Comparison of attitudes toward community-based medicine between regional-quota and general-selected medical student in Japan / Journal of Rural Medicine

Objective: This study compared the regional-quota and general-selected medical students’ understanding, interest, and confidence in the community medicine practice and their attitudes toward the concept guidelines.Methods: We conducted a Web-based questionnaire survey regarding the understanding, interest, and confidence in future community medicine practice and attitudes toward concept guidelines among medical students of all grades (regional-quota and general-selected: n=82 and n=617, respectively).Results: The overall response rates were 68.5% (56/82) and 66.0% (409/617) in the regional-quota and general-selected groups, respectively. Although there was no significant difference between the groups in terms of understanding (P=0.998), interest and confidence in future practice were significantly higher in the regional-quota group (both P<0.001). There was no significant difference between the two groups for any of the six questions regarding community medicine guidelines.Conclusion: The understanding of community medicine or its conceptual guidelines did not significantly differ between the two groups; however, interest and confidence in future practice were significantly higher in the regional-quota group. These results suggest that the regional-quota system positively upregulates the interest in community medicine, which could be associated with confidence in future practice. Comprehensive and longitudinal improvements in the regional-quota system may be effective in cultivating community medicine.

Los estudiantes de Enfermería y la pesquisa durante la COVID-19

Fundamento: el estudio de las enfermedades debe integrar perspectivas e incluir variables relacionadas con los profesionales sanitarios. La aparición de nuevas enfermedades como la COVID-19 ha generado un grupo de investigaciones dirigidas a los profesionales y estudiantes inmersos en su prevención y control. Objetivo: caracterizar las actitudes de los estudiantes de Enfermería vinculados al pesquisaje activo de casos sintomáticos de COVID-19. Métodos: en la universidad médica camagüeyana se realizó un estudio descriptivo, transversal, en el período de marzo a mayo de 2021, con la combinación de metodologías cualitativas. Se aplicaron métodos teóricos para la fundamentación de la investigación y empíricos como la observación externa directa, entrevista semiestructurada y composición, a una muestra de 30 estudiantes de licenciatura en Enfermería. Resultados: las actitudes se caracterizaron por tener una dirección que no indicó rechazo abierto, pero se percibió la dificultad de abordar el tema de la posibilidad del propio contagio en el 49,30 %. Hubo un 62,10 % de inconsistencia interna en las actitudes, al constatarse una relación antagónica entre sus componentes. Conclusiones: la vinculación de los estudiantes de Enfermería a escenarios clínicos y comunitarios permitió la identificación de características en sus componentes, consistencia o funciones que implican exposición a situaciones de riesgo o limitan el desempeño; es imprescindible modificarlas en aras de garantizar las acciones de sostenibilidad y la formación profesional.

Background: the study of diseases must integrate perspectives and include variables related to health professionals. The emergence of new diseases such as COVID-19 has generated a group of research aimed at professionals and students immersed in its prevention and control. Objective: to characterize the attitudes of nursing students linked to active screening in cases of COVID-19. Methods: a descriptive, cross-sectional study was carried out at Camagüey Medical University from March to May 2021, with a combination of qualitative methodologies. Theoretical methods were applied to support the research and empirical methods, such as direct external observation, semi-structured interviews and composition, to a sample of 30 undergraduate Nursing students. Results: the attitudes were characterized by having a direction that did not indicate open rejection, but the difficulty of addressing the issue of the possibility of contagion itself was perceived in 49.30%. There was 62.10% of internal inconsistency in attitudes, as an antagonistic relationship was found among its components. Conclusions: the linking of Nursing students to clinical and community settings allowed the identification of characteristics in their components, consistency or functions that imply exposure to risk situations or limit performance; it is essential to modify them in order to guarantee sustainability actions and professional training.

Entre "centrado na pessoa" e "freestyle": a abordagem do sofrimento mental comum em residências de medicina de família e comunidade / The "patient-centered" or "freestyle" method: the approach to common mental suffering in family and community medicine residency programs / Entre "centrado en la persona" y "freestyle": el abordaje del sufrimiento mental común en residencias de medicina de familia y comunidad

Este trabalho apresenta um estudo qualitativo sobre a abordagem do sofrimento mental comum (SMC) em programas de residência de Medicina de Família e Comunidade de Minas Gerais. Foram realizadas entrevistas semiestruturadas com 16 participantes de três programas de residência, entre março e maio de 2022. A interpretação dos dados seguiu os princípios da Análise Temática de Braun e Clarke. Para os participantes, o SMC é uma demanda frequente na Atenção Primária que deve ser abordada, principalmente com intervenções psicossociais. Contudo, os participantes reconhecem que não têm aplicado essas intervenções nos moldes recomendados pela literatura. Os entrevistados relatam conhecer diversas técnicas de intervenção, mas só sabem aplicar algumas, com destaque para os componentes do "método clínico centrado na pessoa". Esse fato contribui para despertar emoções negativas, como angústia e frustração, e aumentar o número de referenciamentos desnecessários para outros profissionais.

This work presents a qualitative study of the approach to common mental suffering (CMS) in family and community medicine residency programs in the state of Minas Gerais, Brazil. Semi-structured interviews were conducted with 16 participants from three residency programs between March and May 2022. The data were interpreted drawing on the principles of Braun and Clarke's thematic analysis method. According to the participants, CMS is a frequent demand in primary care and should be approached using mainly psychosocial interventions. However, the participants recognize that they have not applied these interventions in the manner recommended by the literature. The interviewees reported that despite being aware of a diverse range of intervention techniques, they only know how to apply some, with emphasis on the components of the "patient-centered clinical method". This fact has contributed to the awakening of negative emotions, such as anguish and frustration, and increased the number of unnecessary referrals to other professionals.

