application, any person in case of a medical emergency can get service from a nearby health care provider within a few minutes. The concept is to raise an alarm alerting the nearby health care practitioners about the person in need of medical assistance. This concept is promising with the advantage that it doesn’t need any special manufacturing of the device. Conducting trials on this concept shall yield good observations and produce hopes for a cost-effective EMS system in India.

Rol de la Peruvian American Medical Society (PAMS) en la cooperación médica norte-sur. Una perspectiva histórica

El presente ensayo es una revisión de las principales acciones realizadas por la Peruvian American Medical Society (PAMS) en materia de cooperación en salud al Perú. En los últimos 48 años, la PAMS ha evolucionando su accionar, pasando de misiones de asistencia médica, a acciones de transferencia de capacidades y fortalecimiento de la educación médica en el Perú. Asimismo, la PAMS ha tenido capacidad para brindar apoyo en situaciones de contingencia, como lo ha demostrado las últimas acciones de apoyo al país, durante la pandemia de COVID-19. Se analiza las lecciones aprendidas de esta experiencia de cooperación, reconociendo posibilidades futuras de contribuir al fortalecimiento del Sistema de Salud Peruano.

This essay is a review of the main activities carried out by the Peruvian American Medical Society (PAMS) in terms of health cooperation in Peru. In the last 48 years, PAMS activities have been evolving, going from assistance through medical missions, to capacity transfer and strengthening of Medical Education in Peru. Likewise, PAMS has demonstrated the capacity to provide support in contingency situations, such as the latest activities in support of the country during the COVID-19 Pandemic. The lessons learned from this cooperative experience are analyzed, recognizing future possibilities that may contribute to the strengthening of the Peruvian Health System.

Comparative and analysis of the medical assistance from China, Japan, the United States and Europe to the Republic of Mozambique / 国际中医中药杂志

As a natural extension of One Belt and One Road Initiative in Africa, the Republic of Mozambique plays an important role in the spread of Chinese medicine in Africa. By searching for the materials from the official foreign aid agencies of China, Japan, the United States and Europe, this paper compares and analyzes the current situation of medical aid to Mozambique by China, Japan, the United States and Europe. It is found that Japan, the United States and Europe focus on basic health facilities, social vulnerable groups, local epidemic diseases and other grassroots assistance. Finally, it proposes to set up projects that cater to the needs of recipient countries and strengthen the exchange of traditional medicine to seek multilateral aid cooperation and develop medical aid based on project audience. We hope that we can learn from others, so that China’s medical aid to Mozambique and thus to Africa could be more comprehensive, and the spread of Traditional Chinese Medicine could be spreaded in Africa.

Comissão de Análise de Solicitações Especiais: uma iniciativa fundamental no contexto da judicialização da saúde / Special Requests Analysis Committee: a key initiative in the context of health judicialization / Comisión de Análisis de Solicitudes Especiales: una iniciativa fundamental en el contexto de judicialización de la salud

RESUMO Objetivo Descrever e analisar o trabalho de Comissão Especial que avalia tecnicamente demandas judiciais em município do interior paulista brasileiro. Método Estudo de natureza qualitativa no qual foram realizadas sete entrevistas semiestruturadas, seguindo a técnica da bola de neve. Os dados discursivos foram interpretados tomando como referência alguns elementos da análise de conteúdo temática. Resultados Os entrevistados, integrantes da Comissão Especial, responderam perguntas referentes a quatro eixos temáticos pré-elaborados: a experiência de trabalho na judicialização, o processo saúde-doença, a responsabilidade do sistema de saúde no bem estar do usuário e o direito à saúde. No primeiro eixo, os entrevistados compartilharam sua rotina de trabalho, expuseram ferramentas utilizadas para emitir pareceres técnicos, reconheceram a relevância da Comissão para qualificar demandas, racionalizar gastos públicos e aproximar as áreas da Saúde e do Direito. No segundo eixo, destacaram a associação entre vários condicionantes e determinantes para ter saúde ou desenvolver doença. No terceiro, ressaltaram a importância da atenção integral para promover o bem-estar e diminuir agravos. No quarto, afirmaram que o direito à saúde não se refere somente ao acesso à assistência em saúde, a envolver também elementos individuais e coletivos que formam as pessoas, famílias e comunidades e que a efetivação do direito à saúde não é processo unilateral. Conclusão Segundo o material empírico, reconhecer as diversas questões, perspectivas, condições e opiniões relacionadas à judicialização pode auxiliar na sua compreensão global e oferecer possibilidades mais justas e racionais para a efetivação do direito à saúde pela via judicial.

