Empatía con el paciente en médicos especialistas que trabajan en un Hospital de Cuenca (Ecuador) / Empathy with the Patient in Medical Specialists Working in a Hospital in Cuenca ­ Ecuador / Empatia com o paciente em médicos especialistas que trabalham em um hospital em Cuenca, Equador

ntroducción: la empatía es uno de los componentes de la estructura de la humanización en la atención de los pacientes. Los médicos especialistas deben tener mucha empatía. El objetivo del artículo es des-cribir los índices de empatía en médicos que trabajan en un hospital de alta complejidad y explorar si existen diferencias entre las especialidades estudiadas. Métodos: se accedió a una muestra por conve-niencia de 237 médicos que representa el 53.55 % del total poblacional (n = 443). La empatía se midió con la Escala de Empatía para Profesionales de la Salud (hp), junto con análisis factorial confirmatorio y análisis multigrupo (para examinar la invarianza del modelo entre los sexos) y análisis de confia-bilidad (α de Cronbach, coeficiente de correlación intraclase y ω de McDonald). Resultados: la espe-cialidad de pediatría tuvo los mayores índices de empatía general y en las dimensiones "cuidado con compasión" y "caminando en los zapatos del paciente", no así en la dimensión "toma de perspectiva", donde es semejante a las especialidades de anestesiología, medicina crítica y terapia intensiva, y gine-cología. Conclusión: los valores de la empatía y los valores en las subescalas "cuidado con compasión" y "caminando en los zapatos del paciente" fueron (en valores absolutos, pero no estadísticos) mayores en la especialidad de pediatría. En la subescala "toma de perspectiva", las especialidades de pediatría, anestesiología, cirugía y clínica se observaron puntuaciones prácticamente iguales. Se requieren otros estudios que permita arribar a una explicación que permita entender por qué algunas especialidades tienen valores de empatía mayores que otras

Introduction: Empathy is one of the components of the structure of humanization in patient care. Medical specialists must have high levels of empathy. Objective: The aim of this paper is to describe the levels of empathy in doctors working in a highly complex hospital and to explore whether there are differ-ences between the specialties studied. Methods: A convenience sample of 237 physicians representing 53.55% of the total population (n = 443) was accessed. Empathy was measured using the Empathy Scale for Health Professionals (hp). Confirmatory factor analysis and multigroup analysis were performed to examine the invariance of the model between the sexes and reliability analyzes (Cronbach's α, intraclass correlation coefficient and McDonald's ω). Results: The specialty of pediatrics had the highest levels in general empathy and in the Compassionate Care and Walking in Patient Shoes subscales, but not in the Perspective Taking subescale where it presents levels similar to the specialties of anesthesiology, critical medicine and intensive care. and gynecology. Conclusions: The empathy values and the values in the compassionate care and "Walking in the patient's shoes" subscales were (in absolute values, but not sta-tistically) higher in the Pediatrics specialty. In the subscale Perspective Taking, Pediatrics, Anesthesiology, Surgery, and Clinic, practically the same scores were observed. Other studies are required to arrive at an explanation that allows us to understand why some specialties have higher empathy values than others.

Introdução: a empatia é um dos componentes da estrutura de humanização no atendimento ao paciente. Os médicos especialistas devem ter altos níveis de empatia. Objetivo: o objetivo deste artigo é descre-ver os níveis de empatia em médicos que trabalham em um hospital de alta complexidade e explorar se há diferenças entre as especialidades estudadas. Materiais e métodos: foi acessada uma amostra de conveniência de 237 médicos, representando 53,55% da população total (n = 443). A empatia foi medida usando a Escala de Empatia para Profissionais de Saúde. A análise fatorial confirmatória e a análise mul-tigrupo foram realizadas (para examinar a invariância do modelo entre os sexos) e a análise de confia-bilidade (α de Cronbach, coeficiente de correlação intraclasse e ω de McDonald). Resultados: a pediatria apresentou os níveis mais altos de empatia geral e nas dimensões "cuidado compassivo" e "estar no lugar do paciente", mas não na dimensão "tomada de perspectiva", em que os níveis foram semelhantes aos da anestesiologia, da medicina crítica e da terapia intensiva, e da ginecologia. Conclusões: os valores de empatia e os valores das subescalas "cuidado compassivo" e "estar no lugar do paciente" foram (em valo-res absolutos, mas não estatisticamente) mais altos na especialidade de pediatria. Na subescala "tomada de perspectiva", as especialidades de pediatria, anestesiologia, cirurgia e clínica tiveram pontuações quase iguais. São necessários mais estudos para explicar por que algumas especialidades têm valores de empatia mais altos do que outras

Presencia de egresados y egresadas de la Universidad Nacional del Sur en el sistema de residencias médicas de Bahía Blanca / Presence of graduates from the National University of the Sur in the medical residency system of Bahía Blanca

Introducción: La atracción, captación y retención son determinantes de una distribución equitativa de profesionales de la salud. Objetivo: describir las decisiones de formación de posgrado de egresados/as de medicina de la Universidad Nacional del Sur (UNS), y su impacto en el sistema de residencias médicas de Bahía Blanca durante el año 2023. Resultados: el 79,63% de quienes egresaron de esta universidad decidieron realizar una residencia médica, y el 51,12 % adjudicó en especialidades del Primer Nivel de Atención con una adjudicación en pediatría menor a la media nacional. La carrera de medicina local cubrió el 39,24 % de las vacantes de Bahía Blanca, y el 38% de sus graduados/as decidió formarse en otras ciudades. Ocho residencias de la ciudad quedaron sin ingresantes en el 2023. Conclusión: existe una gran proporción de egresados/as de la UNS que eligen especialidades de APS. Hay una baja adjudicación en Pediatría que contrasta con la elección de Medicina Familiar, a diferencia de las elecciones a nivel nacional. En términos generales hay un déficit en la atracción y captación de egresados/as de la UNS por parte del sistema de salud local, lo cual demanda a los sectores docentes y asistenciales nuevas estrategias para captar y atraer profesionales en área prioritarias (AU)

Introduction: Attraction, recruitment and retention are determinants of an equitable distribution of healthcare professionals. Objective: to describe the postgraduate training decisions of medical graduates from the National University of the South (UNS), and their impact on the Bahía Blanca medical residency system during the year 2023. Results: 79.63% of Those who graduated from this university decided to carry out medical residency, and 51.12% were awarded in First Level Care specialties with a pediatric award lower than the national average. The local medical career covered 39.24% of the vacancies in Bahía Blanca, and 38% of its graduates decided to train in other cities. Eight residences in the city were left without entrants in 2023. Conclusion: there is a large proportion of UNS graduates who choose APS specialties. There is a low allocation in Pediatrics that contrasts with the choice of Family Medicine, unlike the elections at the national level. In general terms, there is a deficit in the attraction and recruitment of UNS graduates by the local health system, which demands new strategies from the teaching and healthcare sectors to attract and attract professionals in priority areas (AU)

Cooperación entre médicos del departamento de emergencias y dermatólogos por telemedicina / Cooperation between emergency department physicians and dermatologists via telemedicine