Este trabajo presenta un estudio cualitativo sobre el abordaje del sufrimiento mental común (SMC) en programas de residencia de Medicina de Familia y Comunidad del estado de Minas Gerais. Se realizaron entrevistas semiestructuradas con 16 participantes de tres programas de residencia, entre marzo y mayo de 2022. La interpretación de los datos siguió los principios del Análisis Temático de Braun y Clarke. Para los participantes, el SMC es una demanda frecuente en la atención primaria que hay que abordar, principalmente, con intervenciones psicosociales. No obstante, los participantes reconocen que no han aplicado esas intervenciones en los estándares recomendados por la literatura. Los entrevistados relatan que conocen diversas técnicas de intervención, pero que solo saben aplicar algunas, con destaque para los componentes del método clínico centrado en la persona?. Este hecho contribuye para despertar emociones negativas, tales como angustia y frustración, y para aumentar el número de derivaciones innecesarias para otros profesionales.

FOFA da residência em medicina de família e comunidade no estado de São Paulo / SWOT at family and community medicine residency in São Paulo state

Resumo Introdução: A residência médica é o padrão ouro para formação em medicina de família e comunidade. Na última década houve aumento substancial de vagas sem a avaliação da qualidade dos programas. Objetivo: Este estudo teve como objetivos observar e qualificar a percepção dos preceptores da residência nessa área. Método: Aplicou-se um questionário qualiquantitativo no estado de São Paulo, com análise estatística descritiva e elaboração da matriz FOFA associada à tríade de Donabedian a partir da análise de conteúdo dos entrevistados. Resultado: A amostra foi de 64 preceptores em 27 programas, com mediana de idade de 37 anos e composta de 52% de mulheres. A distribuição mais prevalente é de dois residentes por preceptor, e 67% atuam também com a graduação. Da amostra, 56,7% possuem residência médica e 13,4% são titulados, além de 82% com cursos em preceptoria. A análise qualitativa aponta a formação em preceptoria e o aumento de especialistas como pontos relevantes, mas ainda há a dificuldade com a organização dos serviços e o baixo apoio da gestão municipal. Conclusão: Embora haja preceptores com formação adequada, ainda é necessário seu incremento ante o aumento do número de vagas desproporcional à capacidade instalada. Melhoria das condições estruturais e maior apoio dos municípios serão necessários de acordo com a percepção dos preceptores em medicina de família e comunidade.

Abstract Introduction: Medical residency is the gold standard for training in Family and Community Medicine. In the last decade there has been a significant increase in vacancies without evaluating quality of the programs. Objective: To observe and qualify the perception of the residency preceptors in this area. Methodology: Application of a quali-quantitative questionnaire in the state of São Paulo, with descriptive statistical analysis and use of the SWOT matrix associated with the Donabedian Triad based on Content Analysis of the interviewees. Results: The sample consisted of 64 preceptors in 27 programs, with a median age of 37 years, consisting of 52% women. The most prevalent distribution is 2 residents per preceptor and 67% also work with undergraduate students. Of the sample, 56.7% have medical residency and 13.4% have degrees, in addition to 82% courses in preceptorship. The qualitative analysis indicates training in preceptorship and the increase in specialists as relevant points, but there is still difficulty with the organization of services and low support from municipal management. Conclusion: Although there are preceptors with adequate training, it is still necessary to increase their number considering the disproportionate increase in the number of vacancies to the installed capacity. Improvement of structural conditions and greater support from municipalities will be necessary, according to the perception of preceptors in family and community medicine.

Perfil do estudante e fatores que influenciam o interesse pela medicina de família e comunidade / Profile of medical students and factors that influence theirinterest in the family and community medicine residency

RESUMO Introdução: A medicina de família e comunidade (MFC) apresenta-se como uma carreira médica de importância social, porém seu crescimento nas regiões do Brasil ainda é pouco representativo, sendo necessário identificar os fatores que influenciam o estudante do curso de Medicina na escolha dessa carreira profissional. Objetivo: Este estudo teve como objetivo analisar fatores que influenciam o interesse pela residência em MFC pelos alunos do internato do curso de Medicina. Método: Trata-se de um estudo transversal, descritivo, de análise quantitativa, realizado com os alunos matriculados nos estágios do penúltimo e último anos dos cursos de Medicina de uma capital brasileira. Resultado: Participaram da pesquisa 229 estudantes matriculados no internato de Medicina. Aqueles que demonstraram interesse pela MFC eram, em sua maioria, jovens, de ambos os gêneros, na faixa etária entre 26 e 35 anos, casados, com filhos e renda familiar menor que cinco salários mínimos. Duas variáveis estiveram associadas à opção pela MFC: a faixa etária e a avaliação positiva acerca da especialidade. Conclusão: Compreender os fatores que influenciam na escolha da MFC pode contribuir para aprimorar a formação médica, alinhando as preferências dos estudantes com as necessidades da sociedade e do Sistema Único de Saúde.

ABSTRACT Introduction: Family and community medicine (FCM) is presented as a socially important medical career; however, its growth in regions of Brazil remains relatively low. It is necessary to identify the factors that influence medical students in their choice of this professional path. Objective: To analyse factors that influence interest in FCM residency among medical interns. Methods: A cross-sectional, descriptive, quantitative analysis study was conducted with students enrolled in the penultimate and final years of medical courses in a Brazilian capital city. Results: 229 medical interns participated in the research. Those interested in FCM are mostly young, of both genders, aged between 26 and 35, married, with children, and have a family income of less than five minimum wages. Two variables were associated with choosing FCM: age and positive evaluation of the specialty. Conclusion: Understanding the factors that influence the choice of FCM can contribute to improving medical education, aligning student preferences with the needs of society and the Public Healthcare System.

