ABSTRACT
Abstract At the end of 2019 a novel coronavirus was identified as a cause of pneumonia in Wuhan, China. This emerging disease has caused an unexpected turn in the economy and in society, which has led to the necessity of social isolation and confinement. Diabetic foot consultation was affected by the ongoing situation. The aim of this study was to compare the number of medical visits and the severity of new lesions at presentation at the Diabetic Foot Unit during June 2020 compared to June 2019. Three hundred and fifty six medical visits were analyzed, resulting in a 29% reduction in the number of visits during 2020. The number of patients presenting with new lesions increased from 6.4% to 10.3% (p = ns) during pandemic. The number of visits from the patients´ relatives was higher during June 2020 (16.3% vs. 1.4%) (p < 0.05). Controls of feet without active lesions (i.e.: closed wound or periodic control) decreased from 16.8% to 4.5% (p < 0.05). Consultation for medical prescription only was higher in 2020 (22.4%) than in 2019 (7.3%) (p < 0.05). In our sample, there were no significant differences in the severity of new lesions at presentation or on the days of evolution of new ones in comparison with the previous year. During 2020, telehealth consults represented a 7% of all medical visits. There were no major amputations during 2019 and 4 during 2020. Given the dynamics of confinement, further studies about this topic are required to make sound and accurate decisions.
Resumen A fines de 2019 se identificó un nuevo coronavirus como causa de neumonía, en Wuhan, China. Esta nueva enfermedad (COVID-19) causó un inesperado vuelco en la economía y en la sociedad. El aislamiento social y el confinamiento provocaron cambios en la dinámica de las consultas médicas. En este estudio se compararon la cantidad de consultas y la gravedad de las lesiones nuevas en la Unidad de Pie Diabético entre junio de 2020 y junio de 2019. Se analizaron en total 356 visitas médicas, hallando un 29% de reducción en el número de visitas en 2020. El número de consultas por lesión nueva aumentó del 6.4% a 10.3% (p = ns) durante la pandemia. Las visitas de familiares por diversos motivos en lugar del paciente aumentaron durante 2020 de 1.4% a 16.3% (p < 0.05). Los controles de pacientes sin lesión (pie de alto riesgo, control post alta), disminuyeron de 16.8% a 4.5% (p < 0.05) y también aumentaron las visitas únicamente para prescripciones médicas (7.3% a 22.4%, p < 0.05). En nuestra muestra, no hubo diferencias significativas en la gravedad de la presentación ni en los días de evolución de las lesiones nuevas en relación al año anterior. Durante 2020 las teleconsultas representaron el 7% del total. En junio de 2019 no se registraron amputaciones mayores y en 2020 se registraron 4. Dada la dinámica del confinamiento, se requiere un continuo seguimiento y nuevos estudios para evaluar las consecuencias que se producirán en los pacientes con esta enfermedad con el fin de tomar decisiones acertadas.