Las intercurrencias dermatológicas agudas son un motivo de consulta frecuente a las centrales de emergencias, y generalmente los médicos de atención primaria se ocupan del primer nivel de atención. Puede ser necesaria una interconsulta con expertos, aunque no siempre estén disponibles. Ante la necesidad de facilitar dicha interacción a distancia, en Julio 2022 se implementó una herramienta de teledermatología en un hospital de alta complejidad en Buenos Aires, Argentina. Este servicio se limitó a días hábiles con horario restringido, permitiendo la comunicación entre médicos del departamento de emergencias y dermatólogos, a través de WhatsApp institucional. El dermatólogo podía verificar datos de salud relacionados al paciente (ej: comorbilidades y medicación crónica) mediante revisión de la historia clínica electrónica, para decidir sobre un plan de acción. Se evaluó la perspectiva de los usuarios a través de un formulario electrónico tras 3 meses de implementación. Los resultados evidenciaron que la mayoría (85%) de los profesionales conocía la herramienta, y el 57% la había usado al menos una vez. Se obtuvo una mediana de 9 puntos (de una escala de Likert del 1 al 10) sobre la recomendación hacia otro profesional. El teletriage dermatológico resultó beneficioso y fue aceptado, tanto por médicos de guardia como por especialistas. Ante las demoras en la atención ambulatoria, ha resultado una alternativa útil para evitar derivaciones innecesarias y/o acelerar aquellas que verdaderamente lo ameritan. Sin embargo, representa una forma de comunicación informal desde el punto de vista de almacenamiento de datos. Será necesario reflexionar sobre estos tópicos pendientes de esta experiencia asistencial como legalidad, seguridad y confidencialidad (AU)

Acute skin conditions are a frequent reason for consultation in emergency departments, and primary care physicians generally handle them. They might require referrals to experts, who are not always readily available. Recognizing the need to facilitate such interactions remotely, a teledermatology triage tool was implemented in July 2022 at a high-complexity hospital in Buenos Aires, Argentina. The service was limited to business days with restricted hours, enabling communication between emergency department physicians and dermatologists through institutional WhatsApp. Dermatologists could access patient-related health data (e.g., comorbidities and chronic medication) through the electronic medical record to determine an appropriate course of action. The perspective of users was evaluated through an electronic questionnaire after three months of application. Results showed that most professionals were aware of the tool (85%), and 57% used it at least once. The median rating for recommending the tool to other professionals was 9 points (on a Likert scale from 1 to 10). Dermatological teletriage proved beneficial and was well-received by emergency physicians and specialists. In the face of delays in outpatient care, it has been a useful alternative to avoid unnecessary referrals and expedite those that are warranted. However, it represents an informal method of communication with regard to data storage. It will be necessary to rethink on improvements in pending topics such as legal limitations, security, and confidentiality of this healthcare experience (AU)

"Mesmo que a gente seja a mão que cuida": médicas negras e racismo estrutural no contexto da atenção primária à saúde / "Even if we are the caring hand": Black doctors and structural racism in the context of primary health care

Resumo Trata-se de estudo sobre o racismo estrutural na formação e na ocupação de trabalhadoras e trabalhadores negros atuando na atenção primária à saúde (APS) no município do Rio de Janeiro, a partir da experiência de médicas negras. Realizou-se um estudo qualitativo, utilizando grupo focal, conduzido em novembro de 2022. Utilizou-se o interacionismo simbólico como referência para a interpretação relacionada às situações que compõem as experiências/vivências a partir do racismo. Os achados foram reunidos em dois eixos: manifestação do racismo estrutural e institucional no âmbito do SUS; e como o racismo atravessa os processos de trabalho em saúde e suas repercussões. Os resultados revelam uma continuidade das implicações do racismo desde a formação de médicas negras até o trabalho na APS, tornando-se um obstáculo na reorganização do processo de trabalho na perspectiva territorial de atenção à saúde. As participantes identificam o racismo institucional e estrutural na negligência da gestão, na violência do território e na vacância de médicos nas equipes desses territórios, limitando a oferta de um cuidado adequado. É necessário desvelar e aprofundar a compreensão do caráter estrutural do racismo da organização do trabalho em saúde, tendo como imagem-objetivo a saúde como direito.

Abstract This study scrutinizes structural racism's influence on the training and work of Black professionals in primary health care (PHC) in Rio de Janeiro, particularly focusing on the experiences of Black female physicians. Employing a qualitative approach via a Focus Group, conducted in November 2022, we adopted symbolic interactionism to interpret racism-related experiences. Our findings encompass two primary dimensions: the manifestation of structural and institutional racism within the Unified Health System (SUS), and how racism permeates health work processes and consequences. Results highlight enduring impacts, spanning education to PHC roles, hindering healthcare process recalibration. Participants identify institutional and structural racism, from managerial neglect to territorial violence and physician scarcity, constraining comprehensive care. It is crucial to unveil and grasp racism's structural essence within healthcare, aligned with the vision of health as a fundamental right.

Síntomas de Burnout entre médicos y enfermeros antes, durante y después de atender pacientes con COVID-19 / Burnout symptoms among physicians and nurses before, during and after COVID-19 care / Sintomas de burnout entre médicos e enfermeiros antes, durante e depois do cuidado de pacientes com COVID-19

Objetivo: este estudio evaluó síntomas de Burnout entre médicos y enfermeros antes, durante y después de la atención provista a pacientes con la enfermedad COVID-19. Método: estudio comparativo y transversal realizado en la unidad de Atención Respiratoria de un hospital público de nivel terciario. Se empleó el Inventario de Burnout Maslach. Resultados: se distribuyeron 280 encuestas entre los tres períodos: antes (n=80), durante (n=105) y después (n=95) de la atención a pacientes con COVID-19; se obtuvieron 172 encuestas respondidas. Las tasas de respuesta fueron 57,5%, 64,8% y 61,1%, respectivamente. Los valores de prevalencia de Burnout grave fueron 30,4%, 63,2% y 34,5% antes, durante y después de la atención a pacientes por la enfermedad del coronavirus 2019 (p<0,001). Los síntomas de agotamiento emocional (p<0,001) y despersonalización (p=0,002) fueron más prevalentes entre los enfermeros que entre los médicos. El Síndrome de Burnout grave fue más prevalente en las mujeres, los enfermeros y el personal del turno noche. Conclusión: la elevada prevalencia de Burnout se duplicó en el primer pico de internaciones y regresó a niveles previos a la pandemia un mes después de finalizada la atención a pacientes por la enfermedad del coronavirus 2019. El Síndrome de Burnout varió por sexo, turno de trabajo y ocupación, y los enfermeros representaron los grupos más vulnerables. Es necesario enfocarse en estrategias de evaluación y mitigación tempranas para asistir a los enfermeros, no solo durante la crisis sino permanentemente.

Objective: this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care. Method: a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used. Results: 280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p<0.001). Emotional exhaustion (p<0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff. Conclusion: the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.