Modelos de preceptoria de residência em medicina de família e comunidade: um estudo Delphi / Models of preceptorship in family and community medicine residence: a Delphi study

Resumo Introdução: A preceptoria na atenção primária à saúde desempenha papel central na formação do residente, já que 70%-80% da carga horária dos programas de residência de medicina de família e comunidade (PRMFC) acontece na unidade de saúde da família. Como preceptor entende-se o professor que ensina na prática clínica. O cenário atual de expansão dos PRMFC, associado a poucos profissionais especializados em preceptoria, fez com que vários modelos fossem praticados. Uma revisão de literatura feita em estágio anterior a este trabalho, além das contribuições da Sociedade Brasileira de Medicina de Família e Comunidade, identificou quatro modelos de preceptoria em MFC: ombro a ombro, preceptor da equipe ao lado, preceptor de unidade e preceptor de campo. Objetivo: Este estudo teve como objetivos validar esses quatro modelos e identificar outros, determinar, sob a ótica da qualidade de formação dos residentes, a aceitabilidade e o grau de recomendação dos modelos, e reconhecer os pontos positivos e negativos. Método: Utilizou-se a técnica Delphi modificada por questionários on-line. O estudo começou com 24 participantes de todo o Brasil na primeira rodada e terminou com 18. Aplicaram-se a técnica de estatística descritiva e a análise de conteúdo. O estudo foi realizado entre fevereiro e abril de 2022. Resultado: Validaram-se os quatro modelos apresentados, e nenhum outro foi identificado. Os modelos ombro a ombro, preceptor da equipe ao lado e preceptor de unidade foram considerados aceitáveis; e o modelo preceptor de campo, inaceitável. Os modelos ombro a ombro e preceptor de unidade foram recomendados. Reconheceram-se 92 aspectos como pontos positivos e negativos, dos quais 81 atingiram consenso. Conclusão: Obteve-se a validação dos quatro tipos de modelos de preceptoria para PRMFC. Como os modelos ombro a ombro e preceptor de unidade foram elencados como aceitáveis e recomendáveis, é importante que sejam priorizados na implantação e manutenção dos PRMFC. Os modelos preceptor da equipe ao lado e preceptor de campo foram julgados como não recomendados e, portanto, devem ser evitados. O conhecimento das fortalezas e fraquezas de cada modelo prepara os PRMFC para as possíveis dificuldades e os auxilia na escolha do modelo adequado às diversas realidades existentes no país.

Abstract Introduction: Medical residency preceptorship in primary healthcare plays a major role in the professional qualification of medical residents, since 70-80% of the workload of the Family and Community Medical Residency Program (PRMFC) takes place in primary care clinics. A preceptor is understood as an experienced practitioner who teaches during clinical practice. The current scenario of expansion of PRMFCs in Brazil, associated with the limited number of professionals specialized in preceptorship, has resulted in the practice of different preceptorship models. A literature review performed in the previous stage of this study, added to the contributions of the Brazilian Society of Family and Community Medicine, pointed out four models of preceptorship in family practice: shoulder-to-shoulder, next-door team, clinic preceptor and field preceptor. Objective: To validate these four models of preceptorship and identify if there are others models; to determine, from the perspective of the quality of training residents, the acceptability and degree of recommendation of the models and recognize the positive and negative points. Method: The Delphi technique modified by online questionnaires was used. It was initiated with 24 participants from all over Brazil in the first round and ended with 18. Descriptive statistics and content analysis method was applied. The study was conducted between February and April 2022. Result: The four models presented were validated and no others were identified. The shoulder-to-shoulder, nextdoor team preceptor and clinic preceptor models were considered acceptable and the field preceptor model, unacceptable. The shoulder-to-shoulder and clinic preceptor models were recommended. Ninety-two aspects were recognized as positive and negative points. Of these, 81 achieved consensus. Conclusion: The shoulder-to-shoulder preceptor and clinic preceptor models were validated as acceptable and recommended, so it is important to prioritize these models in the implementation and maintenance of PRMFCs. The next-door team preceptor and field preceptor models were deemed as not recommended and, therefore, should be avoided. Information about the strengths and weaknesses of each model prepares the PRMFCs for possible implementation difficulties and helps them to select the appropriate model for the different realities existing in the country.

Programa Médicos pelo Brasil: primeiros resultados / Doctors for Brazil Program: first results

Resumo O acesso ao cuidado médico é essencial para o alcance da atenção primária à saúde (APS) de qualidade. No Brasil, ainda persistem dificuldades de acesso. O Programa Médicos pelo Brasil (PMpB) pretende ampliar a oferta de serviços médicos em locais de difícil provimento ou alta vulnerabilidade. Traz como inovações a priorização das menores e mais isoladas cidades; a seleção de profissionais por processo isonômico; a formação em medicina de família e comunidade; e o fato de ser a primeira carreira médica federal na APS, com salários competitivos, progressão e incentivos financeiros que valorizam a longitudinalidade e o desempenho. O PMpB é executado pela Agência para o Desenvolvimento da Atenção Primária à Saúde (Adaps), o que permite mais eficiência na gestão da política pública. Os primeiros nove meses do programa mostram resultados promissores, com aproximadamente 23 mil médicos interessados em ingressar no programa por meio de seu processo seletivo, 97,1% de ocupação das vagas e 95,4% de permanência após o ingresso. Tais resultados sinalizam o avanço de qualidade do PMpB em relação às políticas anteriores, bem como a necessidade de continuar com sua implementação, a fim de que ela atinja todo o seu potencial de cobertura na APS do SUS.

Abstract Access to medical care is essential to achieve quality primary health care (PHC). In Brazil, access difficulties still persist. The Doctors for Brazil Program (PMpB in Portuguese) aims to expand the offer of medical services in places of difficult provision or high vulnerability. It innovates insofar as it prioritizes smaller and rather isolated cities, by selecting professionals through an isonomic process, offering them training in Family and Community Medicine and a chance to build their first federal medical career in PHC. The program offers competitive salaries, progression and financial incentives that value long-term commitment and performance. The PMpB is rolled out by the Agency for the Development of Primary Health Care (Adaps), which allows better management of public policies. The first nine months of the program showed promising results, as approximately 23,000 candidates seeking to join the program through its selection process, i.e., 97.1% vacancies were filled and retention rate after admittance was 95.4%. These results show to what extent PMpB has improved in quality compared to previous policies, as well as how essential it is to keep implementing the program so that it may reach its full PHC coverage potential within the Brazilian public health system.

