Do vínculo ao encontro cuidador: cartografias sobre o território identitário médico e o cuidado entre médicos de família e usuários / Del vínculo al encuentro cuidador: cartografías sobre el territorio de identidad médico y el cuidado entre médicos de familia y usuario / From the bond to the caring encounter: cartographs about medical identity territory and the care between family doctors and users

Estudo qualitativo com abordagem cartográfica que teve como objetivo compreender os efeitos que o vínculo e a responsabilização entre médicos de família e usuários produzem nos próprios médicos. Foram realizadas dez entrevistas abertas por meio de perguntas disparadoras com médicos de família e médicos residentes. A análise das entrevistas se deu sob o referencial da micropolítica e problematizou, com base nas experiências relatadas, a existência de um "território identitário médico", bem como as possibilidades de desconstituição desse território, sua desterritorialização no sentido de novas reterritorializações, a exemplo de afastar-se da onipotência/infalibilidade não para sofrer, mas para cuidar de si e do outro. Propõe-se que, nesse movimento de reconstrução do território identitário, tanto médico como usuário passem a transitar pela dimensão cuidadora do encontro, em que tecnologias leves podem ser operadas e novas possibilidades de configurações do cuidado acontecem. (AU)

Estudio cualitativo con abordaje cartográfico cuyo objetivo fue comprender los efectos que el vínculo y la toma de responsabilidad entre médicos de familia y usuarios producen en los propios médicos. Se realizaron diez entrevistas abiertas a partir de preguntas desencadenadoras con médicos de familia y médicos residentes. El análisis de las entrevistas se realizó con base en el referencial de la micropolítica y problematizó, a partir de las experiencias relatadas, la existencia de un "territorio de identidad médico", así como las posibilidades de desconstitución de este territorio, su desterritorialización en el sentido de nuevas reterritorializaciones, con el ejemplo de apartarse de la omnipotencia/infalibilidad no para sufrir, sino para cuidar de sí mismo y del otro. Se propone que, en ese movimiento de reconstrucción del territorio de identidad, tanto el médico como el usuario pasan a transitar por la dimensión cuidadora del encuentro, en donde tecnologías leves pueden operar y suceden nuevas posibilidades de configuraciones del cuidado. (AU)

The purpose of this qualitative research with a cartographic approach was to understand the effects that bonding and accountability between family physicians and users can produce on the physicians themselves. Ten open interviews were conducted based on triggering questions with family physicians and medical residents. The analysis of the interviews using the reference of the micropolitics was based on the experiences reported, and it was problematized the existence of a "medical identity territory", as well as the deconstruction of this territory, its "deterritorialization", leading to "reterritorializations", such as moving away from omnipotence / infallibility not to suffer, but to take care of oneself and others. It is proposed that in this movement, both physician and user start to move through the caregiving dimension of the encounter, where light technologies can be operated and new possibilities of configurations of care happens. (AU)

Una mirada crítica sobre la reacción situacional en la atención primaria de salud / A critical glance on the situational reaction in primary health care

La enfermedad situacional es una categoría nosográfica poco analizada en la bibliografía médica. En este artículo se abordan aspectos importantes relacionados con su valor clasificatorio y práctico, así como la importancia que reviste en el plan de formación del médico general integral, debido a las potencialidades de desarrollo en la comunidad. Además, se enfatiza en las posibilidades prácticas de aplicar los procedimientos psicoterapéuticos de apoyo, que son oportunos y facilitadores para evitar la sobresaturación de la demanda asistencial secundaria, resultante del envío o remisión

The situational disease is a nosographic category little analyzed in the medical literature. In this work important aspects related to its classificatory and practical value are approached, as well as the importance that it has in the training plan of the comprehensive general doctor, due to the development potentialities in the community. It is also emphasized on the practical possibilities of implementing the support psychotherapeutic procedures that are opportune and facilitators to avoid the overflood of secondary assistance demand, resulting from referral.

Médicos y médicas, estilos asistenciales distintos: ¿satisfacción diferente de los usuarios? / Male physicians and female physicians, different medical styles: different users' satisfaction?