Objetivo: este estudo avaliou os sintomas de burnout entre médicos e enfermeiros antes, durante e após o cuidado dos pacientes contaminados com o COVID-19. Método: estudo transversal comparativo realizado na unidade de Atenção Pulmonar de um hospital público de nível terciário. Foi utilizado o Inventário de Burnout de Maslach. Resultados: 280 formulários de pesquisa foram distribuídos em três períodos: antes (n=80), durante (n=105) e após (n=95) os cuidados dos pacientes contaminados com COVID-19; 172 formulários foram respondidos. As taxas de resposta foram de 57,5%, 64,8% e 61,1%, respectivamente. A prevalência de burnout grave foi de 30,4%, 63,2% e 34,5% antes, durante e após o atendimento dos pacientes (p<0,001). Os sintomas de exaustão emocional (p<0,001) e despersonalização (p=0,002) foram mais prevalentes entre os enfermeiros do que entre os médicos. O burnout grave foi mais prevalente em mulheres, enfermeiros e funcionários do turno da noite. Conclusão: a alta prevalência de burnout dobrou no primeiro pico de internações hospitalares e voltou aos níveis pré-pandemia um mês após o término dos cuidados dos pacientes contaminados com COVID-19. O burnout variou de acordo com o sexo, turno e profissão, encontrando-se os enfermeiros entre os grupos mais vulneráveis. O foco na avaliação precoce e nas estratégias de mitigação é necessário para apoiar os enfermeiros não apenas durante a crise, mas de forma permanente.

Curso de investigación en Atención Primaria de la Salud: experiencia sobre módulo de búsqueda bibliográfica y gestores de citas / Research course in Primary Health Care: experience with the bibliographic search module and citation managers

La Federación Argentina de Medicina Familiar y General apoyó el desarrollo, la difusión y la implementación de una propuesta educativa sobre investigación en atención primaria. Consiste en 4 módulos independientes, destinado para miembros interesados/as, con 2 encuentros virtuales teórico-prácticos, que favorecieran el intercambio de opiniones y experiencias entre colegas. El objetivo del primer módulo fue proporcionar conocimiento, brindar pautas y ofrecer herramientas para la búsqueda bibliográfica y el uso de gestores de citas. Se realizó difusión mediante sociedades y redes sociales. Se incluyó una evaluación individual, que diera cuenta de lectura complementaria y la aplicación práctica de los contenidos. Se llevó a cabo en Junio, con 39 preinscripto/as, mayoritariamente residentes. Hubo 24 participantes efectivos (61%), asistieron 17 y 20 personas respectivamente, y 11 (46%) obtuvieron el certificado de aprobación por responder la consigna en tiempo y forma. En cuanto a los/as asistentes, hubo predominio de mujeres (79%), provenientes de Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), y otras minorías. Expresaron satisfacción, agradecimiento y reconocimiento por la actividad, destacando la buena predisposición de organizadores y equipo docente, la utilidad práctica de la temática, la evidente planificación, y el apoyo político-económico. Esta valiosa experiencia educativa (planteada como necesidad pendiente) resultó exitosa, ya que los/as participantes demostraron un alto nivel de interés, de asistencia de diferentes provincias, y de compromiso. Los certificados emitidos otorgan créditos educativos válidos para la recertificación (AU)

The Federación Argentina de Medicina Familiar y General supported the development, dissemination and implementation of an educational proposal on research in primary care. It consists of 4 independent modules, intended for interested members, with 2 virtual theoretical-practical meetings, which favored the exchange of opinions and experiences among colleagues. The objective of the first module was to provide knowledge, guidelines and tools for bibliographic search and the use of citation managers. Dissemination was carried out through societies and social networks. An individual evaluation was included, to account for complementary reading and the practical application of the contents. It was carried out in June, with 39 pre-registered participants, mostly residents. There were 24 effective participants (61%), 17 and 20 people attended respectively, and 11 (46%) obtained the certificate of approval for answering the instructions in due time and form. As for the attendees, there was a predominance of women (79%), coming from Asociación Metropolitana de Medicina Familiar (25%), Asociación Cordobesa de Medicina Familiar y Comunitaria (16%), Asociación Misionera de Medicina General/Familiar y del Equipo de Salud (16%), Asociación Tucumana de Medicina Familiar, General y Comunitaria (12%), and other minorities. They expressed satisfaction, gratitude, and recognition for the activity, highlighting the good predisposition of the organizers and teaching team, the practical usefulness of the subject matter, the evident planning, and the political-economic support. This valuable educational experience (raised as a pending need) was successful since the participants showed a high level of interest, attendance from different provinces, and commitment. The certificates issued grant educational credits valid for recertification (AU)

Pensamiento suicida en médicos residentes con la escala de Plutchik en dos instituciones de salud en Ciudad Obregón, Sonora, México

Objetivo: Evaluar la incidencia y factores asociados al pensamiento suicida en una muestra de médicos residentes de dos instituciones. Materiales y métodos: Se realizó un estudio de tipo descriptivo, observacional, prospectivo y transversal, entre los meses de septiembre a octubre del 2022, para estimar el pensamiento suicida en los médicos residentes de dos hospitales con la escala de Plutchik, además de buscar factores asociados. Se aplicó la estadística descriptiva con medidas de tendencia central y de dispersión, frecuencias relativas y absolutas; las pruebas ji al cuadrado de Pearson y de bondad de ajuste, así como la prueba de Kruskal-Wallis se emplearon para examinar las diferencias entre especialidades, y la prueba post-hoc de Tukey para evaluar la especialidad diferente. Resultados: Se respondió un total de 225 encuestas, de las cuales se eliminaron 20 por inadecuado diligenciamiento, y quedaron 205. El promedio de edad fue de 28,66 años (DS ± 2,360) y el 71,2 % correspondió al sexo femenino. En cuanto a las especialidades, se encontró a pediatría con el 28,8 % y a anestesiología con el 20,5 %. Se evidenció asociación significativa entre especialidades, con un valor de p = 0,0000, y grado académico de p = 0,003 (p ≤ 0,05). Según la especialidad, se encontraron diferencias en cuanto al pensamiento suicida; la prueba de Kruskal-Wallis mostró un valor de p = 0,000 y la prueba post-hoc de Tukey reveló que la especialidad de ginecología fue la diferente. Conclusiones: De acuerdo con los resultados de la muestra, alrededor de una cuarta parte de los médicos residentes manifiesta pensamiento suicida. La prevalencia en dicha muestra no presenta diferencia significativa con respecto a la incidencia a nivel latinoamericano. Se encontró una asociación entre ideas suicidas, especialidades médicas y grado académico. En cuanto a comparación entre las especialidades, ginecología fue la que mostró mayor ideación suicida. Este trabajo presenta algunas limitaciones, por ejemplo, existe una gran heterogeneidad de grupos, no se empleó una técnica de selección probabilística y las pruebas estadísticas empleadas fueron no paramétricas.

