Competencia cultural de las enfermeras en el área de salud pública: una metasíntesis / Cultural Competence of Nurses in the Field of Public Health: A Meta-Synthesis / Competência cultural dos enfermeiros na área da saúde pública: uma meta-síntese

Resumen Objetivo: explorar las experiencias y vivencias sobre la competencia cultural de enfermeras en salud pública. Metodología: metasíntesis cualitativa. Las bases utilizadas fueron: Medline, OvidNursing, OvidJournal, Embase y BVS-LILACS, publicados en inglés, español o portugués, entre 2009 y 2014. Se incluyeron diez estudios y fueron valorados usando el Critical Appraisal Skills Programme en español (CASPe). Se implementaron las tres fases del proceso de metaagregación en la extracción y síntesis de hallazgos. Resultados: los hallazgos fueron agregados en seis categorías y dos resultados: 1) paradojas en la atención de salud pública a personas de diversas culturas; 2) sobrepasando barreras: la osadía de las enfermeras de salud pública. Conclusión: las enfermeras vivenciaron y expresaron la competencia cultural desde lo paradójico que resulta el encuentro con el otro culturalmente diferente, manifestaron apertura a comprender y dar sentido a la cultura, aunque fue difícil generar intervenciones culturalmente competentes.

Abstract Objective: To explore the experiences and life events regarding the cultural competence in the public health practice. Methods: A qualitative meta-synthesis covering the databases Medline, OvidNursing, OvidJournal, Embase and BVS-LILACS, including papers in English, Spanish and Portuguese between 2009 and 2014. Ten studies were included and assessed by using the Critical Appraisal Skills Programme in Spanish (CASPe). The three stages of the meta-aggregation programme were applied to do the obtaining and synthesis of findings. Results: The findings were aggregated in six categories and two types of results: 1) paradoxes when providing public health care to people from different culture and 2) going beyond the barriers - the daring by the public health nurses. Conclusion: The nurses experienced and expressed their cultural competence from the paradoxical situation produced when encountering another culturally different people. They showed a stance open to both understand and make sense of the other's culture, even though it was hard to produce culturally competent interventions.

Resumo Objetivo: explorar as experiências e vivências sobre competência cultural de enfermeiras em saúde pública. Metodologia: meta-síntese qualitativa. As bases utilizadas foram: Medline, OvidNursing, OvidJournal, Embase e BVS-LILACS, publicados em inglês, espanhol ou português, entre 2009 e 2014. Dez estudos foram incluídos e valorados usando o Critical Appraisal Skills Programme em espanhol (CASPe). As três fases do processo de meta-agregação na extração e síntese de achados foram implementados. Resultados: os achados foram agregados em seis categorias e dois resultados: 1) paradoxos no atendimento de saúde pública a pessoas de diversas culturas; 2) ultrapassando barreiras: a ousadia das enfermeiras de saúde pública. Conclusões: as enfermeiras vivenciaram e expressaram a competência cultural desde o paradoxal que resulta o encontro com um outro culturalmente diferente, manifestaram apertura para compreender e dar sentido à cultura, embora fosse difícil gerar intervenções culturalmente competentes.

Bacterial meningitis in the elderly: an 8-year review of cases in a University Hospital

The clinical and laboratory characteristics of bacterial meningitis in subjects over 59 years-old were evaluated to establish variables related to prognosis. All patients with clinical and laboratory findings of acute meningitis were included. Sixty-four episodes in 64 patients were registered. S.pneumoniae was responsible for 19 cases (27.5 percent); L.monocytogens - 3; S.aureus -1; S.bovis - 1; S.agalactie - 1 and Corynebacterium jeikeium - 1. Gram negative bacilli caused seven cases; two cases were due to N.meningitidis and one to H.influenzae. In 50 percent of the cases no microorganisms were isolated. The main symptom was fever (67.8 percent). Headache and neck rigidity were absent in about one-half of the cases and the predominant symptoms were psychomotor agitation, stupor or coma. The presence of concomitant diseases, such as diabetes mellitus (26.6 percent) and pneumonia (17.2 percent), were common. The mortality was high (51.5 percent). This poor prognosis was related to L.monocytogens (100 percent), Gram negatives rods (83 percent) and S.pneumoniae (58 percent). The univariate analysis showed that absence of headache (p=0.002), presence of coma (p=0.04), pneumonia (p=0.01) and immunocompromised status (p=0.01) were associated with risk of death. The type of the microorganisms isolated in the elderly patients with meningitis were often unusual ones. The clinical symptoms were minimal and in many cases, the only clinical presentation was change in mental status. Poor prognosis was observed in spite of intensive care. A high index of suspicion for miningitis while caring for elderly with changes in mental status must be maintained to avoid delays in initiating appropriate therapy.

Bacteriología del adenoides en otitis media secretora / Bacteriology of the adenoid in secretory otitis media

Se realizó un estudio en 90 niños del Hospital San Juan de Dios en el período comprendido entre mayo de 1989 y junio de 1990, los que se dividieron en cuatro grupos: Grupo I, de 24 niños con otitis media secretora (OMS) e hiperplasia adenoidea obstructiva (HAO); grupo II, de 28 niños con HAO sin OMS; grupo III, de 24 niños con OMS sin HAO y grupo IV, de 14 niños sin patología otorrinolaringológica. Se cultivó 1 gramo del adenoides de estos niños, en condiciones óptimas de asepsia para estudio de gérmenes aerobios y anaerobios y su sensibilidad a antibióticos. Los resultados se tabularon y sometieron a estudio estadístico mediante pruebas de chi cuadrado y z

Diagnóstico microbiológico de Gardnerella vaginalis / Microbiological diagnosis of Gardnerella vaginalis

Se evalúa la utilidad de la identificación presuntiva de Gardnerella vaginalis en base a algunas características morfológicas y de cultivo, rápidas y simples de determinar, comparándola con estudios bioquímicos más completos del microorganismo. Mediante este procedimiento se identificó el 92.7% de las cepas de Gardnerella estudiada. Las técnicas de identificación son presentadas en detalles