OBJETIVO: Verificar la existencia de diferencias en la satisfacción de los usuarios de los servicios sanitarios, según sea que la atención se reciba de un médico hombre o mujer. MATERIAL Y MÉTODOS: Se utilizó la encuesta realizada a usuarios de atención primaria en 2005 que llevó a cabo el Instituto de Estudios Sociales Avanzados, del Consejo Superior de Investigaciones Científicas (IESA/CSIC). Se efectuó un análisis bivariado entre el sexo del médico y las variables de satisfacción, y un análisis de varianza (ANOVA); se tomó como variable dependiente el indicador de satisfacción general y como variables independientes las características del individuo y del sistema, entre estas últimas el sexo del médico. RESULTADOS: En el análisis bivariado se constató la relación entre sexo del médico y la satisfacción con algunos de los elementos del servicio, si bien en el análisis de dependencia, que incluye variables sociodemográficas y del sistema, esta influencia desaparece. CONCLUSIÓN: Se confirmaron las diferencias en la práctica asistencial de hombres y mujeres médicos, pero no así las diferencias en la satisfacción general con el servicio recibido.

OBJECTIVE: To analyse differences in the satisfaction of health service users associated with the sex of the attending doctor. MATERIAL AND METHODS: Data obtained from the Primary Care Services User Survey (2005), part of a project regarding user satisfaction with the Andalusian Public Health Services. A bivariate analysis was conducted, the two variables being doctors´ sex and user satisfaction, as was an ANOVA, taking as a dependent variable the indicator of general satisfaction and as independent variables the characteristics of the individual and that of the system, including physician sex. RESULTS: In the bivariate analysis a relation was confirmed between doctors´ sex and satisfaction with the components of the health service received. Nevertheless, this influence disappears in the analysis of dependence, which includes sociodemographic and system variables. CONCLUSION: Differences between practices by male and female doctors are confirmed, but not the differences in general satisfaction with the service received.

Development and validation of an instrument to measure family physicians' clinical aptitude in metabolic syndrome in Mexico / Desarrollo y validación de un instrumento para medir la aptitud clínica de médicos familiares en síndrome metabólico en México

OBJECTIVE: The purpose of this work was to measure family physicians' clinical aptitude for the diagnosis and treatment of metabolic syndrome in a representative sample from six Family Medicine Units (UMF) at the Mexican Institute for Social Security (IMSS), in Guadalajara, Jalisco, México. MATERIAL AND METHODS: This is a cross-sectional study. A validated and structured instrument was used, with a confidence coefficient (Kuder-Richardson) of 0.95, that was applied to a representative sample of 90 family physicians throughout six UMFs in Guadalajara, between 2003 and 2004. Mann-Whitney's U and Kruskal-Wallis' tests were used to compare two or more groups, and the Perez-Viniegra Test was used to define aptitude development levels. RESULTS: No statistically significant differences were found in aptitude development between the six family medicine units groups and other comparative groups. CONCLUSIONS: The generally low level of clinical aptitude, and its indicators, reflects limitations on the part of family physicians at the IMSS in Jalisco to identify and manage metabolic syndrome.

OBJETIVO: El propósito de este estudio fue medir la aptitud clínica de los médicos familiares de una muestra representativa de seis Unidades de Medicina Familiar (UMF) del Instituto Mexicano del Seguro Social (IMSS), en Guadalajara, Jalisco, México, en el diagnóstico y tratamiento del síndrome metabólico. MATERIAL Y MÉTODOS: Es un estudio observacional, prospectivo y comparativo. Se diseñó y validó un instrumento estructurado con un coeficiente de confianza (Kuder-Richardson) de 0.95, aplicado a una muestra representativa de 90 médicos familiares de seis UMF en Guadalajara, entre 2003 y 2004. Se utilizaron los tests de Mann-Whitney U y Kruskal-Wallis para comparar dos o más grupos, y el test de Pérez-Viniegra se utilizó para definir los niveles de desarrollo de aptitud. RESULTADOS: No se observaron diferencias significativas en el desarrollo de aptitud entre las seis UMF. CONCLUSIONES: El bajo nivel general de aptitud clínica refleja las limitaciones para identificar y manejar el síndrome metabólico por parte de los médicos familiares.

