Factores de no adherencia al Programa de atención integral de salud para adolescentes, Santa Ana, El Salvador / Factors of non-adherence to the Comprehensive Health Care Program for Adolescents, Santa Ana, El Salvador

Introducción: La adolescencia se considera una etapa fundamental para el desarrollo del sujeto. Desde el 2015 en El Salvador se instauró un programa de atención integral para el adolescente. Objetivo: Caracterizar los principales factores asociados a la no adherencia al Programa de atención integral de salud para adolescente de 11 a 15 años, del municipio Santa Ana del El Salvador. Métodos: Estudio descriptivo transversal en el primer nivel de atención del municipio de Santa Ana, entre enero y marzo de 2018. Se aplicó un instrumento confeccionado por los autores. La muestra fue de 247 adolescentes que recibieron control e inscripción. Resultados: La mayoría de los adolescentes eran del sexo femenino, el 65,2 por ciento residían en el área rural, el 96 por ciento estudiaba, solo el 32,8 por ciento conocía el programa y de estos lo utilizaban el 48,1 por ciento (15,8 por ciento del total de entrevistados), la vía por la que lo conoció fue el promotor de salud (63 por ciento). Los principales factores relacionados con el no conocimiento del programa fueron; residir en el área urbana, nivel de estudios secundarios, ser estudiante, vivir cerca del centro de salud y no tener promotor de salud. Solo el trabajar resultó significativo (razón de prevalencia 1,71 IC 95 por ciento 1,17-2,51) para no ser adherente. Conclusiones: A pesar de los esfuerzos del Estado, los servicios de salud para adolescente deben ser reorientados de acuerdo con los principios y lineamientos de los documentos regulatorios y el marco legal del país, enfatizando en acciones de promoción de la demanda temprana y prestación de servicios de atención integral(AU)

Introduction: Adolescence is considered a fundamental stage for the development of the individual. Since 2015, a comprehensive health care program for adolescents has been established in El Salvador. Objective: Characterize the main factors associated with non-adherence to the Comprehensive Health Care Program for adolescents aging 11 to 15 years, from Santa Ana municipality, El Salvador. Methods: Cross-sectional descriptive study at the first level of care of Santa Ana municipality, from January to March 2018. An instrument made by the authors was applied. The sample was of 247 adolescents who were controlled and registered. Results: Most adolescents were females, 65.2 percent lived in rural areas, 96 percent were studying, only 32.8 percent knew about the programme and it was being used by 48.1 percent (15.8 percent of all interviewees), and the way they knew about it was by the health promoter (63 percent). The main factors related to not knowing on the program were: living in the urban area, junior high school level, being a student, living near the health center and not having health promoter. Only work was significant (prevalence rate 1.71 CI 95 percent 1.17-2.51) for not being adherent. Conclusions: Despite the efforts of the State, health services for adolescents should be redirected in accordance with the principles and guidelines of the country's regulatory documents and legal framework, emphasizing in actions to promote early demand and provide comprehensive care services(AU)

Investigating Compliance with Standard Precautions During Residency Physicians in Gynecology and Obstetrics

OBJECTIVES: Physician compliance with standard precautions is important in the specialty of gynecology and obstetrics because of the high frequency of invasive procedures. The current study investigated compliance with standard precautions among resident physicians working in gynecology and obstetrics. METHOD: A cross-sectional study was conducted among resident physicians in gynecology and obstetrics in their first (R1), second (R2) and third (R3) years of residency at a teaching hospital in a city in São Paulo. A structured questionnaire that included demographic and professional aspects and the Standard Precautions Adherence Scale were used to collect data. Statistical analysis was performed using IBM® SPSS version 20. Ethical aspects were considered. RESULTS: Fifty-eight resident physicians participated in the study. Of the enrolled participants, 27 (46.6%) were in R1, 12 (20.7%) were in R2 and 19 (32.8%) were in R3. The standard precautions compliance score was 4.1, which was classified as intermediate. There were no significant differences in the compliance scores of the resident physicians across the three years of residency (H=2.34, p=0.310). CONCLUSION: Compliance with standard precautions among resident physicians was intermediate. Preventive measures in clinical practice are not fully adopted in the specialty of gynecology and obstetrics. More important, many professionals claimed lack of sufficient training in standard precautions in the workplace. Such circumstances should draw the attention of hospital management with regard to occupational health risks.

