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1.
An. Fac. Med. (Perú) ; 85(1): 92-96, ene.-mar. 2024. tab
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1556808

Résumé

RESUMEN Presentamos la experiencia del Policlínico de la Peruvian American Medical Society (PAMS) en Chincha, en la ejecución de misiones médico-educativas en la región Chincha. El Policlínico PAMS presta atención médica general y especializada a la población de la zona, seis días a la semana. Además, recibe misiones médicas que vienen generalmente de los EE. UU. Desde 2011, se han recibido 43 misiones médicas. La composición y la naturaleza de las misiones han cambiado con el tiempo. Los primeros años se atraía a especialistas con el énfasis de traer equipos e insumos para mejorar la infraestructura del Policlínico. Ahora estamos limitados por la renuencia de voluntarios de venir al Perú en parte debido a que el gobierno americano considera que viajes al Perú son de alto riesgo. Esta limitación nos ha brindado la oportunidad de hacer misiones médicas juntamente con dos excelentes universidades peruanas. La experiencia ha sido positiva.


ABSTRACT We present the experience of the Polyclinic of the Peruvian American Medical Society (PAMS) in Chincha, in the execution of medical educational missions in the Chincha region. The PAMS Polyclinic provides general and specialized medical care to the population of the area, six days a week. In addition, the Polyclinic receives medical missions generally coming from the EE.UU. Since 2011, we have received 43 medical missions. The composition and nature of the missions have changed over time. The first years attracted specialists with the emphasis on bringing equipment and supplies to improve the infrastructure of the Polyclinic. We are now limited by the reluctance of volunteers to come to Peru in part because the U.S. government considers travel to Peru to be high-risk. This limitation has given us the opportunity to do medical missions together with two excellent Peruvian universities. This experience has been positive.

2.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1556968

Résumé

Introducción: El sueño garantiza el bienestar físico y mental del individuo mediante retroalimentación directa. Los trastornos del sueño implican alteraciones respecto a calidad y cantidad de horas de sueño y obedecen a una alteración real de su función fisiológica que controla y opera durante el mismo. La Medicina del Sueño es una especialidad nueva, surgida en los últimos 50 años, cuyo campo de acción aborda la prevención, diagnóstico y tratamiento de los trastornos del sueño; los cuales hasta el momento se han identificado alrededor del centenar. Esta enfermedad se ha convertido en problema social crucial y creciente, difícil de abordar en la práctica médica contemporánea; debido a la complejidad en la toma de decisiones respecto a su diagnóstico y tratamiento. Esta temática requiere ser evaluada desde un enfoque interdisciplinario para reducir la morbimortalidad asociada a manifestaciones neurológicas, psicológicas, psiquiátricas, cardiovasculares y endocrinometabólicas. Objetivo: Establecer la propuesta de Consulta Interdisciplinaria de Medicina del Sueño en la provincia Camagüey. Métodos: Se efectuó una investigación cualitativa de tipo descriptivo para la selección de aspectos pertinentes a una consulta especializada proveedora de pacientes pediátricos con trastornos del sueño, en el período comprendido entre julio y diciembre de 2022, en el Centro de Inmunología y Productos Biológicos de la Universidad de Ciencias Médicas de Camagüey. El universo del grupo de trabajo estuvo integrado por ocho profesionales de las Ciencias Médicas. Se utilizaron métodos teóricos como la revisión documental, histórico-lógico, análisis y síntesis, inducción-deducción, métodos matemáticos-estadísticos y métodos computacionales. Resultados: Se conformó un algoritmo de trabajo para la atención médica, que desarrolló el ordenamiento de los elementos sustantivos propios de la analítica polisomnográfica en el contexto cubano. Logró unificar criterios y opiniones generales de manera consensuada por equipos interdisciplinarios. Conclusiones: Resulta definido el documento científico rector de la Consulta Interdisciplinaria de Medicina del Sueño en Camagüey.


Introduction: Sleep guarantees the physical and mental well-being of the individual through direct feedback. Sleep disorders involve alterations in the quality and quantity of hours of sleep and are due to a real alteration in the physiological function that controls and operates during sleep. Sleep Medicine is a new specialty, emerged in the last 50 years, whose field of action addresses the prevention, diagnosis and treatment of sleep disorders; of which around a hundred have been identified so far. This kind of disorders has become a crucial and growing social problem, difficult to address in contemporary medical practice; due to the complexity in decision-making regarding diagnosis and treatment. This topic requires being evaluated from an interdisciplinary approach to reduce morbidity and mortality associated with neurological, psychological, psychiatric, cardiovascular and endocrine-metabolic manifestations. Objective: To establish the proposal of Interdisciplinary Consultation of Sleep Medicine in the province Camagüey. Methods: A qualitative descriptive research was carried out to select aspects relevant to a specialized consultation providing pediatric patients with sleep disorders, in the period between July and December 2022, at the Center for Immunology and Biological Products of the University of Medical Sciences of Camagüey. The universe of the working group was made up of eight professionals from the Medical Sciences. Theoretical methods such as documentary review, historical-logical, analysis and synthesis, induction-deduction, mathematical-statistical methods and computational methods were used. Results: A work algorithm for medical care was formed, which developed the ordering of the substantive elements of polysomnographic analysis in the Cuban context. It manages to unify general criteria and opinions in a consensus by interdisciplinary teams. Conclusions: The governing scientific document of the Interdisciplinary Consultation of Sleep Medicine in Camagüey is defined.

3.
Cad. Saúde Pública (Online) ; 40(3): e00092123, 2024. tab
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1557392

Résumé

Este estudio tiene como objetivo describir y analizar el pluralismo médico y el tipo de relaciones de hegemonía-subalternidad entre diversas formas o saberes de atención, que se desarrollaron en el itinerario terapéutico de una padeciente de glaucoma, para mostrar el proceso articulatorio y transaccional entre distintos recursos terapéuticos, así como comprender qué elementos estructurales configuraron el itinerario y la elección terapéutica. La investigación es cualitativa, un estudio de caso en el cual se utilizó el enfoque narrativo. Para la reconstrucción de la narrativa se realizó una entrevista semiestructurada, dirigida por una guía temática previamente determinada por un conjunto de categorías apriorísticas, para posteriormente transcribir la entrevista y realizar un proceso de triangulación hermenéutica. Los resultados mostraron, en este caso, que la hegemonía en el pluralismo médico se constituyó mediante relaciones de equivalencia, así, la padeciente sustituyó el uso de medicamentos farmacológicos por terapias de medicina alternativa, no obstante, el proceso relacional de equivalencia se desarrolló en un contexto de significación biomédica, en el cual tratar o controlar la presión intraocular fue la premisa del remplazo. Asimismo, los procesos que desencadenaron la presencia de relaciones hegemónicas se constituyeron por diversos factores sociales, culturales y económicos como el desempleo, la seguridad social y el género, que desempeñaron un papel fundamental durante la búsqueda de la atención y del cuidado.