ABSTRACT Objectives To describe and analyze the work of a Special Commission, which technically evaluates litigations in a municipality in the regional area of São Paulo, in Brazil. Method Qualitative study, in which seven semi-structured interviews were carried out following the snowball technique. The discursive data was analyzed taking as reference some elements of the thematic analysis. Results The members of the Special Commission interviewed, answered questions related to four pre-established thematic axes: the work experience in the judicialization, the health-disease process, the responsibility of the health system regarding the user's well-being, and the right to health. In the first axis, they shared their work routine, exposed the tools they use to issue technical opinions, and recognized the relevance of the Commission to qualify the demands, rationalize public spending and approximate the areas of Health and Law. In the second axis, they highlighted the association between several constraints and determinants to be healthy or to develop a disease. In the third, they emphasized the relevance of integral care to promote well-being and reduce worsening. In the fourth, they affirmed that the right to health is not restricted to access to health care, but to the individual and collective elements that conform people, families and communities, and that the realization of the right to health is not a unilateral process. Conclusion According to the empirical material, recognizing the different issues, perspectives, conditions and opinions related to the judicialization can help in its global comprehension and offer more just and rational possibilities for the realization of the right to health through the judicial process.

RESUMEN Objetivo Describir y analizar el trabajo de una Comisión Especial que evalúa técnicamente demandas judiciales en un municipio del interior paulista brasileño. Método Estudio de naturaleza cualitativa, en el cual se realizaron siete entrevistas semiestructuradas siguiendo la técnica de la bola de nieve. Los datos discursivos fueron interpretados tomando como referencia algunos elementos del análisis de contenido temático. Resultados Los entrevistados, integrantes de la Comisión Especial, respondieron preguntas relacionadas a los cuatro ejes temáticos preelaborados: la experiencia de trabajo en la judicialización, el proceso salud-enfermedad, la responsabilidad del sistema de salud en el bienestar del usuario y el derecho a la salud. En el primer eje, los entrevistados compartieron su rutina de trabajo, expusieron herramientas utilizadas para emitir dictámenes técnicos y reconocieron la relevancia de la Comisión para calificar demandas, racionalizar gastos públicos y acercar las áreas de Salud y del Derecho. En el segundo eje, destacaron la asociación entre varios condicionantes y determinantes para tener salud y desarrollar una enfermedad. En el tercero, resaltaron la importancia de la atención integral para promover el bienestar y disminuir agravamientos. En el cuarto, afirmaron que el derecho a la salud no se refiere solamente al acceso a la asistencia en salud, involucrando también elementos individuales y colectivos que forman a las personas, familias y comunidades y que la efectuación del derecho a la salud no es un proceso unilateral. Conclusión Según el material empírico, reconocer las diversas cuestiones, perspectivas, condiciones y opiniones relacionadas con la judicialización puede auxiliar en su comprensión global y ofrecer posibilidades más justas y racionales para la efectuación del derecho a la salud por la vía judicial.

Percepção de pacientes sobre sua relação com médicos / Perception of patients on their relations with physicians / Percepción de los pacientes sobre su relación con los médicos

Resumo A comunicação adequada é fundamental para a relação médico-paciente e para melhorar a qualidade dos atendimentos. Diante disso, o objetivo deste estudo foi conhecer a percepção de 200 pacientes na cidade de Aracaju/SE sobre sua relação com os médicos. Trata-se de estudo exploratório, transversal, descritivo e quantitativo, com aplicação de questionário. A amostra foi composta majoritariamente por adultos jovens, do sexo feminino (71,5%), solteiros (50%), sem nível superior (47,5%), atendidos principalmente em hospitais da rede pública (26,5%). Um ambiente favorável para a boa relação médico-paciente depende não apenas da infraestrutura clínico-hospitalar, mas também da habilidade comunicativa dos profissionais. Quanto à relação com os médicos, a maioria relatou estar satisfeita (86%) e confiar nos profissionais (84%). A privacidade do paciente também foi respeitada na maioria dos casos.