Objective: To evaluate the incidence and factors associated with suicidal ideation in a sample of resident physicians from two institutions. Materials and methods: A descriptive, observational, prospective and cross-sectional study was carried out to estimate the suicidal ideation and associated factors with the Plutchik Suicide Risk Scale among resident physicians from two hospitals between September and October 2022. Descriptive statistics were used with measures of central tendency and dispersion, as well as relative and absolute frequencies. In addition, Pearson's chi-square goodness of fit test and Kruskal-Wallis H test were used to examine the differences between specialties, and Tukey's Honest Significant Difference test to determine which specialty was different. Results: A total of 225 surveys were answered, out of which 20 were eliminated due to inadequate completion, leaving 205 complete surveys for analysis. The average age was 28.66 years (SD ± 2.360) and 71.2 % were females. Concerning the specialties, pediatrics was found in 28.8 % of the respondents and anesthesiology in 20.5 %. A significant association between specialties with a value of p = 0.0000 and academic degrees with p = 0.003 (p ≤ 0.05) was evidenced. Differences regarding suicidal ideation were found by specialty: Kruskal-Wallis H test showed a value of p = 0.000 and Tukey's Honest Significant Difference test revealed that the specialty of gynecology was the different one. Conclusions: According to the results of the study sample, approximately one fourth of the resident physicians had suicidal ideation. Its prevalence in this sample showed no significant difference with respect to its incidence in Latin America. An association between suicidal ideation, medical specialties and academic degree was found. As for the comparison between specialties, gynecology was the one with the highest suicidal ideation rate. This work had some limitations; for example, the groups were very heterogeneous, a probabilistic selection technique was not used, and the statistical tests were nonparametric.

Factores psicosociales y sociodemográficos asociados con el desgaste profesional en médicos residentes de Sonora (México) / Psychosocial and Sociodemographic Factors Associated with Burnout among Medical Residents of Sonora ­ Mexico / Fatores psicossociais e sociodemográficos associados ao burnout em médicos residentes de Sonora, México

Introducción: la simultaneidad de actividades entre las exigencias académicas y el adiestramiento médico durante las residencias provoca un elevado riesgo de desarrollar un desgaste profesional (o síndrome de burnout [SB]) en los médicos residentes. El objetivo fue identificar los factores psicosociales y socio- demográficos asociados al SB en médicos residentes. Materiales y métodos: estudio transversal y correlacional. Participaron 47 médicos residentes de un hospital público. Se aplicaron la Escala de Desgaste Ocupacional (EDO), el Inventario Multifásico de la Personalidad Minnesota-2 Forma Reestructurada (MMPI2-Rf) y un cuestionario sociodemográfico. Los datos se analizaron mediante la prueba de correlación no paramétrica de Spearman. Resultados: el 25.6 % de los participantes mostró burnout alto, y el 51 %, un agotamiento emocional alto. Respecto a los factores de personalidad y sociodemográficos asociados, solo mostraron relación significativa (p < 0.05) la escala de impulsividad (r = 0.341, p = 0.019) y las horas de ejercicio en la semana (r = −0.414, p = 0.004). Al segmentar por sexo, solo en los hombres del estudio existió una relación entre SB y psicoticismo (r = 0.468, p = 0.018), la disminución de la actividad física (r = −0.620, p = 0.001) y primeros años de residencia (r = −0.396, p = 0.050). Conclusiones: el alto agotamiento emocional de los residentes está asociado con problemas en el manejo de impulsos, distorsiones de la realidad (debido al psicoticismo), pertenecer a los primeros años de residencia y falta de ejercicio físico. Se requiere especial atención a la salud física y mental de estos profesionales

Introduction: The simultaneity of activities between academic demands and medical training during residencies is a high risk of developing burnout syndrome (BS) among resident physicians, which decreases their quality of life. This study aimed to identify the psychosocial and sociodemographic factors associated with BS among resident physicians from a public hospital. Materials and methods: This cross-sectional and correlational study involved 47 resident physicians. The Occupational Burnout Scale (EDO), the Minnesota Multiphasic Personality Inventory-2 Restructured Form, and a sociodemographic questionnaire were applied. The data were analyzed by using nonparametric Spearman's correlation test. Results: We found that 25.6% of the participants had a high level of burnout, while 51% showed a high level of emotional exhaustion. Regarding personality and sociodemographic factors associated with BS, only the impulsivity scale (r = 0.341; p = 0.019) and the hours of exercise performed in a week (r = −0.414; p = 0.004) showed a significant relationship (p < 0.05). When segmented by sex, a relationship between BS and psychoticism (r = 0.468; p = 0.018), decreased physical activity (r = −0.620; p = 0.001), and first years of residence (r = −0.396; p = 0.050) were noted only in men. Conclusions: A high level of emotional exhaustion was evidenced among the medical residents in relation to the development of their activities, which were associated with problems in the management of impulses, distortions of reality (due to psychoticism), belonging to the first years of residency, and the lack of physical exercise. Hence, special attention must be given to the physical and mental health of medical residents

Introdução: a simultaneidade de atividades entre as demandas acadêmicas e ao mesmo tempo a formação médica durante as residências acarreta alto risco de desenvolvimento da Síndrome de Burnout (SB) nos médicos residentes, diminuindo sua qualidade de vida. O objetivo da pesquisa foi identificar os fatores psicossociais e sociodemográficos associados à SB em médicos residentes. Materiais e métodos: estudo transversal e correlacional. Participaram 47 médicos residentes de um hospital público. Aplicou-se a Escala de Desgaste Ocupacional (EDO), o Inventário Multifásico da Personalidade Minnesota-2 Forma Reestruturada (MMPI2-Rf) e adicionalmente um questionário sociodemográfico. Os dados foram analisados por meio do teste de correlação não paramétrica de Spearman. Resultados: 25,6% dos participantes apresentaram alto burnout e 51% alto nível de exaustão emocional. Em relação aos fatores de personalidade e sociodemográficos associados à SB, apenas a escala de impulsividade (r = 0,341; p = 0,019) e as horas de exercício por semana (r = −0,414; p = 0.004) apresentaram relação significativa (p < 0,05). Quando segmentado por sexo, apenas nos homens do estudo houve relação entre SB e psicoticismo (r = 0,468; p = 0,018), diminuição da atividade física (r = −0,620; p = 0,001) e primeiros anos de residência (r = −0,396; p = 0,050). Conclusões: destaca-se o elevado desgaste emocional vivenciado pelos residentes no desenvolvimento das suas atividades, que se associa a problemas na gestão dos impulsos, distorções da realidade (devido ao psicoticismo), estar nos primeiros anos de residência e falta de exercício físico. É necessária atenção especial à saúde física e mental desses profissionais

Importancia de la acreditación internacional de facultades de medicina

A partir de 2024, egresados de facultades de medicina que deseen hacer estudios de postgrado en los EE.UU o el Canadá, deberán graduarse en escuelas de medicina con programas educativos de calidad avalados por agencias reconocidas capaces de otorgar una acreditación internacional. La World Federation for Medical Education (WFME) es una de estas agencias. La WFME aceptó la nueva política de acreditación del Educational Committee for Foreign Medical Education (ECFMG) por la que médicos que postulen para la certificación del ECFMG del 2024 en adelante, tendrán que haberse graduado en un centro universitario de medicina acreditado por una agencia de aseguramiento de calidad que se encuentre reconocida por la WFME. El COMAEM (Consejo Mexicano para la Acreditación de la Educación Médica) está avalado por la WFME y otros organismos internacionales que aseguran la calidad de la educación superior. La acreditación que concede el COMAEM es un reconocimiento que el programa de medicina cumple con los criterios, indicadores y parámetros de calidad establecidos por este organismo. A partir de 2024, los egresados de un programa acreditado podrán postular para la certificación del ECFMG a través del examen de licencia médica de los Estados Unidos o USMLE (United States Medical Licensing Examination) y así poder hacer una residencia de especialización o trabajar en EE. UU. En el Perú, solo la Facultad de Medicina Alberto Hurtado de la Universidad Peruana Cayetano Heredia ha completado el proceso de acreditación internacional a través de COMAEM y ha recibido dicha acreditación.

