Aprendizagem sobre teleconsulta: representações de um grupo de alunos de um curso de Medicina / Learning about teleconsultation: representations of a group of Medical students / Aprendizaje sobre teleconsulta: representaciones de un grupo de alumnos de un curso de Medicina

Com o avançar da tecnologia, passou a fazer parte da graduação médica atual o aprendizado em teleconsultas. Esta pesquisa apresenta as representações de um grupo de alunos de um curso de Medicina localizado na capital do estado de São Paulo sobre suas experiências com a realização de teleconsultas síncronas supervisionadas durante estágio realizado em um ambulatório-escola, durante o segundo semestre de 2021. Trata-se de pesquisa qualitativa que utilizou o software IRaMuTeQ® e "Análise do Conteúdo". Esses educandos pontuam entraves para a utilização das teleconsultas, destacando preocupações com a humanização, segurança da pessoa atendida e qualidade da consulta, mas visualizam potencialidades tais como a facilidade de acesso e a comodidade. Reconhecem a importância da prática durante sua Graduação em um mundo cada vez mais tecnológico, mas trazem inquietações relacionadas à perda do exame físico e à mercantilização da Medicina.

With the progress of technology, teleconsultation has become part of medical degree courses. This article presents the representations of a group of medical students from a university in the capital of the state of São Paulo regarding their experiences with supervised synchronous teleconsultations during an internship in a teaching clinic in the second semester of 2021. We conducted a qualitative study using the software IRaMuTeQ® and content analysis. The students highlighted barriers to the use of teleconsultation, emphasizing concerns with humanization, patient safety and consultation quality, but also perceived strengths such as ease of access and convenience. They recognize the importance of practice on the degree course in an ever more technological world, but raise concerns about the lack of physical examination and the commodification of medicine.

Con el avance de la tecnología, el aprendizaje en teleconsultas pasó a formar parte de la graduación médica actual. Esta investigación presenta las representaciones de un grupo de alumnos de un curso de medicina localizado en la capital del estado de São Paulo sobre sus experiencias con la realización de teleconsultas sincronizadas supervisadas durante una pasantía realizada en un ambulatorio escuela, durante el segundo trimestre de 2021. Se traba de una investigación cualitativa que utilizó el software IRaMuTeQ® y Análisis de Contenido. Estos alumnos puntúan obstáculos para la utilización de las teleconsultas, destacando preocupaciones con la humanización, seguridad de la persona atendida y calidad de la consulta, pero visualizan potencialidades tales como la facilidad de acceso y la comodidad. Reconocen la importancia de la práctica durante su graduación en un mundo cada vez más tecnológico, pero presentan inquietudes relacionadas a la pérdida del examen físico y a la mercantilización de la medicina.

Análise da percepção de médicos do Sistema Único de Saúde sobre o uso da teleinterconsulta em Campo Grande-MS, Brasil / Analysis of the perception of doctors of the Unified Health System about the use of teleconsultation in Campo Grande-MS, Brazil / Análisis de la percepción de los médicos en el Sistema Único de Salud sobre el uso de la teleconsulta en Campo Grande-MS, Brasil

Resumo O presente estudo visou analisar a percepção da utilização da teleinterconsulta por médicos do Sistema Único de Saúde em Campo Grande-MS, como ferramenta auxiliar para o atendimento de pacientes do SUS, abordando efetividade, satisfação e acesso a resultados, direcionados a médicos de diferentes especialidades. De uma população total de 127 profissionais, 100 participaram voluntariamente da pesquisa. Os resultados demonstraram que a teleinterconsulta foi percebida como vantajosa, destacando-se o intercâmbio de saberes (44,1%) e a redução do tempo de espera (42,5%). Desvantagens incluíram baixo investimento na estrutura operacional (25,2%) e dificuldades técnicas de comunicação (23,6%). A teleinterconsulta mostrou-se inovadora, proporcionando intensa troca de conhecimentos e redução do tempo de espera. Embora apresente desafios técnicos, a maioria dos médicos a percebeu como efetiva e segura.

Abstract This study aimed to analyze the perception of the use of teleconsultation by physicians of the Unified Health System in Campo Grande-MS, as an auxiliary tool for the care of SUS patients, addressing effectiveness, satisfaction and access to results, directed to physicians of different specialties. Of a total population of 127 professionals, 100 voluntarily participated in the survey. The results demonstrated that teleconsultation was perceived as advantageous, highlighting the exchange of knowledge (44.1%) and the reduction of waiting time (42.5%). Disadvantages included low investment in the operational structure (25.2%) and technical difficulties of communication (23.6%). Teleconsultation proved to be innovative, providing intense exchange of knowledge and reducing waiting time. Although it presents technical challenges, most physicians perceived it as effective and safe.

