Impacto de la pandemia por COVID-19 en la población pediátrica con apendicitis aguda: experiencia en un hospital general de tercer nivel / Impact of the COVID-19 pandemic on the pediatric population with acute appendicitis: Experience at a general, tertiary care hospital

Introducción. La apendicitis constituye la principal causa de abdomen agudo quirúrgico en pediatría. Durante la pandemia por COVID-19, se replantearon las estrategias de manejo ydisminuyeron las consultas en las guardias, lo que podría asociarse a diagnósticos tardíos y complicaciones. El objetivo de este estudio fue analizar el impacto de la pandemia en los niños con apendicitis aguda. Métodos. Estudio analítico retrospectivocomparativo de pacientes pediátricos conapendicitis aguda durante los cinco meses del confinamiento por COVID-19 versus los meses equivalentes del año previo. Se analizaron la incidencia, la clínica, el estadio, el abordajequirúrgico y las complicaciones. Resultados. Los casos totales de apendicitisse redujeron un 25 % (n = 67 versus n = 50 en 2020). El tiempo medio hasta la consulta fue de 24 horas en ambos períodos (p = 0,989). La incidencia de peritonitis fue del 44 % (n = 22) versus el 37 % (n = 22) (p = 0,22) en 2019. No se evidenció diferencia en los estadios deenfermedad de acuerdo con lo informado en los partes quirúrgicos. En 2019, todas las cirugías se realizaron por vía laparoscópica; en 2020, solo un42 % (n = 21). La incidencia de complicaciones fue del 6 %, contra 7,5 % en el período previo (p = 0,75). Un paciente fue COVID-19 positivo. Conclusión. A pesar de la reducción en el númerode casos de apendicitis, no se evidenció una demora en la consulta en nuestra población. El mayor impacto se asoció a la readecuación del manejo, evitando el abordaje laparoscópico para reducir la diseminación del virus.

Introduction. Appendicitis is the leading cause of surgical acute abdomen in pediatrics. During the COVID-19 pandemic, management strategies were reassessed and the number of visits to the emergency department dropped down, which may be associated with delayed diagnoses and complications. The objective of this study was to analyze the impact of the pandemic on children with acute appendicitis. Methods. Analytical, retrospective, comparative study of pediatric patients with acute appendicitis in the 5 months of COVID-19 lockdown versus the same period in the previous year. Incidence, clinical data, stage, surgical approach, and complications were analyzed. Results. The total number of appendicitis cases went down by 25 % (n = 67 versus n = 50 in 2020). The mean time to consultation was 24 hours in both periods (p = 0.989). The incidence of peritonitis was 44 % (n = 22) versus 37 % (n = 22) (p = 0.22) in 2019. No differences were  observed in terms of appendicitis stage based on surgery reports. In 2019, all surgeries were laparoscopic; while in 2020, only 42 % (n = 21). The incidence of complications was 6 % versus 7.5 % in the previous period (p = 0.75). One patient was COVID-19 positive. Conclusion. Although in our population the number of appendicitis cases dropped down, consultation was not delayed. The greater impact was associated with the reformulation of management strategies, in which the laparoscopic approach is avoided to reduce virus transmission.

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

ABSTRACT Objectives To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.

Impact of the COVID-19 pandemic in the time to endoscopy in patients with upper gastrointestinal bleeding / Impacto de la pandemia de COVID-19 en el tiempo hasta la endoscopia en pacientes con hemorragia digestiva alta

ABSTRACT Introduction : During the COVID-19 pandemic, endoscopic procedures are associated with a high risk of SARS-CoV-2 infection. However, in cases of upper gastrointestinal bleeding (UGIB), priority should be given to an early endoscopy. Objective : The main objective was to compare the time since arrival at the hospital and the performance of the endoscopy between both groups. Materials and methods : We performed a retrospective study. Data contains information of patients who attended to the hospital with UGIB and underwent an endoscopy between October 19th, 2019 and June 6th, 2020. Patients were divided into 2 phases: pre-pandemic and pandemic. The time between arrival at the hospital and the performance of the endoscopy in both phases were compared as well as other indicators such hospital stay and in-hospital mortality. Results : With information from 219 patients, the median age was 69 years. 154 and 65 endoscopies were performed in pre-pandemic and pandemic phase, respectively. The time between arrival at the hospital and the performance of the endoscopy was significantly longer during the pandemic (10.00 vs. 13.08 hours, p-value = 0.019). Nevertheless, there were no significant differences in hospital stay or mortality. Conclusion : The management of patients with UGIB during the COVID-19 pandemic is complex and requires the application of clinical judgment to decide the best timing to perform an endoscopy without affecting patient care.