This study aims to describe and analyze the medical pluralism and the type of hegemony-subordination relation between forms of care or knowledge in the treatment of a patient with glaucoma to show the articulatory and transactional process between several therapeutic resources and understand which structural elements shaped the treatment itinerary and option. This is a qualitative research that used a narrative case study. To reconstruct the narrative, a semi-structured interview was conducted based on a thematic script previously established by a set of a priori categories to later transcribe the data and perform hermeneutic triangulation. Results showed that the hegemony in medical pluralism was based on equivalence relations, so that the patient replaced the use of pharmacological drugs with alternative medicine treatments. However, the relational process of equivalence developed itself in a context of biomedical significance, in which the treatment or control of intraocular pressure configured the substitution premise. Thus, the processes that triggered the hegemonic relations were constituted by various social, cultural, and economic factors such as unemployment, social security, and gender, which played a fundamental role during the search for care.


Este estudo visa descrever e analisar o pluralismo médico e o tipo de relação de hegemonia-subalternidade entre diversas formas de atendimento ou conhecimentos, que ocorreram no tratamento de um paciente com glaucoma, com a finalidade de mostrar o processo articulatório e transacional entre diferentes recursos terapêuticos, bem como entender quais elementos estruturais moldaram o itinerário e a opção de tratamento. Trata-se de uma pesquisa qualitativa, que utilizou um estudo de caso com abordagem narrativa. Para a reconstrução da narrativa, foi realizada uma entrevista semiestruturada, com base em um roteiro temático previamente estabelecido por um conjunto de categorias a priori, para posteriormente transcrever os dados e realizar a triangulação hermenêutica. Os resultados mostraram que a hegemonia no pluralismo médico esteve baseada em relações de equivalência, de modo que o paciente substituiu o uso de medicamentos farmacológicos por tratamentos da medicina alternativa; no entanto, o processo relacional de equivalência desenvolveu-se em um contexto de significância biomédica, na qual o tratamento ou controle da pressão intraocular foi a premissa para a substituição. Desse modo, os processos que desencadearam a presença de relações hegemônicas foram constituídos por fatores sociais, culturais e econômicos diversos como desemprego, previdência social e gênero, os quais tiveram papel fundamental durante a busca por atendimento e cuidado.

4.
Cad. Saúde Pública (Online) ; 40(4): e00146523, 2024. tab
Article Dans Anglais | LILACS-Express | LILACS | ID: biblio-1557416

Résumé

Abstract: This study aimed to analyze the prevalence of indicators of use of healthcare services according to sex, income and race/skin color, in adolescents (aged 10-19 years old) based on data from the Health Survey of the Municipality of Campinas (ISACamp), carried out in 2014/2015 in Campinas, São Paulo, Brazil. The chi-square test was used to evaluate the differences between the outcome variables (indicators of use of healthcare service) and sex, income and race/skin color. Adjusted prevalence ratios (PR) were estimated using Poisson multiple regression models. The demand for medical care was high in the last year of the interview (79.2%), mostly attended by the Brazilian Unified National Health System (65.2%), with routine consultations being more prevalent for females (PR = 1.17; 95%CI: 1.01-1.34) and injury for the male population (PR = 0.47; 95%CI: 0.26-0.84). Economic and racial differences were found in the evaluation of the last medical consultation, with a higher prevalence of worse care among those with lower income (PR = 1.46; 95%CI: 1.14-1.87) and black people (PR = 1.27; 95%CI: 1.01-1.61). Inequalities remained for delay or failure to carry out exams (PR = 1.64; 95%CI: 1.02-2.64) and worse quality of dental care (PR = 2.10; 95%CI: 1.38-3.21) in those with lower income. Also, black people had fewer appointments with dentists (PR = 0.90; 95%CI: 0.82-0.99).


Resumo: O estudo objetivou estimar a prevalência dos indicadores de uso de serviços de saúde de acordo com sexo, renda e etnia/cor da pele entre adolescentes (10 a 19 anos) com base nos dados do Inquérito de Saúde no Município de Campinas (ISACamp), realizada em 2014/2015 em Campinas, São Paulo, Brasil. O teste qui-quadrado foi utilizado para avaliar as diferenças entre as variáveis de desfecho (indicadores de utilização de serviços de saúde) e sexo, renda e etnia/cor da pele. As razões de prevalência (RP) ajustadas foram estimadas por meio de modelos de regressão múltipla de Poisson. A demanda por atendimentos médicos foi elevada no último ano da entrevista (79,2%), atendidos majoritariamente pelo Sistema Único de Saúde (65,2%), sendo as consultas de rotina mais prevalentes no sexo feminino (RP = 1,17; IC95%: 1,01-1,34) e lesão na população masculina (RP = 0,47; IC95%: 0,26-0,84). Diferenças econômicas e raciais foram encontradas na avaliação da última consulta médica, com maior prevalência de pior atendimento entre aqueles com menor renda (RP = 1,46; IC95%: 1,14-1,87) e negros (RP = 1,27; IC95%: 1,01-1,61). Desigualdades permaneceram em termos de atraso ou falha na realização de exames (RP = 1,64; IC95%: 1,02-2,64) e pior qualidade do atendimento odontológico (RP = 2,10; IC95%: 1,38-3,21) naqueles com menor renda. E os negros consultaram menos os serviços de dentistas (RP = 0,90; IC95%: 0,82-0,99).


Resumen: El objetivo de este estudio fue estimar la prevalencia de los indicadores de uso de servicios de salud según el sexo, ingresos y etnia/color de la piel entre adolescentes (10 a 19 años) basado en los datos de la Encuesta de Salud de la Ciudad de Campinas (ISACamp), realizada entre 2014 y 2015 en Campinas, São Paulo, Brasil. Se utilizó la prueba de chi-cuadrado para evaluar las diferencias entre las variables de resultado (indicadores de uso de servicios de salud) y sexo, ingresos y etnia/color de la piel. Se estimaron las razones de prevalencia (RP) ajustadas a través de modelos de regresión múltiple de Poisson. La demanda de atención médica fue alta en el último año de la entrevista (el 79,2%), mayoritariamente asistidos por el Sistema Único de Salud (el 65,2%), con las consultas de rutina más frecuentes para el sexo femenino (RP = 1,17; IC95%: 1,01-1,34) y la atención por lesiones más frecuentes para la población masculina (RP = 0,47; IC95%: 0,26-0,84). Se encontraron diferencias económicas y raciales en la evaluación de la última consulta médica, con mayor prevalencia de peor atención entre aquellos con menores ingresos (RP = 1,46; IC95%: 1,14-1,87) y personas negras (RP = 1,27; IC95%: 1,01-1,61). Las desigualdades persistieron en términos de retraso o no realización de exámenes (RP = 1,64; IC95%: 1,02-2,64) y peor calidad de la atención odontológica (RP = 2,10; IC95%: 1,38-3,21) en aquellos con menores ingresos. Y las personas negras fueron las que menos consultaron los servicios de dentistas (RP = 0,90; IC95%: 0,82-0,99).