Resumen El presente estudio tuvo como objetivo analizar la percepción sobre el uso de la teleconsulta por parte de los médicos del Sistema Único de Salud de Campo Grande-MS, como herramienta auxiliar para la atención a los pacientes del SUS, abordando la efectividad, la satisfacción y el acceso a los resultados, dirigido a médicos de diferentes especialidades. De una población total de 127 profesionales, 100 participaron voluntariamente en la investigación. Los resultados demostraron que la teleconsulta fue percibida como ventajosa, destacándose el intercambio de conocimientos (44,1%) y la reducción del tiempo de espera (42,5%). Las desventajas incluyeron baja inversión en la estructura operativa (25,2%) y dificultades de comunicación técnica (23,6%). La teleconsulta demostró ser innovadora, proporcionando un intenso intercambio de conocimientos y reduciendo los tiempos de espera. Aunque presenta desafíos técnicos, la mayoría de los médicos lo percibieron como eficaz y seguro.

Consultoria colaborativa em educação física: planejamento e implementação de programa para estudante com deficiência física / Consultoría colaborativa en educación física: planificación e implementación de un programa para estudiantes con discapacidad física / Collaborative consulting in physical education: program planning and implementation for students with physical disabilities

Resumo O objetivo do estudo foi planejar, aplicar e avaliar um programa de consultoria colaborativa como modelo de suporte à inclusão de estudante com deficiência física no contexto da Educação Física escolar. Foi realizada uma pesquisa de campo de abordagem colaborativa, como estratégia recorreu-se ao estudo de caso. Participou desse estudo um professor de Educação Física de uma escola pública do interior do estado de São Paulo, que ministrava aulas para estudantes com deficiência física. O programa foi desenvolvido em quatro etapas: 1) Aproximação e estabelecimento de vínculos; 2) Identificação do problema e Planejamento do plano de ação; 3) Implementação e 4) Avaliação do programa. Os resultados indicaram que a prestação do serviço de consultoria colaborativa se mostrou uma estratégia de apoio viável no contexto das aulas de Educação Física, sendo capaz de fornecer ao professor do ensino regular mais segurança para lidar com os desafios da inclusão escolar.(AU)

Resumen El objetivo del estudio fue planificar, aplicar y evaluar un programa de consultoría colaborativa como modelo para apoyar la inclusión de estudiantes con discapacidad física en el contexto de la Educación Física en la escuela. Se realizó una investigación de campo con enfoque colaborativo, como estrategia se recurrió al estudio de caso. En este estudio participó un profesor de Educación Física de una escuela pública del interior del estado de São Paulo, quien impartió clases para estudiantes con discapacidad física. El programa se desarrolló en cuatro etapas: 1) Aproximación y establecimiento de vínculos; 2) Identificación de problemas y planificación del plan de acción; 3) Implementación y 4) Evaluación del Programa. Los resultados indicaron que la prestación del servicio de consultoría colaborativa resultó ser una estrategia de apoyo viable en el contexto de las clases de Educación Física, pudiendo brindar más seguridad al docente de educación regular para enfrentar los desafíos de la inclusión escolar. (AU)

Abstract The aim of the study was to plan, apply and evaluate a collaborative consulting program as a model to support the inclusion of students with physical disabilities in the context of Physical Education. A field research with a collaborative approach was conducted, as a strategy we resorted to the case study. Participated in this study a Physical Education teacher from a public school in the interior of the state of São Paulo, who taught classes for students with physical disabilities. The program was developed in four stages: 1) Approximation and establishment of bonds; 2) Problem identification and action plan planning; 3) Implementation and 4) Program Evaluation. The results indicated that the provision of collaborative consulting service provided to be a viable support strategy in the context of Physical Education classes, being able to provide the regular education teacher with more security to deal with the challenges of school inclusion. (AU)

Consultoría colaborativa y educación inclusiva: una revisión sistemática de estudios brasileños / Consultoria colaborativa e educação inclusiva: uma revisão sistemática de estudos brasileiros / Colaborative consulting and inclusive education: a systematice review of brazilian studies

A pesquisa trata de uma revisão sistemática de estudos brasileiros. O objetivo consistiu em analisar os artigos desenvolvidos sobre consultoria colaborativa na perspectiva da inclusão escolar, considerando o ano e a área de publicação dos artigos, o tipo de trabalho que realizam, os consultores envolvidos, a metodologia utilizada e as características dos alunos Público-Alvo da Educação Especial (PAEE). Os descritores utilizados foram: consultoria colaborativa; inclusão; inclusão escolar e educação especial, em conjunto com os operadores booleanos "AND". As buscas foram realizadas no portal do periódico da CAPES, no Google Acadêmico e no Portal Regional da BVS. Foram identificados 409 artigos e 25 deles satisfizeram o critério de elegibilidade. Os artigos foram lidos na íntegra e categorizados com base em um protocolo elaborado para esta investigação. Os estudos evidenciaram a contribuição de pesquisas recentes sobre o assunto, principalmente produzidas por pesquisadores associados à UFSCar.