RESUMEN Introducción : Durante la pandemia de COVID-19, los procedimientos endoscópicos se asocian con un alto riesgo de infección por SARS-CoV-2. Sin embargo, en casos de hemorragia digestiva alta (HDA), se debe dar prioridad a una endoscopia precoz. Objetivo : El objetivo principal fue comparar el tiempo transcurrido desde la llegada al hospital y la realización de la endoscopia entre ambos grupos. Materiales y métodos : Realizamos un estudio retrospectivo. Los datos contienen información de pacientes que acudieron al hospital con HDA y fueron sometidos a endoscopia entre el 19 de octubre de 2019 y el 6 de junio de 2020. Los pacientes se dividieron en 2 fases: prepandémica y pandémica. Se comparó el tiempo transcurrido entre la llegada al hospital y la realización de la endoscopia en ambas fases, así como otros indicadores como la estancia hospitalaria y la mortalidad intrahospitalaria. Resultados : Con información de 219 pacientes, la mediana de edad fue de 69 años. Se realizaron 154 y 65 endoscopias en fase prepandémica y pandémica, respectivamente. El tiempo entre la llegada al hospital y la realización de la endoscopia fue significativamente mayor durante la pandemia (10,00 frente a 13,08 horas, valor de p = 0,019). Sin embargo, no hubo diferencias significativas en la estancia hospitalaria ni en la mortalidad. Conclusión : El manejo de pacientes con HDA durante la pandemia de COVID-19 es complejo y requiere la aplicación del juicio clínico para decidir el mejor momento para realizar una endoscopia sin afectar la atención del paciente.

Interventional Pulmonology and COVID-19: Experience from a Malaysian Tertiary Hospital

The ongoing pandemic of COVID-19 has presented multiple challenges to global healthcare services, dictating changes in almost every aspect of daily medical practice. Performing aerosol generating procedures (AGPs) in the field of interventional pulmonology can lead to profound formation of aerosols, leading to a high risk of infection among healthcare workers (HCWs). We share our experiences on performing AGPs in the midst of a COVID-19 pandemic by focusing on changes in AGP practices. In a pandemic, HCWs ought to adapt to the ever-changing situation and use available resources to provide the best possible healthcare to patients, ensure safety of staff, and continue medical education of future pulmonologists.

Consumo do benzodiazepínico clonazepam (Rivotril®) no estado do Rio de Janeiro, Brasil, 2009-2013: estudo ecológico / Consumption of the benzodiazepine clonazepam (Rivotril®) in Rio de Janeiro State, Brazil, 2009-2013: an ecological study

Resumo O objetivo do estudo é estimar a prevalência do uso de clonazepam no Estado do Rio de Janeiro (RJ). Estudo ecológico e descritivo do consumo de clonazepam (2009-2013), com dados do Sistema Nacional de Gerenciamento de Produtos Controlados da Anvisa. O consumo foi medido pela Dose Diária Definida, com indicadores por população total e com 18 anos e mais utilizando a DDD padronizada de 8mg (anticonvulsivante) e a de 1mg (hipnosedativo). Os Municípios da Região Metropolitana foram agrupados segundo os Índices de Desenvolvimento Humano (IDH) e de GINI, submetidos à análise de conglomerados e apresentados segundo o consumo de clonazepam. No Estado do RJ, o consumo entre 2009 e 2013 aumentou de 0,35 para 1,97 DDD/1000 habitantes. Os valores são maiores para os indivíduos acima de 18 anos. Empregando-se 1mg ao invés de 8mg, chega-se a 21 DDD/1000 habitantes acima de 18 anos, em 2013. Rio de Janeiro e Niterói, com os maiores IDH, apresentaram em 2013 os maiores consumos, 3,38 e 4,52 DDD, respectivamente. Os dados sugerem que até 2% da população adulta é usuária de clonazepam, possivelmente como hipnosedativo. Deve-se atentar para o uso ampliado e fora de indicações terapêuticas, dados o potencial de abuso e as reações adversas ao clonazepam.