5.
Chinese Medical Ethics ; (6): 578-582, 2024.
Article Dans Chinois | WPRIM | ID: wpr-1012944

Résumé

The combination of medical care and nursing is an important measure of health care for the aged, and it is also an important part of aging work. Under the background of increasing aging, and under the background of changing from disease-centered and patient-centered medical model to health-centered "big medicine" model, medical humanities are particularly important for how to make the elderly spend their old age in peace and make the road of combining medical care with nursing care wider. Based on the practice of combination of medical care and nursing, under the guidance of the concept of great health, this paper discussed the establishment of a "Five-sphere" all-round humanistic care concept integrating medical care, nutrition care, sports care, mental care and other convalescent health care factors, and provided a series of comprehensive multi-angle humanistic care service measures from physiology to psychology for elderly patients with chronic diseases, which has achieved good results.

6.
Malaysian Journal of Medicine and Health Sciences ; : 263-270, 2024.
Article Dans Anglais | WPRIM | ID: wpr-1012783

Résumé

@#Introduction: The use of the lean approach in healthcare has rapidly gained popularity globally, although this approach was more routinely used in the manufacturing sector as opposed to health. Besides, recent studies confirm the suitability of the lean approach applications for improving the quality of medical care. This study aimed to determine the Lean approach’s capacity to improve the waiting time in outpatient clinics in hospitals. Methods: The systematic review approach was employed to help in the research procedures. Search databases used included Ovid, Google scholar, PubMed, MEDLINE, and archive. Besides, search terminologies such as the Lean approach, Hospital-implementation, waiting time, and patient flow were used to help identify sources that best suited the investigation process. Results: The review revealed that the lean approach is suitable for the reduction of waiting times as well as for improving efficiency in the clinic. The outcomes provide a basis for reducing the average waiting time within the hospital. Conclusion: This study recommended that healthcare facilities and departments should take a keen interest in implementing the Lean approaches, as they are crucial for reducing waiting time.

7.
Rev. méd. Urug ; 39(3)sept. 2023.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1508731

Résumé

Introducción: la crisis sanitaria por COVID-19 impactó en la atención de diversas patologías, entre ellas, el cáncer. Con el fin de disminuir el riesgo de contraer SARS-CoV-2 se redujo el número de consultas, lo que determinó un aumento en la tasa de morbilidad y mortalidad para otras patologías, lo que se ha denominado la "segunda pandemia". Objetivo: describir la actividad asistencial de la Unidad de Mastología (UM) en el período marzo 2020 - marzo 2022 y compararla con la del período marzo 2019 - marzo 2021. Objetivo: describir la actividad asistencial de la Unidad de Mastología (UM) en el período marzo 2020 - marzo 2022 y compararla con la del período marzo 2019 - marzo 2021. Material y método: estudio observacional retrospectivo que incluyó a pacientes asistidas por cáncer de mama (CM) en el período marzo 2019 - marzo 2022. Resultados: durante el año previo a la pandemia se asistieron 30 nuevas pacientes. En cuanto al tiempo entre el diagnóstico anatomopatológico y el primer tratamiento, en 73,3% fue ≤ 2 meses, 16,6% > 2 meses y ≤ 4 meses y en 10% fue > 4 meses. Durante la pandemia se asistieron 50 pacientes nuevas, lo que se traduce en un descenso de 16,6%. En cuanto al tiempo entre el diagnóstico anatomopatológico y el primer tratamiento: en 41% fue ≤ 2 meses, 33% > 2 meses y ≤ 4 meses y en 25% fue > 4 meses. Conclusiones: si bien se logró mantener la actividad asistencial y dar continuidad a la mayoría de los tratamientos, durante la pandemia COVID-19 se redujo el número de pacientes derivadas al servicio en aproximadamente 16,6% y se produjo un aumento en el tiempo transcurrido entre el diagnóstico y el primer tratamiento.


Introduction: the COVID-19 health crisis had a significant impact on the management of various pathologies, including cancer. To reduce the risk of contracting SARS-CoV-2, the number of consultations was reduced, leading to increased morbidity and mortality rates for other pathologies, which has been referred to as the "second pandemic." Objective: The aim of this study is to describe the clinical activity of the Breast Unit (BU) during the period March 2020-2022 and compare it with the activity during the period March 2019-2021. Objective: the aim of this study is to describe the clinical activity of the Breast Unit (BU) during the period March 2020-2022 and compare it with the activity during the period March 2019-2021. Method: retrospective observational study including patients attending the BU during the period March 2019-2022. Results: in the year before the pandemic, 30 new patients were assisted. Regarding the time between anatomopathological diagnosis and the initiation of the first treatment: in 73.3% of cases, it was ≤ 2 months, 16.6% > 2 months and ≤ 4 months, and in 10%, it was > 4 months. During the pandemic, 50 new patients were assisted, representing a decrease of approximately 16.6% in the number of new patients attended. Regarding the time between anatomopathological diagnosis and the initiation of the first treatment: in 41% of cases, it was ≤ 2 months, 33% > 2 months and ≤ 4 months, and in 25%, it was > 4 months. Conclusion: although the BU managed to maintain its clinical activity and continuity of most treatments during the COVID pandemic, there was a reduction in the number of patients referred to the service by approximately 16.6% and an increase in the time elapsed between diagnosis and the initiation of the first treatment.


Introdução: a crise sanitária causada pela COVID-19 impactou o atendimento de diversas patologias, inclusive o câncer. Para diminuir o risco de contrair SARS-CoV-2, reduziu-se o número de consultas, o que determinou um aumento da taxa de morbimortalidade por outras patologias, o que tem sido chamado de "segunda pandemia". Objetivo: descrever a atividade assistencial da Unidade de Mastologia (UM) no período março de 2020 - março de 2022 e compará-la com a do período março de 2019 - março de 2020. Material e método: estudo observacional retrospectivo que incluiu pacientes atendidos pelo CM no período março de 2019 - março de 2022. Resultados: no ano anterior à pandemia foram atendidos 30 novos pacientes. Em relação ao tempo entre o diagnóstico patológico e o primeiro tratamento: em 73,3% foi ≤2 meses, 16,6% >2 meses e ≤4 meses e em 10% foi >4 meses. Durante a pandemia, foram atendidos 50 novos pacientes, o que se traduz em uma queda de 16,6%no número de novos pacientes atendidos. Quanto ao tempo entre o diagnóstico patológico e o primeiro tratamento: em 41% foi ≤2 meses, 33% >2 meses e ≤4 meses e em 25% foi >4 meses. Conclusão: embora tenha conseguido manter a atividade assistencial e dar continuidade à maioria dos tratamentos, durante a pandemia de COVID-19 o número de pacientes encaminhados para o Serviço diminuiu cerca de 16,6% e houve um aumento do tempo decorrido entre o diagnóstico e o primeiro tratamento.