Impacto de protocolo de dor torácica sobre a adesão às diretrizes societárias: um ensaio clínico / Impact of chest pain protocol on compliance with society guidelines: a clinical trial

Fundamentos: A redução de eventos coronarianos ocorre quando a síndrome coronariana aguda (SCA) é tratada de acordo com evidências de eficácia comprovada, medidas adotadas pelas diretrizes de sociedades. O uso de protocolos surge como instrumento de otimização da qualidade de atendimento.Objetivo: Avaliar o impacto da utilização de protocolo de abordagem da SCA sobre a adesão às recomendaçõesdas diretrizes societárias. Métodos: Ensaio clínico controlado randomizado por cluster, de controle unicego. Oito médicos-residentes foram randomizados para receber ou não o protocolo deabordagem da SCA. Foram elegíveis para avaliação, os prontuários de 112 pacientes admitidos por SCA. A adesão às recomendações das diretrizes foi analisada através de um sistema de pontuação que atribuiu um ponto para cada uma das 18 condutas recomendadas no protocolo.Resultados: Houve uma adesão média significativamente maior no grupo-protocolo (8,9±3,9 vs. 5,4±3,2; p<0,001). Estiveram mais presentes no grupo-protocolo (p<0,001):qualificação da dor (74,5% vs. 22,8%), realização de eletrocardiograma em até 10min (43,6% vs. 12,3%), repetição do eletrocardiograma em 6 horas (47,3% vs. 12,3%) e estratificação de risco (41,8% vs. 7,0%). Foramsignificativamente mais prescritos no grupo-protocolo (p<0,05): AAS (83,6% vs. 64,9%), oxigênio (44,4% vs.22,2%), clopidogrel (52,7% vs. 29,8%), morfina (32,7% vs. 10,5%), betabloqueador (49,1% vs. 22,8%), enoxaparina (47,3% vs. 26,3%), estatina (38,2% vs. 15,8%) e IECA(36,4% vs. 17,5%). Não houve diferença significativa namortalidade e no tempo médio de internação ou observação Conclusão: A utilização do protocolo na emergênciapromoveu maior aderência às recomendações das diretrizes societárias..

Background: Coronary events decrease when acute coronary syndrome (ACS) is treated according to proven evidence of efficacy, established by societyguidelines. The use of protocols arises as a tool for optimizing the quality of care. Objective: To assess the impact of using a protocolbased approach to ACS in terms of compliance with the recommendations set forth in society guidelines. Methods: A randomized single-blind controlled clinical trial was conducted through a cluster. Eightresident physicians were randomly selected to receive or not receive the ACS approach protocol, with themedical records of 112 patients admitted for ACS eligible for assessment. Compliance with guidelinerecommendations was analyzed through a scoring system that awarded one point for each of the 18 lines of conduct recommended in the protocol.Results: There was a significantly higher average compliance in the protocol group (8.9±3.9 vs. 5.4±3.2,p <0.001), with the following aspects also noted more in the protocol group (p<0.001): pain classification(74.5% vs. 22.8%); electrocardiogram within 10 minutes (43.6% vs. 12.3%); repeat electrocardiogram at 6h (47.3% vs. 12.3%) and risk rating (41.8% vs. 7%). The following were prescribed significantly more in the protocol group (p <0.05): AAS (83.6% vs. 64.9%);oxygen (44.4% vs. 22.2%); clopidogrel (52.7% vs. 29.8%); morphine (32.7% vs. 10.5%); beta-blockers(49.1% vs. 22.8%); enoxaparin (47.3% vs. 26.3%); statins(38.2% vs. 15.8%) and ACE inhibitors (36.4% vs. 17.5%). There was no significant difference in mortalityrates or the average lengths of hospitalization or observation. Conclusion: The use of the protocol in the emergency promoted greater adherence to the recommendations ofthe corporate guidelines.