Abstract This descriptive, ecological study of clonazepam consumption in Rio de Janeiro State (RJ) estimated use prevalence from 2009 to 2013 using data from the National Controlled Product Management System operated by Brazil's health surveillance agency, Anvisa. Consumption was measured by total population and by population over 18 years old, using the standardised Daily Defined Doses of 8 mg (anticonvulsant) and 1 mg (sedative-hypnotic). The municipalities of the Rio de Janeiro Metropolitan Region were grouped by Human Development Index (HDI) and GINI index, subjected to cluster analysis and ranked by clonazepam consumption. From 2009 to 2013, consumption in the state rose from 0.35 to 1.97 DDD/1000 population, but the figures are higher for individuals over 18 years of age. A DDD of 1 mg instead of 8mg returns consumption in 2013 of 21 DDD/1000 population over 18 years of age. Consumption in 2013 was highest - 3.38 and 4.52 DDD, respectively - in Rio de Janeiro and Niterói, which have the highest HDIs. This suggests that up to 2% of the adult population uses clonazepam, possibly as a sedative-hypnotic. This broad use and use outside therapeutic indications deserves attention, given clonazepam's potential for abuse and adverse reactions.

Contributions of the nurse's clinical practice to Primary Care / Las contribuciones de la práctica clínica del enfermero a la asistencia en la Atención Primaria / Contribuições da prática clínica do enfermeiro para o cuidado na Atenção Primária

ABSTRACT Objective: To understand the repercussions of the nurse's clinical practice on Primary Health Care. Method: Qualitative research with the theoretical and methodological contribution of Grounded Theory. Data collection took place between May and October 2016 in Florianópolis' Primary Care service. The theoretical sample was comprised of 18 nurses divided into two groups. Results: nurses' clinical practice has repercussions on the consolidation of the trust bond between individuals, families and communities, by amplifying the problem-solving efficacy of the Primary Health Care professional's clinical practice. This is due to the implementation of clinical nursing protocols, and also the use of the International Classification for Nursing Practice. Final considerations: Nurses' clinical practice has positive repercussions on the health of Primary Health Care users.

RESUMEN Objetivo: Identificar cómo la práctica clínica del enfermero influye en la asistencia a los usuarios de la Atención Primaria a la Salud. Método: Investigación cualitativa, utilizándose como marco teórico-metodológico la Teoría Fundamentada en los Datos. La recolección de datos ocurrió entre mayo y octubre de 2016, en el servicio de Atención Primaria de Florianópolis, Brasil. El muestreo teórico comprendió a 18 enfermeros, siendo que fueron divididos en dos grupos. Resultados: La práctica clínica del enfermero influye en la consolidación del vínculo de confianza con los individuos, la familia y la comunidad por medio de la ampliación de resolutividad de la práctica clínica del profesional en la Atención Primaria a la Salud por la implementación de los protocolos clínicos de enfermería y por el uso de la Clasificación Internacional para la Práctica de Enfermería, en este escenario, y sus contribuciones a una práctica clínica efectiva y de calidad. Consideraciones Finales: La práctica clínica del enfermero influye positivamente en la asistencia a los usuarios de la Atención Primaria a la Salud.

RESUMO Objetivo: Compreender como a prática clínica do enfermeiro repercute no cuidado aos usuários na Atenção Primária à Saúde. Método: Pesquisa qualitativa com aporte teórico metodológico da Teoria Fundamentada nos Dados. A coleta de dados ocorreu entre maio e outubro de 2016 no serviço de Atenção Primária de Florianópolis. A amostragem teórica compreendeu 18 enfermeiros divididos em dois grupos. Resultados: A prática clínica do enfermeiro repercute na consolidação do vínculo de confiança com os indivíduos, família e comunidade através da ampliação da resolutividade da prática clínica do profissional na Atenção Primária à Saúde pela implementação dos protocolos clínicos de enfermagem e, também, do uso da Classificação Internacional para a Prática de Enfermagem nesse cenário e suas contribuições para uma prática clínica efetiva e de qualidade. Considerações finais: A prática clínica do enfermeiro repercute de maneira positiva no cuidado à saúde dos usuários na Atenção Primária à Saúde.