Abstract Communicating properly is fundamental to improve physician-patient relations and the quality of health care. Considering this, the current study analyzed the perception of 200 patients in Aracaju/SE, Brazil, on their relations with physicians. This is an exploratory, cross-sectional, descriptive and quantitative study with the application of a questionnaire. The sample was composed of young adults, females (71.5%), single (50.0%), without higher education (47.5%) and mainly attended in public hospitals (26.5%). A favorable environment for a good physician-patient relationship concerns not only the hospital infrastructure, but also the communication skills of health professionals. Regarding the relationship with physicians, most patients are satisfied (86%) and declared trust in the professionals (84%). Patient privacy was respected in most cases.

Resumen La comunicación adecuada es fundamental para la relación médico-paciente y para mejorar la calidad de la atención. Este estudio tuvo como objetivo conocer la percepción de 200 pacientes en la ciudad de Aracaju, capital del estado de Sergipe, Brasil, sobre su relación con los médicos. Se trata de un estudio exploratorio, transversal, descriptivo y cuantitativo, con aplicación de un cuestionario. La muestra estuvo formada mayoritariamente por adultos jóvenes, del sexo femenino (71,5%), solteros (50%), sin nivel superior (47,5%), atendidos principalmente en hospitales de la red pública (26,5%). Un ambiente favorable para la buena relación médico-paciente depende no solo de la infraestructura clínico-hospitalaria, sino también de la habilidad comunicativa de los profesionales. En cuanto a la relación con los médicos, la mayoría relató estar satisfecha (86%) y confiar en los profesionales (84%). También se respetó la privacidad del paciente en la mayoría de los casos.

Educación médica durante la pandemia del COVID -19: iniciativas mundiales para el pregrado, internado y el residentado médico / Medical education during the COVID -19 pandemic: global initiatives for undergraduate, internship, and medical residency

RESUMEN La pandemia de enfermedad por coronavirus de 2019 (COVID-19) ha planteado diversos retos a los estamentos de la sociedad y la educación médica no ha sido la excepción. A nivel mundial, las universidades han planteado diversas iniciativas en el pregrado y el internado medico como la virtualización parcial de su contenido curricular, la modificación de su currículo y las actividades educativas y la incorporación de estudiantes de los últimos años a las actividades asistenciales. En el residentado médico, las especialidades quirúrgicas y las que basan su aprendizaje en procedimientos son las más afectadas. Se ha incorporado residentes de distintas especialidades a labores asistenciales diferentes a su especialidad y se ha virtualizado algunas de sus actividades de aprendizaje. El Perú debe hacer una evaluación de estas estrategias y la posible adaptación a nuestra realidad.

ABSTRACT The 2019 coronavirus disease pandemic (COVID-19) has posed various challenges to the strata of society and medical education has been no exception. Globally, universities have proposed various initiatives in undergraduate and medical internships such as the partial virtualization of their curricular content, the modification of their curriculum and educational activities and the incorporation of students from the last years to the management of COVID-19 patients. In medical residency, surgical specialties and those that base their learning on procedures are the most affected. Residents of different specialties have been incorporated into healthcare tasks different from their specialty and some of their learning activities have been virtualized. Peru must make an evaluation of these strategies and the possible adaptation to our reality.

Summary and thinking of medical training during Cambodian medical assistance / 中华医学教育探索杂志

Medical assistance is an important part of China's foreign aid. At present, the literature about teaching and training of foreign medical assistance is not frequent to find. Cambodia is a friendly diplomatic country of China, and the Changzheng Hospital has undertaken medical assistance about 13 years. This paper summarized the medical training and teaching experience of Changzheng Hospital to Preah Ket Mealea Hospital of Cambodia, including Department of Anesthesiology, Neurosurgery, Cardiovascular Center, Radiology and so on in recent years, and found that teaching methods combining various teaching approaches, cooperating with multiple departments, teaching students in accordance with their aptitude, and having flexible time and space are more suitable for Cambodia. The experience of assisting Cambodia can be further used in other countries, and establish an improved teaching system which is suitable for their national conditions and educational systems according to different medical status of different countries.

