Crianças com condições crônicas complexas de saúde moradoras de uma pediatria: por que é tão difícil desospitalizar? / Children with complex chronic health conditions living in a pediatric ward: why is it so difficult to dehospitalize?

O estudo pretende promover uma discussão sobre a desospitalização de crianças com condições crônicas complexas de saúde que vivem uma internação prolongada e poderiam se beneficiar com o tratamento em casa. Almeja-se também, dar maior visibilidade à situação das crianças que aguardam a efetivação da transição do cuidado seguro para o ambiente familiar. Tem-se como principal objetivo conhecer e analisar a situação de hospitalização por tempo prolongado e a proposta de desospitalização do Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) vinculado a Universidade Federal do Rio de Janeiro, visando a contribuir com propostas de adequação desse processo. O trabalho consiste num estudo exploratório de cunho qualitativo, que busca responder às seguintes questões: estratégias utilizadas pela equipe de saúde e pela gestão do hospital para propiciar a redução do tempo da internação e viabilizar a desospitalização; organização do processo de desospitalização nessa instituição de saúde; fatores que interferem direta e indiretamente no processo de desospitalização e impedem a ida dessas crianças para casa; os obstáculos existentes para as famílias receberem a criança, como elas se organizam e suas percepções sobre sua situação; e o que poderia ser feito para melhorar esse processo. Entre os meses de dezembro de 2021 e janeiro de 2022 foram entrevistados 31 profissionais de saúde, 2 gestores e 5 familiares. O estudo foi aprovado pelo comitê de ética em pesquisa do IPPMG. Os resultados da pesquisa mostraram que o conceito de desospitalização está claro para a maioria dos profissionais e para a gestão, no entanto, as ações são ainda incipientes. São necessárias condições externas (familiares, de acesso a insumos, equipamentos, medicamentos, de apoio dos serviços locais de saúde, da comunidade, das condições das moradias) e internas (uma liderança do processo e uma equipe multiprofissional em dedicação de tempo necessário) para promover a desospitalização prevista pelo Ministério da Saúde. Observa-se a falta de prioridade por parte da gestão de se institucionalizar o processo de desospitalização na unidade sob a escusa de que faltam pessoal e condições objetivas. Nenhuma das crianças citadas realmente conseguiu ainda ir para casa com o devido acompanhamento. Em geral, os familiares têm muitas dúvidas e passam por muitos caminhos tortuosos e sofrimentos para promover o retorno da criança ao lar, entretanto, querem os filhos de volta em casa. Há obstáculos estruturais que contradizem o que propugnam as políticas de proteção: o desamparo por parte do Estado que deixa de prover pessoal, transporte, medicamentos, insumos, alimentação especial, equipamentos e serviços de atendimento domiciliar, além dos longos processos judiciais para a aquisição destes itens. A desospitalização traz um benefício inequívoco para a criança, colocando-a de forma assistida no ambiente familiar, o que significa teoricamente mais qualidade de vida para ela e seus familiares e, para a unidade hospitalar, a redução de custos de internação, diminuição de gastos e maior rotatividade de pacientes, liberando vagas para outras crianças No entanto, tudo isso só pode ser devidamente tratado e equacionado quando há um programa que focalize todas as dimensões e interfaces de um processo de desospitalização adequado.

The study aims to promote a discussion about the dehospitalization of children with complex chronic health conditions who experience a prolonged hospitalization and could benefit from treatment at home. It is also intended to give greater visibility to the situation of children who are waiting for the effective transition from safe care to the family environment. The main objective is to know and analyze the situation of hospitalization for a long time and the proposal of dehospitalization of the Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG) linked to the Federal University of Rio de Janeiro (UFRJ), aiming to contribute with proposals for the adequacy of this process. The work consists of an exploratory study of a qualitative nature, which seeks to answer the following questions: strategies used by the health team and hospital management to reduce the length of hospital stay and enable dehospitalization; organization of the dehospitalization process in this health institution; factors that interfere directly and indirectly in the dehospitalization process and prevent these children from going home; the existing obstacles for families to receive the child, how they organize themselves and their perceptions of their situation; and what could be done to improve this process. Between December 2021 and January 2022, 31 health professionals, 2 managers and 5 family members were interviewed. The study was approved by the Research Ethics Committee (CEP/IPPMG). The survey results showed that the concept of dehospitalization is clear to most professionals and management, however, the actions are still incipient. External conditions (family members, access to supplies, equipment, medicines, support from local health services, the community, housing conditions) and internal conditions (a process leader and a multiprofessional team dedicating the necessary time) are needed to promote the dehospitalization provided by the Ministry of Health. There is a lack of priority on the part of the management to institutionalize the process of dehospitalization in the unit under the excuse that there is a lack of personnel and objective conditions. None of the children mentioned actually managed to go home with the proper follow-up. In general, family members have many doubts and go through many tortuous paths and suffering to promote the child's return home, however, they want their children back home. There are structural obstacles that contradict what protection policies advocate: the helplessness on the part of the State that fails to provide professionals, transport, medicines, supplies, special food, equipment and home care services, in addition to the long legal processes for the acquisition of these items. Dehospitalization brings an unequivocal benefit to the child, placing him in an assisted way in the family environment, which theoretically means better quality of life for him and his family and for the hospital unit, the reduction of hospitalization costs, reduction of expenses and greater patient turnover, freeing up spaces for other children. However, all of this can only be properly addressed and equated when there is a program that focuses on all dimensions and interfaces of an adequate dehospitalization process.