En la investigación se trata de una revisión sistemática de estudios brasileños. El objetivo es analizar los artículos desarrollados sobre consultoría colaborativa en la perspectiva de la inclusión escolar, considerando el año y el área de publicación de los artículos, el tipo de trabajo que realizan, los consultores involucrados, la metodología utilizada y las características de los alumnos Público-Objetivo de la Educación Especial (PAEE). Se utilizaron los descriptores: consultoría colaborativa; inclusión; inclusión escolar y educación especial, en conjunto con los operadores booleanos "AND". Las búsquedas se realizaron en el portal del periódico de la CAPES, en el Google Académico y en el Portal Regional de la BVS. Se identificaron 409 artículos y 25 de ellos satisficieron el criterio de elegibilidad. Se leyeron los artículos en la íntegra y categorizados con base en un protocolo elaborado para esta investigación. Los estudios evidenciaron la contribución de investigaciones recientes sobre el tema, principalmente producidas por investigadores asociados a la UFSCar.

The research deals with a systematic review of Brazilian studies. The objective was to analyze the articles developed on collaborative consulting from the perspective of school inclusion, considering the year and area of publication of the articles, the type of work they carry out, the consultants involved, the methodology used and the students' characteristics of Special Education (PAEE). The descriptors used were: collaborative consulting; inclusion; school inclusion and special education, together with the Boolean operators "AND". The searches were carried out on the CAPES journal portal, Google Scholar and the VHL Regional Portal. A total of 409 articles were identified and 25 of them met the eligibility criteria. The articles were read in full and categorized based on a protocol developed for this investigation. The studies showed the contribution of recent research about the subject, mainly produced by researchers associated with UFSCar.

Evaluation on the application of community hypertension screening model by automated blood pressure measurement / 上海预防医学

ObjectiveTo evaluate the effect of standardized blood pressure measurement in consulting room （SBPM） model on blood pressure screening of non-hypertensive patients in community. MethodsFour communities were randomly selected from Fengxian District of Shanghai， and non-hypertensive patients in the communities were included for screening. Based on the communities， participants were further classified into the intervention group and control group. A one-year intervention study was conducted from January 1， 2021 to December 31， 2021. The intervention group received the intervention measures of standardized measurement， and the control group remained the routine measurement. The distribution of blood pressure values and last digit of the values between the intervention group and control group were tested using Chi-square test and normality test. Then changes in abnormal blood pressure rate before and after the intervention were determined by double difference method. Statistical analysis was performed using SPSS 20.0. ResultsA total of 15 368 participants were included in the intervention group， and 19 811 participants in the control group. After the intervention， range of the last digit of blood pressure values in the intervention group was 9.55%‒10.41%， of which that of systolic and diastolic blood pressure were equally distributed （P=0.932 and 0.871， respectively）. The range of the last digit in the control group was 1.31%‒42.58%， of which that of systolic and diastolic blood pressure showed unequal distribution （P<0.001）. Through one-year standardized measurement intervention， the abnormal rate of blood pressure in the intervention group was 26.29%， which was 7.61 times as high as that in the control group （OR=7.55， 95%CI： 6.75‒8.57， P<0.001）. ConclusionStandardized blood pressure measurement in consulting room is suitable for the screening of blood pressure measurement in community， which has higher data quality than that of routine measurement.

Cultivating global health professionals: evaluation of a training course to develop international consulting service competence in China / 《全球健康杂志（英文）》

Background:China's accelerating development and increasingly important role in global health engagement create a great demand for global health professionals including international consulting experts.This study reported the detailed development and evaluation of an international consulting training for global health workforce.Methods:Based on Kirkpatrick's model,a mixed-methods approach was used to evaluate the effectiveness of the training.Quantitative and qualitative data on participants' reaction,learning,and application of the learned knowledge and skills were collected by a training evaluation survey at the ending of training and a follow-up interview in three months after the training.Results:Thirty-six participants attended the training and 34 of them completed quantitative investigation.The training satisfaction evaluations were positive,for which participants rated the training program highly and over 90％ of them agreed with the usefulness of the training.About knowledge and skills change,participants showed improved consulting knowledge and skills from pre-to post-training (P ＜ 0.001).A total of 23 participants accepted follow-up interview,and most participants applied knowledge and skills learned from the training in their daily work or study.However,only 30.4％ of participants applied their learning in the consulting program.The largest barrier of application was the lack of consulting opportunities.In addition,almost all the participants reported that they would be glad to attend more training courses in the future.Conclusion:The international consulting training program was well-received,and was feasible to improve the consulting service competence of global health professionals.According to participants' feedback,it is essential to develop and expand consulting training in the field of global health.