Summary and thinking of medical training during Cambodian medical assistance / 中华医学教育探索杂志

Medical assistance is an important part of China's foreign aid. At present, the literature about teaching and training of foreign medical assistance is not frequent to find. Cambodia is a friendly diplomatic country of China, and the Changzheng Hospital has undertaken medical assistance about 13 years. This paper summarized the medical training and teaching experience of Changzheng Hospital to Preah Ket Mealea Hospital of Cambodia , including Department of Anesthesiology , Neurosurgery , Cardiovascular Center, Radiology and so on in recent years, and found that teaching methods combining various teaching approaches, cooperating with multiple departments, teaching students in accordance with their aptitude, and having flexible time and space are more suitable for Cambodia. The experience of assisting Cambodia can be further used in other countries, and establish an improved teaching system which is suitable for their national conditions and educational systems according to different medical status of different countries.

Disaster medical response system in Korea

Disasters have frequently been a problem in Korea. Many initiatives have been carried out to mitigate this problem and to respond to disasters properly. The National Medical Emergency Center organized the Disaster Medical Response Center, which operates 24 hours a day. Regional emergency medical centers were designated as hospitals that receive disaster victims. Along with the designated disaster hospitals, the Ministry of Health and Welfare, city and district governments, and community health centers were all assigned standard roles to carry out in case of disasters. Disaster medical assistance teams were developed to respond to disaster events in their regions. This system has enabled a more rapid and systematic response to disaster events, and has standardized disaster-related medical equipment and vehicles to ensure the proper treatment of disaster victims. Although many valuable systems have been developed to respond to disasters, practical training within each institution and community-wide team training are still lacking; therefore, the government needs to further develop and support such programs.

Prenatal care and hypertensive gestational syndromes: A systematic review / Atenção pré-natal e síndromes gestacionais hipertensivas: uma revisão sistemática

Abstract Objective Evaluate the influence of prenatal care on the occurrence of gestational hypertension. Methods The Web of Science, Scopus, Pubmed, Cochrane and ClinicalTrials electronic databases were searched for articles published between January 1st, 2012 and December 31st, 2016. No language restrictions were imposed. The following keywords were used: prenatal care, medical assistance, prenatal education, pregnancy-induced hypertension. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist was employed. Two hundred and forty articles were identified during the initial search, but only seven met the inclusion criteria. This systematic review is registered with the international prospective register of systematic reviews (PROSPERO; #CRD42017064103). Results The seven studies hada lowriskof bias,withmethodological quality scores ranging fromsix to eight points. Five studies found a positive relationship between prenatal care and pregnancy-induced hypertension, whereas two studies found no significant association between the two variables. The divergence among the studies may have been due to the type of healthcare service at which the study was conducted and the sample size. Conclusion Although the studies analyzed differed with regard to methodological aspects, the findings demonstrate the importance of prenatal care during the gestational period as a prevention and health promotion measure.

Resumo Objetivo Avaliar a influência da assistência pré-natal no acometimento de síndromes hipertensivas gestacionais. Métodos A revisão buscou artigos publicados nas plataformas eletrônicas de pesquisa Web of Science, Scopus, Pubmed, Cochrane e Clinical Trials, sem restrições de linguagem e com os artigos publicados entre 01/01/2012 e 31/12/2016. Os descritores utilizados foram: assistência pré-natal, assistência médica, educação pré-natal, hipertensão induzida pela gravidez, gestação. Foi utilizado o checklist preferred reporting items for systematic reviews and meta-analyses PRISMA. A busca na literatura, de acordo com a estratégia adotada, identificou 240 artigos. Contudo, somente 7 artigos foram selecionados de acordo com os critérios de inclusão. A revisão sistemática foi incluída no registro prospectivo internacional de revisões sistemáticas (PROSPERO, na sigla em inglês; #CRD42017064103). Resultados Cinco estudos encontraram relação positiva entre a assistência pré-Natal e síndromes hipertensivas gestacionais. Dois estudos não encontraram uma associação estatística significativa entre estas duas variáveis. Os sete estudos apresentam um baixo risco de viés, com as pontuações na análise de qualidade variando entre seis e oito. As possíveis diferenças entre os achados podem ser devidas ao momento do diagnóstico das síndromes hipertensiva gestacionais, tipo de serviço onde foi realizada a pesquisa e o tamanho amostral. Conclusão Embora os estudos apresentem diferentes aspectos metodológicos, observou-se a importância da implementação da Assistência Pré-Natal durante o período gestacional, o que atuará como medida de promoção e prevenção em saúde.

