RESUMEN
One of the commonly accepted merits of cohort studies (CSs) refers to the exposure precedes outcome superior to other observational designs. We use Directed Acyclic Graphs to construct a causal graph among research populations under CSs. We notice that the substitution of research population in place of a susceptible one can be used for effect estimation. Its correctness depends on the outcome-free status of the substituted population and the performance of both screening and diagnosis regarding the outcomes under study at baseline. The temporal precedence of exposure over outcome occurs theoretically, despite the opposite happens in realities. Correct effect estimate is affected by both the suitability of population substitution and the validities of outcome identification and exclusion.
Asunto(s)
Causalidad , Estudios de Cohortes , Factores de Confusión Epidemiológicos , Métodos Epidemiológicos , Tamizaje Masivo , Proyectos de InvestigaciónRESUMEN
One of the commonly accepted merits of cohort studies (CSs) refers to the exposure precedes outcome superior to other observational designs.We use Directed Acyclic Graphs to construct a causal graph among research populations under CSs.We notice that the substitution of research population in place of a susceptible one can be used for effect estimation.Its correctness depends on the outcome-free status of the substituted population and the performance of both screening and diagnosis regarding the outcomes under study at baseline.The temporal precedence of exposure over outcome occurs theoretically,despite the opposite happens in realities.Correct effect estimate is affected by both the suitability of population substitution and the validities of outcome identification and exclusion.
RESUMEN
O Programa de Valorização do Profissional da Atenção Básica (Provab) e o Programa Mais Médicos são estratégias diferentes adotadas em paralelo pelo Ministério da Saúde (MS) para enfrentar a falta de médicos na Atenção Básica do Sistema Único de Saúde (SUS), que convergem no objetivo de atrair brasileiros para atuar em áreas vulneráveis do país. Este artigo analisa perfil e motivações dos egressos do Provab que migraram para o Mais Médicos em 2016. Foram utilizados dados secundários do MS de um survey de monitoramento do Provab. Os resultados apontam que o Provab atraiu recém-egressos de Medicina e dão indícios de que o bônus de 10% ofertado aos que o concluem vem tornando o Provab uma via alternativa de acesso ao Mais Médicos para médicos com pouca experiência e indecisos sobre os rumos profissionais, mas que demonstram entusiasmo crescente em relação à Atenção Básica.
The Primary Care Professional Valorization Program (Provab) and the More Doctors Program are different strategies that were adopted simultaneously by the Brazilian Ministry of Health to tackle the lack of primary care physicians in the Brazilian National Health System (SUS), and they have the converging objective of recruiting Brazilians to work in vulnerable areas around the country. This paper analyzes the profiles and motivations of Provab professionals who migrated to the More Doctors Program in 2016. Secondary data from a Provab monitoring survey carried out by the Ministry of Health were used. The results showed that Provab attracted recently graduated physicians and suggest that the 10% bonus offered to graduates is making Provab a viable alternative to accessing the More Doctors Program for inexperienced physicians who have not yet chosen their career paths, but who are increasingly enthusiastic with regard to primary care.
El Programa de Valorización del Profesional de la Atención Básica (Provab) y el Programa Más Médicos son estrategias diferentes adoptadas en paralelo por el Ministerio de la Salud para enfrentar la falta de médicos en la Atención Básica del Sistema Brasileño de Salud (SUS) que convergen en el objetivo de atraer a brasileños para que actúen en áreas vulnerables del país. Este artículo analiza el perfil y las motivaciones de los egresados del Provab que migraron para el Más Médicos en 2016. Se utilizaron datos secundarios del MS de una survey de monitoreo del Provab. Los resultados señalan que el Provab atrajo a recién egresados de medicina y dan indicios de que el bono del 10% ofrecido a los que lo concluyen ha convertido al Provab en una vía alternativa de acceso al Más Médicos para médicos con poca experiencia e indecisos sobre los rumbos profesionales, pero que demuestran un entusiasmo creciente con relación a la Atención Básica.
Asunto(s)
Humanos , Médicos/provisión & distribución , Atención Primaria de Salud , Consorcios de Salud , Programas de Gobierno/métodos , Distribución de Médicos , Brasil , Planes de Incentivos para los MédicosRESUMEN
Objective To determine the index weight of ICU-teamwork, according to the index weight, the paper want to explore and assess the importance of the index. Methods Delphi method and precedence chart were used together to determine the index weight. Results The paper divided into six first- level indicators, which were Organizational management (20% )、Environment(18% ) andPatients(17%). Conclusion Active treatment patients′ primary diseases, creating a healthy of teamwork culture,constructing a reasonable technical structure, improving medical staff′ work environment,increasing medical staff,establishing a scientific scheduling mode,strengthening nurse training are beneficial for the improvement of ICU-acquired infection and patient safety.