Autopercepción de capacidades de autocuidado para prevención de enfermedades crónicas no transmisibles en estudiantes universitarios / Self-perception on self-care capacity in preventing noncommunicable chronic diseases among university students / Autopercepção de capacidades de autocuidado para prevenção de doenças crónicas não transmissíveis em estudantes universitários

Introducción: La incidencia de enfermedades crónicas no transmisibles (ECNT), va en aumento entre la población más joven. La autopercepción de capacidades de autocuidado (CAC), es un punto de partida para el desarrollo de habilidades y destrezas para el propio cuidado. Objetivo: Identificar el nivel de autopercepción de CAC para la prevención de enfermedades crónicas no transmisibles en estudiantes universitarios de nuevo ingreso, para establecer estrategias que permitan un mejor conocimiento de su salud. Métodos: Estudio cuantitativo, descriptivo, transversal y analítico. Muestra aleatorizada, obtenida por cálculo de poblaciones finitas. Se aplicó el Instrumento para identificar las capacidades de autocuidado en enfermedades crónico-degenerativas, salud sexual-reproductiva y prevención de adicciones; análisis descriptivo y analítico, con pruebas paramétricas y no paramétricas. Resultados: La autopercepción de CAC fue muy buena en un 8%, buena en 54%, regular en 36% y mala en 2%. Las diferencias entre áreas de conocimiento y el nivel de autopercepción fueron significativas (p=0.025). La licenciatura en medicina tuvo mejor puntaje de autocuidado ( x -=27.51). Discusión: Los principales resultados encontrados coinciden con diversos estudios que evalúan la dimensión de autopercepción. Existen claras divergencias entre el autocuidado percibido y el realizado, lo que hace evidente la necesidad de desarrollo de CAC. Conclusiones: Es necesario promover estilos saludables para mitigar efectos, costos e implicaciones sociales. Se puede incidir desde la consultoría de enfermería, para favorecer el desarrollo de capacidades de autocuidado en estudiantes universitarios.

Introduction: The incidence of non-communicable chronic diseases among younger populations is on the rise. Self-perception of self-care capacity is a beginning point to develop abilities and skills to address the own care. Objective: To identify the level of self-perception of self-capacity to prevent non-communicable chronic diseases among newly enrolled university students in order to establish strategies which convey a better understanding of this population's health. Methods: This is a quantitative, descriptive, transversal, and analytic study which used a random sample gathered by finite populations calculation. The Identification instrument on the capacity of self-care regarding chronic-degenerative diseases, sexual-reproductive health, and addiction prevention was administered. A descriptive and analytic analysis calculating parametric and non-parametric tests was carried out. Results: Self-perception on self-capacity showed to be very good in 8% of the sample, good in 54%, fair in 36%, and poor in 2%. The differences between the knowledge level and the self-perception level were significant (p=0.025). Students enrolled in Medicine had the highest mean score. Discussion: The main results of this study reflect agreement with other studies assessing the dimension of self-perception; nevertheless, a clear gap between perceived self-care and performed self-care, still remains. Conclusions: It is necessary to promote healthy lifestyles among university students in order to enhance their health self-perception and consequent self-care.

Introdução: A incidência de doenças crónicas não transmissíveis (ECNT), vai em aumento entre a população mais jovem. A autopercepção de capacidades de autocuidado (CAC), é um ponto de partida para o desenvolvimento de habilidades e destrezas para o cuidado próprio. Objetivo: Identificar o nível de autopercepção de CAC para a prevenção de doenças crónicas não transmissíveis em estudantes universitários de ingresso novo, para estabelecer estratégias que permitam um melhor conhecimento de sua saúde. Métodos: Estudo quantitativo, descritivo, transversal e analítico. Amostra aleatorizada, obtida por cálculo de populações finitas. Aplicou-se o Instrumento para identificar as capacidades de autocuidado em doenças crônico-degenerativas, saúde sexual-reprodutiva e prevenção de dependência; análise descritiva e analítica, com probas paramétricas e não paramétricas. Resultados: A autopercepção de CAC foi muito boa em um 8%, boa em 54%, regular em 36% e precária em 2%. As diferenças entre áreas de conhecimento e o nível de autopercepção foram significativas (p=0.025). A licenciatura em medicina teve melhor pontuação de autocuidado ( x -=27.51). Discussão: Os principais resultados encontrados coincidem com diversos estudos que avaliam a dimensão de autopercepção. Existem divergências manifestas entre o autocuidado percebido e o realizado, o que faz evidente a necessidade de desenvolvimento de CAC. Conclusões: É necessário promover estilos saudáveis para mitigar consequências, custos e implicações sociais. Pode influir desde a consultoria de enfermagem, para favorecer o desenvolvimento de capacidades de autocuidado em estudantes universitários.