As of 2024, medical school graduates who wish to pursue graduate studies in the U.S. or in Canada, they must have graduated from medical schools with quality educational programs endorsed by recognized agencies, capable of granting international accreditation. The World Federation for Medical Education (WFME) is one of these agencies. The WFME accepted the new accreditation policy of the Educational Committee for Foreign Medical Education (ECFMG) whereby physicians applying for ECFMG certification from 2024 onwards, must have graduated from a university medical center accredited by a quality assurance agency that is recognized by the WFME. The COMAEM (Mexican Council for the Accreditation of Medical Education) is endorsed by the WFME and other international organizations that ensure the quality of higher education. The accreditation granted by COMAEM is a recognition that the medical program meets the criteria, indicators and quality parameters established by this organization. Starting in 2024, graduates of an accredited program will be able to apply for ECFMG certification through the United States Medical Licensing Examination (USMLE) and thus be able to do a specialty residency or work in the U.S. In Peru, only the Alberto Hurtado School of Medicine of the Cayetano Heredia Peruvian University has completed the international accreditation process through COMAEM and has received such accreditation.

Awareness and recommendation of home blood pressure measurement among physicians in India: Results from Asia HBPM survey 2020

Background: Awareness of hypertension and blood pressure (BP) control rates are still low in India. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including the prevention of cardiovascular diseases(CVD) and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India. Materials and methods: As part of Asia HBPM Survey 2020, a cross-sectional survey was conducted among healthcare providers from India between June 2020 to June 2021. The questionnaire consisted of 37 questions and sub-questions related to HBPM awareness and recommendations to patients. Results: A total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. 31.3% of physicians instruct their patients to measure their BP before taking antihypertensive drugs, while around 30% of physicians gave no instructions. The reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34.4%) and home BP (15.1%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 34.9% of their patients own HBPM device and 30.4% of the patients measure their own BP at home. Conclusion: The survey reveals that HBPM instructions to the patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM use among patients. Clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians

Glaucoma suspects referred by general ophthalmologists to a tertiary center in Brazil: outcomes of the glaucoma specialist assessment / Suspeitos de glaucoma encaminhados do oftalmologista geral para um centro terciário no Brasil: resultados da avaliação do especialista em glaucoma

ABSTRACT Purpose: To characterize patients with suspected glaucoma who were referred to the clinic for suspected glaucoma in a tertiary public hospital in southern Brazil and to evaluate differences in functional and structural damages between patients diagnosed with different types of glaucoma, those with normal eye examination results, and those who remained as glaucoma suspects. Methods: This is a cohort study of patients referred by general ophthalmologists to the clinic for suspected glaucoma at Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, between March 2016 and December 2018. The patients were followed up until they had undergone reliable examinations (eye examination, visual field screening, and optic coherence tomography for classification as normal and having a suspected glaucoma, glaucoma with an elevated intraocular pressure, normotensive glaucoma, or ocular hypertension. Results: A total of 135 patients were included in this study. Of the patients, 117 subjects completed all examinations and met the inclusion criteria. Most patients were normal (36.8%), followed by those with suspected glaucoma (25.64%), normal tension glaucoma (18.8%), glaucoma with elevated intraocular pressure (12%), and ocular hypertensive (6%). The main reason for referral was increased optic nerve head cupping. The patients with normal tension glaucoma were older than the other subjects on average (p=0.03). In addition, the normal tension glaucoma group had a significantly worse baseline visual field index and mean deviation of the visual field than the normal, glaucoma suspect, and ocular hypertensive groups. The circumpapillary retinal nerve fiber layer on OCT was thinner on average in the normal tension glaucoma group than in the normal and glaucoma suspect groups (p<0.002) but did not significantly differ between the glaucoma group with elevated intraocular pressure and the other groups. Conclusions: Patients with normal tension glaucoma tend to be diagnosed later because of their normal intraocular pressures; thus, the optic nerve cupping must be greater to raise the suspicion of glaucoma. In this study, we found that the patients with normal tension glaucoma had worse disease at the time of diagnosis.

RESUMO Objetivo: Caracterizar a população com suspeita de glaucoma encaminhada a um centro público terciário no sul do Brasil e avaliar diferenças no dano dos parâmetros funcionais e estruturais entre os pacientes diagnosticados com diferentes tipos de glaucoma e aqueles classificados como normais e aqueles mantidos como suspeitos de glaucoma. Métodos: Esta é uma coorte dos pacientes encaminhados para o setor de glaucoma suspeito do Hospital Nossa Senhora da Conceição, Porto Alegre - BR, no período de março de 2016 a dezembro de 2018. Os pacientes foram acompanhados até obterem exames confiáveis (exame oftalmológico completo, campimetria visual, tomografia de coerência óptica) para serem classificados como: normal, glaucoma suspeito, glaucoma com pressão intraocular elevada, glaucoma de pressão normal ou hipertenso ocular. Resultados: Um total de 135 pacientes foram incluídos neste estudo, sendo que destes, 117 pacientes completaram todos os exames e foram incluídos neste estudo. A maioria dos pacientes foi considerada normal (36,8%), seguido por glaucoma suspeito (25,64%), glaucoma de pressão normal (18,8%), glaucoma com pressão intraocular elevada (12%) e hipertensão ocular (6%). A principal razão para encaminhamento foi escavação do nervo óptico aumentada. Pacientes com glaucoma de pressão normal eram em média mais velhos que os demais (p=0,03). Esses também apresentavam índice de campo visual e desvio médio da campimetria visual piores que sujeitos normal, com suspeita de glaucoma e hipertensos oculares, e tinham a camada de fibra nervosa medida pela tomografia de coerência óptica mais fina que normais e suspeitos de glaucoma (p<0,002). Os pacientes com glaucoma de pressão elevada não diferiram significativamente dos outros grupos. Conclusão: Pacientes com glaucoma de pressão normal tendem a ser diagnosticados mais tardiamente devido ao fato da pressão intraocular não estar elevada, logo a escavação do disco óptico deve ser maior para gerar a suspeita de glaucoma. Neste estudo, paciente com glaucoma de pressão normal apresentaram doença mais avançada no momento do diagnóstico em comparação com os outros grupos.