Current trends of percutaneous nephrolithotomy in a developing country

ABSTRACT Introduction To present the current practice patterns on percutaneous nephrolithotomy (PCNL) in a developing country. Materials and Methods A survey was offered to Brazilian urologists during the II International Endourology Symposium held in Sao Paulo, in 2015. The first seven questions were related to demographic data while the 20 remaining were directed to urologists who performed PCNL. Results From 250 participants, 100 replied to the survey, 81% performed PCNL and 60.4% of performers had been in practice for less than 15 years. Eighty-one percent were trained in the prone position and 64% in supine. PCNL was learned during the residency in 66.7% and 2.5% had fellowship training. Prone position was the preferred decubitus for simple or complex calculi, though for obese patients there was no difference. Younger surgeons prefer supine while older surgeons prefer prone. The access was obtained by the surgeon in all cases, 96.3% use fluoroscopy and 3.7% prefer ultrasonography. Forty-seven percent use ultrasonic lithotripters and 4.1% laser. For kidney drainage, 71.6% place a nephrostomy tube. Double J stent is left in 77%. The postoperative image method was CT for 50%. Colonic injury was reported by 25%, predominantly in the senior group without statistically difference between positions. Conclusions From a selected group of urologists, we observe that Brazilian urologists usually gain their own access for PCNL guided by fluoroscopy. They predominantly prefer the prone position, use fascial dilators, ultrasonic lithotripters and place a nephrostomy tube when exiting the kidney. Fellowship programs, ultrasonography, flexible nephoscopy and tubeless procedures could be encouraged.

Guías Argentinas para el diagnóstico, la prevención y el tratamiento de la osteoporosis 2015 / Argentine guidelines for the diagnosis, prevention and treatment of osteoporosis, 2015

La osteoporosis es una enfermedad en constante crecimiento y que afecta a más de 200 millones de personas a nivel mundial. Nuestras recomendaciones son guías para el diagnóstico, la prevención y tratamiento, pero no normas para las decisiones clínicas en casos individuales. El médico debe adaptarlas a situaciones en la práctica clínica cotidiana, incorporando factores personales que trascienden los límites de estas guías y hacen al saber y al arte de la práctica médica. Como todo conocimiento científico, deben ser actualizadas periódicamente a medida que se adquieran nuevas, mejores y más efectivas herramientas diagnósticas y terapéuticas. (AU)

Osteoporosis is an evolving disease which affects over 200 million people worldwide. Our recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual cases. The physician must adapt them to individual special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the practice of Medicine. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available. (AU)

Drug utilization review of mupirocin ointment in a Korean university-affiliated hospital

BACKGROUND/AIMS: Intranasal mupirocin and chlorhexidine bathing are candidate strategies to prevent healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). In Korea, intranasal mupirocin is not available, and mupirocin ointment, an over-the-counter drug, has been used indiscriminately. Furthermore, because it is covered by health insurance, mupirocin is easy to prescribe within hospitals. METHODS: We performed a mupirocin drug utilization review (DUR) within Hallym University Sacred Heart Hospital. Annual use of mupirocin was investigated between 2003 and 2013, and monthly consumption of mupirocin was assessed during the final 2-year period. The DUR focused on August 2012, the period of highest use of mupirocin. Also, we investigated trends in mupirocin resistance in MRSA between 2011 and 2013. RESULTS: Annual consumption of mupirocin increased from 3,529 tubes in 2003 to 6,475 tubes in 2013. During August 2012, 817 tubes were prescribed to 598 patients; of these, 84.9% were prescribed to outpatients, and 77.6% at the dermatology department. The most common indication was prevention of skin infections (84.9%), and the ointment was combined with systemic antibiotics in 62.9% of cases. The average duration of systemic antibiotic administration was about 7.8 days. The rate of low-level mupirocin resistance in MRSA increased from 8.0% to 22.0%, and that of high-level mupirocin resistance increased from about 4.0% to about 7.5%. CONCLUSIONS: Inappropriate use of mupirocin is prevalent. Considering the increase in resistance and the future application of intranasal mupirocin, prophylactic use of mupirocin in dermatology departments should be reconsidered.