8.
Medisur ; 21(4)ago. 2023.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1514584

Résumé

Fundamento: la pandemia de COVID-19 tensó enormemente los servicios de salud en el mundo entero y Cuba no fue una excepción. Aunque la proporción de casos confirmados en niños fue menor, es necesaria la descripción de la atención médica a este sector de la población. Objetivo: describir la organización de los servicios médicos y morbilidad hospitalaria durante la COVID-19, de enero 2021 a febrero 2022, en el pediátrico de Cienfuegos. Métodos: estudio descriptivo realizado en el Hospital Pediátrico de Cienfuegos sobre la atención médica a niños, durante la pandemia de COVID-19. Se analizaron las variables número de casos, edad, sintomatología, casos ingresados en unidades de cuidados intensivos, egreso. Resultados: fueron ingresados 2758 pacientes confirmados de COVID-19; los meses de junio a septiembre aportaron el mayor número de casos, con agosto como más representativo con 46,4 %. Cienfuegos y Cumanayagua fueron los municipios con más casos; predominaron los menores de cinco años (88,3 %) fundamentalmente los menores de un año (49,2 %). La presentación clínica asintomática fue preponderante y sintomatología leve. Requirieron cuidados intensivos el 1,1 % del total y la letalidad fue de 0,04 %. El enfrentamiento a la enfermedad tuvo un carácter intersectorial; el cumplimiento de los protocolos y guías se dieron en un contexto donde primó la reorganización de los servicios y la gestión del conocimiento. Conclusiones: la atención médica oportuna y encaminada a alcanzar el mayor detalle científico asistencial, acompañado de una continua gestión del conocimiento para su adherencia permitió que la mayoría de los niños con COVID-19 egresaran de manera satisfactoria.


Foundation: the COVID-19 pandemic greatly strained health services throughout the world and Cuba was no exception. Although the proportion of confirmed cases in children was lower, it is necessary to describe the medical care provided to this sector of the population. Objective: to describe the medical services organization and hospital morbidity during COVID-19, from January 2021 to February 2022, at the Cienfuegos pediatric hospital. Methods: descriptive study carried out at the Cienfuegos Pediatric Hospital on medical care for children, during the COVID-19 pandemic. The variables number of cases, age, symptomatology, cases admitted to intensive care units, and discharge were analyzed. Results: 2758 confirmed COVID-19 patients were admitted; from June to September contributed to the greatest number of cases, with August as the most representative with 46.4%. Cienfuegos and Cumanayagua were the municipalities with the most cases; there was a predominance of children under five years of age (88.3%), mainly those under one year of age (49.2%). The asymptomatic clinical presentation was preponderant and mild symptoms. 1.1% of the total required intensive care and the lethality was 0.04%. The confrontation with the disease had an intersectoral character; compliance with the protocols and guidelines occurred in a context where the reorganization of services and knowledge management prevailed. Conclusions: timely medical care aimed at achieving the greatest scientific care detail, accompanied by continuous knowledge management, allowed most children with COVID-19 to be discharged satisfactorily.

9.
Int. j. cardiovasc. sci. (Impr.) ; 36: e20230134, jun.2023.
Article Dans Anglais | LILACS-Express | LILACS | ID: biblio-1528760
10.
Medisur ; 21(2)abr. 2023.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1440663

Résumé

Debido a que los pronósticos favorables en relación con el control de la pandemia de COVID-19 en Cuba, se anunció una etapa de "nueva normalidad", con "desescalamiento" progresivo de medidas que se habían implementado para prevenir la enfermedad. Esto ha sido posible gracias a la labor conjunta de toda la sociedad, con sus máximas autoridades al frente, la capacidad y entrega de los profesionales de la salud organizados en un vigoroso sistema nacional de salud, la obtención y aplicación de fármacos autóctonos eficaces y la inmunización masiva contra el SARS-COV-2, con nuestras vacunas cubanas Abdala y Soberanas. Se comenta acerca de un grupo de lecciones aprendidas durante la pandemia, de la existencia de muchas dudas e interrogantes aún sin respuestas, de los nuevos riesgos -sobre todo para los más vulnerables- incluyendo el denominado síndrome poscovid, cuando se incrementa la celebración de eventos masivos de diferente índole, así como se alerta de la aparición frecuente de variantes del nuevo coronavirus y de recientes "olas" de enfermos en diferentes países. Se aborda de manera abreviada la situación actual de la COVID-19 en Cuba y las recomendaciones aconsejadas para esta etapa.


Due to the favorable prognoses in relation to the control of the COVID-19 pandemic in Cuba, a stage of "new normality" was announced, with a progressive "de-escalation" of measures that had been implemented to prevent the disease. This has been possible thanks to the joint efforts of the whole of society, with its highest authorities ahead, the capacity and dedication of health professionals organized in a vigorous national health system, obtaining and applying effective native drugs and the massive immunization against SARS-COV-2, with our Cuban Abdala and Soberanas vaccines. Comments are made on a group of lessons learned during the pandemic, on the existence of many doubts and questions still unanswered, on the new risks -especially for the most vulnerable- including the so-called post-COVID syndrome, when events are held more massive outbreaks of different kinds, as well as alerting to the frequent appearance of new coronavirus' variants and recent "waves" of patients in different countries. The current situation of COVID-19 in Cuba and the suggested recommendations for this stage are briefly addressed.

11.
Article | IMSEAR | ID: sea-216075

Résumé

A 26-year-old Malaysian woman (childbearing age) attended a private primary care clinic with a known case of gastroesophageal reflux disease (GERD) and complained of persistent nausea and a few episodes of vomiting. She had no known drug allergy, no surgical history, no hospitalization in the last two years, was a non-smoker, and no history of drug or alcohol abuse. The patient was prescribed Tab metoclopramide 10 mg TDS and Tab ranitidine 150 mg BD for five days. About 30 min after oral administration of both medicines, her eyes rolled involuntary upward, leading to lateral deviation of the eyes, and mouth jaws clenched as if “dislocated jaws.” The patient was immediately brought into an emergency department (ED) of a public tertiary care hospital. A drug challenge test was done which resulted in the withdrawal of metoclopramide. The accompanied sister later disclosed that the patient had taken metoclopramide and ranitidine from a private clinic earlier in the day. The patient self-assumed to have a sudden seizure, due to excessive hot weather and dehydration. A slow intravenous infusion of 50 mg/mL diphenhydramine hydrochloride in 0.9% w/v NaCl 100 mL was administered stat. Consequently, the symptoms vanished after approximately 30 min of the therapy, devoid of relapse. The patient was discharged from ED post 8 hours of monitoring with complete recovery. Physicians frequently prescribe metoclopramide to treat nausea and vomiting, which may cause adverse drug reaction of acute dystonic oculogyric crisis (OGC). Due to its unwanted and unpredictable extrapyramidal symptoms, metoclopramide should be prescribed and dispensed with caution. Thorough history taking at ED is imperative for correct early diagnosis and treatment, as metoclopramide-induced dystonic OGC has a high probability of confusion with other causes of dystonia such as conversion and seizures, encephalitis, tetanus, and hypercalcemic tetany.