Genealogia da Prevenção Quaternária: entre o uso da Medicina Baseada em Evidências e a reformulação do cuidado na Atenção Primária à Saúde / Genealogical analysis of Quaternary Prevention: between the use of Evidence-Based Medicine and care reformulation in Primary Health Care

Resumo Realizamos uma análise genealógica da Prevenção Quaternária, instrumento da Atenção Primária à Saúde de enfrentamento à medicalização e a iatrogenia, a partir de seus enunciados e de entrevistas com seus formuladores. Identificamos que a ferramenta tem sido tanto apresentada como uma reformulação do cuidado e da relação médico-paciente, como também reduzida ao cálculo do risco-benefício por meio da aplicação atualizada de evidências científicas. Analisamos os paradoxos da Medicina Baseada em Evidências e problematizamos sua relação com a Prevenção Quaternária e a Atenção Primária à Saúde. Por fim, sugerimos questionar a verdade das evidências para o desenvolvimento de outros paradigmas de saúde.

Abstract We conducted a genealogical analysis of quaternary prevention, an instrument of primary health care to address overmedicalization and iatrogenesis, based on related statements and interviews with the creators of this concept. This tool has been used in the reformulation of care and the doctor-patient relationship, but limited to the risk-benefit assessment by using current scientific evidence. In this study, we analyze the paradoxes of evidence-based medicine (EBM) and discuss the relationship of EBM and quaternary prevention and primary health care (PHC). Finally, we suggest questioning the truth of the evidence for the development of other health paradigms.

Medicina familiar, principios bioéticos y final de la vida en Colombia / Family Medicine, Bioethical Principles and End of Life in Colombia

Introducción: La medicina familiar, dentro de su enfoque biopsicosocial, acoge la valoración integral de cada individuo en su curso de vida, donde es indispensable integrar todos los principios bioéticos para brindar una atención adecuada, oportuna y humanizada. El abordaje del especialista en medicina familiar sobre el final de vida debe estar ligado a estos aspectos, lo que permite ampliar la relación clínica desde el paciente hasta su núcleo familiar y su equipo en salud. Objetivo: Discutir los principios bioéticos desde una perspectiva integrativa a partir de un recorrido por los principales apartados legales que se han desarrollado en Colombia desde la sentencia C-239 de 1997, en relación con el derecho a morir dignamente. Métodos: Se realizó una revisión narrativa mediante la búsqueda en PubMed, Elsevier, Scielo y la normativa del contexto colombiano. Conclusiones: La disponibilidad de la información permite tener claridad sobre los conceptos al final de vida y el quehacer de los profesionales de la salud en esta etapa, que permita brindar al paciente y a su familia información clara y alternativas en su manejo integral, que dignifique la relación médico-paciente-familia-equipo de salud(AU)

Introduction: Family medicine, within its biopsychosocial approach, welcomes the comprehensive assessment of each individual in his or her life course, where it is essential to integrate all bioethical principles to provide adequate, timely and humanized care. The approach of the family medicine specialist at the end of life should be linked to these aspects, which allows extending the clinical relationship of the patient to the family nucleus and the health team. Objective: To discuss bioethical principles from an integrative perspective based on the review of the main legal paragraphs that have been developed in Colombia since the C-239 ruling of 1997 in relation to the right to die with dignity. Methods: A narrative review was carried out through searches in PubMed, Elsevier, SciELO and in the normativity of the Colombian context. Conclusions: The availability of information allows clarity about the concepts at the end of life and the work of health professionals at this stage, which allows providing the patient and family with clear information and alternatives in their comprehensive management, which dignifies the doctor-patient-family-health team relationship(AU)

A preceptoria médica em medicina de família e comunidade: uma proposta dialógica com a andragogia / Medical preceptorship in family and community medicine: a proposal for dialogue with andragogy

Resumo: Introdução: O Brasil está em um amplo processo de fortalecimento das residências médicas nas áreas básicas, porém existe a necessidade de um currículo estruturado para qualificar a formação do preceptor. Objetivo: Este estudo teve como objetivo construir uma matriz dialógica para orientar a formação educacional da preceptoria em medicina de família e comunidade (MFC). Método: Por meio de um estudo qualitativo-analítico, analisaram-se três programas de preceptoria médica no Brasil: Associação Brasileira de Educação Médica, Hospital Sírio-Libanês e Hospital Alemão Oswaldo Cruz. Em seguida, uma proposta formativa foi apresentada contendo macrodiretrizes que possibilitem mudanças nos processos de ensino e aprendizagem para qualificação da prática preceptora em diálogo com a andragogia. Resultado: A matriz construída norteia-se pela aprendizagem do adulto, enfatizando a autonomia do aprendiz, em detrimento do controle da aprendizagem pelo educador. Envolve cinco dimensões: direcionalidade da formação; conteúdo; estratégias pedagógicas; concepções e estrutura formativa; e relação entre saúde, educação e pesquisa. Cada uma delas agrega um conjunto de diretrizes que valorizam o contexto e os princípios da formação em serviço no SUS; o desenvolvimento de competências acerca de conteúdos da atenção, gestão e educação em saúde; concepções e estruturas pautadas pela construção de vínculos significativos entre os sujeitos envolvidos no ato educativo, respeitando seus saberes prévios e experiências; estratégias pedagógicas colaborativas, trabalho com grupos operativos e o uso de tecnologias da informação e comunicação; e o estímulo à pesquisa como princípio educativo. Conclusão: A matriz considerou as necessidades da formação em MFC, baseando-se em aspectos-chave da andragogia. Acredita-se que ela possa promover mudanças nos processos de ensino-aprendizagem dos preceptores, com o objetivo de qualificar sua prática.