General Health Questionnaire (GHQ12): new evidence of construct validity / Questionário de Saúde Geral (QSG-12): novas evidências de validade de construto

Abstract This study aimed to gather evidence on the adequacy of the General Health Questionnaire (GHQ-12) in Brazil, considering a random sample of Brazilian physicians. Specifically aimed: (1) to test the GHQ-12 bifactor structure compared to alternative models, (2) to check its factorial invariance regarding to gender and the diagnosis of mental and behavioral disorders, and (3) to know the association of this measure with indicators of poor health (e.g., suicidal thoughts, decreased libido, medication use). The study included 1,085 physicians with a mean age of 45.7 (SD = 10.6), mostly male (61.5%), married (72.6%) and Catholic (59.2%). They answered the GHQ-12, the Positive and Negative Suicidal Ideation Inventory, and demographic questions. The best fit model was the bifactor structure composed of anxiety and depression, in addition to a general dimension, which presented Cronbach's alpha, McDonald's ω and composite reliability higher than 0.70 just for a general fact. Psychological distress scores correlated with suicidal ideation and indicators of health and sexual satisfaction. This is a psychometrically suitable instrument that can be used in terms of its total, but its specific factors need to be used with caution.

Resumo Este estudo teve como objetivo reunir evidências sobre a adequação do Questionário de Saúde Geral (QSG-12) no Brasil, considerando uma amostra aleatória de médicos brasileiros. Especificamente, objetivou-se: (1) testar uma estrutura bifactor em comparação com modelos alternativos, (2) verificar invariância fatorial em relação ao gênero e ao diagnóstico de transtornos mentais e comportamentais, e (3) conhecer a associação com indicadores de saúde precária (por exemplo: pensamentos suicidas, diminuição da libido e uso de medicamentos). Participaram do estudo 1.085 médicos, com média de idade de 45,7 (DP = 10,6), maioria de sexo masculino (61,5%), casados ​​(72,6%) e católicos (59,2%). Eles responderam ao QSG-12, ao Inventário de Ideação Suicida Positiva e Negativa e a questões demográficas. O modelo de melhor ajuste foi a estrutura bifactor (composta por ansiedade, depressão e uma dimensão geral), que apresentou alfa de Cronbach, ômega de McDonald e confiabilidade composta superior a 0,70 apenas para o fato geral. Pontuações de sofrimento psicológico se correlacionaram a ideação suicida e indicadores negativos de saúde e satisfação sexual. O instrumento foi psicometricamente adequado e pode ser utilizado em termos de sua pontuação total, mas seus fatores específicos precisam ser utilizados com cautela.

Healthcare Seeking Behaviour of Hospitalised COVID-19 Patients During Second Wave in Tertiary Care Hospital of Northern India

Background: The Coronavirus Disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people’s perceptions of preventive and curative measures changed. Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients. Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients’ healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview. Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 ± 14.7 years. Self-medication was significantly associated with study subjects’ mortality (p=0.03). Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19.

Conhecimento e percepção dos enfermeiros e médicos sobre moralidade do aborto induzido e sua legislação / Knowledge and perception of nurses and physicians about morality of induced abortion and its legislation / Conocimiento y percepción de enfermeras y médicos sobre la moralidad del aborto inducido y su legislación

Objetivo: Relatar o conhecimento e a percepção dos profissionais enfermeiros e médicos sobre a moralidade do aborto induzido e sua legislação. Métodos: Estudo quantitativo, envolvendo 39 Enfermeiros e Médicos de duas Maternidades do sul do Brasil. Para a coleta de dados foi utilizado o "Mosaico de Opiniões Sobre o Aborto Induzido" e um questionário complementar. Para análise descritiva e associações foi utilizado o pacote estatístico Data Analysis and Statistical Software. Resultados: Constatou-se que os profissionais possuem adequado conhecimento a respeito da legislação, conhecimento insuficiente a respeito dos documentos necessários para o aborto legal e sobre o direito a objeção de consciência, sendo este último principalmente entre os enfermeiros. Os profissionais defendem outras possibilidades de aborto na legislação, e a respeito do Mosaico, predominam os padrões liberais em comparação aos conservadores. Conclusão: Se faz necessária a discussão sobre o tema, ampliando o conhecimento a respeito dos direitos sexuais e reprodutivos das mulheres e sobre a conduta durante a assistência ao aborto. (AU)

Objective: Report the knowledge and perception of nurses and physicians about the morality of induced abortion and its legislation. Methods: Quantitative study, involving 39 nurses and physicians at two maternity hospitals in southern Brazil. For data collection the "Mosaic of Opinions on Induced Abortion" and a complementary questionnaire were used. For descriptive analysis and associations, the Data Analysis and Statistical Software statistical package was used. Results: It was found that the professionals have adequate knowledge about the legislation, insufficient knowledge about the documents necessary for legal abortion and about the right to conscientious objection, the latter occurred mainly among nurses. Professionals defend other possibilities of abortion in the legislation, and regarding the Mosaic, liberal standards prevail in comparison to conservatives. Conclusion: It is necessary to discuss the topic, expanding knowledge about women's sexual and reproductive rights and about conduct during abortion care. (AU)

Objetivo: Informar el conocimiento y percepción de enfermeras y médicos profesionales sobre la moralidad del aborto inducido y su legislación. Métodos: Estudio cuantitativo, que involucró a 39 enfermeras y médicos de dos maternidades del sur de Brasil. Para la recolección de datos se utilizó el "Mosaico de Opiniones sobre el Aborto Inducido" y un cuestionario complementario. Para el análisis descriptivo y las asociaciones se utilizó el paquete estadístico Data Analysis and Statistical Software. Resultados: Se constató que los profesionales tienen conocimiento adecuado sobre la legislación, conocimiento insuficiente sobre los documentos necesarios para el aborto legal y sobre el derecho a la objeción de conciencia, siendo este último principalmente entre enfermeras. Los profesionales defienden otras posibilidades de aborto en la legislación, y con respecto a Mosaic, los estándares liberales prevalecen en comparación con los conservadores. Conclusión: Es necesario discutir el tema, ampliando el conocimiento sobre los derechos sexuales y reproductivos de las mujeres y sobre la conducta durante la atención del aborto. (AU)

Exploring physicians' perception of diagnostic information in clinical practice / Exploración de la percepción de los médicos sobre la información diagnóstica en la práctica clínica

A well-informed diagnostic process results in better health outcomes and less overdiagnosis. While there have been studies conducted to explore doctors' knowledge, attitudes, and practice regarding diagnostic test information, there are no reports from Latin America. We invited physician readers of a Latin American medical journal to answer a survey on their professional and demographic characteristics and previous exposure to diagnostic information training. Two hundred fifteen responded, of whom 88% agreed to some extent that diagnostic information is helpful for clinical practice and that more training is needed. This brief exploratory survey underscores the need for more resources to train in the diagnostic process and the utilization of diagnostic information in clinical practice. However, given the limitations of this study, more evidence is needed.