12.
Article Dans Espagnol | LILACS, CUMED | ID: biblio-1536263

Résumé

Introducción: La telemedicina es una herramienta para los servicios de atención en pediatría, ya que permite el seguimiento de los pacientes pediátricos en el manejo de enfermedades crónicas y de grupos vulnerables; disminuye los costos y mejora el acceso a los servicios de salud. Objetivo: Explorar, por medio de una revisión sistemática de la literatura, la efectividad de la teleconsulta en el manejo de enfermedades crónicas y grupos vulnerables en la población pediátrica. Métodos: Se realizó una revisión sistemática de la literatura, utilizando los términos MESH pediatrics AND telehealth AND primary care AND control care en las bases Medline PubMed, EMBASE, Scopus, Web of Science, Cochrane, Science Direct. Se incluyeron metaanálisis, revisiones sistemáticas, experimentos clínicos controlados, estudios de cohortes, casos y controles, realizados desde 1998 hasta julio de 2021. Se obtuvieron 54 estudios para la revisión final. Resultados: Los principales resultados de la búsqueda arrojaron beneficios a nivel del control de enfermedades crónicas, control posterior al egreso de la unidad de cuidado intensivo, poscirugía pediátrica, cuidado paliativo, enfermedades mentales, acceso a los servicios de salud de población proveniente de regiones apartadas. Se encontró un beneficio para prevenir las visitas al servicio de urgencias. Conclusiones: La telemedicina tiene una diversidad de utilidades e intervenciones como herramienta de la salud. Se ha encontrado evidencia científica robusta para la atención de enfermedades crónicas y/o seguimiento en pediatría. Asimismo, la prestación de servicios en la modalidad de telemedicina en pediatría debe incluirse en los procesos de atención y guías de práctica clínica de la especialidad(AU)


Introduction: Telemedicine is a tool for pediatric care services, since it allows monitoring of pediatric patients in the management of chronic diseases and vulnerable groups; lowers costs and improves access to health services. Objective: To explore, through a systematic review of the literature, the effectiveness of teleconsultation in the management of chronic diseases and vulnerable groups in the pediatric population. Methods: A systematic review of the literature was carried out, using the MESH terms pediatrics AND telehealth AND primary care AND control care in Medline PubMed, EMBASE, Scopus, Web of Science, Cochrane, Science Direct databases. Meta-analyses, systematic reviews, controlled clinical trials, cohort, case-control studies, conducted from 1998 to July 2021, were included. Fifty-four studies were obtained for the final review. Results: The main results of the search showed benefits at the level of chronic disease control, control after discharge from the intensive care unit, pediatric post-surgery, palliative care, mental illness, access to health services for populations from remote regions. A benefit was found in preventing visits to the Emergency Department. Conclusions: Telemedicine has a diversity of utilities and interventions as a health tool. Robust scientific evidence has been found for the care of chronic diseases and/or follow-up in pediatrics. Likewise, the provision of services in the telemedicine modality in pediatrics should be included in the care processes and clinical practice guidelines of the specialty(AU)


Sujets)
Humains , Mâle , Femelle , Nourrisson , Enfant d'âge préscolaire , Enfant , Adolescent , Groupes à Risque , Maladie chronique , Télémédecine/méthodes , Télépédiatrie
13.
Ginecol. obstet. Méx ; 91(4): 256-263, ene. 2023. tab
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1506256

Résumé

Resumen OBJETIVO: Determinar la sensación de maltrato o de acciones contra el natural modo de proceder durante la atención obstétrica e identificar los factores asociados con esa percepción por parte de las pacientes atendidas en un hospital público de Ciudad Juárez, Chihuahua. MATERIALES Y MÉTODOS: Estudio descriptivo, prospectivo, de serie de casos al que se incluyeron todas las pacientes internadas en el área de Ginecología del Hospital 66 del Instituto Mexicano del Seguro Social de Ciudad Juárez, Chihuahua, con diagnóstico de puerperio de parto, cesárea y aborto atendidas entre los meses de junio a diciembre de 2022. RESULTADOS: De 496 pacientes, 13.9% (n = 67) percibieron algún tipo de procederes incorrectos en las dimensiones de: mal trato y abuso 9.9% (n = 49), atención médica no autorizada 2.4% (n = 12). En percepción de acciones contra el natural modo de proceder: 22% (n = 109) de las mujeres entre 14 y 19 años percibieron que el trato recibido no fue el adecuado. De las pacientes atendidas en el turno nocturno 18% percibieron tratos inadecuados. El 17% de las mujeres atendidas por aborto percibieron que el trato recibido no fue adecuado. Riesgo de atención alejada del natural modo de proceder: grupo de edad de 14 a 19 años (RR 1.96; 1.30-3.72), las mujeres que han tenido 1 embarazo tuvieron un RR 1.92 (1.15-3.21) y con escolaridad secundaria RR 1.35 (0.81-2.24). CONCLUSIONES: Las pacientes en mayor riesgo de no recibir una atención obstétrica apegada a las normas de buen trato fueron las adolescentes de entre 14 a 19 años, las mujeres con escolaridad secundaria, las atendidas en el turno nocturno y las primíparas. Esto evidencia que la atención obstétrica no estrictamente apegada al natural modo de proceder sigue siendo una problemática importante en nuestra población de estudio.


Abstract OBJECTIVE: To determine the feeling of mistreatment or actions against the natural way of proceeding during obstetric care and to identify the factors associated with this perception on the part of patients attended in a public hospital in Ciudad Juárez, Chihuahua. MATERIALS AND METHODS: Descriptive, prospective, case series study including all patients admitted to the Gynaecology Department of Hospital 66 of the Instituto Mexicano del Seguro Social in Ciudad Juárez, Chihuahua, with a diagnosis of postpartum labour, caesarean section and abortion attended between June and December 2022. RESULTS: Of 496 patients, 13.9% (n = 67) perceived some type of incorrect procedures in the following dimensions: mistreatment and abuse 9.9% (n = 49), unauthorised medical care 2.4% (n = 12). In perception of actions against the natural way of proceeding: 22% (n = 109) of the women between 14 and 19 years of age perceived that the treatment received was not adequate. Of the patients seen during the night shift, 18% perceived obstetric violence. 17% of the women attended for abortion perceived that the treatment received was inadequate. Risk of care away from the natural way of proceeding: age group 14-19 years (RR 1.96; 1.30-3.72), women who have had 1 pregnancy had a RR 1.92 (1.15-3.21) and with secondary schooling RR 1.35 (0.81-2.24). CONCLUSIONS: Patients at highest risk of not receiving obstetric care adhering to standards of good treatment were adolescents aged 14-19 years, women with secondary schooling, those seen on the night shift and primiparas. This shows that obstetric care that is not strictly adherent to the natural way of proceeding continues to be a major problem in our study population.