Os cuidados paliativos pediátricos sob o olhar dos profissionais de saúde: caminhos para a garantia deste direito / Pediatric palliative care from the point of view of health professionals: ways to guarantee this right

Preconizado por legislações e políticas públicas, o direito à saúde na atual conjuntura social, política e econômica encontra desafios à sua garantia. Considerando o grupo específico das crianças com condições crônicas complexas de saúde, a oferta dos cuidados paliativos pediátricos corresponde a um dos desafios. A presente pesquisa situa-se sob a temática dos cuidados paliativos com ênfase na saúde da criança, um tema multiprofissional e interdisciplinar, que perpassa importantes reflexões sobre os modelos de atenção à saúde e a qualidade da assistência prestada pelo Sistema Único de Saúde. Trata-se de uma pesquisa interpretativa de abordagem qualitativa, que tem por objetivo analisar os aspectos relacionados à garantia do direito aos cuidados paliativos às crianças com condições crônicas complexas de saúde em internação hospitalar no Sistema Único de Saúde. Para se debruçar sobre essa questão na realidade do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, mediante o método estudo de caso foi utilizada a técnica de entrevista via ambiência digital. Direcionada aos profissionais de saúde vinculados aos serviços de internação pediátrica UPI, UI e UPG, a entrevista contemplou profissionais de saúde atuantes na assistência como integrantes das equipes de referência e profissionais atuantes na função de chefia. Foram explorados aspectos como: elegibilidade dos usuários dos serviços de internação em específico para os cuidados paliativos, o trabalho multiprofissional no atendimento as crianças elegíveis a esta abordagem, a oferta de cuidados paliativos nas enfermarias pediátricas e as condições oferecidas aos profissionais para o exercício de ações de cuidados paliativos pediátricos. Com o estudo identificou-se que o perfil de usuários da instituição e dos serviços de internação em específico é elegível aos cuidados paliativos pediátricos, entretanto o conhecimento sobre a temática varia entre profissionais e serviço de internação, podendo ser considerado mediano. A oferta de cuidados paliativos pediátricos ocorre de modo parcial e, apesar da inexistência de uma comissão especializada, as enfermarias e suas equipes de referência demostram interesse em garantir uma atenção multidisciplinar e preocupação com o alívio de dores e sofrimentos físicos, sociais, psicológicos e espirituais das crianças e adolescentes com condições crônicas complexas de saúde. Conclui-se que para uma melhora da oferta de cuidados paliativos pediátricos na instituição é fundamental que seja estruturada e assim instituída uma comissão especializada que possa coordenar as ações de cuidados paliativos auxiliando as equipes de referência das enfermarias e ambulatórios. É também necessário o investimento na qualificação dos profissionais de saúde, disponibilizando para estes espaços de treinamento e educação permanente referentes aos cuidados paliativos pediátricos.