Respuesta del sistema municipal de salud al huracán Irma. Aguada de Pasajeros, 2017 / Response of the Municipal Health System to Irma Hurricane. Aguada de Pasajeros, 2017

Fundamento: en la respuesta del sistema de salud ante un huracán, los municipios y sus establecimientos tienen un papel protagónico.Objetivo: describir la respuesta del sistema municipal de salud del municipio de Aguada de Pasajeros ante el paso del huracán Irma por el territorio. Métodos: estudio prospectivo, transversal, en sistema y servicios de salud, desarrollado en el municipio de Aguada de Pasajeros entre el 7 y 30 de septiembre de 2017. El universo lo constituyó la totalidad de trabajadores e instituciones del territorio, todos involucrados en la respuesta al huracán Irma. Se incluyeron la revisión documental (planes, indicaciones de los Consejos de Defensa y del Ministerio de Salud) y la observación participativa. También se revisaron indicadores de posible impacto y del cuadro de salud municipal. Resultados: se planificaron y ejecutaron un total de 88 acciones por el sistema municipal de salud; 50 durante la fase informativa, 29 en la de alarma y nueve en la de alerta. El plan de reducción de desastres fue cumplido en su totalidad, al que se le agregaron ocho nuevas tareas como parte de las lecciones aprendidas. No hubo fallecidos atribuidos al huracán, ni cambios en la morbilidad posterior al evento. Existió cobertura asistencial mantenida en sitios de difícil acceso y albergues. Todas las instituciones mantuvieron su vitalidad. Conclusiones: las acciones desarrolladas en el municipio permitieron mantener el cuadro de salud, la atención integral a las personas que demandaron asistencia médica durante el paso del fenómeno natural, así como la vitalidad de las instituciones.

Foundation: in response of the health system before a hurricane, municipalities and establishments have a protagonist role. Objective: to describe the Aguada de Pasajeros municipal health system at the Irma hurricane's path across its territory. Methods: prospective cross study, in the health and service system, developed in the Aguada de Pasajeros Municipality between September the 7th and 30th, 2017. The universe was the territory total of workers and institutions, all involved in the response to Irma's hurricane. A documentary review was included (plans, instructions from the Defense Councils, and the Minister of Health) and participating observation. Indicators of possible impact and municipal health situation. Results: a total of 88 actions by the municipal health system; 50 during the informative phase and 9 in alert. The plan for disaster reduction was totaly achieved, to which 9 new tasks were added. There were no deaths due to the hurricane nor morbidity after the event. There was maintained assistance coverage in sites of difficult access and shelters. All the institutions maintained vitality. Conclusion: the actions developed in the municipality allowed maintaining the health situation, the comprehensive care to the people who demanded medical services during the path of the natural phenomena across the territory institutional vitality.

Planos privados individuais de saúde: o consumidor ainda tem poder de escolha? / Individual health plans: Does the consumer still have power of choice? / Planes de salud individuales: ¿El consumidor todavía tiene poder de elección?

Objetivo: Estudou-se o fenômeno da redução da oferta de planos de saúde privados de assistência médica individuais/familiares. Metodologia: Tratou-se de estudo com abordagem quali-quantitativa, descritivo e explicativo, realizado por intermédio de procedimentos de pesquisa documental e bibliográfica. Resultados: Os planos individuais e coletivos têm características diferentes; as regras aplicáveis aos contratos individuais são mais rígidas; o mercado de planos individuais está altamente concentrado; há pouca oferta desse tipo de produto pelas operadoras, sobretudo de abrangência nacional. Conclusão: A redução da oferta de planos individuais/familiares e a comercialização de produtos mais restritos afetam o direito à saúde visto que reduz o poder de escolha do consumidor, as possibilidades de mobilidade, e dificulta a contratação de planos por aqueles que estão fora do mercado de trabalho formal, principalmente os idosos

Objective: The article studied the supply reduction of individual health plans that include medical assistance. Methodology: The study had a qualitative and quantitative approach. It was realized in an explanatory and descriptive way, through procedures of documentary and bibliographic research. Results: The results show that: individual and group health plans have different characteristics and there are stricter rules applicable to the individual plans; the supply of this product is low; this market is concentrated; there are few options of national coverage plans. Conclusion: The supply reduction of individual health plans that include medical assistance affects the right to health, because the supplemental health users don't have power of choice or possibilities to move to another provider. It is more difficult for elderly users