14.
Interface (Botucatu, Online) ; 27: e220072, 2023.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1430620

Résumé

Resumen Los procesos de digitalización del siglo XX extendieron el uso de Tecnologías de Información y Comunicación al campo de la salud. El artículo aborda la Historia Clínica Electrónica a partir de las críticas y debilidades señaladas por especialistas en Clínica Médica, Medicina General y/o de Familia del Área Metropolitana de Buenos Aires, Argentina. El diseño metodológico cualitativo incluyó 43 entrevistas realizadas entre junio de 2019 y marzo de 2020. El andamiaje teórico interpretativo articula tres campos: Comunicación y Salud; Biomedicina, Biopolítica y Tecnologías de Información y Comunicación; Subjetividad, Derechos y Género. Los principales resultados conciernen a cambios en las relaciones médico-paciente, registro y uso de datos, implicancias sobre los derechos y las subjetividades, potencialidades y problemáticas de la informatización en salud en un contexto de precaria infraestructura, desafíos en la regulación y desigualdades estructurales.(AU)


Abstract Digitalization has extended the use of information and communications technologies in the field of health. This article addresses electronic medical records drawing on the criticisms and weaknesses highlighted by clinical specialists, general practitioners, and family doctors working in the metropolitan region of Buenos Aires, Argentina. The qualitative research design included 43 interviews conducted between June 2019 and March 2020. We developed an interpretive framework structured around three categories: communications and health; biomedicine, biopolitics and information and communication technologies; subjectivity, rights and gender. The main results refer to: changes in doctor-patient relations; data recording and usage; implications for rights and subjectivities; potential and challenges of health informatization in a context of precarious infrastructure; and regulatory challenges and structural inequalities.(AU)


Resumo Os processos de digitalização do século XX estenderam o uso das Tecnologias da Informação e Comunicação ao campo da saúde. O artigo aborda o Registro Médico Eletrônico a partir das críticas e fragilidades apontadas por especialistas em Clínica Médica, Medicina Geral e / ou Família da Área Metropolitana de Buenos Aires, Argentina. O desenho metodológico qualitativo incluiu 43 entrevistas realizadas entre junho de 2019 e março de 2020. O referencial teórico interpretativo articula três campos: Comunicação e Saúde; Biomedicina, Biopolítica e Tecnologias de Informação e Comunicação; Subjetividade, Direitos e Gênero. Os principais resultados referem-se a mudanças nas relações médico-paciente, registro e uso de dados, implicações em direitos e subjetividades, potencialidades e problemas de informatização em saúde em um contexto de infraestrutura precária, desafios na regulação e desigualdades estruturais.(AU)

15.
Rev. bras. educ. méd ; 47(4): e120, 2023. tab
Article Dans Portugais | LILACS-Express | LILACS | ID: biblio-1521695

Résumé

Resumo Introdução: O conceito de deficiência relaciona-se às limitações socialmente impostas aos deficientes por seus corpos não corresponderem ao modelo aceito como normal. Em geral, o acesso à saúde dessa população é precário, em parte, pela falta de preparação voltada ao cuidado dos pacientes deficientes durante a formação médica, demonstrando que os currículos das faculdades necessitam de revisão. Objetivo: Este estudo teve como objetivo analisar a percepção do aluno interno do curso de Medicina da Universidade Federal do Ceará (UFC) acerca do modelo curricular atual no contexto da formação médica, especificamente voltado ao atendimento destinado às pessoas com deficiência. Método: Foi disponibilizado um formulário elaborado no Google Formulários, para coletar informações de internos da Faculdade de Medicina (Famed). Depois, realizaram-se entrevistas semiestruturadas via Google Meet mediante questões que objetivaram entender a relação entre futuros médicos e pessoas com deficiências, além da confiança do preparo para o atendimento a tais pacientes. Para exame do material empírico adquirido, utilizou-se a análise de discurso de Rueda. Resultado: Foram entrevistados 13 internos que relataram limitação no aprendizado do estabelecimento da relação médico-paciente em relação a pessoas com deficiência, durante o ciclo básico (do primeiro ao quarto semestre), evoluindo, principalmente, para o internato. Consideraram-se a educação, o entendimento das condições socioeconômicas e culturais do paciente, e a construção de um plano terapêutico executável as qualidades a serem desenvolvidas pelo interno. Quanto aos principais problemas relatados, destacou-se a dificuldade na realização do exame físico e na comunicação. Por sua vez, a ajuda de acompanhantes e o auxílio da equipe profissional foram apontados como aspectos positivos. Percepções referentes ao preparo para atender deficientes foram contrastantes: alguns relataram segurança por capacitações e conhecimentos empíricos, enquanto outros se sentiram inseguros ou incapazes. Percebe-se, também, importante consideração para haver adaptação curricular acerca desse tema, com intervenções nas disciplinas obrigatórias e optativas. Conclusão: Evidenciou-se que os entrevistados sentem dificuldades no atendimento destinado a deficientes, o que sugere alterações no currículo da Famed-UFC.


Abstract Introduction: The concept of disability is related to the socially-imposed limitations on the disabled because their bodies do not correspond to the model accepted as normal. Access to health care for this population is generally precarious, partly due to the lack of preparation for the care of disabled patients during medical school. This suggests that the school curricula need to be revised. Objective: To analyse the perception of the senior medical students at the Federal University of Ceará (UFC) about the current curriculum, specifically, in relation to the care of people with disabilities. Method: A form previously prepared on the Google Forms platform was made available to collect information from senior medical students at the School of Medicine (FAMED). Afterwards, semi-structured interviews were carried out via Google Meet using questions that aimed to understand the relations between future doctors and people with disabilities, as well as the confidence of the students in their preparation for caring for such patients. For analysis of the empirical material acquired, we used Rueda's speech analysis. Result: Thirteen interns were interviewed, who reported limitations in learning how to establish a doctor-patient relationship with patients with disabilities during the first two years of medical school, having effects on the future clinical rotations. Politeness, knowledge of the patient's socioeconomic and cultural conditions, and building an executable therapeutic plan were considered qualities to be developed by the student. The main problems reported was difficulty in performing the physical examination and communication with disabled patients. However, help from the patients' carers and from the professional team was considered positive by the students. Perceptions regarding the preparation to care for the disabled were contrasting: some reported confidence, due to training and empirical knowledge, while others felt insecure or incapable. It is also important to consider adapting the curriculum on this subject, with interventions in compulsory and elective subjects. Conclusion: Considering the responses and analyses, it was evident that the interviewees experience difficulties in caring for the disabled, suggesting changes to the FAMED-UFC curriculum.

16.
Salud colect ; 19: e4549, 2023. tab, graf
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1530374

Résumé

RESUMEN En la definición de las políticas de salud y en la toma de decisiones por parte de la gestión suele primar una separación entre clínica, epidemiología y salud pública, situación naturalizada desde la mirada de los hospitales y ministerios, pero artificial en los territorios, donde los problemas no se estructuran siguiendo la fragmentación de saberes, sino que se expresan en la complejidad de los problemas de las personas y los conjuntos poblacionales. Desde esa concepción, este trabajo recopila y analiza los estudios de ecología de la atención médica, realizados entre 1928 y 2018, que retoman el estudio precursor "The ecology of medical care", de White, Williams y Greenberg, para centrar la discusión en tres ejes: 1) las regularidades presentes en los estudios de ecología de la atención médica, independientemente del año y el país; 2) los sistemas de información en salud y las encuestas de salud; y 3) la hegemonía institucional del hospital en el campo de la salud.