As advocated by laws and public policies, the right to health in the current social political and economic situation faces challenges to its guarantee. Considering the specific group of children with chronic and complex health conditions, the provision of pediatric palliative care is one of the challenges. This research is located under the theme of palliative care with an emphasis on child health, a multidisciplinary and interdisciplinary theme, which permeates important reflections on the models of health care and the quality of care provided by the Unified Health System. It is based on an interpretative research with a qualitative approach, which aims to analyze aspects related to guaranteeing the right to palliative care for children with chronic and complex health conditions during hospitalization in the Unified Health System. from the National Institute of Health of Women, Children and Adolescents Fernandes Figueira, using the case study method, the technique of interviewing via digital environment was used. Directed to health professionals linked to the pediatric inpatient services UPI, UI and UPG, the interview included health professionals working in the assistance as members of the reference teams and professionals working in the leadership role. Aspects such as: eligibility of inpatient services users specifically for palliative care, multiprofessional work in the care of children eligible for this approach, the provision of palliative care in pediatric wards and the conditions offered to professionals for the exercise of actions were deepened pediatric palliative care. With the study, it was identified that the profile of users of the institution and in-hospital services in particular is eligible for pediatric palliative care, however the professionals' knowledge on the subject is medium and uneven, varying between professionals and inpatient service. The provision of pediatric palliative care occurs in a partial way, and despite the lack of a specialized commission, the wards and their reference teams show interest in guaranteeing multidisciplinary care and concern with the relief of physical, social, psychological and spiritual pain and suffering of women. children and adolescents with chronic and complex health conditions. It is concluded that for an improvement in the offer of pediatric palliative care in the institution, it is essential that a specialized committee be structured and thus instituted to coordinate palliative care actions, assisting the reference teams of the wards and outpatient clinics. It is also necessary to invest in the qualification of health professionals, providing these spaces for training and continuing education regarding pediatric palliative care.

Abordajes para la intervención desde enfermería en la Díada en condiciones de cronicidad / Approaches for the intervention of nursing in the Dyad in chronic conditions

El objetivo de esta investigación fue describir la forma en que se ha abordado e intervenido a la Diada desde Enfermería en condiciones crónicas y pluripatología. Se empleó la metodología de Revisión integrativa siguiendo los pasos de Whittemore y Knafl, los buscadores empleados fueron: Ovid Nursing, Science Direct, BVS y el metabuscador Ebsco (de éste último se emplearon: Medline, Medline Complete, Academic Search Complete y OmniFile Full Text Mega (H.W. Wilson). Se identificaron 5.530 piezas investigativas en todas las bases de datos, de las cuales al proceso de depurar por título y resumen quedaron 1.022 piezas. De estas al revisar el texto completo arrojó la revisión para el estudio de 70 piezas. Los hallazgos más significativos están relacionados con las bases de datos y el aporte que tuvo cada una de ellas, donde EBSCO tuvo una participación significativamente mayor que las demás, los países de los que más investigaciones se tuvieron en cuenta también fue un resultado importante, por el lugar que tiene Colombia en este, puesto que, solo es superado por Estados Unidos y España, las patologías que más se estudiaron fueron: en primer lugar fue la Enfermedad Pulmonar Obstructiva Crónica, el cáncer en sus diferentes clasificaciones, la Enfermedad Renal Crónica, la Insuficiencia Cardíaca, la Diabetes Mellitus y el Alzheimer. Las investigaciones realizadas con abordaje de diada representan el 41.66% de todas las investigaciones, lo que demuestra la importancia que tiene abordar a ambos miembros de la misma, pues dichas investigaciones tienen mayor impacto en la sociedad, y la mayoría busca no solo caracterizarlos sino que, también buscan mejorar la calidad de vida de ambos individuos. La representatividad del año de publicación, muestra que los investigadores han puesto sus ojos en los pacientes crónicos y en la Díada, pues a partir del 2013 el aumento ha sido cada vez mayor y su pico se da en el año 2016, y el 2017 también aporta gran parte de los estudios, pues se ha evidenciado lo importante que es entender a la Díada, y generar cambios en ella para mejorar su calidad de vida. De los 5.530 documentos revisados, solo uno habla de pluripatología, pues es un concepto relativamente nuevo, aun así, ya se encuentra ese término en la literatura mundial, pues si bien es cierto que la multimorbilidad continúa siendo un término empleado con bastante frecuencia, también es cierto que ambos conceptos tienen diferencias significativas, particularmente en que los primeros pueden tener comorbilidades y en la pluripatología, todas las entidades patológicas son independientes unas de otras. La díada se ha intervenido principalmente desde el aspecto educativo, con el fin de brindar las herramientas necesarias para que continúen con su proceso de cuidado, en cuanto al abordaje, en la mayoría de los casos se aborda solo al cuidador, en otra gran proporción se abordan ambos miembros de la díada y en un pequeño porcentaje se hace solo con el paciente, esto en términos generales de cronicidad, pues solo un estudio develó pluripatología.