Objetivo: El artículo estudia la reducción de la oferta de planes de salud individuales que incluyen asistencia médica. Metodología: Se trató de estudio descriptivo, explicativo, cualitativo y cuantitativo, hecho a través de procedimientos de investigación documental y bibliográfica. Resultados: Los resultados muestran que: los planes de salud individuales y de grupo tienen características distintas; las normas aplicables a los contratos son más rígidas; el mercado está concentrado; hay escasez de oferta de este producto. Conclusión: La reducción de la oferta de planes de salud individuales que incluyen asistencia médica perjudica el derecho a la salud, porque los usuarios de la salud complementaria no tienen poder de elección y no puedan cambiar a otra operadora. Los consumidores ancianos tienen más dificultades con la contratación de planes de salud

Analysis of medical assistance provided to spectators at the 2014 fifa world cup matches / Análise da assistência médica prestada aos espectadores nos jogos da copa do mundo da fifa de 2014

ABSTRACT Objective: Several studies have already described the main injuries to soccer players during FIFA World Cup events; however, little is known about the main reasons spectators require medical assistance during these matches. The aim of this study is to assess the number of cases and main reasons spectators required medical assistance during the 2014 World Cup matches in Brazil. Methods: Data were collected from spectators who received medical assistance on all game days, and factors related to the assistance provided were analyzed. Results: Medical assistance was given to spectators in a total of 6,222 cases during the 64 games played in Brazil, an average of 97.2 times per game. The total number of spectators removed from the stadiums by ambulance was 167, a mean of 2.6 removals per game. The main reasons spectators required medical assistance during the World Cup games were headache, gastrointestinal problems, and trauma. Conclusions: Most spectators required medical assistance during the World Cup games for headache, gastrointestinal problems, and trauma; this information is fundamental to develop new prevention strategies and plan medical assistance for large-scale events. Level of Evidence IV; Case series.

RESUMO Objetivo: Vários estudos já descreveram as principais lesões dos jogadores de futebol durante os eventos da Copa do Mundo da FIFA; entretanto, pouco se sabe sobre as principais razões para assistência médica aos espectadores durante as partidas. O objetivo deste estudo é avaliar o número de casos e as principais razões pelas quais os espectadores necessitaram de assistência médica durante os jogos da Copa do Mundo de 2014 no Brasil. Métodos: Foram coletados dados dos espectadores que receberam assistência médica durante todos os dias de jogos e os fatores relacionados ao atendimento foram analisados. Resultados: A assistência médica foi prestada aos espectadores em 6.222 casos durante os 64 jogos no Brasil, com média de 97,2 assistências por jogo. O número total de remoções com ambulância foi de 167, com média de 2,6 remoções por jogo. As principais razões para a assistência médica durante os jogos da Copa do Mundo foram cefaleia, problemas gastrintestinais e trauma. Conclusões: A maioria dos espectadores precisou de assistência médica durante os jogos da Copa do Mundo em decorrência de cefaleia, problemas gastrintestinais e trauma; essa informação é fundamental para o desenvolvimento de novas estratégias de prevenção e planejamento de assistência médica em eventos de massa. Nível de Evidência IV; Série de casos.

Experience of a Disaster Medical Assistant Team activation in the fire disaster at Jecheon sports complex building: limitation and importance of rescue

OBJECTIVE: This study was designed to report on the progress of the fire at Jecheon sports complex and to assess the adequacy of Disaster Medical Assistant Team (DMAT)'s activities in response to the fire disaster. METHODS: We conducted a retrospective review based on camera recordings and medical records that were recorded at the disaster site for assessment of activities. We cooperated with firefighters, police officers, local hospital medical staffs and public health personnel in Jecheon in order to classify patients in the disaster field and to understand the patients' progress. RESULTS: At 15:53, the first request for emergency rescue came to the 119 general emergency call center, and a request for DMAT activation came at 16:28. DMAT arrived at the site at 17:04 and remained active until the following day at 00:43. The total number of casualties was 60, including 27 minimal (Green) patients, 29 expectant (Black) patients, three delayed (Yellow) patients, and one immediate (Red) patient. There were 32 patients who received on-site care by DMAT. Two patients were transferred from a local hospital to Wonju Severance Christian Hospital for hyperbaric oxygen therapy. CONCLUSION: Twenty-nine victims were found in the sports complex building, and there were 31 mildly to moderately injured patients in this fire disaster. The main cause of death was thought to be smoke suffocation. Although DMAT was activated relatively quickly, it was not able to provide effective activity due to the late rescue and difficulty with fire suppression.