Subject(s)
Humans , Diabetic Foot/diagnosis , Diabetic Foot/prevention & control , Diabetic Foot/epidemiology , Diabetes Mellitus , COVID-19 , Referral and Consultation , Pandemics , SARS-CoV-2ABSTRACT
O curso de medicina pode ser fonte de ansiedade? Várias são as situações a que o estudante de medicina é exposto, e que são de elevada tensão, como: a singularidade de cada paciente; a verdade relativa e provisória em medicina, o que obriga a convivência com dúvidas e incertezas; a imensidão de conhecimentos necessários em reduzido tempo de formação; a inexistência e ineficácia de tratamento específico para várias doenças, o que exige que atue de forma a aliviar o sofrimento, e pouca influência sobre a evolução da história natural da enfermidade. Cada estudante, entretanto, reage a essas tensões de acordo com sua maturidade emocional, e muitas delas são inevitáveis e se dissipam naturalmente, sem maior consequência, à medida que avança no curso. É importante que o estudante seja provocado a desenvolver juízo crítico e discernimento, para que não se limite à objetividade da medicina, nem aceite passivamente esquemas, normas, diretrizes, e que esse desafio o projete para sua inserção decisiva em defesa do bem-estar do paciente. (AU)
Can medical school be a source of anxiety? There are several situations to which the medical student is exposed, and which are of high tension, such as: the singularity of each patient; the relative and provisional truth in medicine, which requires the coexistence with doubts and uncertainties; the immensity of knowledge required in a short period of training; the inexistence and inefficacy of specific treatment for various diseases, which requires that it act in a way to relieve suffering, and little influence on the evolution of the natural history of the disease. Each student, however, reacts to these tensions according to their emotional maturity, and many of them are inevitable and dissipate naturally, without further consequence, as the course progresses. It is important that the student be challenged to develop critical judgment and discernment, so that it is not limited to the objectivity of medicine, or passively accepted schemes, norms, guidelines, and that this challenge projects him to his decisive insertion in defense of the well-being of the patient. (AU)
Subject(s)
Physician-Patient Relations , Patient Comfort , Students , Students, Medical , Physicians' Offices/ethics , Medical History TakingABSTRACT
O relacionamento médico-paciente requer não só o conhecimento das técnicas da entrevista clínica, mas, também, é preciso ter a consciência de que o mundo do paciente e sua família, pode ser tão diverso daquele domédico, que a comunicação só será possível se souberusar a principal qualidade do método clínico, a sua flexibilidade. (AU)
The doctor-patient relationship requires not only the knowledge of the techniques of clinical interview, but also, it is necessary to be aware that the world of the patient and his family may be so different from that of the doctor, that communication will only be possible if able to use the main quality of the clinical method, its flexibility. (AU)
Subject(s)
Physician-Patient Relations , Students, Medical , Physicians' Offices , Medical History TakingABSTRACT
This exploratory study aimed to investigate the predisposing, enabling and health need characteristics associated with lack of medical visits in the last 12 months, among 23,620 elderly hypertensive and/or diabetic individuals. In this research, we used the theoretical behavioral model of Andersen and Newman for use of health services. The data analyzed were produced by the health supplement of the Brazilian National Household Survey (PNAD) 2008, nationwide. To identify the associations, we used the Poisson regression model, which estimates the prevalence ratios and confidence intervals of 95%, considering the significance level of 5%. The results showed that 10.6% of the study population did not consult the doctor in the period considered, and the prevalence was higher among hypertensive subjects (10.5%) than among diabetic ones (7.1%). The lack of medical consultation was negatively associated with female sex and increasing age (predisposing characteristics), with health insurance coverage (enabling characteristic), worse self-rated health, chronic health conditions selected and the presence of hypertension associated with diabetes (health needs), while the fact of living in the Northeast, North and Midwest appeared positively associated with the event under investigation. These results corroborate those observed in national and international studies and show evidence of inequality and inequity in the use of medical consultation for this population, based on the findings related to health plan coverage and geographic region.