Un proceso de diagnóstico bien informado da lugar a mejores resultados de salud y a menos sobrediagnósticos. Aunque se han realizado estudios para explorar los conocimientos, las actitudes y la práctica de los médicos en relación con la información sobre las pruebas diagnósticas, no existen estudios realizados en América Latina. Invitamos a los médicos lectores de una revista médica latinoamericana a responder una encuesta de opinión sobre sus características profesionales y demográficas y su exposición previa a la formación en información diagnóstica. Recibimos 215 respuestas, de las cuales el 88% estuvo de acuerdo en que la información diagnóstica es útil para la práctica clínica, y que se necesita más capacitación. Esta breve encuesta exploratoria subraya la necesidad de dedicar más recursos en la formación sobre el proceso diagnóstico y la utilización de la información diagnóstica en la práctica clínica. Sin embargo, dado las limitaciones de este estudio se hace necesario mayor evidencia al respecto.

Mortalidad de médicos por COVID-19 de acuerdo con su especialidad en la primera y segunda ola de la pandemia en el Perú

Introducción : El COVID-19 es una enfermedad infecciosa, declarada pandemia por la OMS en marzo 2020. Ha causado millones de muertes, incluidos médicos en el mundo. El objetivo fue determinar las características de la mortalidad de médicos por COVID-19 y la tasa de mortalidad específica por especialidad durante la pandemia del COVID-19 en el Perú. Material y métodos: Estudio descriptivo que evalúo la totalidad de médicos fallecidos reportados por el Colegio Médico del Perú hasta noviembre 2021 y que cumplieron con tener su certificado de defunción. Se definió tres grupos: médicos especialistas con alto (EMACC) y bajo contacto (EMBCC) con pacientes COVID-19 y médicos sin especialidad. Resultados: La edad >60 años y tener el sexo masculino en los EMACC mostraron un p=0,003 y 0,016 respectivamente. El 69,4% de médicos fallecieron en Lima y donde más fallecieron fue Hospital Rebagliati Martins (21%). La mayor tasa de mortalidad específica por especialidad (TME) fue 29,7 y 25,0 en epidemiología y administración de salud respectivamente. En la ciudad de Lima, fallecieron 69,4% de médicos, principalmente el grupo de EMBCC. Conclusión: Los médicos varones y >60 años son los que murieron con mayor frecuencia, sobre todo en la ciudad de Lima y en el grupo de EMACC. Las mayores tasas de mortalidad por el COVID-19 ha sido en el grupo de EMBCC.

Introduction: COVID-19 is an infectious disease declared a pandemic by the WHO in March 2020. It has caused millions of deaths, including among doctors in the world. The objective was to determine the characteristics of physician mortality from COVID-19 and the specific mortality rate by specialty during the COVID-19 pandemic in Peru. Material and methods: Descriptive study that evaluated all deceased physicians reported by the Medical College of Peru until November 2021 and who complied with having their death certificate. Three groups were defined: specialist physicians with high (EMACC) and low (EMBCC) contact with COVID-19 patients and physicians without a specialty. Results: Age >60 years and males in the EMACC showed p=0.003 and 0.016, respectively. 69.4% of doctors died in Lima, and most died at Rebagliati Martins Hospital (21%). The highest specialty-specific mortality rate was 29.7 and 25.0 in epidemiology and health administration, respectively. In Lima, 69.4% of physicians died, mainly in the EMBCC group. Conclusion: Male physicians >60 years old are the ones who die more frequently, especially in the city of Lima and in the EMACC group. The highest mortality rates from COVID-19 were in the EMBCC group.

Validação de conteúdo de protocolo de decanulação de pacientes adultos traqueostomizados / Content validation of the decannulation protocol for adult tracheostomized patients

RESUMO Objetivo Realizar a validação de conteúdo de um protocolo de decanulação de pacientes adultos traqueostomizados. Método Para a validação de conteúdo do protocolo elaborado por fonoaudiólogas foi utilizada a técnica Delphi. Os 11 itens do protocolo foram julgados por peritos, por meio de rodadas via e-mail e foram classificados como adequados, parcialmente adequados ou inadequados, além de fornecerem comentários e sugestões sobre cada item. Foram convidados 30 fonoaudiólogos, 30 fisioterapeutas respiratórios e 30 médicos responsáveis pelo procedimento de traqueostomia e decanulação. O percentual de concordância adotado foi ≥ 80% e o processo foi interrompido quando obtido esse percentual em todos os itens. Resultados Ao final do processo, 24 profissionais participaram da terceira rodada, sendo 46% fonoaudiólogos, 29% fisioterapeutas e 25% médicos. Após as sugestões e comentários dos peritos, dois itens foram mantidos como estavam no protocolo inicial, sete foram reformulados, seis incluídos e dois excluídos. A versão final do protocolo incluiu: identificação, ausência de secreções abundantes, características da secreção, tosse eficaz, capacidade para remover secreções, tolera o balonete desinsuflado, aptidão no processo de decanulação, nível de consciência, troca de cânula para menor calibre, ausência de infecção vigente/ ativa, deglutição espontânea e eficaz de saliva, uso de válvula de fala, aptidão à oclusão da cânula, avaliação da aptidão para decanulação e exames objetivos. Conclusão Por meio da Técnica Delphi houve a validação do conteúdo do instrumento, ocorrendo mudanças substanciais. A próxima etapa de validação do instrumento é a obtenção de evidências de validade em relação a estrutura interna.

ABSTRACT Purpose Perform content validation of a decannulation protocol for tracheostomized adult patients. Methods To validate the content of the protocol developed by speech therapists, the Delphi technique was used. The 11 items of the protocol were judged by experts through rounds via e-mail and were classified as adequate, partially adequate or inadequate, in addition to providing comments and suggestions on each item. 30 speech therapists, 30 respiratory physiotherapists and 30 physicians responsible for the tracheostomy and decannulation procedure were invited. The percentage of agreement adopted was ≥ 80% and the process was interrupted when this percentage was obtained in all items. Results At the end of the process, 24 professionals participated in the third round, being 46% speech therapists, 29% physiotherapists and 25% physicians. After the experts' suggestions and comments, two items were kept as they were in the initial protocol, seven were reformulated, six were included and two were excluded. The final version of the protocol included: identification, absence of abundant secretions, characteristics of the secretion, effective cough, ability to remove secretions, tolerate the deflated cuff, aptitude in the decannulation process, level of consciousness, change of cannula to a smaller caliber, absence of current/active infection, spontaneous and effective swallowing of saliva, use of a speech valve, aptitude for occlusion of the cannula, assessment of aptitude for decannulation and objective examinations. Conclusion Through the Delphi Technique, the content of the instrument was validated, with substantial changes occurring. The next stage of instrument validation is obtaining evidence of validity in relation to the internal structure.