A busca de uma identidade para o médico de família / In search of identity for the family doctor

Este artigo reflete algumas preocupações em relação ao médico de família, no sentido de se perguntar quem é esse sujeito dentro de uma formação médica “biologizante”, que não valoriza a atenção primária, deixando confuso seu ideal de profissão. Tem o objetivo de disponibilizar uma discussão que, na inter-relação entre educação e trabalho, invoca uma reflexão sobre a identidade profissional do médico de família. Realiza uma abordagem qualitativa sobre as práticas dos médicos de família do município do Rio de Janeiro enquanto objeto de análise. Resulta em considerações que refletem a reprodução de um modelo de atenção tradicional, fazendo crer que a educação permanente é uma estratégia importante na busca do acolhimento da população.

This paper discusses some concerns about the family doctor, wondering who is this subject within a biologicist medical formation, who does not valueprimary attention, making his professional ideal confused. It aims to present a discussion that, in theinter-relation between education and work, demands reflection on the professional identity of the familydoctor. It carries out a qualitative approach on family doctors’ practices in the City of Rio de Janeiro, as object of analysis. As a result, it presentsconsiderations that reflect the reproduction of a traditional attention model, leading to the idea that continuing education is an important strategy in the search of population reception.

Questionnaire study of primary care physicians referral patterns and perceptions of patients with epilepsy in a Brazilian city, 2005

A una muestra de médicos de familia del Programa de Médicos de Familia de Niterói, Río de Janeiro, Brasil, se aplicó en abril de 2005 un cuestionario autoadministrado para determinar la percepción de los médicos de atención primaria sobre la calidad del servicio para epilepsia y los patrones de remisión y su opinión sobre la atención que se brinda. Los encuestados consideraron que los neurólogos deben ser los responsables del diagnóstico y de la prescripción inicial de medicamentos antiepilépticos, mientras que los médicos de familia se deben responsabilizar de la atención subsiguiente. Los encuestados informaron estar insatisfechos con sus conocimientos sobre la epilepsia y los medicamentos antiepilépticos. Se consideró que los profesionales mejor calificados para la atención de la epilepsia son los neurólogos (58,9 por ciento), seguidos de los médicos de familia (35,7 por ciento). Casi todos los encuestados consideraron que los lineamientos y seminarios mejoraron su capacidad para atender a sus pacientes. Los encuestados no se sentían seguros de la atención que brindaban a los pacientes con epilepsia y por lo general los remitían al neurólogo. Sin embargo, el Programa de Médicos de Familia tiene un potencial inexplotado para tratar a los pacientes con epilepsia, debido al interés de estos profesionales en mejorar su calificación.

Attitudes of Japanese primary care physicians toward publicly endorsed periodic health examinations: a cross sectional survey.

BACKGROUND: Despite the lack of evidence for efficacy, an annual health examination has been advocated for the general population by the Japanese government. We conducted a cross-sectional survey to understand the attitudes of Japanese physicians toward the annual examinations. METHODS: In October 2003, a questionnaire was mailed to 1971 physicians registered with Aichi Prefecture Medical Association as internists. The survey was designed to determine their opinions about the effectiveness of the periodic health examination and each of its components. RESULTS: The response rate was 37%. Eighty-five percent believed that a periodic health examination was effective. Nearly 80% believed that height and weight should be measured, and more than 90% supported blood pressure measurements. Nearly 70% supported a physical examination of chest and abdomen. About half believed that vision and hearing tests should be performed for all ages. More than 90% considered performing a variety of laboratory tests valuable. Three-quarters supported hepatitis B surface antigen and hepatitis C antibody determinations. Seventy to eighty percent valued the screening tests for lung, stomach, colon, breast and cervical cancer. CONCLUSIONS: Most Japanese primary care physicians believe that a comprehensive annual health examination as currently endorsed by public health authorities is effective.