Investigation and strategy research on third party service needs of medical device industry:case report with Ningbo Zhejiang as an example / 医疗卫生装备

Objective To study third party service needs of the medical device manufacturing enterprises,so as to provide references for the cultivation of relevant institutions and the promotion of medical device industry. Methods Through questionnaire and interviewing survey,the data on enterprises'demands for innovation and third party service were obtained and analyzed. Some solutions were proposed based on the analysis. Results Most of the medical device manufacturing enterprises were small in scale, and they had no corresponding ability and confidence although gained motivation for innovation and upgrading.The enterprises needed third party services while were not satisfied with the existing services,and they hoped that the government could provide more comprehensive services to support their innovation and upgrading. Conclusion The government has to strengthen testing, regulations consulting and etc and enhance third party service institutions from the aspects of mission,rules and mechanism so as to promote medical device industry.

Research on the Development of Online Health Communities in China / 中国医院管理

Online health community is the typical mode of online health service.The government encourages the development of the internet-based health services to propose the health policy.Through finding out problems of online health communities,and analyzing the practice and theory status of literature research,political suggestions are put forward for online health development.Through summarizing the development status and practice effect of online health community,the achievements and problems of online health communities in China are analyzed.The rational use of online health communities helps to optimize health care resource allocation.However,there is no mature models and regulation.The development and the impact of health care reform needs further study.

Utilización de Test Psicológicos en Procesos de Selección del Personal en Consultoras de Recursos Humanos de Asunción

Los test psicológicos son considerados herramientas esenciales en las organizaciones, para la selección del personal. Su uso es defendido por muchos, pero también hay quienes cuestionan su efectividad, debido a su incorrecta utilización. Considerando la importancia que los instrumentos de evaluación psicológica tienen en las organizaciones, se llevó a cabo un estudio exploratorio - descriptivo, de enfoque cuantitativo y corte sincrónico transversal, a fin de determinar el modo en que se utilizan los test psicológicos en los procesos de selección del personal; se ha desarrollado un instrumento de encuesta que se aplicó a profesionales que realizan selección del personal de un universo de contingencia compuesto por 64 consultoras de recursos humanos, situadas en la ciudad de Asunción. Con base en los resultados obtenidos, se puede deducir que los profesionales encuestados en su mayoría carecen de información suficiente acerca de los test psicológicos que utilizan comúnmente en sus procesos de selección. Las diferencias notables que se hallaron, fueron específicamente en dos puntos importantes y ejes fundamentales de los criterios a tener en cuenta para el manejo de los test psicológicos; la validación de los test y el diseño de los mismos.

Psychological tests are considered essential instruments in organizations for the selection of personnel. Its use is defended by many, but there are also those who question its effectiveness, due to its incorrect use. Considering the importance that the instruments of psychological evaluation have in organizations, an exploratory - descriptive study was carried out, with a quantitative focus and a transversal synchronous cut, in order to determine the way in which psychological tests are used in the selection processes of personnel; a survey instrument has been developed that was applied to professionals who make personnel selection, of a contingency universe composed of 64 human resources consulting firms, located in the city of Asunción. Based on the results obtained, it can be deduced that the professionals surveyed mostly they lack information about the psychological tests they commonly use in their selection processes. The notable differences that were found were specifically in two important points and fundamental axes of the criteria to be taken for the use of psychological tests; the validation of the tests and their design.

Rol del Consultorio de Leishmaniosis en las investigaciones del IICS / Leishmaniasis Consulting Room at the IICS: its role in research

La leishmaniosis tegumentaria es una enfermedad desatendida y descontrolada que afecta a sectores sensibles de la población. El IICS, a través de este consultorio especializado, brinda los servicios de establecer el diagnóstico y acompañar el tratamiento de los casos que se presentan, así como de realizar seguimiento de los casos curados. Esta labor aporta permanentemente datos y suscita discusiones científicas que se convierten en fuentes de trabajos de investigación para la Institución. Y estamos hablando de una enfermedad con bastantes aspectos aún desconocidos, que amerita ser estudiada con prioridad en nuestro país

Tegumentary leishmaniasis is a neglected and uncontrolled disease affecting sensitive sectors of the population. The IICS, through this specialized practice, provides the services of establishing the diagnosis and to accompany the treatment of the cases presented, as well as to follow up the cured cases. This work provides data permanently and raises scientific discussions that become sources of research to the institution. And we are talking about a disease with many still unknown aspects that deserve to be studied with priority in our country.