O presente estudo, de caráter exploratório, teve como objetivo investigar as características predisponentes, facilitadoras e de necessidades de saúde associadas à não realização de consulta médica nos últimos 12 meses, junto a 23.620 idosos hipertensos e/ou diabéticos. Nesta investigação, utilizou-se como referencial teórico o modelo comportamental de Andersen e Newman para utilização de serviços de saúde. Os dados analisados foram produzidos pelo Suplemento de Saúde da Pesquisa Nacional por Amostra de Domicílios (PNAD) 2008, de abrangência nacional. Para identificação das associações, utilizou-se o modelo de regressão de Poisson, que estima razões de prevalências e respectivos intervalos de confiança de 95%, considerando-se o nível de significância de 5%. Os resultados mostraram que 10,6% da população estudada não consultaram o médico no período considerado, sendo que a prevalência foi maior entre hipertensos (10,5%) do que entre diabéticos (7,1%). A ausência de consulta médica esteve negativamente associada com o sexo feminino e com o aumento da idade (entre as características predisponentes), com a posse de plano de saúde (característica capacitadora), pior autoavaliação de saúde, presença de condições crônicas de saúde selecionadas e presença da hipertensão associada ao diabetes (entre as necessidades de saúde); já o fato de residir nas regiões Nordeste, Norte e Centro-Oeste apresentou-se positivamente associado ao evento investigado. Esses resultados corroboram o observado em estudos nacionais e internacionais e apontam indícios de desigualdade e iniquidade na utilização da consulta médica pelos idosos hipertensos e/ou diabéticos, a partir dos achados relativos à cobertura por plano de saúde e região geográfica.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , Referral and Consultation , Brazil/epidemiology , Family Characteristics , Prevalence , Health ServicesABSTRACT
OBJETIVO: Analisar as desigualdades socioeconômicas na utilização de consultas médicas (CM) no último ano no Brasil. MÉTODOS: Dados da Pesquisa Nacional por Amostra de Domicílios (≥ 20 anos de idade) das Regiões Nordeste (2003, n = 75.652 e 2008, n = 79.779) e Sudeste (2003, n = 76.029 e 2008, n = 79.356) foram analisados segundo CM. Compararam-se as prevalências de CM segundo as variáveis exploratórias demográficas e de saúde no primeiro (D1) e último (D10) decil de renda familiar per capita. As análises consideraram o desenho amostral complexo. RESULTADOS: A proporção de pessoas com CM aumentou no período na Região Nordeste (61,2 para 66,9%) e Sudeste (67,9 para 73,5%). A diferença absoluta de CM, segundo D1 e D10 no período, foi de 6,4 pontos percentuais (pp) no Nordeste e 4,2 pp no Sudeste. Houve importante redução das desigualdades entre os homens; naqueles sem doenças crônicas; naqueles que tinham uma percepção positiva da sua saúde e naqueles sem plano de saúde com direito a CM. A Região Sudeste ainda apresentou redução entre aqueles com apenas uma morbidade autorreferida (8 pp) e com percepção negativa da saúde (6 pp). CONCLUSÃO: Houve aumento de CM no Brasil. Observa-se ainda persistente desigualdade entre os mais pobres e os mais ricos, maior no Nordeste do que no Sudeste. Políticas para a redução da desigualdade em saúde mais eficazes e equânimes devem ser adotadas no Brasil. .
OBJECTIVE: To analyze the socioeconomic inequalities in medical visits (MV) in the past year in Brazil. METHODS: Data from adults aged ≥ 20 years old who participated in the Brazilian National Household Surveys and living in the Northeastern (2003; n = 75,652 and 2008, n = 79,779) and Southeastern (2003; n = 76,029 and 2008; n = 79,356) regions were analyzed according to MV. We compared MVs according to demographic and health variables in the first (D1) and last (D10) per capita family income deciles. All analyses considered the complex cluster design. RESULTS: The proportion of people who had MV during this period increased in the Northeastern (from 61.2 to 66.9%) and the Southeastern (from 67.9 to 73.5%) regions. The absolute difference (AD) in the use of MV, according to D1 and D10 in this period, was equal to 6.4 percentage points (pp) in the Northeastern and 4.2 pp in the Southeastern regions. Significant reduction in inequalities was observed among men without chronic diseases, in those who had a positive perception of their health, and among those without health insurance which included MV. The Southeastern region has also showed significant reduction among those with chronic disease (8 pp) and with negative health self-perception (6 pp). CONCLUSION: The increasing number of MVs was found in Brazil. However, persistent inequalities were observed between the poorest and the richest, higher in the Northeastern than in the Southeastern region. More effective and equitable policies to reduce health inequalities should be adopted in Brazil. .
Subject(s)
Animals , Female , Humans , Mice , Adenocarcinoma/pathology , Colonic Neoplasms/pathology , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Neoplasm Metastasis/pathology , Adenocarcinoma/drug therapy , Antimetabolites, Antineoplastic/therapeutic use , Antineoplastic Agents, Phytogenic/therapeutic use , Cell Adhesion , Cell Line, Tumor , Camptothecin/analogs & derivatives , Camptothecin/therapeutic use , Collagen Type II/metabolism , Colonic Neoplasms/drug therapy , Fibronectins/metabolism , Floxuridine/therapeutic use , Fluorouracil/therapeutic use , Laminin/metabolism , Liver Neoplasms/drug therapy , Mice, Nude , Models, Biological , Neoplasm Metastasis/prevention & control , Paclitaxel/therapeutic useABSTRACT
The medical consulting service, disease inquiry and seeking medical advice functions of 10 commonly available APP software in China for seeking medical advice, such asRapid Asking Doctors,Handholding Doc-tor Selection, andChunyu Handholding Doctors, were compared, which showed that although the functions of APP software in China for seeking medical advice could meet the requirement of people for seeking medical advice, importance should be further attached to their accurate and integrative information and establishment of profit-making model in order to promote the sustainable development of medical APP software.