Diferencias por sexo, síndrome de Burnout y manifestaciones clínicas, en los médicos familiares de dos instituciones de salud, Guadalajara, México / Differences by sex, syndrome of Burnout and clinical manifestations, in the familiar doctors of two institutions of health, Guadalajara, México

Desde la perspectiva psicosocial la definición más aceptada sobre el Síndrome de burnout es la propuesta por Maslach y Jackson, la cual designa un estado de agotamiento físico y mental, con un sujeto despersonalizado y desmotivado para trabajar. El objetivo del trabajo es identificar las diferencias entre el ser hombre o ser mujer con Síndrome de burnout y sus repercusiones en la salud en los médicos familiares de dos instituciones de salud en Guadalajara, México. El estudio es de tipo transversal retrospectivo. La población seleccionada la conformaron los profesionales "médicos familiares" en dichas instituciones. El estudio consta de un cuestionario de datos sociodemográficos y laborales, así como la escala de valoración de "Maslach Burnout Inventory (MBI)" para evaluar la presencia del síndrome de burnout. Del total de la población encuestada en ambas instituciones 154 (78.2 por ciento), las mujeres conforman el 37.1 por ciento (73) y los hombres el 62.9 por ciento (78) sujetos. La prevalencia del síndrome de burnout es del 41.8 por ciento, 28 mujeres y 54 hombres. La dimensión "agotamiento emocional" es la más vulnerable en ambos sexos. De los 92 médicos familiares con síndrome de burnout, 17 mujeres de 28 (77.3 por ciento) y 23 hombres de 54 (57.5 por ciento) presentaron alguna molestia y/o enfermedad en los últimos meses. Mantener un buen estado de salud y bienestar, así como trabajar bajo condiciones seguras, traerá consecuencias positivas para la institución, para el trabajador y la población en general.

Primary care physician satisfaction with patients diagnosed with depression: International Depression Project results from Colombia

OBJECTIVE: To characterize physician satisfaction with doctor-patient encounters, distinguishing between those involving patients diagnosed with depression and those involving patients without depression, as well as to determine the impact of an educational intervention aimed at improving the recognition and management of depression in primary care practice, in Bogotá, Columbia. METHOD: Physician satisfaction when treating outpatients in primary care centers was assesed by means of a questionnaire applied before and after the intervention. RESULTS: The intervention was given to 18 physicians and 5 nurses. A total of 1650 questionnaires related to visits were collected in the first phase, and 1832 were collected in the second one. The percentage of patients diagnosed with depression increased from 5.9 percent (95 percent CI: 4.8-7.1 percent) before the intervention to 10.6 percent (95 percent CI: 9.2-12.06 percent) after. The total duration of the clinical encounter did not change significantly. The percentage of time spent on the physical problems/concerns of the patients decreased in both types of visits. CONCLUSIONS: Health professional satisfaction was the greatest when dealing with the physical problems of the patient. However, in both types of visits, the degree of satisfaction when dealing with the psychological aspects increased after the intervention.

OBJETIVO: Caracterizar a satisfação dos clínicos com os encontros médico-paciente, distinguindo entre aqueles que envolvem pacientes diagnosticados com depressão e aqueles que envolvem pacientes sem depressão, bem como determinar o impacto de uma intervenção educacional visando a melhorar o reconhecimento e o gerenciamento da depressão na prática de atendimento primário em Bogotá, Colômbia. MÉTODO: A satisfação dos clínicos ao tratarem de pacientes ambulatoriais em centros de atendimento primário foi avaliada por meio de um questionário aplicado antes e depois da intervenção. RESULTADOS: A intervenção foi ministrada a 18 clínicos e cinco enfermeiras. Um total de 1.650 questionários relativos às visitas foram coletados na primeira fase e 1.832 foram coletados na segunda fase. O percentual de pacientes diagnosticados com depressão aumentou de 5,9 por cento (IC 95 por cento: 4,8-7,1 por cento), antes da intervenção, para 10,6 por cento (IC 95 por centoI: 9,2-12,06 por cento) após a mesma. A duração total do encontro clínico não se modificou significativamente. O percentual de tempo despendido como os problemas/preocupações físicos dos pacientes decresceu em ambos os tipos de visitas. CONCLUSÕES: A satisfação dos profissionais de saúde foi mais alta ao tratarem dos problemas físicos dos pacientes. No entanto, em ambos os tipos de visitas o grau de satisfação ao tratarem dos aspectos psicológicos aumentou após a intervenção.