Exploring application of WeChat for gestational diabetes mellitus management / 中国实用护理杂志

Objective To researching the effect of gestational diabetes mellitus (GDM) prevention and control management by WeChat consultation on the Internet platform. Methods There were 586 pregnant women who performed prenatal care regularly and accepted glucose tolerance test for GDM at 24 to 28 weeks in our hospital during 2015 and 2016 as research objects. Determination of the observation group:in 2016, the 308 people who match the condition of the study during annual prenatal examination in line, in addition to routine guidance outside the clinic and joined the division to establish a dedicated WeChat group for a comprehensive health management consulting. Determination of the control group:in 2015, the 278 people who match the condition of the study during annual prenatal examination in line were treated as control groups. The two groups of observation indexes included the fasting blood glucose and two-hour postprandial blood glucose control in GDM pregnant women, the weight growth rate of the whole pregnancy, cesarean section rate, birth rate of newborns, neonatal referral rate and so on. Results The rate of fasting blood glucose and two-hour postprandial blood glucose control in the observation group was significantly better than that in the control group (t=2.01-3.11, all P<0.05). According to the pre-pregnancy physical index, the weight growth of the observation group was significantly better than the control group (t=2.12-3.76, all P<0.05).The cesarean section rate, birth rate and neonatal referral rate were 21.10％(65/308), 4.87％(15/308), 7.14％(22/308)in the observation group , and 28.78％(80/278), 10.07％(28/278), 12.23％(34/278)in the control group, there were significant differences (U = 2.10-2.42, all P<0.05). Conclusions Gestational diabetes prevention and control management in the Internet platform for WeChat consultation application effect is remarkable, which can effectively improve the maternal and child outcomes. In the protection of maternal and child health is of great significance.

Theory and Practice of Constructing Medical Information Consulting Service System / 医学信息学杂志

The paper analyzes the urgency of constructing the medical information consulting service system in big data era as well as the features of the system,describes the architecture of the system from the perspectives of function,process relation and technology,introduces the construction of the mobile clients of the system,discusses the promotion and application of mobile clients.

Pacientes policonsultantes: ¿un síntoma del sistema de salud en Chile? / Pacientes policonsultantes: um sintoma do sistema de saúde no Chile? / Poly-consultant patients: a symptom of the Chilean healthcare system?

En el presente artículo se exponen una serie de reflexiones producto de un estudio exploratorio y cualitativo realizado en un Centro de Salud Familiar de Santiago de Chile. La pregunta que guía este artículo es si se puede considerar la alta tasa de pacientes policonsultantes como un síntoma de que algo no funciona en el sistema público de salud chileno. Se concluye que existe un desencuentro entre la demanda del paciente y el saber de los profesionales, el cual deja en evidencia la falta de claves de la medicina biológica para interpretar este tipo de quejas. Dada la ausencia de respuesta, estos pacientes suelen ser derivados a las "duplas psicosociales", sin mucha claridad sobre los fundamentos de esta derivación, dando cuenta así de algunas insuficiencias de un sistema sanitario que dice operar bajo un paradigma "biopsicosocial". Esto se ve agravado por la forma de gestionar la atención sanitaria impuesta en las últimas dos décadas, pues se trata de pacientes que atentan contra la eficiencia de las instituciones y no caben en las metas establecidas en torno a diagnósticos. Sin embargo, mientras el sistema de salud busca veladamente deshacerse de dichos pacientes, estos más insisten con sus demandas.

This paper shows a series of reflections resulting from an exploratory and qualitative study carried out in a Family Health Care Center of Santiago, Chile. The question guiding this paper consists in considering whether the high rate of poly-consultant patients is a symptom of malfunctioning of the public Chilean health care system. It is concluded that there is a discrepancy between patient demands and professional knowledge, evidencing lack of biomedical keys to interpret this type of demands. Given de absence of answers, these patients generally are derived to "psychosocial couples", without much clarity over the basis of this derivation; thus, accounting for some deficiencies of a health care system which pretends to operate under a "bio-psychosocial" paradigm. This is aggravated by the way the managing of health care is imposed in the last two decades, since these are patients which face the efficiency of institutions and they do not enter into the established goals assigned to the different diagnosis. Nevertheless, while the health care system seeks in a veiled way to get rid of these patients, these insist even more with their demands.

No presente artigo se expõe uma série de reflexões produto de um estudo exploratório e qualitativo realizado num Centro de Saúde Familiar de Santiago do Chile. A pergunta que guia este artigo é se pode ser considerada a alta taxa de pacientes policonsultantes como um sintoma de que algo não funciona no sistema público de saúde chileno. Conclui-se que existe um desencontro entre a demanda do paciente e o saber dos profissionais, que deixa em evidência a falta de chaves da medicina biológica para interpretar este tipo de queixas. Dada a ausência de resposta, estes pacientes podem ser derivados para as "duplas psicossociais", sem muita clareza sobre os fundamentos desta derivação, dando conta assim de algumas insuficiências de um sistema sanitário que diz operar sob um paradigma "biopsicossocial". Isto se vê agravado pela forma de gerir a atenção sanitária imposta nas últimas duas décadas, pois se trata de pacientes que atentam contra a eficiência das instituições e não cabem nas metas estabelecidas em torno de diagnósticos. No entanto, enquanto o sistema de saúde busca veladamente desfazer-se destes pacientes, eles mais insistem com suas demandas.