ABSTRACT
In Latin America there is little information about the frequent reasons of medical consultation and euthanasia in dogs, and the implications of behavior problems. Especially in Uruguay there isn't information about it. The aim of this study was to know the most frequent reasons for medical consultation and euthanasia of dogs in Montevideo city through a survey of veterinary practitioners and the implications of behavioral problems. A survey to veterinary practitioners from one hundred (n = 100) randomly sampled veterinary clinics in the city of Montevideo was carried out. The most frequent reasons for medical consultation about dogs in veterinary practioners are consultations of skin affections, followed by digestive and respiratory affections, and less frequently infections, accidents and neoplasias (p < 0.0001). The behavioral problems occupied only the 1% of the reasons for medical consultation in dogs. The most frequent reasons for euthanasia of dogs were by elderly dog and neoplasias, followed by kidney affections, infections and accidents (p < 0.0001). Only 35% of veterinarians performed euthanasia for behavioral problems in their clinics. Among them, the euthanasia for behavior problems accounted for only 2%. Although euthanasia is carried out in Uruguay for behavior problems, it is so in a very low percentage.
En América Latina existe poca información acerca de los motivos frecuentes de consulta médica y eutanasia en perros, así como de las implicaciones de los problemas de comportamiento. Especialmente en Uruguay no hay información al respecto. El objetivo de este estudio fue conocer las causas más frecuentes de consulta médica y eutanasia de los perros en la ciudad de Montevideo a través de una encuesta a los médicos veterinarios, y la implicancia de los problemas de comportamiento. Se realizó una encuesta a una muestra aleatoria (n = 100) de médicos veterinarios de clínicas de Montevideo. Las causas más frecuentes de consulta médica por dueños de perros son las afecciones de la piel, seguido de afecciones digestivas y respiratorias, y menos frecuentemente las infecciones, los accidentes y los neoplasias (p < 0,0001). Los problemas de conducta ocupan solo el 1% de los motivos de consulta. Las razones más frecuentes para la eutanasia de perros fueron por edad (ancianos) y por neoplasias, seguidas por afecciones renales, infecciones y accidentes (p < 0,0001). Solo el 35% de los veterinarios ha llevado a cabo eutanasias en sus clínicas; entre ellas, la eutanasia por los problemas de conducta representó apenas el 2%. Aunque en Uruguay se realizan eutanasias por problemas de comportamiento, las mismas se dan en un muy bajo porcentaje.
ABSTRACT
O atendimento ginecológico de qualidade na adolescência vem se tornando cada vez mais necessário na atualidade devido à ocorrência mais precoce da atividade sexual, com consequente aumento das gestações não planejadas, das doenças sexualmente transmissíveis e da probabilidade de câncer de colo uterino. Este estudo teve como objetivo avaliar a consulta ginecológica sob a ótica dos médicos e das adolescentes. Foi desenvolvido um estudo de corte transversal através de questionário estruturado aplicado a 191 ginecologistas filiados à Associação de Ginecologia e Obstetrícia do Estado do Rio de Janeiro e a 418 estudantes do ensino médio de escolas estadual, federal e privada da cidade do Rio de Janeiro. Os médicos responderam questões sobre dados pessoais, qualificação profissional, condutas na culsuta ginecológica e sobre a necessidade de capacitação para o atendimento de adolescentes. Para as colegiais foram abordados aspectos sócio-demográficos, comportamento sexual e avaliação da consulta ginecológica. Para a análise dos dados utilizou-se o teste qui-quadrado e o t de student. Os resultados mostraram que não houve diferenças significativas entre as escolares do ensino privado e da escola pública federal que, no entanto, apresentaram características distintas quando comparadas às estudantes da instituição estadual. Estas eram predominantemente da raça negra, com responsáveis de menor escolaridade e tinham piores condições de moradia. Apesar do maior número de parceiros, gestações e de abortamentos, além de histórico de violência sexual, foram à consulta ginecológica em idade mais tardia, devido à dificuldade de acesso a serviços de saúde sexual e reprodutiva. Os três grupos de estudantes manifestaram, em comum, o desejo de que o profissional investisse mais tempo, paciência e disponibilidade no atendimento ginecológico. Quanto aos profissionais, foi constatado que os mais jovens e as do sexo feminino apresentaram atitudes consideradas menos conservadoras...