Assessment of Knowledge Among the Physicians Regarding Dental Screening Prior to Chemotherapy and Radiotherapy

ABSTRACT Objective: To evaluate the physicians' knowledge regarding the referral for dental screening prior to chemotherapy and radiotherapy. Material and Methods: We conducted a cross-sectional study using simple random sampling among 468 physicians from various specialties with diverse experience levels from different regions in Saudi Arabia. A self-reporting questionnaire was distributed among the physicians, which consisted of questions assessing the physicians' knowledge about oral health and complications in patients prior to chemotherapy and radiotherapy. Statistical analysis was done after the data was collected employing SPSS, and p<0.05 was taken as significant. Results: Residents were more as expected (39.3%), followed by specialists (2.31%). The majority had a practice experience for more than five years (67.8%).The scores for the knowledge assessment showed that 51.3%, nearly half of the participants, had lower scores. The scores were statistically significant (p<0.05). Conclusion: General physicians and specialists should be aware of the dental complications and associated diseases in patients with malignancies and those undergoing chemo and radiotherapy. It is proposed that more awareness should be raised among physicians to rectify this lapse.

Planejamento reprodutivo e inserção de dispositivo intrauterino realizada por médicos e enfermeiras no brasil / Reproductive planning and insertion of intrauterine devices by physicians and nurses in brazil / Planificación reproductiva e inserción de dispositivos intrauterinos realizadas por médicos y enfermeras en brasil

RESUMO: Objetivo: analisar os registros referentes à consulta de planejamento reprodutivo e a inserção do dispositivo intrauterino realizadas por enfermeiros e médicos na Atenção Primária à Saúde do Brasil, no ano de 2021. Método: trata-se de estudo quantitativo, transversal e descritivo, utilizando-se de dados secundários do Sistema de Informação em Saúde para a Atenção Básica e submetido à análise estatística descritiva simples dos dados. Resultados: foram registrados no país 18.243 procedimentos sobre a inserção do DIU com prevalência da atuação do profissional médico, exceto no estado de Roraima; e o quantitativo de 54.186 consultas de planejamento reprodutivo com hegemonia de 41.184 (76%) do profissional enfermeiro em relação aos médicos 13.002 (24%). Conclusão: há necessidade de investimento na capacitação de médicos e enfermeiros para ampliar o acesso e direito à atenção à vida sexual das mulheres no país. A atuação da Enfermagem se constitui em uma via para consolidar o direito à atenção à vida sexual e reprodutiva das mulheres.

ABSTRACT Objective: to analyze the records referring to reproductive planning consultations and to intrauterine device insertion performed in 2021 by nurses and physicians in Primary Health Care in Brazil. Method: this is a quantitative, cross-sectional and descriptive study that resorted to secondary data from the Health Information System for Primary Care and submitted to simple descriptive statistics data analysis. Results: a total of 18,243 procedures about IUD insertion were recorded in the country, with prevalence of physicians, except for the state of Roraima; as well as 54,186 reproductive planning consultations with predominance of 41,184 (76%) nurses in relation to physicians (13,002; 24%). Conclusion: there is a need to invest in the training of physicians and nurses in order to expand access and the right to sexual life care of the women living in the country. Nursing care is a way to consolidate women's right to sexual and reproductive life care.

RESUMEN Objetivo: analizar los registros sobre la consulta de planificación reproductiva y la inserción del dispositivo intrauterino realizadas por enfermeros y médicos en la Atención Primaria de Salud en Brasil, en el año 2021. Método: se trata de un estudio cuantitativo, transversal y descriptivo, utilizando datos secundarios del Sistema de Información en Salud para la Atención Primaria y sometidos a análisis estadístico descriptivo simple de los datos. Resultados: se registraron 18.243 procedimientos de inserción de DIU en el país, en los que predominaron los profesionales médicos, excepto en el estado de Roraima; mientras que, de las 54.186 consultas de planificación reproductiva registradas, 41.184 (76%) fueron realizadas por los profesionales de enfermería y 13.002 (24%) por médicos. Conclusión: es necesario invertir en la formación de médicos y enfermeros para ampliar el acceso y el derecho al cuidado de la vida sexual de las mujeres en el país. El trabajo de Enfermería constituye una forma de consolidar el derecho al cuidado de la vida sexual y reproductiva de las mujeres.

Women in surgery: do surgical specialties keep up with the feminization of medicine in Brazil? / Mulheres na cirurgia: as especialidades cirúrgicas acompanham a feminização da medicina no Brasil?

ABSTRACT Introduction: historically, surgical medical specialties are mostly male, a scenario which, in recent years, has undergone changes. In this sense, despite the relevance of the growth of female participation in the medical career, little is discussed about the distribution between genders of the main surgical medical specialties in the country. Objective: discuss the process of feminization in surgical specialties in Brazil over the last few years, tracing a distribution profile of these specialties. Methods: this is a retrospective and cross-sectional study with secondary data from the Censuses of Medical Demography in Brazil in the years 2011, 2013, 2015, 2018, 2020 and 2023, including the surgical specialties: Urology, Orthopedics and Traumatology, Thoracic Surgery, Neurosurgery, Digestive System Surgery, Cardiovascular Surgery, Hand Surgery, General Surgery, Head and Neck Surgery, Vascular Surgery, Plastic Surgery, Ophthalmology, Coloproctology, Otorhinolaryngology, Pediatric Surgery, and Gynecology and Obstetrics. Results: males prevails in numbers, among the surgical specialties, however, with a lower growth rate compared to females. Specialties such as urology, orthopedics and traumatology and neurosurgery are mostly male, while gynecology and obstetrics are female. Conclusion: it is evident that female participation in the surgical medical field has increased significantly over the last few years.

RESUMO Introdução: historicamente, as especialidades médicas cirúrgicas são, majoritariamente, masculinas, cenário o qual, nos últimos anos, passa por mudanças. Nesse sentido, apesar da relevância do crescimento da participação feminina na carreira médica, pouco se debate sobre a distribuição entre sexos das principais especialidades médicas cirúrgicas no país. Objetivo: discutir o processo de feminização nas especialidades cirúrgicas no Brasil ao longo dos últimos anos, traçando um perfil de distribuição dessas especialidades. Métodos: Trata-se de um estudo retrospectivo e transversal com dados secundários oriundos dos Censos de Demografia Médica no Brasil dos anos de 2011, 2013, 2015, 2018, 2020 e 2023, incluindo as especialidades cirúrgicas:Urologia, Ortopedia e Traumatologia, Cirurgia Torácica, Neurocirurgia, Cirurgia do Aparelho Digestivo, Cirurgia Cardiovascular, Cirurgia da Mão, Cirurgia Geral, Cirurgia de Cabeça e Pescoço, Cirurgia Vascular, Cirurgia Plástica, Oftalmologia, Coloproctologia, Otorrinolaringologia, Cirurgia Pediátrica e Ginecologia e Obstetrícia. Resultados: O sexo masculino prevalece em números, dentre as especialidades cirúrgicas, porém, com menor taxa de crescimento em comparação ao sexo feminino. Especialidades como a urologia, ortopedia e traumatologia e neurocirurgia são majoritariamente masculinas, enquanto a ginecologia e obstetrícia, feminina. Conclusão: evidencia-se que a participação feminina na área médica cirúrgica aumentou significativamente ao longo dos últimos anos.