The objective of this investigation was to describe the way in which the Dyad has been approached and intervened from Nursing in chronic conditions and pluripathology. The methodology of Integrative Review was used, following the steps of Whittemore and Knafl. The search engines used were: Ovid Nursing, Science Direct, VHL and the Ebsco metasearch engine (the latter were used: Medline, Medline Complete, Academic Search Complete and OmniFile Full Text Mega (HW Wilson). 5,530 pieces of research were identified in all the databases, of which 1,022 pieces were left in the process of debugging by title and summary, and when reviewing the full text the published review for the study was 70 pieces. The most significant findings are related to the databases and the contribution that each of them had, where EBSCO had a significantly higher participation than the others. The countries from which more research was taken into account was also an important result, the place that Colombia has in this, since it is only surpassed by the United States and Spain, the pathologies that were studied the most were: first, Chronic Obstructive Pulmonary Disease, cancer in its different classifications, Chronic Kidney Disease, Heart Failure, Diabetes Mellitus and Alzheimer's. The investigations approach out in Dyads represent 41.66% of all the investigations, which shows the importance of addressing both members of the same, since such investigations have a greater impact on society, and most of them seek not only to characterize them but also seek to improve the quality of life of both individuals. The representativeness of the year of publication, shows that the researchers have set their eyes on chronic patients and on the Dyad, since as of 2013 the increase has been increasing and its peak occurs in 2016, and the 2017 also contributes a large part of the studies, since it has become clear how important it is to understand the Dyad, and generate changes in it to improve their quality of life. Of the 5,530 documents reviewed, only one speaks of pluripathology, as it´s a relatively new concept, even so, that term is already found in world literature, although it is true that multi morbidity continues to be a term used quite frequently, also it is true that concepts have significant differences, particularly in the first they may have comorbidities and in pluripathology entities are independent of each other. The dating has been intervened mainly from the educational aspect, in order to provide the necessary tools to continue with their care process, in terms of the approach, in most cases only the caregivers is addressed, in another large proportion the two members a dyad and in a small percentage it is done only with the patient, this in general term of chronicity, as only a study of development of pluripathology.

Geriatric patients: compliance issues and ways of its optimization

The aim of the study is to increase the effectiveness of diseases treatment in elderly patients. The work is based on the study of the nature and the role of compliance disorders, optimizing the effectiveness with the use of therapeutic complex of pharmacotherapy associated with psychotherapeutic component. As a result of the analysis of morbidity in elderly age and the nature of compliance in elderly patients, an optimal therapeutic complex was proposed, which consists of rational pharmacological load and psychotherapeutic intervention, aimed at informing a patient about the disease, methods of its treatment, as well as at creating an effective therapeutic alliance which provides proper medical care and prevents self-treatment in such patients.

Síndrome de sobrecarga en cuidadores familiares de adultos mayores y factores asociados. Chordeleg, 2017 / The overload syndrome in family caregivers of elderly adults and associated factors. Chordeleg, 2017

Objetivo general: determinar la prevalencia del síndrome de sobrecarga en cuidadores familiares de adultos mayores y su relación con factores asociados en el cantón Chordeleg, durante el año 2017. Material y métodos: es un estudio analítico transversal con 123 cuidado-res familiares. Se utilizó el cuestionario del Instituto Nacional de Estadís-ticas y Censos, test de Zarit, índice de Katz y test FF-SIL. Las variables fueron expresadas en porcentajes y en frecuencias absolutas. Los factores asociados fueron evaluados a través de la razón de prevalencia con inter-valo de confianza (95%) y el Chi cuadrado. Resultados: la mayor proporción de individuos tuvo 40 a 59 años de sexo femenino; el 73.17% son casados; el 40.65% tienen estudios primarios incompletos y en la relación con el paciente el 47.15% fueron hijos. El 58.50% de la población del estudio presentó sobrecarga, asociándose a tener más de 5 años como cuidador (RP 1.42 IC95% 1.07-1.88, p=0.003) y a la incapacidad severa y moderada del paciente (RP 2.46, IC95% 1.74 ­ 3.18, p=0.000).Conclusiones: el perfil del cuidador no difiere de otros estudios.Existió una alta prevalencia de síndrome de sobrecarga, asociándose a tener más de 5 años de cuidador y a la incapacidad moderada-severa del paciente.

General objective: to determine the prevalence of Overload syndrome in family caregivers of older adults and its relationship with associated factors in Chordeleg canton during 2017.Material and methods: it is a transversal analytical study with 123 family caregivers. The questionnaire of the National Institute of Statistics and Censuses, the Zarit test, the Katz index and the FF-SIL test were used. The variables were expressed in per-centages and absolute frequencies. The associated factors were evaluated through the Prevalence Ra-tio with a confidence interval (95%) and Chi square.Results: the highest proportion of individuals was between 40 and 59 years of age; the 73.17% are married; 40.65% had incomplete primary studies and in the relationship with the patient, the 47.15% were children. The 58.50% of the study population showed overload, they have been associated with having more than 5 years as a caregiver (RR 1.42 IC95% 1.07-1.88, p = 0.003) and the severe and moderate disability of the patient (RP 2.46, 95% CI 1.74-3.18, p = 0.000).Conclusions: the caregiver profile does not differ from other studies. There was a high prevalence of Overload syndrome, which is associated with having more than 5 years as a caregiver and the moderate-severe disability of the patient.