General Internists' Perspectives Regarding Primary Care and Currently Related Issues in Korea

Although primary care has been recognized as an essential element of the healthcare system, the primary healthcare of Korea has not been highly valued. Listening to the voices of physicians who are engaged in primary care should be the first step for improving the level of primary care in Korea. In this study, we conducted a questionnaire survey of general internists to investigate their perspectives regarding primary care, and which included the evaluation of current primary care, perception of the five, key attributes of primary care, and their opinions regarding the management system of chronic diseases. A total of 466 general internists' responses were used in this analysis. The results showed that primary care is considered to have an important role, according to general internists, although their evaluation of the overall status of primary care in Korea indicated that it is poor. The respondents also indicated that the functions of coordination and comprehensiveness in primary care, which can be integral for treating patients with chronic diseases, are most vulnerable. Given the high level of agreement regarding the need for a new medical management system for chronic diseases, based on physicians' autonomy and provided by clinics, establishing a policy encouraging the participation of general internists should be emphasized.

Changing Trends in Surgery for Retinal Detachment in Korea

PURPOSE: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013. METHODS: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001. RESULTS: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001). CONCLUSIONS: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.

Antimicrobial prescribing pattern in acute tonsillitis: a hospital based study in Ajman, United Arab Emirtaes

The objective of the present study was to determine the antimicrobial prescription pattern in patients with acute tonsillitis. A cross sectional study was carried out among all the patients attending the ENT outpatient department with acute tonsillitis from January 2011 to December 2011. The data were retrieved from the medical records using a questionnaire. Statistical analysis was carried out using SPSS. 19. A total of 238 patients were included in the study [Males 138; females 100]. The majority of the patients were Indians [49 [20.6%]], Emiratis [35 [14.7%]], and Pakistanis [31 [13%]]. The common types of tonsillitis noted were acute parenchymatous tonsillitis, acute follicular tonsillitis and acute pharyngotonsillitis. Of the total, seven [2.9%] patients had self medicated themselves prior to the hospital visit. About 96% of the total drugs were prescribed by brand name. The median number of drugs prescribed was four [range 1-7]. Eighty eight percent of the prescriptions contained antimicrobial agents, which was the most commonly prescribed group of drugs, followed by analgesics and antipyretics. Amoxicillin/Clavulanic acid [24.8%] and Ceftriaxone [12.2%] were the most commonly prescribed antimicrobials. About 23.7% of the patients on Amoxicillin/Clavulanic acid had received the drug as intravenous injection. Culture and sensitivity tests were carried out in 106 [44.5%] of the cases. Antimicrobials were changed/ added on after the culture and sensitivity test in 25 patients. No pattern was noticed with regard to the change in AMA; however Cefuroxime was the most frequently added AMA based on the sensitivity report. Therapeutic guidelines based on the current sensitivity pattern can be developed to optimize the use of antimicrobial agents and provide cost effective treatment

Cumplimiento del modelo maternidad segura centrada en la familia en el Departamento de Neonatología Hospital Materno Provincial Córdoba. Septiembre-Octubre 2012 / Compliance safe motherhood model family centered in the Department of Provincial Maternal and Neonatal Hospital Córdoba. September-October 2012

Valorar el cumplimiento del modelo MSCF según las madres y los miembros del equipo de salud en el Dto. de Neonatología del HMP de Córdoba, en el período Septiembre-Octubre 2012. Especifico:1)Caracterizar la población bajo estudio.2)Determinar acuerdos entre el equipo de salud y las madres respecto al Cumplimiento de Protección de derechos, Promoción de la Participación, Practica Efectiva-COPAP y Fortalecimiento de HAMN. 3) Objetivar posibles asociaciones entre edad y antigüedad del equipo de salud y Protección de derechos, situación de pareja de las madres y Promoción de la participación y finalmente entre edad y situación de pareja de las madres y Protección de los derechos. Material y Método: La población estudiada se conformó por la totalidad de los miembros del equipo de salud (enfermeras y médicos) que participaron de la asistencia directa de los neonatos internados y por una muestra, equivalente al 40%, de las madres que tuvieron sus hijos al menos 3 días internados en UCI/ UTI del Dto. de Neonatología del HMP de Córdoba. La muestra se seleccionó mediante técnica de muestreo aleatorio simple, por el número de terminación de Historia Clínica neonatal cuyo número sea múltiplo de 2.El estudio correspondió a una investigación descriptiva, transversal y prospectiva. Los datos fueron recogidos mediante la técnica de Encuesta (equipo de salud) y Entrevista voluntaria (madres) a través de un cuestionario aplicado durante la internación neonatal. Principales conclusiones y recomendaciones La característica poblacional reveló en el equipo de salud predominio femenino, enfermeras, >40 años y > 10 años de antigüedad. En las madres una media de 24,18 años, de 2 hijos y 32% en situación de pareja informal. Respecto al modelo MSCF, hubo acuerdos de Cumplimiento en Protección de los derechos., Promoción de la Participación y Prácticas efectivas-COPAP. Fortalecimiento de HAMN resultó en Cumplimiento (equipo de salud) y Total Cumplimiento (madres)...