Consultoria empresarial de Serviço Social: expressões da precarização e da terceirização profissional / Social Service business consulting: expressions of professional precariousness and outsourcing

O presente artigo é resultado da minha dissertação de mestrado que teve por finalidade apreender a consultoria empresarial de Serviço Social em face da reestruturação produtiva e da expansão da precarização das relações de trabalho, cuja terceirização é uma de suas expressões. Assim, utilizo cinco eixos de análise para identificar expressões de precarização a partir da terceirização ocorrida nesse espaço sócio-ocupacional do Serviço Social.

This article originated in my master degree dissertation whose aim was to explain Social Service business consulting in view of production restructuring and expansion of the precariousness in work relations, being outsourcing one of its results. Thus, I use five axes of analysis to identify expressions of precariousness from the outsourcing in this Social Service practice.

Histeroscopia de consultorio: evaluación del dolor / Office hysteroscopy: pain assessment

Objetivo: Evaluar el dolor durante la histeroscopia de consultorio, sin anestesia e investigar los factores relacionados. Métodos: Estudio prospectivo, descriptivo, analítico y de corte transversal en una población de 309 pacientes de la Maternidad “Concepción Palacios” que acudieron al Servicio de Ginecología entre agosto 2010 y agosto 2011, quienes tenían indicación para histeroscopia. Se registraron antecedentes y datos clínicos relacionados con la percepción del dolor, así como la intensidad de dolor percibida mediante una escala análoga de 0 al 10. Resultados: Se obtuvo una media de percepción de dolor de 2,9. La percepción de dolor fue leve en 56.%, dolor moderado: 36,2 %, dolor intenso: 4,9 %, dolor intolerable: 2,9 %, nada de dolor: 4,2 %. No se encontró relación entre la percepción de dolor y la edad, paridad, estado hormonal, indicación del estudio ni tipo de procedimiento. El 60,6 % de las pacientes con cuello permeable, presentaron dolor leve, mientras que las que tenían sinequias o estenosis lo presentaron en 25,5 % y 31, 3 % respectivamente. Con cuello permeable hubo 0,4 % de dolor intolerable y en presencia de sinequias la cifra fue 12,5 % (P<0,05). 88,8.% de las pacientes con dolor intolerable presentaban estenosis o sinequias. Conclusiones: La histeroscopia de consultorio es un procedimiento bien tolerado por la mayoría de las pacientes; es independiente de la paridad, condición hormonal, indicación del estudio, edad y tipo de procedimiento. La percepción de dolor fue mayor en pacientes con estenosis o sinequias cervicales.

Objective: Assess pain during no anesthesia office hysteroscopy and investigate related factors. Method: Prospective, descriptive, analytical and cross-section study in a population of 309 patients who attended the gynaecology service of Maternidad Concepción Palacios between August 2010 and August 2011, who had indication for hysteroscopy. Background and clinical data was collected, relating to the perception of pain, as well as the intensity of pain perceived by means of an analog scale of 0 to 10. Results: An average of 2.9 pain perception. The perception of pain was mild in 56 %, moderate pain: 36.2 %, severe pain: 4.9 %, intolerable pain: 2.9 %, none of pain: 4.2 per cent. No relationship was found between the perception of pain and age, parity, hormonal state, indication of the study or type of procedure. 60.6 % of patients with permeable cervix presented mild pain, while if they had adhesions or stenosis the mild pain was present in 25.5 % and 31, 3 % respectively. With permeable cervix there was 0.4 % of intolerable pain and in the presence of adhesions was only 12.5 % (P < 0,05), 88.8 % of patients with intolerable pain had cervical stenosis or adhesions. Conclusions: Office hysteroscopy is a procedure well tolerated by most patients; It is independent of parity, hormonal condition, indication of the study, age and type of procedure. The perception of pain was greater in patients with cervical stenosis or adhesions.