Caracterización sociodemográfica y clínica psiquiátrica de pacientes con síntomas médicamente inexplicables en una institución prestadora de salud de Medellín (Colombia) / Sociodemographic Characterization and Psychiatric Symptoms of Patients with Medically Unexplained Symptoms in a Healthcare Institution in Medellin (Colombia)

RESUMEN Introducción: Se define como síntoma médicamente inexplicado los síntomas físicos de varias semanas de duración cuya adecuada evaluación médica no revele alguna enferme dad que los explique; cuando estos síntomas se tornan persistentes, llevan a exploraciones clínicas exhaustivas y múltiples intervenciones. Estos pacientes tienen un deterioro mayor, o al menos comparable en cuanto a funcionamiento físico, salud mental y percepción nega tiva de su salud, que los pacientes con múltiples enfermedades médicas crónicas; tienen significativamente más eventos estresantes vitales (abuso psicológico, físico y/o sexual) y más probabilidades de cumplir criterios diagnósticos de ansiedad y depresión. Objetivo: Caracterizar sociodemográfica y psiquiátricamente un grupo de pacientes identi ficados en atención primaria con síntomas médicamente inexplicados. Métodos: Estudio descriptivo transversal de pacientes de 18-70 años, a quienes se aplicó el PHQ-15, el PHQ-9 y el PHQ para ansiedad y una encuesta diseña para la investigación. Resultados: Se analizó a 36 pacientes, el 94,4% mujeres, con una mediana de edad de 45 [20] años; el 33,3% de ellas estaban casadas y el 91,7% tenía hijos. El 55% tenía síntomas somáticos funcionales graves, el 77,8% tenía 1 o más trastornos somáticos funcionales y el 77,7% presentaba síntomas afectivos o ansiosos de relevancia clínica. El 25% de los pacientes reportaron antecedente de maltrato en la infancia; el 41,7%, maltrato de pareja, y el 41,6% había sido víctima del conflicto armado colombiano. Conclusiones: El principal hallazgo de este estudio fue que cerca de 8 de cada 10 pacientes cumplían criterios de un trastorno somático funcional con gran intensidad sintomática, y cerca de 3 de cada 10 pacientes cumplían criterios de 2 trastornos funcionales, la mayoría de estos pacientes sin otras enfermedades médicas de base. Además, en estos pacientes se encontró alta prevalencia de exposición a diferentes tipos de violencia a lo largo de la vida.

ABSTRACT Introduction: Medically unexplained symptoms are defined as physical symptoms that have been present for several weeks and that an adequate medical evaluation has not revealed any disease that explains them; when these symptoms become persistent, they lead to comprehensive clinical investigations and multiple interventions. These patients have a greater or at least comparable commitment to physical functioning, mental health, and negative health perception than patients with multiple chronic medical conditions; have significantly more stressful life events (psychological, physical and/or sexual abuse) and are more likely to meet diagnostic criteria for anxiety and depression. Objective: To characterize sociodemographic and psychiatric characteristics of a group of patients identified in primary care with medically unexplained symptoms. Methodology: A descriptive, cross-sectional study with patients from 18 to 70 years old who were given PHQ-15, PHQ-9 and PHQ for anxiety, and a survey designed for the study. Results: 36 patients were analysed, 94.4% women, median age 45 [RIC, 20] years-old, 33.3% married, 91.7% had children. 55% had severe functional somatic symptoms, 77.8% had one or more functional somatic disorders, and 77.7% had clinically relevant affective or anxiety symptoms. 25% of the patients reported a history of child abuse, 41.7% were mistreated by a partner, and 41.6% were victims of the Colombian armed conflict. Conclusions: The main finding of this study was that 8 out of 10 patients met criteria for a functional somatic disorder with great symptomatic severity and three out of ten patients met criteria for two functional disorders, most of these patients without otherbasic medical diseases. In addition, we found a high prevalence of exposure to different types of violence that these patients have been subjected to throughout their life.