To evaluate the performance of the model MSCF as mothers and members of the health team in the disc.Neonatal of HMP of Córdoba, in the period September-October 2012. Specific: 1) Characterize the population under study.2) Determine agreements between the health team and mothers regarding the Compliance rights protection, promotion of participation, Effective Practice and Capacity-COPAP HAMN. 3) Aim to possible associations between age and age of equipment health and rights protection, partner status of mothers and promoting engagement and finally between age and marital status of mothers and protection of rights. Material and Methods:The study population was formed by all members of the health team (nurses and doctors) who participated in the direct care of hospitalized infants and a sample equivalent to 40% of mothers who had their children hospitalized at least 3 days in ICU / ICU of Disc. Neonatal of HMP Cordoba. The sample was selected by simple random sampling technique, by the number of termination of neonatal clinical history whose number is multiple of 2. The study corresponded to a descriptive, cross-sectional and prospective research. Data were collected by the technique of Inquiry (health team) and voluntary Interview (mothers) through a questionnaire administered during the neonatal hospitalization. Main conclusions and recommendations Population feature revealed in female-dominated health team, nurses,> 40 and> 10 years old. In mothers an average of 24.18 years, 2 children and 32% in extreme casual partner. Regarding the model MSCF, there were agreements Compliance rights protection., Promotion of Participation and effective-COPAP Practices. Strengthening HAMN resulted in Compliance (health team) and Total Compliance (mothers)...

Validación de una escala para medir el bienestar subjetivo de los médicos (BISUMED) / Generation and validation of a scale to measure physicians' wellbeing

Background: The recent and ongoing changes in the structure and social organization of medicine have deeply transformed medical practice. Aim: To study the perception of these changes by physicians, the impact of these changes in their subjective wellbeing and their strategies of adjustment. Material and Methods: A scale, consisting of 54 items grouped in nine dimensions to measure physicians’ subjective wellbeing was devised. It was applied to a random sample of 580 physicians residing in Metropolitan Santiago and affiliated to the Colegio Médico de Chile (the Chilean Medical Association). Results: The internal consistency analysis in the instrument showed a global Cronbach´s alpha of 90 percent. Conclusions: These results support our methodological approach based on an initial qualitative identification of relevant topics in our local context, which afterwards were included as items in the scale to measure specific components of subjective wellbeing.

Atitude médica e autonomia do doente vulnerável / Medical attitude and vulnerable patient's autonomy

Este artigo apresenta os resultados de pesquisa envolvendo amostra de 42 médicos de um serviço de oftalmologia de hospital terciário em Portugal. Foi aplicado um questionário com dez perguntas, destinado a avaliar as atitudes de três grupos de médicos com idades e formação pedagógica distintas, em face da autonomia do doente glaucomatoso. Os dados foram analisados indicando a correlação descritiva por meio do teste de Pearson c2. Resultam três atitudes diferentes com significado estatístico (valor de p<0,05) permitindo considerar a existência de três padrões de comportamento médico, adequados ao grupo etário. A formalização da prática médica à medida que a idade diminui (medicina defensiva) caracterizou o Grupo 1. O respeito pelo doente dominou o Grupo 2. No Grupo 3 prevaleceu a tendência para a medicina paternalista, onde o esclarecimento depende da educação e caráter do médico. Conclui que a conduta dos médicos remonta ao momento em que iniciaram a atividade profissional, à cultura médica predominante no período e à formação bioética.