Determinantes de la mortalidad infantil en Colombia: path análisis / Determinants of infant mortality in Colombia: path analysis

RESUMEN Objetivo Separar y analizar los efectos de los factores biológicos, ambientales, socioeconómicos, de atención médica y servicios de salud; y su probabilidad de generar una muerte infantil. Materiales y Métodos Se aplica el Path análisis utilizando las características del niño y de la madre en los registros individuales de nacimiento y defunción infantil, y la disponibilidad de camas materno infantil entre 2003 y 2009. Resultados El efecto biológico más importante para asegurar la supervivencia infantil fue el peso al nacer cerca de las 37 semanas de gestación. La principal intervención para reducir la mortalidad infantil fue el control prenatal. Variables socioeconómicas para la supervivencia infantil fueron la educación de la madre, acceso a servicios materno infantil para el régimen contributivo en el mismo municipio de residencia, el cual se encontró asociado a la calidad de los servicios de salud. Conclusiones El estudio sugiere que, además de participar en acciones de promoción de la salud, las madres del régimen subsidiado deben tener acceso a camas de cuidado intensivo neonatal, disponibles en el mismo departamento de residencia, para contribuir a reducir la mortalidad infantil.(AU)

ABSTRACT Objective To disentangle the singular effects of biological, environmental, socioeconomic, and medical factors on the probability for infants to die. Materials and Methods Apply a Path Analysis to Colombia's complete records of infant births and deaths, and the availability of maternal and child health services, during 2003-2009. Results From a biological perspective, a high birth weight resulting from a normal gestational age is the most important variable to ensure the infant's survival. Prenatal care is key to reduce infant mortality. From a socioeconomic perspective, high levels of education and relative access to high quality care in the contributory social health insurance regime for maternal residence, contribute to higher chances of infant survival. Conclusions Related findings suggest that augmenting access to maternal, child and intensive care beds supported by the subsidized regime can reduce infant mortality.(AU)

Desarrollo de la competencia médica para el ejercicio profesional en centros ambulatorios / Development of competence for the professional practice in ambulatory centres

El desarrollo de competencias, es una característica profesional que trasciende las aulas, y cuyo progreso se describe como un proceso continuo. En un grupo de médicos se planeó analizar el grado de identificación con aspectos de la competencia presentados "Modelo de tres circulos" y la opinión de los mismos sobre el contexto laboral donde se inician como profesionales, siguiendo un diseño cuantitativo-cualitativo. Participaron 296 médicos egresados de 8 universidades venezolanas (promedio de egreso: 9 meses desviación estándar: 5,41 meses). Laborando en abulatorios rurales. Se utilizó un modelo descriptivo de la competencia que agrupa las actitudes, habilidades y conocimientos en 12 dominios, para elaborar dos cuestionarios validados llamados "dominios clínicos" de 95 ítems, y "dominios no clínicos" de 75 ítems, con un escalamiento tipo Likert de cinco puntos, con una confiabilidad aceptable (Alfa>0,75). Con el objeto de explorar las posibles variaciones entre diferentes subgrupos de la muestra de médicos, se consideraron las variables procedencia y universidad de origen. Para este fin se compararon los promedios de cada subgrupo en los puntajes totales de cada cuestionario mediante análisis de varianza o Kruskal Wallis, usando el programa SPSS versión 12.0 y Excel 2003. Los datos cualitativos relativos a opiniones sobre su experiencia laboral, se recogieron en 146 médicos mediante un cuestionario de preguntas abiertas, y un diario de campo, triangulando con tres informantes claves. Esta información fue procesada usando el programa Atlas/ti versión 4.2. Se encontró que los médicos se identifican con los aspectos de la competencia explorados en un 79% y se observaron diferencias significativas en los puntajes promedio de los instrumentos según la universidad de origen. La exploración cualitativa mostró una opinión desfavorable, en los médicos participantes en el estudio, hacia el ejercicio en centros ambulatorios, relacionada con factores económicos...

The development of competition is a profesional characteristic which go beyond the lecture room and its progress is described as a continual process. In a medical group it was decided to analyze the identification level with competition included in the model of the three circles and their opinions on the labour context where they begin as professionals, following a qualitative-qualitative design. In the study participate 296 medical doctors from 8 venezuelan universities (avaerage time of graduation: 9 ± 5,4 months) and working in rural health clinics. A descriptive competition model was used which includes evaluation of attitudes, skills and knowledge on 12 scopes, in order to elaborate two validated questionnaires: clinical (95 items) and non clinical (75 items), in a Lickert scale of five points with acceptable confidence (Cronbach alpha > 0.75. In order to explore possible vartation among the different sub-group of the sample of medical doctors, origin and university were considered. Mean scores from each type of questionnaire were compared by analysis of variance or Kruskall Walls test using the Statistical Package for the Social Sciences, 12th version and Excel 2003. Opinions on labour experience were collected from 146 medical doctors by means of a set of open ended questions and a field work diary and triangulation with three key informants. This qualitative data was processed by means of the Atlas/ti program, version 4.2. According to the results the medical doctors identified themselves in a 79% with the competition explored aspects. The qualitative inquire show unfavourable opinions from the participants medical doctors on their practice in the raraul clinics in relation to economic factors, labour contest and few opportunities to professional bring up. to date

A relação entre o acompanhamento médico e a incidência de lesões esportivas em atletas jovens de São Paulo / Relation between medical clinical monitoring and the incidence of sports injuries in young athletes of São Paulo

O objetivo deste estudo foi relacionar a estrutura médica de atendimento de 20 clubes de São Paulo com a incidência de lesões esportivas de atletas jovens praticantes do basquetebol, futsal e voleibol. Para isso, foi utilizado um questionário de lesão com 323 atletas e uma entrevista estruturada com os médicos responsáveis. Foram identificadas 343 lesões esportivas ou 1,7 lesão/atleta/ano. Dos 20 clubes avaliados, apenas oito possuem atendimento médico especializado dentro da instituição. No basquetebol, não houve relação estatística entre a presença ou não do médico dentro do clube com as ocorrências de lesão. No futsal e no voleibol, o número de lesões foi maior com a presença do médico dentro do clube; isso porque nos clubes que não possuem médico, as lesões de menor gravidade não são detectadas. O estudo sugeriu reestruturação no atendimento médico oferecido aos atletas jovens.

The objective of this study was to evaluate the relation between medical clinical monitoring and the incidence of the main sports injuries found in young athletes in sports modalities such basketball, indoor soccer and volleyball from 20 clubs located in São Paulo (Brazil). To obtain those data, a questionnaire was applied to 323 athletes and surveys were performed among eight physicians. The results of the study showed a total of 343 injuries or 1,7 injury/athlete/year. In basketball, there was not statistic relation between rates of injury and clinical monitoring in the club. In indoor soccer and volleyball, the rate of injury was bigger with clinical monitoring, because the injuries of less gravity do not are detected in clubs without physician. This study suggest specialized clinical care for young in sports clubs.