Quedas em pacientes psiquiátricos: uma revisão integrativa / Psychiatric patients' falls: an integrative review

Objective: characterize the production on adult psychiatric patients' fall events. Method: Integrative review based on Whittemore theoretical-methodological assumptions. For data collection, the following descriptors were used: accidental falls, mental health, psychiatry, psychiatric nursing and nursing in Lilacs, MedLine, PubMed, Cinahl andEmbase data bases. Through inclusion criteria and instruments for control of quality and level of evidences, a sample with 57 papers was obtained. Results: Aspects referring to psychiatric patients' risk factors, mechanisms and instruments used to evaluate falls in psychiatric patients and interventions associated to fall prevention emerged from the integrative review. Conclusion: Therefore, the scientific production presents fundamental elements on fall events in psychiatric patients, contributing to these patients' safety in psychiatric hospitalization units.

Objetivo: caracterizar a produção sobre o evento quedas em pacientes psiquiátricos adultos. Método:Trata-se de uma revisão integrativa baseada nos pressupostos teórico-metodológicos de Whittemore. Para coleta de dados utilizou-se os descritores: acidentes por quedas, saúde mental, psiquiatria, enfermagem psiquiátrica e enfermagem nas bases de dados Lilacs, MedLine, PubMed, Cinahl e Embase. Por meio dos critérios de inclusão e instrumentos de controle de qualidade e níveis de evidências, totalizou-se uma amostra de 57 artigos.Resultados: Emergiu da revisão integrativa aspectos referentes aos fatores de risco de pacientes psiquiátricos, mecanismos e instrumentos para avaliar as quedas em pacientes psiquiátricos e intervenções relacionadas à prevenção de quedas. Conclusão: Portanto a produção científica apresenta elementos fundamentais sobre o evento quedas em paciente psiquiátrico, contribuindo para a segurança desses pacientes nas unidades de internações psiquiátricas.

Pharmaceutical clinical services in basic care in a region of the municipality of São Paulo

Pharmaceutical care has undergone several transformations in the health context over the years. Thus, the pharmacist has suffered a reconfiguration of his performance, mainly with the incorporation of clinical services and patient approach. The study analyzed the results of the implementation of pharmaceutical clinical services in Primary Health Care, through the use of indicators of supply, demand and productivity, clinical and process quality related to pharmaceutical care. We included all the clinical visits (n=1,833) performed to 1,080 users in 12 Basic Health Unit facilities from May to November 2016, of which 40.8% (n=748) were consultations in the establishments and 50.2% (n=1,085) home visits. Most patients (73.5%) were referred by team and 17.5% were captured through active search. Of the total workload, 12.5% ​​were dedicated to pharmaceutical consultations and 20.0% to home visits. In total, we identified 3,078 pharmacotherapy-related issues, an average of 2.8 per patient, and 6,882 pharmaceutical interventions were performed, equivalent to 6.3 interventions per patient. The problem with adherence to pharmacotherapy and the intervention of medication counseling were the most found. Results reinforce the importance of pharmaceutical clinical services in identifying the control of the most prevalent health conditions and monitoring the therapeutic results associated with drug use

Reintroducción del consumo regular de Quinua en Riobamba, Ecuador: estudio piloto / Reintroucción of regular consumptin of quinoa in Riobamba, Ecuador: a piloy study

En Ecuador la incidencia de obesidad, diabetes y otras afecciones crónicas de salud, que se han asociado parcialmente con cambios en los hábitos alimentarios, está aumentando y muchas veces se acentúa en los centros urbanos más pequeños. El consumo omnipresente de arroz blanco es probablemente una práctica alimentaria presente en esta transición nutricional, mientras que el consumo de alimentos tradicionales saludables como la quinua permanece generalmente bajo. En nuestra encuesta realizada en 2013, el 67% de los 240 residentes encuestados en la pequeña ciudad andina de Riobamba informaron que preferirían comer "arroz de quinua" (quinua preparada como arroz) por lo menos dos veces por semana en lugar de arroz blanco. Con el objetivo de reintroducir el consumo regular de quinua en los hogares de esta población, a finales de 2015 se inició una intervención para promover el consumo de arroz de quinua 3 veces por semana, entre 131 adultos en Riobamba. Entre la línea de base y los datos obtenidos al final de la intervención cuatro meses más tarde, no hubo cambios significativos en el IMC observado. Sin embargo, a los 2, 4 y 7 meses post-basal, el 52%, 40% y 47% de los encuestados, respectivamente, informaron haber disfrutado del consumo de arroz de quinua en lugar de arroz blanco, afirmando que les gustaba "mucho" o "en general", y el 64%, 55% y 68% de los encuestados refirieron que "definitivamente" o "muy probablemente" continuarán consumiendo quinua en lugar de arroz, por lo menos a veces. Estos hallazgos sugieren una aceptación modesta de esta (re)introducción de un alimento tradicional y saludable, aunque otras investigaciones más amplias y extensas podrían evaluar con mayor precisión los posibles impactos en la salud de este tipo de cambio reportado en los hábitos alimentarios de la población.