Effectiveness of group counseling in the social anxiety among college students: a meta-analysis / 中华行为医学与脑科学杂志

Objective To systematic evaluate the effectiveness of group counseling in the social anxiety among college students.Methods Relevant literature between January 1990 and December 2013 was searched by computer and relevant group intervention study about social anxiety among college students was collected,and then meta analysis was used in statistical analysis.Results In terms of each factor score of SCL-90,they showed significant differences not only between pre-treatment and post-treatment of the intervention group,but also between pretreatment and follow-up.The results indicated that the combined effect size of comparison of the data in these reports with pre-treatment vs.post-treatment varied between 0.27 and 0.66,pre-treatment vs.follow-up varied between 0.24 and 0.67.Conclusion Group counseling can effectively increase the level of mental health of the social anxiety among college students.

Investigation and analysis of psychological consulting requirement for the hospital staff / 中华医院管理杂志

Objective To learn the psychological needs of the hospital staff in terms of their life,medical care and psychological health.Methods 2910 hospital staff were interviewed with questionnaires and the outcomes analyzed with x2 test and descriptive analysis.Results 96.9％of the surveyed found themselves in need of psychological counseling; considerable consulting needs of the staff; most of them turn to friends to complain instead of their leaders.Conclusion The psychological counseling should be enhanced to build effective communication channels and ease stress of the staff.

Contribuições da terapia ocupacional para a inclusão escolar de crianças com autismo / Contributions of occupational therapy for the school inclusion of children suffering from autism

Objetivou-se relatar a experiência da atuação do terapeuta ocupacional fundamentada no referencial teórico da consultoria colaborativa em duas escolas de educação infantil da rede regular de ensino, pertencentes a dois municípios de pequeno porte do interior do estado de São Paulo. A metodologia caracteriza-se por um estudo de caso e as informações foram coletadas pelo período de seis meses, por meio de entrevistas abertas e diário de campo, juntamente com a intervenção planejada através do projeto de extensão Consultoria colaborativa na inclusão escolar de crianças com transtornos de desenvolvimento - proposta de atuação da terapia ocupacional. Foram alvo da intervenção sujeitos de duas escolas: dois alunos com diagnóstico de autismo, suas mães e equipe técnica da escola, composta por coordenador pedagógico, professora, monitora e diretora. A intervenção proposta teve início com a formação de parceria entre os atores envolvidos e da organização das reuniões que consistiram em espaços de partilha de experiências e planejamento de ações. Os resultados foram positivos quanto à efetivação da inclusão escolar, destacando o acesso e permanência das crianças na escola, a facilitação de seu aprendizado e a conscientização dos atores envolvidos quanto à diversidade, respeito e trabalho em equipe. A ação do terapeuta ocupacional deu-se na articulação do trabalho em equipe, no auxílio à percepção e identificação das necessidades e conquistas, avaliando e construindo conjuntamente as estratégias e ações, contribuiu na análise das atividades e orientações quanto a suas possibilidades de adaptação e flexibilização, no suporte oferecido aos atores envolvidos quanto às normas, leis e aspectos específicos de cada criança.

In this study, we aimed to report the experience of occupational therapists based on the theoretical reference of Collaborative Consulting. The experiment was carried out in two children education schools of the regular school network from two small cities in countryside of the state of São Paulo. The methodology is characterized by a case study and the information was gathered within the period of six months, through open interviews and a diary, along with the intervention planned by the Extension Project Collaborative Consulting on the school inclusion of children suffering from development disorders - an Occupational Therapy procedure proposal. Subjects from two schools were used as targets for this intervention: two students with diagnosed autism, their mothers, and the schools' technical teams: the pedagogical coordinators, the teachers, the monitors, and the principals. The proposed intervention began with the construction of a corporation between the actors involved and the organization of the meetings, which consisted of an environment for sharing the experiences as well as for action planning. The results were positive concerning the effectiveness of school inclusion, highlighting the access and permanence of children in school, the facilitation of their learning, and the awareness of the involved actors regarding diversity, respect and team work. The action of the occupational therapist occurred on the articulation of the team work, the support towards awareness, and the identification of needs and achievements, evaluating and building together with the strategies and actions. These actions contributed to the analysis of the activities and orientations about their possibilities of adaptation and flexibility, on the support offered to the actors involved regarding the rules, legislation and specific aspects of each child.

Serviço Social em empresas: consultoria e prestação de serviço / Social Work in private companies: consulting and service

Este artigo apresenta o resultado de pesquisa qualitativa realizada com assistentes sociais, trabalhadores de consultorias empresariais, cujas atividades são terceirizadas para empresas privadas. As consultorias apresentam-se como um possível espaço ocupacional para o profissional, surgido a partir da reestruturação produtiva brasileira. No entanto, na condição de trabalhador terceirizado, ele vivencia o processo de flexibilização e precarização de trabalho.

This article present the result of the qualitative research realized with social workers, business consultants, whose activities are outsourced to private companies. The consultancy firms presents itself as a possible occupational space to the professional, emerged from the brazilian productive restructuring, however, in condition of outsourced worker, the same will experience the process of flexibilization and precariousness of work.