Acompanhamento na terceira etapa do método canguru: desafios na articulação de dois níveis de atenção / Follow-up during the third stage of the kangaroo method: challenges in articulation at two levels of care / Acompañamiento de la tercera etapa del método canguro: desafíos en la articulación entre dos niveles de atención

Este artigo analisa a percepção de trabalhadores de saúde sobre a articulação entre os serviços de Unidade Neonatal e da atenção primária em saúde (APS) no acompanhamento de crianças na terceira etapa do Método Canguru. Trata-se de pesquisa qualitativa, exploratória, realizada em capital do Nordeste brasileiro, com profissionais de uma unidade neonatal de referência e de sete Unidades de Saúde. Foram realizadas entrevistas semiestruturadas abordando questões gerais sobre o Método Canguru, com ênfase na terceira etapa. Fez-se análise de conteúdo na modalidade temática. Foram entrevistados 47 trabalhadores de saúde, sendo 14 da atenção especializada e 33 da atenção primária. Os profissionais de ambos os níveis de atenção perceberam os recém-nascidos pré-termo e/ou baixo peso como permanentemente frágeis, devendo ser sempre acompanhados no setor hospitalar. Durante a internação não é construída a vinculação da família com a APS e os trabalhadores da APS não reconhecem seu papel na atenção à criança egressa de unidade neonatal. No entanto, foi possível observar um movimento no sentido de promover o cuidado compartilhado. A percepção dos profissionais de saúde sobre risco das crianças que nasceram pré-termo ou de baixo peso faz, muitas vezes, com que os profissionais da APS não reconheçam a sua importância nos cuidados comuns a todas as crianças, contribuindo para a fragmentação do cuidado. A terceira etapa do Método Canguru deve acontecer com articulação entre o acompanhamento especializado e o realizado pelas equipes da APS. Assim, será possível estabelecer uma linha de cuidado que promova a continuidade da atenção.

This study analyzes the perception of health workers about the articulation between the services of the Neonatal Unit and primary healthcare (PHC) in the monitoring of children in the third stage of the Kangaroo Method. This qualitative, exploratory research was performed in a capital of the Northeast Region of Brazil involving professionals of a reference neonatal unit and seven basic health units. Semi-structured interviews were conducted addressing general questions focusing on the third stage of the Kangaroo Method. Content analysis was performed in the thematic modality. A total of 47 health workers were interviewed, of which 14 were from specialized care and 33 from primary care. Professionals at both levels of care perceived preterm and/or low birth weight as permanently fragile and should be followed up at the hospital. During hospitalization, the family is not tied to PHC, and PHC workers do not recognize their role in the care of Neonatal Unit children. However, it was possible to observe a movement to promote shared care. The perception of risk of children who were born preterm and/or low birth weight by health professionals often causes PHC professionals to fail to recognize their importance in the care common to all children, which contributes to the fragmentation and discontinuity of care. The third stage of the Kangaroo Method must happen in articulation with specialized care and the care performed by the PHC teams. This should thus allow to establish a line of care that promotes the continuity of care.

El presente estudio analiza la percepción de los trabajadores de la salud sobre la articulación entre los servicios de Unidad Neonatal y de la atención primaria de salud (APS) en el acompañamiento de niños en la tercera etapa del método Canguro. Es una investigación cualitativa del tipo exploratoria, realizada en una capital en el Nordeste brasileño, con profesionales de una unidad neonatal de referencia y de siete unidades básicas de salud. Se realizaron entrevistas semiestructuradas abordando cuestiones generales sobre el método Canguro, con énfasis en la tercera etapa. Se realizó el análisis de contenido en la modalidad temática. Se entrevistaron a 47 trabajadores de la salud, de estos, 14 eran de la atención especializada; y 33, de la atención primaria. Los profesionales de ambos niveles de atención percibieron los recién nacidos pretérmino y/o bajo peso como permanentemente frágiles, quienes debían recibir acompañamiento integral en el sector hospitalario. Durante la internación no se construye el vínculo de la familia con la APS, y los trabajadores de la APS no reconocen su papel en la atención al niño egresado de Unidad Neonatal. Sin embargo, fue posible observar un movimiento en el sentido de promover el cuidado compartido. La percepción de los profesionales de la salud acerca del riesgo de los niños que nacieron prematuros o de bajo peso a menudo los hace no reconocer su importancia en la atención común a todos los niños, lo que contribuye a la fragmentación y discontinuidad del cuidado. La tercera etapa del método Canguro debe ocurrir en articulación entre el acompañamiento especializado y el realizado por los equipos de la APS. Así, será posible establecer una línea de cuidado que promueva la continuidad de la atención prestada.