Abstract: Introduction: Brazil is in a broad process of strengthening medical residencies in basic areas, but there is a need for a structured curriculum to qualify the training of preceptors. Objective: To build a dialogic matrix to guide the educational training of preceptorship in Family and Community Medicine (FFM). Methodology: Through a qualitative-analytical study, three medical preceptorship programs in Brazil were analyzed, namely: Associação Brasileira de Educação Médica, Hospital Sírio-Libanês and Hospital Alemão Oswaldo Cruz. A training proposal was subsequently presented containing macro-guidelines that allow changes in the teaching and learning processes to qualify preceptor practice in dialogue with andragogy. Results: Based on andragogy, the resulting matrix emphasized the learner's autonomy, to the detriment of the educator's control of learning. It involves five dimensions: directionality of training; contents; pedagogical strategies; training concepts and structure; and the relationship between health, education and research. Each dimension included guidelines that value: the context and principles of in-service training in the SUS; the development of competences about the contents of health care, management and education; conceptions and structures guided by the construction of significant bonds between the subjects involved in the educational act, respecting their previous knowledge and experiences; collaborative pedagogical strategies, work with operative groups and the use of information and communication technologies; and encouraging research as an educational principle. Conclusion: The matrix considered the needs of FCM training, based on key aspects of andragogy. It can promote changes in the teaching-learning processes of preceptors, with the aim of qualifying their practice.

Palliative Radiotherapy in Home Care

Palliative radiotherapy, when properly administered, contributes to improving the quality of life of patients. Although the usefulness of radiotherapy has been increasingly recognized, the need for palliative radiotherapy from home healthcare institutions has not yet been met. Although there are patients undergoing home care who would benefit from radiotherapy to improve their quality of life, it is difficult to determine the indication in the home care setting, where diagnostic imaging tests are not readily available. In addition, patients undergoing treatment at home often have a lowered performance status, making frequent visits to the hospital difficult and limiting their means of transportation. Under these circumstances, we have been providing palliative radiotherapy in cooperation with home care clinics.

Current Status and Issues of Cardiovascular Surgery Institution in Community Medicine / 日本心臓血管外科学会雑誌

Lately, there has been a trend towards integration among cardiovascular surgery institutions. However, local institutions continue to play a crucial role in community-based medicine, given the emergent nature of cardiovascular diseases and the challenges involved in transporting patients with such conditions over long distances. We present the results of a questionnaire survey we conducted to examine the current status and issues faced by cardiovascular surgery institutions in community-based medicine.

Programa educativo para el control de factores de riesgo modificables asociados al embarazo en adolescentes / Educational program for the control of modifiable risk factors associated with pregnancy in adolescents

Fundamento: el embarazo en adolescentes es una preocupación a nivel mundial, sobre todo para las naciones en desarrollo. Objetivo: determinar la efectividad de un programa educativo para el control de factores de riesgo modificables asociados al embarazo en la adolescencia, en el Consultorio Médico 5 de Esperanza entre febrero 2020-febrero de 2022. Métodos: se realizó un estudio de intervención de tipo cuasi experimental sin grupo de control. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético, inductivo-deductivo y abstracto-concreto. Del nivel empírico; revisión documental y encuesta. Resultados: se constató un predominio significativo de pacientes en etapa tardía de la adolescencia, 54,2 % con nivel preuniversitario, 79,2 % con primeras relaciones sexuales, de 15 años (45,8 %) y el vínculo de parejas de concubinato (29,2 %), sin abortos (58 %), como causa de los abortos forzados las dificultades económicas (17 %), no presencia de antecedentes familiares (54,1 %), la no presencia de infecciones de trasmisión sexual (75 %). Se modificaron los factores: consumo de alcohol, función familiar y uso de anticonceptivos. Se produjeron cambios muy significativos en el nivel de información de forma positiva. Conclusiones: se verificó la efectividad del programa educativo para el control de factores de riesgo modificables asociados al embarazo en la adolescencia.

Background: early pregnancy in adolescents is a global concern, especially for developing nations. Objective: determine the effectiveness of an educational program to control modifiable risk factors associated with teenage pregnancy, at the Esperanza 5 Medical Office from February 2020 to February 2022. Methods: a quasi-experimental intervention study was carried out without a control group. Theoretical methods were used: historical-logical, analytical-synthetic, inductive-deductive and abstract-concrete. From the empirical level; documentary review and survey. Results: a significant predominance of patients in late adolescence was found, 54.2% with pre-university level, 79.2% with first sexual relations, 15 years of age (45.8%) and the bond of cohabiting couples ( 29.2%), without abortions (58%), as the cause of forced abortions: economic difficulties (17%), no family history (54.1%), no presence of sexually transmitted infections (75% ). The factors were modified: alcohol consumption, family function and contraceptive use. There were very significant changes in the level of information in a positive way. Conclusions: the effectiveness of the educational program for the control of modifiable risk factors associated with pregnancy in adolescence was verified.

Improving the Quality of Residency Programs in Family and Community Medicine / Aprimorando a qualidade de Programas de Residência em Medicina de Família e Comunidade

ABSTRACT OBJECTIVE To develop and present an instrument to evaluate and monitor the quality of medical residency programs in residencies in family and community medicine (FCM) based on preceptors and residents, considering the insertion of the health network program. METHOD The instrument was developed in three stages: 1) interview with the preceptors of FCM; 2) literature review; and 3) production, adequacy, and approval of the evaluation instrument by renowned professionals of the Brazilian FCM. The third stage included 9 people and used the Delphi technique with 80% agreement. For the qualitative results, Bardin's Content Analysis was used. RESULTS In all, there were five evaluation cycles to adapt the proposed recommendations, with the elimination of one item and weighting, with a results analysis methodology of 10 resulting items, reaching an expected matrix for organizing residency programs in the health network, divided into 3 domains: Organization of the Unit, Human Resources, and Preceptor-resident relationship. CONCLUSION An instrument for evaluating and monitoring residency programs in family and community medicine can be a tool to facilitate program managers and allow evaluation and monitoring, continuously qualifying them.