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Aim: To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment. Study Design: Prevalence based cohort Place and Duration of Study: Penang General Hospital, Hospital USM, and– Univesiti Malaya Medical Center; 2005 – 2008. Methods: Study patients were placed in the TB only, DM only, or DM-TB groups,with each group including 200 patients. Information related to demographics, chronic disease comorbidity, duration of hypertension (HTN) and DM, and economic variables were obtained from the patients’ medical files both at the beginning and end of the study period. The economic burden of DM-TB patients was assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests. Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DMonly group compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for the TB only and DM only groups, respectively; however, 43% of TB only subjects needed surgical intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for theTB only and DM only groups, respectively. Conclusions: DM antedated HTN in our patients. Durations of both DM and HTNwere longer for the DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only group required the most surgical intervention.
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La ecolocación humana es una habilidad genuina, inexplorada y vinculada con la localización de sonidos reflejados, que resulta crucial en la movilidad independiente de la persona ciega. Se inscribe en el área poco estudiada de la audición cotidiana de sonidos no verbales e implica autoproducir sonidos para obtener información (reflexiones) a fin de localizar y reconocer objetos que no se ven. Se presenta una revisión histórica de estudios realizados sobre la temática, que refleja cambios paradigmáticos del devenir científico. Las conceptualizaciones históricas de la ecolocación resultan ejemplificadoras: al comienzo se la consideraba como un fenómeno paranormal mientras que en la actualidad, se la trata como una habilidad utilizada inconscientemente por la mayoría de las personas. En esta primera parte se exponen aspectos teóricos relevantes y los estudios realizados en dos de los tres períodos en que se ha dividido esta revisión histórica. El tercer período se presenta en la segunda parte de este artículo.
Echolocation is a genuinely human though greatly unexploited ability that is closely related to the localization of reflected sounds. It is part of the scarcely studied and promising field of the percept-cognitive processes involved in everyday audition of non-verbal sounds. It implies self-producing sounds (original or direct signal) with the specific purpose of obtaining auditory information (reflected signal) to detect, locate and recognize unseen objects. This ability turns out to be crucial to the blind person's independent mobility, an aspect that is severely affected by blindness. We present an historical revision of the main studies that have been carried out on this particular phenomenon, describing the paradigm changes that occurred in scientific history. The historical conceptualizations of echolocation are specially revealing: while it was initially considered a paranormal phenomenon, a kind of sixth sense, now it is treated as an ability that could be unconsciously used by most of us. In this first part of this paper we present relevant theoretical aspects and the studies carried out during two of the three periods this historical revision has been divided in: (a) First approaches (1700 - 1935) and (b) Scientific study of human echolocation (decades from 40s to 80s). The third period, named recent studies, is developed in the second part of this article. The questions that were initially asked were concerned the explanation of which of the sense organs was involved and which sensory stimulation was the necessary and sufficient condition for this ability. Some researchers and many blind persons were inclined to look for the answer in the sense of touch, from stimuli such as differences in pressure, air currents or differences in temperature upon the skin of the face; this originated the name of facial vision with which echolocation is also known. During the 40s a vast and rigorous research program was put forward in order to elucidate the sensory basis of echolocation. Experimental subjects (blind and blindfolded sighted participants) that took part of the program had to walk through a corridor and halt at the moment they perceived the presence of an obstacle (mobile panel); then they kept on walking approaching the obstacle as near as possible without making contact (first perception and final appraisal, respectively). A series of ingenious tests was designed in which tactile or auditory input was artificially suppressed, one at a time. None of the subjects was able to perceive the object in the case of auditory input suppression. To confirm this finding, other tests were conducted in extreme conditions: for example, the subject was in another room using a telephone communication device and he / she had to perform the same task but this time it was the experimenter that walked across the corridor instead of him / her. The performance was not significantly affected in this extreme condition. In this way, it was unequivocally established that audition is the sensory basis of this particular kind of ability and that changes in pitch are its necessary and sufficient condition. Later studies inquired into the discriminatory power of echolocation and its scopes. It was demonstrated that, on the one hand, blind subjects and appropriately trained blindfolded sighted subjects were able to accurately judge the position, distance, size, material and shape of the objects. On the other hand, for the first time, research about the spontaneous generation of sounds by blind persons was carried out. It was observed that they used clicks or vocalizations to detect presence /absence of the object and continuous sibilant sounds to perceive its borders. Their performance was not significantly affected when they used artificial sounds that mimicked their own or sound signals that they had described as not preferred. Around the end of the second period the underlying psychoacoustic mechanisms were studied and two auditory fusion phenomena were postulated: repetition pitch and the precedence effect.