Autoevaluación de fortalezas, debilidades y confianza de los médicos de atención primaria en el abordaje de enfermedades reumatológicas / Self assessment of strengths, weaknesses and self confidence¿ of primary care physicians taking care of rheumatic diseases

Background: Rheumatologic diseases are common and frequently managed by primary care physicians. Aim: To assess strengths, weaknesses and self confidence of primary care physicians in the management of rheumatic diseases. Material and methods: A self assessment and anonymous questionnaire was mailed to primary care physicians of two Chilean regions. Using a 10 points Likert scale, they were asked about personal interest, undergraduate training, continuous medical education, availability of medical literature, complementary laboratory tests and consultation with a rheumatologist. Medical skills, knowledge, therapeutic approach and performance of rheumatologic procedures were evaluated under the item confidence. Results: Three hundred forty seven out of 763 physicians (45%) answered the questionnaire. Their age range extended from 25 to 75 years, 59% were male, 58% were Chilean and 74% worked in the Metropolitan region. The worst evaluated parameters were availability of literature with a score of 2.2±2, access to consultation with a rheumatologist (3.8±2.2) and to continuous medical education (4.3±2.7). Physicians had a better confidence in their knowledge (6.7±1.5) and in their therapeutic approach (6.1±1.5). The worst confidence score was for shoulder injection therapy (3.4±2.6). Continuous medical education correlated with knowledge but not with clinical skills. Conclusions: Primary care physicians perform a bad assessment of their skills in rheumatology. They have a low level of confidence in their clinical skills to perform rheumatologic procedures. Continuous medical education improves confidence in knowledge but not in skills.

Apoyo social laboral y extralaboral en los médicos familiares que laboran para dos instituciones de salud en Guadalajara, México / Labour and extra-labour-based social support among family physicians employed by two health care institutions in Guadalajara, Mexico

Es conocido que el apoyo social genera en el individuo un desarrollo óptimo emocional y satisfactorio con consecuencias positivas hacia su salud, en beneficio de su calidad de vida y de las personas que le rodean. La percepción que el sujeto tiene de que recibe apoyo, de que su red es confiable y efectiva, es un determinante importante de su estado de salud, independientemente de la condición real del sujeto. El objetivo del trabajo fue analizar las condiciones en que se encuentra el apoyo social extralaboral y laboral y su asociación con algunas variables sociodemográficas y laborales en los médicos familiares, que laboran para dos instituciones de salud en la zona metropolitana de Guadalajara, México. El estudio es descriptivo y transversal. La población incluye a los médicos familiares de ambas instituciones. Se les aplicó un cuestionario de datos generales y el inventario de Recursos Sociales de Díaz Veiga para evaluar el apoyo social. Participaron 196 médicos, 73 mujeres y 123 hombres, el promedio de edad fue de 46.29 años, la mayoría de ellos son casados (79,7 por ciento), el nivel máximo de estudios es la especialidad (92,9 por ciento) y el 52,8 por ciento trabaja por las mañanas. En general las redes sociales de apoyo con las que cuentan los médicos fueron "muy buenas", lo bastante como para no observarse asociación ni factores de riesgo con alguna manifestación en salud. Se sugiere continuar con su red de apoyo y, para quienes no la tienen, habrá que crearla y mantenerla adecuadamente.