RESUMO OBJETIVO Desenvolver e apresentar um instrumento para avaliar e monitorar a qualidade de programas de residência médica em medicina de família e comunidade (MFC) a partir dos preceptores e residentes, considerando a inserção do programa de rede de saúde. MÉTODO A elaboração do instrumento foi desenvolvida em três etapas: 1) entrevista com preceptores em MFC; 2) revisão da literatura; e 3) produção, adequação e aprovação do instrumento avaliativo por profissionais renomados na MFC brasileira. A terceira etapa contou com nove pessoas e utilizou a técnica Delphi com obtenção de 80% de concordância. Para os resultados qualitativos foi utilizada a análise de conteúdo de Bardin. RESULTADOS Ao todo ocorreram cinco ciclos de avaliação para adequação das recomendações propostas, com eliminação de um item e ponderação, e metodologia de análise de resultado de dez itens resultantes. Atingiu-se uma matriz esperada para a organização de programas de residência na rede de saúde, dividida em três domínios: organização da unidade, recursos humanos e relação preceptor-residente. CONCLUSÃO Um instrumento de avaliação e monitoramento de programas de residência em MFC pode ser uma ferramenta para auxiliar gestores de programas e permite a avaliação e monitoramento, qualificando-os continuamente.

Programa educativo para prevenir la leptospirosis en una zona rural de Jibacoa, Manicaragua, Cuba / Educational program to prevent leptospirosis in a rural area of Jibacoa, Manicaragua, Cuba

Fundamento: la leptospirosis es una zoonosis de distribución mundial que puede presentarse en zonas urbanas y rurales cuyo evidente resurgimiento se ilustra en los brotes recientes en todos los continentes. Objetivo: desarrollar un programa educativo sobre la leptospirosis en el Consultorio Médico 036-11, del poblado de Jibacoa, Manicaragua. Métodos: se desarrolló un estudio prexperimental de intervención educativa aprobado por especialistas, en el Consultorio Médico 036-11, de Jibacoa, Manicaragua entre marzo 2020-marzo 2022. Se utilizaron métodos teóricos: análisis-síntesis, inductivo-deductivo e histórico-lógico; empírico: análisis documental y cuestionario; y matemático-estadísticos para el análisis de los datos encontrados. Resultados: en el diagnóstico realizado predominaron los trabajadores del sexo masculino, la mayoría de ellos con riesgos para contraer la leptospirosis, la presencia de animales domésticos y roedores, e inadecuados conocimientos sobre la enfermedad. El análisis de situación de salud permitió caracterizar la comunidad rural con condiciones favorables para la proliferación de las leptospiras, por lo que se diseñó un programa educativo para capacitar a los habitantes del lugar sobre el tema, el cual valorado por criterios de especialistas. Conclusiones: después de valorado como adecuado se aplicó y demostró su efectividad al modificar positivamente los conocimientos de los habitantes en riesgo dentro de esa comunidad rural.

Background: leptospirosis is a zoonosis with worldwide distribution that can occur in urban and rural areas whose evident resurgence is illustrated in recent outbreaks on all continents. Objective: to develop an educational program on leptospirosis in the Doctor´s Office 036-11, in the town of Jibacoa, Manicaragua. Methods: a pre-experimental study of educational intervention approved by specialists was carried out at Doctor´s Office 036-11, in Jibacoa, Manicaragua from March 2020 to March 2022. Theoretical methods were used: analysis-synthesis, inductive-deductive and historical-logical; empirical: documentary analysis and questionnaire; and mathematical-statistical for the analysis of the data found. Results: male workers predominated in the diagnosis, most of them at risk of contracting leptospirosis, the presence of domestic animals and rodents, and inadequate knowledge about the disease. The analysis of the health situation allowed to characterize the rural community with favorable conditions for the proliferation of leptospirosis, for which an educational program was designed to train the inhabitants of the place on the subject, which was valued by specialist criteria. Conclusions: after being assessed as adequate, it was applied and demonstrated its effectiveness by positively modifying the knowledge of the inhabitants at risk within that rural community.

Modelo para capacitar sobre percepción de riesgo en VIH/sida a jóvenes del municipio Manicaragua / Model to train young people from the Manicaragua municipality, Cuba, on risk perception in HIV/AIDS

Fundamento: el VIH/sida es un problema de salud caracterizado por un severo compromiso de la inmunidad; esta entidad constituye factor de riesgo para el desarrollo de las principales causas de muerte a nivel mundial. Objetivo: proponer un modelo para capacitar sobre percepción de riesgo sobre el VIH/sida a jóvenes del Consultorio Médico 41 del área de salud Manicaragua. Métodos: se realizó un estudio observacional, descriptivo, transversal en el Consultorio Médico 41 del área de salud Manicaragua en la provincia de Villa Clara. Se aplicaron métodos teóricos: histórico-lógico, análisis síntesis, inducción-deducción, sistémico-estructural y modelación; empíricos: el cuestionario a jóvenes y la historieta de conflictos; matemáticos-estadísticos para el análisis de los datos. Resultados: las insuficiencias más frecuentes en la percepción de riesgo estuvieron relacionadas con las carencias en la información, la comprensión y la toma de decisiones para la prevención de salud. Se ofrece un modelo para la capacitación en percepción de riesgo ante el VIH/sida el cual fue valorado por criterios de especialistas. Conclusiones: el modelo posibilita la adquisición de conductas promotoras de la salud sexual, comprender y predecir cómo puede responderse a los peligros ante la enfermedad, contribuir al cambio de intención y comportamiento, y a asumir actitudes de protección. Fue valorado como aceptado por los especialistas consultados.