The qualified gynecological consultation with adolescents has become an increasing necessity nowadays due to the early occurrence of sexual activity and as consequence, the increase of umplanned pregnancies, STD and the probability of cervical cancer. This study had the objective of evaluating the gynecological consultation under the doctors' and adolescents' point of view. Investigations with qualitative and quantitative methods were made to achieve it, with the predominance of the latter. In the qualitative method, we conducted an analysis of the phenomenon in-depth studies during the interviews with adolescents and gynecologists. A cross-sectional study was developed by structured questionary applied to 191 gynecologists from the Associação de Ginecologia e Obstetrícia do Estado do Rio de Janeiro and to 418 high school students (Federal, State and Private) from Rio de Janeiro. Data collected included personal information, professional qualification, procedures during gynecological consultation and about the necessity of specific training for the adolescents' consultations. The students' interview dealt with social and demographic aspects, sexual behavior and evaluation of gynecological consultation. To analyze the data we used the Chi-square test and the Student's t. The results showed no significant differences between students from private and federal schools, but presented distinct characteristics when compared to the state school girls' answers. The latter, with the predominance of afro-descendents, their parents had lower education levels, and worse house conditions. These students prsented a higher number of pregnancies, abortions and sexual partners, and sexual violence history, they had later contact with gynecological consultation due to the difficulty of access to sexual and reproductive health outpatient clinic. The three groups of students showed the common wish for more time with the physicial, patience and availability...
Subject(s)
Humans , Female , Adolescent , Adolescent Health , Contraception , Cross-Sectional Studies , Gynecology , Pregnancy in Adolescence/prevention & control , Office Visits , Physician-Patient Relations , Sexual Behavior , Sexuality , Unsafe Sex , Sexually Transmitted Diseases/prevention & controlABSTRACT
The number of Internet users is rapidly increasing in Korea. Because of the busy modern life style, demands for the convenient medical services using the Internet are also increased. There are about 10,000 medical Internet sites in Korea. However, several surveys on the Internet medical information in Korea have shown disapointing results. As in other nations medical information is often inappropriate for the questions and some might be even harmful. Somewhat insufficient role of the Internet medical consultation do not satisfy the people' needs. There are eseveral movements for the improving medical Internet information system in Korea but are still at the beginning state. By using the Internet technology, telemedicne for the remote area, for the dementia patients, for the emergency care, and for the elderaly have been tried in Korea. But legal problems, insufficient evidence for its efficiency, and several other drawback make telemedicine be still remaining at the experimental state. However, increasing demands for the better medical services, developing inforamtion technology, expanding high-velocity network system, and fucure capacity mobile communication systems will obviate these problems in the near future.
Subject(s)
Humans , Dementia , Emergency Medical Services , Information Systems , Internet , Korea , Life Style , TelemedicineABSTRACT
OBJECTIVE:To seek for the countermeasures to standardize the administration of medical consultation service in the retail pharmacy.METHODS:To analyse the existing problems of the consultation service in the retail pharmacy.RESULT_S&CONCLUSION:We suggest that the consultation service should be carried out by speciallyassigned persons,CIS should be introduced,computer network should be manipulated and a standardized administration system should be established.Only in this way can the quality of service be raised and the security of medication of the public be ensured.