Caracterización del médico de familia / Characterization of the family physician

Se exponen las dificultades que existen para definir y caracterizar al Médico de Familia, y se relacionan un grupo de principios, habilidades y atributos de este profesional, así como los elementos comunes a muchas definiciones de la medicina familiar. Se plantea que la continuidad en la atención puede ser el elemento central en la caracterización del Médico de Familia

General physicians' perspective of sleep apnea from a developing country.

To assess the knowledge of general physicians about the diagnosis and management of obstructive sleep apnea (OSA), a self-administered questionnaire, containing 15 questions, was distributed to 160 doctors attending a pulmonary CME program in March 2002. After 15 minutes of response time, the questionnaires were collected. The data were entered and analyzed using SPSS (Version 10.0) software. One hundred and twenty (75%) questionnaires were returned. Only 41% of responders had ever read an article about OSA and 36% had suspected it at least once in their practice. The majority (61-77%) of responders were aware of the common symptoms of OSA, but 55% did not recognize its association with hypertension. A significant number of doctors were not aware that OSA could occur in non-obese individuals (33%), women (42%) and children (39%). Only 25% of responders recognized that a history and blood tests were insufficient to make a reliable diagnosis of OSA. Half of the responders were aware of CPAP therapy for OSA, whereas 18% would have prescribed sedatives to treat sleep disturbances in OSA.

Adherence of the private sector to national tuberculosis guidelines in the Islamic Republic of Iran, 2001-02

We determined the knowledge and practice of private sector physicians in three cites regarding management of pulmonary tuberculosis [TB] and their determinants. A random sample questionnaire survey was conducted of 732 private physicians. Stratified analysis and logistic regression were used to identify the adjusted determinants of the two outcomes. A high proportion of the doctors had correct knowledge about the major diagnostic criteria but there was a low level of knowledge and practice of TB management. Significant risk factors for poor knowledge were age > / = 36 years, being a GP rather than a specialist and no attendance in TB training courses or attendance in courses held by institutions other than the public health system. Age > / = 36 years was the only significant risk factor for poor practice

[Depressive symptoms in medical students and physicians]

Depression is one of the most commom and disabliding mental disorders with 15-25% life time prevalence. Physicians are not immune against this disorder and depression of them may be so dangerous for their patients .The aim of this study is determination of depressive symptoms in medical students and physicians. In a cross- sectional study, 1000 Beck Depression Inventories [BDI]were distributed among different grades medical students, general practitioners and specialists.Primary data analyzed by chi-square, anova and Kruskal -Wallis tests in the spss software. 435[26Imales and 171 females] completed the questionnaires. 69.2% of them were single and 30.8% were married. Mean Beck Score [BS] WAS 13.6 for all of them. In the 1[st], 4[th] and 6[th] Grade student, general practitioners and specialists groups the mean BS were 11.2, 11.9,16.3, 19.8 and 9.6 respectively. There was no significant differences between males and females or between singles and who married according to BS. The results of this study indicate that depressive symptoms are common in medical students and physicians, specially general practitioners, and so appropriate interventions for prevention and treatment of this problem is strongly recommended

Factores de la personalidad relacionados con la participación de los médicos en un sistema de vigilancia del dengue / Personality factors and physician participation in a surveillance system for dengue control

Introducción. El conocimiento de la incidencia del dengue en una población es un factor importante para la toma de deciciones referentes a las medidas preventivas y de control de la enfermedad. Esta incidencia se puede conocer si los médicos solicitan los estudios de diagnósticos necesarios para su confirmación y si se reportan sus casos a las autoridades sanitarias. Objetivo. El presente estudio tuvo como objetivo el determinar los factores de personalidad que se asocian con la participación en el sistema de vigilancia del dengue, en un grupo de médicos generales y familiares de cuatro instituciones públicas de salud de la ciudad de Mérida. Material y Métodos. Los datos obtenidos en el presente estudio fueron analizados mediante un modelo de regresión logística. Los factores de personalidad fueron estudiados en los médicos, mediante el método de Cattell. Resultados. De los factores de personalidad, el factor F, característico de personas entusiastas, se asoció a la actitud positiva hacia la participación en el sistema de vigilancia del dengue, establecido en su sitio de trabajo