Background: HIV/AIDS is a health problem characterized by a severe compromise of immunity; this entity constitutes a risk factor for the development of the main causes of death worldwide. Objective: to propose a model to train young people from the Doctor´s office 41 in the Manicaragua health area on risk perception on HIV/AIDS. Methods: an observational, descriptive, cross-sectional study was carried out in the Doctor´s office 41 of the Manicaragua health area in the province of Villa Clara. Theoretical methods were applied: historical-logical, analysis synthesis, induction-deduction, systemic-structural and modeling; empirical ones: the questionnaire for young people and the conflict story; mathematical-statisticians for data analysis. Results: the most frequent deficiencies in risk perception were related to deficiencies in information, understanding and decision-making for health prevention. A model for training in risk perception to face HIV/AIDS is offered, which was assessed by specialist criteria. Conclusions: the model enables the acquisition of behaviors that promote sexual health, understanding and predicting how to respond to the dangers of the disease, contributing to the change of intention and behavior, and assuming protective attitudes. It was valued as accepted by the specialists consulted.

Superación del médico general para la atención integral a niños con necesidades educativas especiales / Knowledge improvement of the general practitioner for comprehensive care for children with special educational needs

Fundamento: la superación especializada del médico general integral debe de estar encaminada a elevar su nivel profesional en la atención primaria de salud, particularizando en las características individuales de cada paciente. Objetivo: diagnosticar el estado actual de preparación de los médicos generales de la atención primaria de salud en cuanto al conocimiento para brindar atención integral y especializada a los niños con necesidades educativas especiales, pertenecientes al Policlínico Universitario "Ignacio Agramonte", de Camagüey. Métodos: se realizó un estudio descriptivo transversal entre los meses septiembre-diciembre de 2021. Se aplicaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; y empíricos, revisión documental y cuestionario a los médicos que laboran en los consultorios médicos del área. Resultados: el diagnóstico realizado permitió identificar falencias en la formación profesional del médico general desde su programa de formación en la especialidad Medicina General Integral, las que dificultan el trabajo exitoso en cuanto a la atención integral a niños con necesidades especiales, en aras de promover su inclusión social y el beneficio de su desarrollo individual. Conclusiones: las deficiencias encontradas ratifican la necesidad de implementar una estrategia de superación en cuanto al tema para perfeccionar el distintivo trabajo comunitario del médico general integral.

Background: the specialized improvement of the comprehensive general practitioner must be aimed at raising their professional level in primary health care, particularizing the individual characteristics of each patient. Objective: to diagnose the current state of preparation of general practitioners in primary health care in terms of knowledge to provide comprehensive and specialized care to children with special educational needs, belonging to the "Ignacio Agramonte" University Polyclinic in Camagüey. Methods: a cross-sectional descriptive study was carried out between from September to December 2021. Theoretical methods were applied: historical-logical, analysis-synthesis and induction-deduction; and empirical ones, documentary review and questionnaire to the doctors who work in the doctor´s offices of the area. Results: the diagnosis made possible to identify shortcomings in the professional training of the general practitioner from his training program in the Comprehensive General Medicine specialty, which hinder successful work in terms of comprehensive care for children with special needs, in order to promote their social inclusion and the benefit of their individual development. Conclusions: the deficiencies found ratify the need to implement an improvement strategy regarding the subject to improve the distinctive community work of the comprehensive general practitioner.

Rasgos de profesionalidad médica en el ámbito de la atención primaria: respeto por la autonomía / Traits of medical professionalism in the field of primary care: respect for autonomy

Fundamento: el respeto por la autonomía del paciente y una conducta respetuosa en general son rasgos centrales de la profesionalidad médica. Objetivo: indagar la presencia de los rasgos profesionales de respeto por la autonomía de los pacientes y de respeto en general en las expresiones verbales de profesionales del ámbito de atención primaria de la salud durante su interacción con pacientes y estudiantes del último año de la carrera de Medicina. Métodos: se efectuó una investigación cualitativa de carácter exploratorio en contextos de prácticas finales obligatorias en dos Centros de Atención Primaria de la Salud de la ciudad de Tandil, República de Argentina, durante el año 2019. Como métodos teóricos se emplearon: análisis-síntesis, inductivo-deductivo y método de revisión crítica de la literatura y empírico: se realizó el registro grabado de 28 encuentros entre expertos, estudiantes y pacientes. Las sesiones se analizaron mediante triangulación de investigadores. Resultados: las expresiones verbales de los expertos permitieron identificar enunciados relacionados con rasgos de respeto en general y respeto por la autonomía de los pacientes. Estos se evidenciaron en enunciados para construir un ambiente de confianza y confidencialidad, el esfuerzo por brindar explicaciones de forma clara y sencilla, la atención a las dudas de los pacientes y la formulación de explicaciones sobre cómo proceder, en un lenguaje accesible. Conclusiones: se identificó la presencia de los rasgos profesionales de respeto por la autonomía de los pacientes y de respeto en general, tanto en las interacciones con pacientes como con los estudiantes.

Background: respect for the autonomy of the patient and a respectful behavior in general are key features of medical professionalism. Objective: to investigate the presence of professional traits of respect for the autonomy of patients and of respect in general in the verbal expressions of professionals in the field of primary health care during their interaction with patients and students in the last year of the Medicine degree. Methods: a qualitative research of an exploratory nature was carried out in the context of mandatory final practices in two Primary Health Care Centers in the city of Tandil, Republic of Argentina, during the year 2019. The following theoretical methods were used: analysis-synthesis, inductive-deductive and method of critical review of the literature and empirical ones: the recorded record of 28 meetings between experts, students and patients was made. The sessions were analyzed by opposing sources of researchers. Results: the verbal expressions of the experts made it possible to identify statements related to traits of respect in general and respect for the autonomy of the patients. These were evidenced in statements to build an environment of trust and confidentiality, the effort to provide explanations in a clear and simple way, the attention to the patients' doubts and the formulation of explanations on how to proceed, in an accessible language. Conclusions: the presence of professional traits of respect for the autonomy of patients and respect in general was identified, both in interactions with patients and with students.