ABSTRACT In the definition of health policies and decision-making on the part of health officials, there is often a prevailing separation between clinical practice, epidemiology, and public health. Although this division is naturalized from the viewpoint of hospitals and public agencies, it is artificial in the context of concrete territories and communities, where problems are not structured according to the fragmentation of knowledge, but rather express the complexities of the problems faced by individuals and population groups. In this context, this article compiles and analyzes studies on the ecology of medical care carried out between 1928 and 2018 that have revisited the pioneering study "The ecology of medical care" by White, Williams and Greenberg. The discussion is structured around three central issues: 1) recurrent themes in studies on the ecology of medical care; 2) health information systems and health surveys; and 3) the institutional hegemony of hospitals in the health field.

17.
Salud colect ; 19: 4280-4280, 2023.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1442155

Résumé

RESUMEN Con la llegada del coronavirus a México, los consultorios adyacentes a farmacias desempeñaron un rol preponderante en el diagnóstico, atención y prevención del covid-19. De acuerdo a las encuestas nacionales, entre el 11,7% y el 23% de las personas con síntomas de covid-19 se atendieron en uno. Por ello, este artículo busca identificar el papel de los consultorios adyacentes a farmacias (CAF) como sistema de salud privado que atendió a personas con síntomas de covid-19 en la ciudad de Oaxaca y describir y analizar los factores que influyeron en su utilización. Desde una metodología cualitativa, entre septiembre de 2020 y agosto de 2022 se entrevistó a 12 médicos y médicas y se aplicó un cuestionario a 59 personas usuarias de los consultorios adyacentes a farmacias del municipio de Oaxaca de Juárez. Asimismo se hizo una recopilación y análisis de fuentes secundarias. Entre los hallazgos, se describen sus funciones como frente de atención al covid-19 y a otras necesidades de salud que emergieron con la crisis sanitaria y se analizan los factores determinantes en las trayectorias de atención de personas usuarias de estos consultorios, como son el incremento en la percepción del riesgo y la desconfianza hacia los servicios públicos o hacia las estrategias implementadas por el gobierno federal.


ABSTRACT With the arrival of coronavirus in Mexico, doctors' offices adjacent to private pharmacies (DAPPs) played a major role in the diagnosis, care, and prevention of Covid-19, providing treatment for 11.7% to 23% of people with Covid-19 symptoms according to national surveys. Therefore, this article seeks to identify the role of DAPPs as a private health system providing care for patients with Covid-19 symptoms in the city of Oaxaca, and to describe and analyze the factors that influenced their utilization. Using a qualitative methodology, twelve physicians were interviewed and 59 users responded to a questionnaire at doctors' offices adjacent to pharmacies in the municipality of Oaxaca de Juárez between September 2020 and August 2022. Secondary data were also collected. Among the findings, the function of these offices at the front line of care for Covid-19 and other health needs that emerged with the public health crisis is described, and the determining factors in care trajectories of users that sought care there are analyzed, such as the increase in perception of risk and mistrust towards public services or strategies implemented by the federal government..

18.
Saúde Soc ; 32(2): e210215es, 2023. tab
Article Dans Espagnol | LILACS | ID: biblio-1442164

Résumé

Resumen El objetivo de este trabajo fue indagar el impacto de la pandemia de la covid-19 en el acceso de personas trans a tratamientos hormonales en los servicios de salud pública de la provincia de Córdoba, Argentina. En los meses de junio/julio de 2020, se realizaron 16 entrevistas telefónicas a personas trans en proceso de hormonización y usuarias de servicios públicos de salud, a profesionales sanitarios de dispositivos específicos de atención a personas trans, integrantes de organizaciones sociales y de gestión. Se aplicó un análisis temático que identificó tres temas y subtemas: 1) Estar a la deriva en relación al tratamiento hormonal: Reestructuración de servicios de salud; Sentimientos de incertidumbre; 2) Lo necesito, el cuerpo lo pide: suministro de hormonas: Significados en torno al tratamiento; Estrategias y resistencias; 3) Oportunidad de visibilizar fallas estructurales: las hormonas como la punta del iceberg: Déficit en las políticas públicas: en pandemia desde hace muchos años; Exclusiones del CIStema de salud. Se concluyó que la pandemia acarreó un grave retroceso para los derechos de las personas trans. Sin embargo, se identificaron estrategias claves de acceso, vinculadas principalmente a las organizaciones y activistas trans y travestis.


Abstract The purpose of this research was to study the impact of covid-19 pandemic on transgender people's access to healthcare and hormone gender-affirming treatments in public healthcare services of the province of Córdoba, Argentina. Between June/July-2020, sixteen telephone interviews were conducted with people in gender-affirming hormone treatments in public healthcare services, professionals, members of social organizations and management. A thematic analysis was carried out, identifiying three themes and sub-themes: 1) Being adrift in relation to hormonal treatment: Restructuring of healthcare services; Feelings of uncertainty. 2) I need it, the body asks for it: supply of hormones: Meanings around treatment; Strategies and resistance. 3) Opportunity to make visible structural failures: hormones as the tip of the iceberg: Deficit in public policies: in a pandemic for many years; Exclusions from the CISHealthcare System. We conclude that the pandemic implied a serious setback for transgender people's rights. However, strategies were identified, mainly linked to transgender organizations and activists, which were key to access.


Sujets)
Humains , Mâle , Femelle , Politique publique , Transsexualisme , Systèmes de Santé , Identité de genre , COVID-19 , Accessibilité des services de santé , Hormones/usage thérapeutique
19.
Article Dans Espagnol | LILACS-Express | LILACS | ID: biblio-1450049

Résumé

Introducción: La satisfacción de los integrantes de una organización de cualquier tipo y, en particular, de aquellas que prestan servicios médicos es un tema de mucho interés e importancia si de lograr altos niveles de satisfacción y, por ende, de lealtad de los pacientes y sus familiares se trata. Objetivo: Determinar las dimensiones y atributos para la satisfacción y lealtad del cliente interno en instituciones de salud en Barranquilla durante el año 2021. Método: Se realizó un estudio exploratorio descriptivo en instalaciones relacionadas con los servicios de salud en Barranquilla en 367 funcionarios (n=367) aunado con la revisión de la literatura correspondiente. Se aplicó un cuestionario con el fin de conocer las dimensiones y atributos antes mencionados. Los atributos fueron agrupados por eje de acuerdo a su mayor peso y sobre la base de esto fue definida el nombre de las dimensiones considerando diversos estudios realizados y la experiencia. Se realizaron pruebas para determinar fiabilidad y validez para la encuesta, así como pruebas de adecuación muestral. Se aplicó el análisis factorial y componentes principales. Resultados: El 79 % de la varianza total abarcó las dimensiones: trabajo en equipo, reconocimiento laboral, condiciones de trabajo y beneficios laborales. Se mostró una distribución de los atributos en las dimensiones capaz de explicar la situación en un alto nivel. Conclusiones: El cliente interno es factor clave en una organización, considerándose adecuados los atributos propuestos para la satisfacción y lealtad del mismo en instituciones de salud.