Abstract: In Ecuador the incidence of obesity, diabetes and other chronic health conditions -- which are partly due to changes in dietary behavior -- has been increasing, often most dramatically in smaller urban centers. The ubiquitous consumption of white rice is likely one important factor in this nutritional transition, while the consumption of traditional healthy foods such as quinoa remains generally low. In a 2013 survey we conducted, 67% of the 240 residents surveyed in the small Andean city of Riobamba reported they would prefer eating quinoa "rice" at least twice weekly instead of white rice. With the objective of encouraging more normative household consumption of quinoa in this population, in late 2015 an intervention was begun to promote consumption of quinoa rice 3 times a week among 131 adults in Riobamba. Between the baseline and the termination of the intervention four months later, no significant change in BMI was observed. However, at 2, 4 and 7 months' post-baseline, 52%, 40% and 47% of respondents, respectively, reported enjoying consumption of quinoa rice instead of white rice either "very much" or "in general," and 64%, 55% and 68% of respondents "definitely" or "very likely" planned to continue doing so. Our findings suggest a modest acceptance of this (re)introduction of a traditional and healthy food, though further and more extensive research could assess with greater precision the potential health impacts of such reported changes in dietary habits. Reintroducción del consumo regular de Quinua en Riobamba, Ecuador: estudio piloto.

La comorbilidad y su valor para el médico generalista en Medicina Interna / Comorbidity and its value for the general doctor in Internal Medicine

Introducción: La comorbilidad es un fenómeno que complejiza el cumplimiento de las funciones del médico generalista en la atención a pacientes en salas de medicina interna. Objetivo: Fundamentar las bases de la comorbilidad como variable, en tanto se define en lo conceptual, lo operacional y relaciones esenciales internas y externas con el enfoque en sistema de las funciones del médico clínico en las salas de Medicina Interna de los hospitales. Material y Métodos: Se realizó una revisión bibliográfica que abordasen la comorbilidad y que facilitaran cumplir el objetivo de la investigación. Desarrollo: En el plano conceptual se define la comorbilidad como la asociación de enfermedades donde una tiene carácter protagonista Se presenta la definición conceptual de la comorbilidad. La relación entre enfermedades comórbidas puede estar explicada por asociaciones de clara dependencia patogénica o por coincidencia en el paciente sin relación patogénica directa. Existen numerosos y diversos instrumentos para operacionalizarla disponibles para su aplicación en investigación y la práctica clínica. Conclusiones: Las relaciones entre las diferentes enfermedades son multilaterales y requieren de una interpretación etiopatogénica y fisiopatológica profunda para ser comprendida y analizada en el cumplimiento de las funciones asistenciales, investigativa, docentes y administrativas del médico en salas de Medicina Interna(AU)

Introduction: The comorbidity is a phenomenon that complicates general doctor´s fulfillment of their functions regarding the care of patients at Internal Medicine Wards. Objective: To base the bases of comorbidity as a variable, insofar it is defined in the conceptual, the operational and essential internal-external relationships with a systemic approach of the functions of the clinical physician in the hospital´s Internal Medicine wards. Material and Methods: A bibliographic revision that take into account comorbidity and allow to satisfy the objective was performed. Development: Conceptually, comorbidity is defined as the association of diseases in which one has a leading role character. The conceptual definition of comorbidity is presented. The relationship between comorbid diseases can be explained by associations of a clear pathogenic dependence or by coincidence in the patient without direct pathogenic relationship. There are numerous and diverse instruments available to make it operable for its application in research and clinical practice. Conclusions: The relations between different diseases are multilateral and need a deep etiopathogenic and fisiopathological interpretation to be understood and examined in the fulfillment of its asitencials, investigative, teaching and administrative functions of the doctor at Internal Medicine wards(AU)

Esclerosis Sistémica en el Hospital Carlos Andrade Marín / Systemical sclerosis in Carlos Andrade Marin Hospital

Introducción: La esclerosis sistémica es una enfermedad crónica multisistémica, caracterizada por alteraciones vasculares, activación inmune y fibrosis de tejidos y órganos. Materiales y métodos: Estudio descriptivo. Pacientes con diagnóstico de Esclerosis Sistémica que cumplieron los criterios de clasificación ACR-EULAR 2013, atendidos en la Unidad de Reumatología del Hospital Carlos Andrade Marín durante el año 2015. Resultados: De 80 pacientes, 18 presentaron esclerosis sistémica en su forma CREST; 32 como CREST incompleto; 14 en la forma difusa; uno con esclerosis sistémica sin esclerosis cutánea; 13 con síndrome de superposición; y, 2 con EMTC. Discusión: Las características clínicas y epidemiológicas de nuestros pacientes coincidieron con las descritas a nivel internacional.