Dr. Serafín Ruiz de Zárate Ruiz: aportes al ideal médico social desde su gestión ministerial / MD. Serafín Ruiz de Zárate Ruiz: contributions to the social medical ideal from his ministerial management

Fundamento: los años 1959 y 1960 fueron decisivos en las proyecciones y concreción del ideal médico social, como proceso iniciado, a establecerse en Cuba. Objetivo: identificar los aportes más relevantes del Dr. Serafín Ruiz de Zárate Ruiz, en su gestión como ministro de salud pública a la conformación del ideal médico social cubano en la década del sesenta del siglo XX. Métodos: se realizó una investigación documental de corte histórico en el año 2022. Se aplicaron métodos teóricos que permitieron analizar el objetivo de estudio, basado en la interacción de lo histórico y lo lógico y desde las dimensiones temporal y espacial; y empíricos: análisis de contenido y la consulta bibliográfica para procesar en conjunto el producto resultante, se empleó la triangulación para mejorar la validez y confiabilidad de los datos obtenidos. Resultados: la designación y actuación del Dr. Ruiz de Zárate frente al Ministerio de Salud Pública sentó las bases y logró avanzar, bajo una aguda lucha de clases, en el camino de modificar las condiciones higiénico-sanitarias de la población, posible solo por los cambios de concepciones médicas de lo asistencial curativo a lo social. Conclusiones: el Dr. Ruiz de Zárate en su gestión como ministro hizo relevantes aportes a la conformación del ideal médico social. Diversas y amplias fueron las acciones encaminadas para materializarlo, expresadas concretamente en políticas, leyes, planes, medidas, entre otras, que fueron superadas y fortalecidas con el mismo objetivo por el Dr. José Ramón Machado Ventura.

Background: the years 1959 and 1960 were decisive in the projections and concretion of the social medical ideal, as an initiated process, to be established in Cuba. Objective: to identify the most relevant contributions of MD. Serafín Ruiz de Zárate Ruiz, as Minister of Public Health, to the conformation of the Cuban social medical ideal in the sixties of the 20th century. Methods: a historical documentary research was carried out in the year 2022. Theoretical methods were applied that allowed us to analyze the objective of the study, based on the interaction of the historical and the logical and from the temporal and spatial dimensions; and empirical ones: content analysis and bibliographic consultation to jointly process the resulting product, sources contrasting was used to improve the validity and reliability of the data obtained. Results: the appointment and action of MD. Ruiz de Zárate in front of the Ministry of Public Health laid the foundations and managed to advance, under an acute class struggle, in the path of modifying the hygienic-sanitary conditions of the population, possible only because of the Changes in medical conceptions from curative care to social. Conclusions: MD. Ruiz de Zárate as minister of public health made relevant contributions to the conformation of the social medical ideal. Diverse and extensive were the actions aimed at materializing it, specifically expressed in policies, laws, plans, measures, among others, which were overcome and strengthened with the same objective by MD. José Ramón Machado Ventura.

Huellas históricas de la COVID-19 en la asistencia médica de los habitantes de Manicaragua, Cuba / Historical traces of COVID-19 in the medical care of the inhabitants of Manicaragua, Cuba

Fundamento: la pandemia de COVID-19 ha tenido un efecto socioeconómico disruptivo en el mundo; pero ha dejado huellas que constituyen lecciones aprendidas entre la población de numerosos países. Objetivo: describir las huellas históricas de la COVID-19 en el municipio de Manicaragua, Villa Clara, Cuba, como expresión de la reorganización y regionalización de los servicios de salud que demandaba el enfrentamiento a la pandemia. Métodos: se realizó un estudio descriptivo longitudinal cuantitativo sobre el comportamiento de la COVID-19 en Manicaragua desde el inicio de la pandemia, abril 2020 hasta el 2022. Se emplearon métodos teóricos: análitico-sintético e histórico-lógico; empíricos: análisis documental; y matemático-estadísticos: para los valores absolutos y relativos. Resultados: fue analizado el impacto de la COVID-19 a partir de los casos diagnosticados y sus tasas de incidencia por habitantes en las distintas áreas de salud. Se destacan cifras predominantes: el poblado de Manicaragua y el grupo etario de 19 a 64 años como los de mayor presencia de contagiados, la fuente de infección superior fue la intradomiciliaria y Estados Unidos como el país que aportó la mayor cifra de contaminados. Se argumentan algunas formas de indisciplinas sociales como causas de los rebrotes epidemiológicos. Conclusiones: la COVID-19 dejó huellas que pueden considerarse históricas en Manicaragua, pues representó una pausa en su desarrollo social y un reordenamiento de los servicios médicos asistenciales. El incumplimiento de los protocolos y la actuación comunitaria frente a las indisciplinas sociales hoy se consideran lecciones aprendidas frente a próximos eventos epidemiológicos.

Background: the COVID-19 pandemic has had a disruptive socioeconomic effect on the world; but it has left traces that constitute lessons learned among the population of many countries. Objective: to describe the historical traces of COVID-19 in the municipality of Manicaragua, Villa Clara, Cuba, as an expression of the reorganization and regionalization of health services that the confrontation with the pandemic demanded. Methods: a quantitative longitudinal descriptive study was carried out on the behavior of COVID-19 in Manicaragua from the beginning of the pandemic, April 2020 to 2022. Theoretical methods were used: analytical-synthetic and historical-logical; empirical ones: documentary analysis; and mathematical-statistical: for absolute and relative values. Results: the impact of COVID-19 was analyzed based on the diagnosed cases and their incidence rates per population in the different health areas. Predominant figures stand out: the town of Manicaragua and the age group from 19 to 64 years as the ones with the highest presence of infected people, the highest source of infection was intra-domiciliary and the United States as the country that contributed the highest number of infected people. Some forms of social indiscipline are argued as causes of epidemiological outbreaks. Conclusions: COVID-19 left traces that can be considered historical in Manicaragua, since it represented a pause in its social development and a reordering of medical care services. Failure to comply with the protocols and community action against social indiscipline today are considered lessons learned in the face of upcoming epidemiological events.