RESUMO
La participación comunitaria ha sido uno de los aspectos fundamentales en las políticas sanitarias en Chile desde 1990. Sin embargo, aun reconociéndose la importancia de la participación comunitaria en el trabajo de los equipos de salud, esta estrategia ha presentado dificultades en su implementación, derivadas tanto de aspectos prácticos como de problemas teóricos. La ausencia de definiciones conceptuales claras y compartidas acerca de la participación resulta en tensiones ideológicas y políticas que se expresan a su vez en una interpretación, aplicación y evaluación distinta de las actividades de participación. Así, se hace necesario desarrollar herramientas de evaluación de la participación que, utilizándose transversalmente, fortalezcan el trabajo de los equipos de salud, al mismo tiempo que promuevan el desarrollo teórico del área. Un instrumento de evaluación de la participación comunitaria, diseñado especialmente para ser utilizado en atención primaria de salud, lo constituye el Spidergram, o mapa en tela de araña, que incorpora la evaluación de cinco dimensiones del proceso participativo. El presente estudio tiene por objetivo adaptar y validar este instrumento en un contexto urbano en Chile. Se evaluó la validez del cuestionario grupal traducido al español basado en la revisión de la literatura, la aplicación del instrumento piloto y las discusiones sostenidas por parte del equipo de investigación. Este instrumento alcanzó un adecuado nivel de consistencia interna y de concordancia interobservador en la mayoría de las variables al ser aplicado por moderadores externos, permitiéndose su recomendación como herramienta de trabajo para los equipos de atención primaria de salud.
Community participation has been one of the fundamental aspects of Chilean health care policies since 1990. Though the importance of health care teams' community participation should be recognized, this strategy has nevertheless faced a number of obstacles during its implementation, due to practical and theoretical problems. The absence of a clear and common conceptual definition of community participation results in ideological and political tensions that are, in turn, expressed in different interpretations, applications, and assessments of participatory activities. Thus, it is necessary to develop methods for the assessment of community participation that can be used across the board, and which may allow health care workers to strengthen their work with local communities, while promoting theoretical advances in the area. One instrument for measuring community participation, especially designed to be used in primary health care settings, is the Spidergram, which includes the evaluation of 5 variables related to the participatory process. This study aims to adapt and validate this assessment method in an urban context in Chile. The validity of the instrument was assessed through a literature review, a pilot application of a version translated into Spanish, and multiple discussions within the multidisciplinary research team. This instrument achieved adequate internal consistency and inter-observer concordance in most variables when applied by external observers, supporting its recommendation as a valuable tool for primary health care workers.
Assuntos
Humanos , Atenção Primária à Saúde , Inquéritos e Questionários , Participação da Comunidade , Traduções , Chile , Estudos TransversaisRESUMO
Background: The effectiveness against radiation of tungsten bismuth caps, used in interventional cardiology is not well known. Aim: To determine the degree of radiation protection conferred by these caps in real work conditions. Material and Methods: We compared the gross electric charges received at brain lobe levels by three occupationally exposed professionals who participated in 22 consecutive procedures, inside and outside of the tungsten bismuth cap. Results: The median electric charges outside and inside the cap were 3.71 (range 1.46-5.62) and 2.2 (range 1.29-3.93) nC, which correspond to a 40% radiation attenuation. However, the protection was heterogeneous. Conclusions: Tungsten bismuth caps provide an adequate attenuation, but its degree is heterogeneous.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Roupa de Proteção , Lesões por Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Tungstênio , Bismuto , Radiografia Intervencionista , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Exposição Ocupacional/estatística & dados numéricos , Exposição à Radiação/prevenção & controleRESUMO
Abstract. There are several methods for measuring the absorbed radiation dose of occupationally exposed professionals, but it is unknown if these are reproducible at low doses. The aim of this study is to determine the level of reproducibility of thermoluminescent dosimeters (TLD) and optically stimulated luminescence dosimeters (OSL) in simulated conditions. A reproducibility study was performed using two types of dosimeters, which were placed in the location of medical interventionist work area inside the catheter laboratory. An anthropomorphic phantom was used as a patient and the same projections, collimation and radiographic techniques that were employed in the past 30 angiographies, an examination considered as low exposure in the context of interventional cardiology. Lin's concordance coefficient correlation was calculated, obtaining a value of -0.006 with a 95% CI of -0.069 to 0.056 for TLD dosimeters with OSL. The data obtained showed poor reproducibility at low doses of radiation.
Resumen. Existen varios métodos para medir la dosis de radiación absorbida por los profesionales ocupacionalmente expuestos, pero se desconoce si estos son reproducibles entre sí a bajas dosis. El objetivo del estudio fue determinar el grado de reproducibilidad entre los dosímetros termoluminiscentes (TLD) y los dosímetros luminiscentes ópticamente estimulados (OSL), en condiciones simuladas. Se realizó un estudio de reproducibilidad, empleando 2 tipos de dosímetros, los cuales se dispusieron en la ubicación de trabajo del médico intervencionista dentro del pabellón. Se empleó un fantoma antropomórfico como paciente y se replicaron las mismas proyecciones, colimación y técnicas radiológicas empleadas en las últimas 30 coronariografías, examen considerado de baja exposición en el contexto de cardiología intervencionista. Se aplicó el coeficiente de correlación de concordancia de Lin, obteniéndose un valor de -0,006 con un IC al 95% de -0,069 a 0,056 para los dosímetros TLD con OSL. Los datos obtenidos mostraron una escasa reproducibilidad a bajas dosis de radiación.
Assuntos
Humanos , Doses de Radiação , Cardiologia , Monitoramento de Radiação/métodos , Monitoramento de Radiação/instrumentação , Reprodutibilidade dos Testes , Dosímetros de Radiação , Dosimetria por Luminescência Estimulada OpticamenteRESUMO
Background: Acute ischemic stroke in adults was given an Explicit Guarantee of diagnosis and treatment (GES) with Clinical Guidelines in 2007 as part of the on-going Chilean National Health Reform. Aim: To evaluate the adherence to official guidelines with regard to the use of diagnostic methods for patients with acute ischemic stroke during their stay in a public hospital. Patients and Methods: The study included a review of the medical records of 101 patients aged 70 ±13 years (49 males and 52 females) diagnosed with acute ischemic stroke and discharged within August and September of 2008 and 2009 from a public hospital. Three trained ob-servers independently determined the degree of dependency of patients at discharge using the Modified Rankin score. The completion of recommended diagnostic tests (electrocardiogram, carotid Doppler ultrasound and echocardiogram) as well as their overuse was evaluated. Results: Ten patients died before discharge, 38 percent were discharged with and 52 percent were discharged without disabilities. Nineteen percent of patients with a Modified Rankin score of two or less (corresponding to a slight disability) had a complete diagnostic workup, compared with 87 percent of patients with a score of 3 to 5 (moderate to severe disability). In 27 percent of the patients, there was an overuse of diagnostic tests. No association between the diagnostic test use adequacy and year of discharge was observed. Conclusions: There exists a disparity between the recommended diagnostic testing and the actual tests completed among patients with acute ischemic stroke.