Introduction: Systemic sclerosis is a chronic multisystemic disease characterized by vascular disorders, immune activation, organ and tissue fibrosis. Methods: Descriptive study. Patients diagnosed with systemic sclerosis who met the criteria ACR- EULAR classification 2013, that receive medical care at Carlos Andrade Marín hospital. Results: Prevalence: From 80 patients,18 had systemic sclerosis, full CREST form; 32 had incomplete CREST form; 14 had a diffuse form; one had systemic sclerosis without cutaneous impairment; 13 had overlaping syndrome and two EMTC. Discusion: Clinical and epidemiological characteristics of our patients were consistent with those described in the medical literature.

Association of endotheline receptor gene rs1878406 polymorphism with severe multi-vessel coronary disease / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the association of single nucleotide polymorphisms (SNPs) of endotheline receptor gene with the severity of coronary heart disease (CHD).</p><p><b>METHODS</b>A total of 553 CHD patients, including 324 patients with mult-vessel disease based on result of selected coronary angiography, and 553 age- and sex-frequency matched controls were selected. Clinical data were collected. Genotypes of rs501120, rs899997, rs1878406 and rs7173743 were determined with TaqMan-MGB probes.</p><p><b>RESULTS</b>The distribution of genotypes of the 4 SNPs showed no significant difference between the two groups. However, the frequency of A allele of rs501120 and T allele of rs1878406 were significantly higher in the CHD group compared with the control group (P< 0.05). For rs7173743 and rs899997, no significant difference was detected between the two groups. After adjusting for conventional risk factors by logistic regression analysis, the results suggested that the distribution of rs1878406 TT+TC genotype in severe multi-vessel disease group is significantly higher than that in the control group (OR=1.43, 95% CI: 1.05-2.07, P=0.033).</p><p><b>CONCLUSION</b>The above results suggested that the rs1878406 polymorphism of endotheline receptor gene may serve as a genetic marker for severe multi-vessel disease in CHD among ethnic Han Chinese.</p>

Cirugía para la obesidad y sus efectos metabólicos. artículo de revisión / Surgery for obesity and its metabolic effects. review article

En el Ecuador según la Encuesta Nacional de Salud y Nutrición publicada en el 2013, la prevalencia de Obesidad en personas mayores de 19 y menores a 60 años es del 62.8%, mientras que la principal causa de muerte de los ecuatorianos en el 2011 según el INEC fue la Diabetes Mellitus Tipo II. La aso-ciación entre obesidad y sus comorbilidades genera un importante impacto en la salud pública y en los costos que se generan de su atención. La cirugía metabólica (bariátrica) representa una excelente opción terapéutica para el tratamiento a largo plazo de la obesidad y sus comorbilidades.

In Ecuador, according to the National Health and Nutrition Survey published in 2013, the prevalence of obesity in people over 19 and under 60 years is 62.8%, while the main cause of Ecuadorians ́ death in 2011 according to the INEC was the Diabetes Mellitus Type II. The association between obesity and its comorbidities generates a significant impact on public health and its costs. The metabolic surgery is an excellent treatment option for long-term treatment of obesity and its comorbidities.

Cumplimiento terapéutico en pacientes con enfermedades crónicas / Adherence to treatment by patients with chronic diseases

Objetivo: determinar el cumplimiento del tratamiento farmacológico en pacientes ambulatorios con enfermedades crónicas. Métodos: estudio observacional, prospectivo, transversal en pacientes con hipertensión, diabéticos tipo II y dislipémicos a quienes se les realizó el test de Morisky Green. Resultados: el 38 por ciento de los pacientes manifestóconductas de incumplimiento del tratamiento, con prevalencia de los hipertensos; seguidos de las mujeres y de los que usan más de un fármaco en la terapéutica. Conclusión: los pacientes manifestaron como principal causa de no adherencia las socioeconómicas(AU)

Objective: to determine the compliance with the drug treatment of outpatients with chronic diseases. Methods: observational, prospective, cross-sectional patients with hypertension, type II diabetes and dyslipidemia, who underwent the Morisky Green test. Results: in this group, 38 percent of patients do not adhere to treatment, with prevalence of hypertensive patients, women, and those who use more than one drug in their therapy. Conclusions: The patients reported socio-economic reasons as the main cause of non-adherence to treatment(AU)