Introduction: Satisfaction of internal members of any organization, in particular those which provide medical services, is of a great interest and importance when it comes to achieve high levels of satisfaction and, therefore, loyalty of both patients and their families. Objective: To determine dimensions and attributes to get internal customer satisfaction and loyalty in health institutions in Barranquilla, throughout 2021. Method: An exploratory descriptive study was carried out in healthcare facilities in Barranquilla. The study was conducted in 367 health officials (n=367). Also it was carried out a review of related literature. It was applied a questionnaire to determine the dimensions and attributes. The attributes were grouped by axis according to those with widest impact and, based on this assess, the name of the dimensions was defined taken into account various previous studies and experiences. Factor and principal component analyses were applied. Results: The 79 % of the total variance covered the following dimensions: teamwork, job recognition, working conditions and work benefits. The attributes distributed in the dimensions can certify the high level found. Conclusions: The internal customer is a key factor in any institution, and the proposed attributes for customer satisfaction and loyalty in health institutions are considered adequate.


Introdução: A satisfação dos membros de uma organização de qualquer tipo e, em particular, daqueles que prestam serviços médicos é um tema de grande interesse e importância se pretendemos alcançar elevados níveis de satisfação e, portanto, de fidelização dos pacientes e seus parentes são tratados. Objetivo: Determinar as dimensões e atributos para a satisfação e lealdade do cliente interno em instituições de saúde em Barranquilla durante o ano de 2021. Método: Estudo descritivo exploratório realizado em instalações relacionadas a serviços de saúde em Barranquilla em 367 funcionários (n=367) juntamente com a revisão da literatura correspondente. Aplicou-se um questionário para conhecer as dimensões e atributos mencionados. Os atributos foram agrupados por eixo de acordo com seu maior peso e com base nisso foi definido o nome das dimensões considerando diversos estudos e experiências. Foram realizados testes para determinar a confiabilidade e validade da pesquisa, bem como testes de adequação da amostra. Aplicou-se análise fatorial e componentes principais. Resultados: 79% da variância total cobriu as dimensões: trabalho em equipe, reconhecimento do trabalho, condições de trabalho e benefícios do trabalho. Foi apresentada uma distribuição dos atributos nas dimensões, capaz de explicar a situação em alto nível. Conclusões: O cliente interno é um fator chave em uma organização, considerando adequados os atributos propostos para a satisfação e fidelização do mesmo nas instituições de saúde.

20.
Cad. Saúde Pública (Online) ; 39(1): e00137322, 2023. tab
Article Dans Portugais | LILACS-Express | LILACS | ID: biblio-1421010

Résumé

Nesta pesquisa, estudamos os custos de transporte por consulta ambulatorial em pacientes referenciados para avaliação cirúrgica especializada em um hospital terciário no Rio de Janeiro, Brasil. Trata-se de um estudo descritivo com responsáveis por pacientes pediátricos agendados para consulta de cirurgia pediátrica, questionando fatores ligados ao custo de transporte e de oportunidade (perda de remuneração, alimentação, pagamento de cuidadores para outros filhos, despesas para outros acompanhantes). Aproximadamente metade dos pacientes tinham até 5 anos de idade, cerca de 2/3 apresentavam doenças de resolutividade cirúrgica simples e definitiva e 181 famílias (89,17%) contavam com renda familiar mensal de até R$ 1.999,00. A proporção de famílias beneficiadas por transporte gratuito variou entre 4,26-15,56% para pacientes morando até 100km de distância do hospital (45,83% para pacientes com residência a mais de 100km da instituição). Dos responsáveis, 176 (87,13%) relataram despesas para alimentação, 12 (5,94%) pagavam cuidadores para os outros filhos no dia da consulta e 80 (39,6%) referiram perda do pagamento do dia de trabalho. Dos casos de alta complexidade, 9,33% das mães entrevistadas abriram mão de exercer atividade remunerada regular. As despesas com transporte para uma consulta em cirurgia pediátrica em um hospital de referência do Rio de Janeiro custam em média 4,42% do salário mínimo vigente, com uma média de 217,32 minutos de deslocamento por consulta. Despesas com alimentação e perda de remuneração pela ausência no trabalho também implicam encargos financeiros ou perda de remuneração significativos para o paciente em cada consulta.


In this study, we investigated the costs of transportation for each outpatient consultation in patients referred to specialized surgical evaluation in a tertiary hospital in Rio de Janeiro, Brazil. Descriptive study with guardians of pediatric patients scheduled for pediatric surgery, questioning transportation cost, and opportunity costs (loss of remuneration, food, payment of caregivers for other children, expenses for other companions). About half patients were aged up to five years; about two thirds had diseases of simple and definitive surgical resolution; and 181 families (89.17%) presented monthly family income up to BRL 1,999.00. The proportion of families that benefited from free transportation ranged from 4.26% to 15.56% for patients living up to 100 km away from the hospital (45.83% for patients living more than 100 km away from the institution). A total of 176 (87.13%) guardians reported expenses buying food, 12 (5.94%) paid caregivers to the other children on the day of the consultation, and 80 (39.6%) reported loss of remuneration for the working day. Among the high complexity cases, 9.33% of the mothers have given up their regular paid employment. Transportation expenses for a pediatric surgery consultation at a reference hospital in Rio de Janeiro cost about 4.42% of the current minimum wage, spending around 217.32 minutes of displacement/consultation. Expenses with food and loss of remuneration due to absence at work also entail significant financial charges or loss of remuneration for the patient at each consultation.


En esta investigación se estudiaron los costes de transporte por visita ambulatoria en pacientes remitidos para evaluación quirúrgica especializada en un hospital de atención terciaria en Río de Janeiro, Brasil. Es un estudio descriptivo con responsables de pacientes pediátricos programados para consulta de cirugía pediátrica, en el que se cuestionaron factores relacionados con el coste del transporte y los costes de oportunidad (pérdida de remuneración, alimentación, pago de cuidadores de otros niños, gastos de otros cuidadores). Aproximadamente la mitad de los pacientes tenían hasta 5 años de edad; cerca de 2/3 presentaban enfermedades de resolución quirúrgica simple y definitiva, 181 familias (89,17%) con renta familiar mensual de hasta BRL 1.999,00. La proporción de familias que se benefician de transporte gratuito varía entre el 4,26% y el 15,56% para los pacientes que viven hasta a 100 km del hospital (45,83% para los pacientes que viven a más de 100 km de la institución). Ciento setenta y seis (87,13%) cuidadores declaran gastos de alimentación, 12 (5,94%) pagan a los cuidadores de sus otros hijos en el día de la consulta y 80 (39,6%) declaran pérdida de salario por la jornada laboral. De los casos de alta complejidad, el 9,33% de las madres entrevistadas habían abandonado su actividad remunerada habitual. Los gastos de transporte para una consulta de cirugía pediátrica en un hospital de referencia de Río de Janeiro cuestan de media el 4,42% del salario mínimo vigente, con una media de 217,32 minutos de tiempo de viaje/consulta. Los gastos de alimentación y la pérdida de salario por ausencia en el trabajo también implican una importante carga económica o pérdida de salario para el paciente en cada cita.

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