Trayectorias territoriales de la asistencia a víctimas de trata de personas. Análisis cualitativo desde la perspectiva de los actores institucionales en Santander, Colombia / Territorial paths for providing assistance to victims of human trafficking. Qualitative analysis from the institutional actors' perspective in Santander, Colombia / Trajetórias territoriais do assistência às vítimas do tráfico humano. Análise qualitativo da perspectiva dos atores institutionais em Santander, Colômbia

Resumen La respuesta del Estado colombiano a la trata de personas se encuentra descentralizada. Los entes territoriales tienen competencias específicas en la materia. Este artículo estudia las acciones de asistencia a víctimas de trata de personas en Santander, Colombia. Su objetivo es ofrecer un diagnóstico de la atención a las víctimas, a partir de un examen cualitativo de las experiencias relatadas por funcionarios. Se reconstruyen cinco casos ocurridos entre el 2012 y el 2015. La información proviene de entrevistas narrativas a nueve personas que asistieron a las víctimas. A partir de la reconstrucción de los casos se presenta un conjunto de prácticas y debilidades en la asistencia, que evidencian la necesidad de fortalecer las capacidades de funcionarios e instituciones a nivel local. Los resultados son coherentes con los de otros estudios realizados en Colombia. También apuntan a fenómenos poco conocidos, como los procesos de juicio social de los funcionarios y la escasa atención que reciben las víctimas secundarias. Se sugiere la necesidad de promover una descentralización, que acompañe la delegación de responsabilidades a las entidades territoriales con un mayor apoyo técnico y financiero desde el nivel central.

Abstract The response of the Colombian State to human trafficking can be described as decentralized, since territorial entities have their own specific competencies in this area. In this article, the actions aimed at assisting the victims of this despicable crime in the Department of Santander, Colombia, are examined. Its objective is to offer a diagnosis based on a qualitative analysis of experiences told by officers. Five cases occurring between 2012 and 2015 are reconstructed. The information comes from the narrative surveys of nine persons having assisted sufferers and, from the reconstruction of their narratives, the exposed set of attempted practices and setbacks evidences the need to strengthen the abilities and capacities of both officers and institutions at the local level. The results obtained are coherent with those originating in other studies carried out in Colombia. They also point out to less known phenomena such as the social judgment of officers and the poor attention and care given to secondary victims. A suggestion has been made concerning the need to promote a decentralization serving to accompany the delegation of responsibilities to territorial entities with stronger technical and financial support from the central level.

Resumo A resposta do Estado colombiano ao tráfico humano é descentralizada. Os organismos territoriais têm competências específicas na matéria. Este artigo estuda as ações da assistência às vítimas do tráfico humano em Santander, Colômbia. O objetivo é fornecer um diagnóstico da atenção às vítimas, de um exame qualitativo das experiências relatadas pelos funcionários. Cinco casos que aconteceram entre 2012 e 2015 são reconstruidos. A informação vem das entrevistas narrativas a nove pessoas que assistiram às vítimas. Da reconstrução dos casos, um conjunto de práticas e fraquezas na assistência é apresentado, e demonstram a necessidade de fortalecer as capacidades de funcionarios e de instituições no nível local. Os resultados são coherentes com aqueles de outros estudos feitos na Colômbia. Também visam aos fenômenos pouco conhecidos, como os procesos do juízo social dos funcionários e a escassa atenção que recebem as vítimas secundárias. Sugeri-se a necessidade de promover uma descentralização, que acompanhe a delegação de responsabilidades aos organismos territoriais com um maior apoio técnico e financeiro do nível central.