Monitoreo del impacto en la formación de especialistas en Medicina Intensiva y Emergencias en Matanzas / Monitoring the impact in the formation of specialist in intensive medicine and emergencies, Matanzas

Introducción: la evaluación y acreditación de la calidad en la formación de las especialidades médicas en Cuba, conceptualiza el monitoreo del impacto como el proceso dirigido a evaluar la correspondencia entre los objetivos del programa y los resultados alcanzados por sus participantes en el entorno social donde se desarrollan profesionalmente. Objetivo: aplicar la metodología diseñada para el monitoreo del impacto en la formación de las especialidades médicas en el Programa de Medicina Intensiva y Emergencias. Materiales y métodos: se realizó un estudio de corte pedagógico donde se aplicó la metodología diseñada en la Universidad de Ciencias Médicas de Matanzas, para monitorear el impacto en la formación de la especialidad de Medicina Intensiva y Emergencias, desarrollado en el Hospital Universitario Comandante Faustino Pérez Hernández. Participaron 6 egresados, 11 profesores, 8 tutores y 4 directivos de la última edición concluida (octubre de 2016 a noviembre de 2019). Resultados: se observó un alto impacto en la institución y mediano en el individuo, con contraste entre el diagnóstico inicial y durante la formación: de excelencia en el 100 % de los residentes, pero un diagnóstico final con 33,3 % excelente y 66,6 % bien. No se evaluó la etapa de transferencia o impacto en la sociedad, por el corto de tiempo de experiencia laboral de los egresados. Conclusiones:la metodología aplicada permitió conocer un mediano impacto en la formación de los egresados de Medicina Intensiva y Emergencias, por contrastación entre el diagnóstico inicial y durante la formación, de excelente con un diagnóstico final de bien (AU).

Introduction: the evaluation of the quality in the formation of the medical specialties in Cuba, conceptualize the monitored of the impact like the process directed to evaluate the correspondence among the objectives of the program and the results reached by their participants in the social environment where they are developed professionally, guaranteeing the relevancy of the program. Objective: to apply the methodology designed for the monitored of the impact in the formation of the medical specialties in the program of intensive Medicine and emergencies. Materials and methods: carried out a study of pedagogic court where the methodology was applied designed in the Medical University of Matanzas, for the monitored of the impact in the formation of the specialty of intensive Medicine and emergencies, developed in the university hospital "Faustino Pérez Hernández." They participated six graduate, four directives, 11 professors and tutors of the last concluded edition, from October of the 2016 to November of the one 2019. Results: a high impact was observed in the institution and medium in the individual, with a contrast among the initial diagnosis and during for formation of excellence in 100% of the residents, with a final diagnosis of 33,3% excellent and 66,6% well. It was not evaluated the transfer stage or impact in the society, for the short of time of labor experience of the graduate. Conclusions: the applied methodology allowed to know the medium impact in the formation of graduate in Intensive Medicine and Emergencies in Matanzas, for a contrast among the initial diagnosis and during the formation of excellent with the final diagnosis of well (AU).

Residência multiprofissional em saúde: inserção de atores no Sistema Único de Saúde / Multiprofessional residency in health: insertion of actors in the unified national health system in Brazil

Os programas de Residência Multiprofissional em Saúde (RMS) são regulamentados pelos Ministérios da Educação e da Saúde, e visam promover assistência à população e formar profissionais de excelência para o trabalho, segundo as necessidades de saúde local. O objetivo deste estudo foi analisar a inserção da RMS no hospital universitário da Universidade Federal de Mato Grosso do Sul. Sob um desenho prospectivo, foi analisada a assistência realizada pelos residentes da fisioterapia, enfermagem, odontologia, farmacologia e nutrição, nos sete primeiros meses de implantação do programa. Os dados foram coletados do livro de registros de atendimentos e analisados segundo: perfil e o número de pacientes assistidos; quantidade de atendimentos realizados por especialidade; e desfecho dos casos. Na análise estatística, aplicaram-se os testes qui-quadrado e Mann-Whitney (U), com significância de 5%. Quarenta e seis pacientes foram atendidos pela equipe durante o período, perfazendo 1.979 atendimentos (média de 43,02 assistências/paciente). Não houve diferença entre a quantidade de atendimentos realizados por cada área (p=0,89). A implantação da RMS no referido hospital mostrou-se positiva, proporcionando amparo e conforto aos pacientes. Estabelecer múltiplos cenários de prática integrada é fundamental para a formação de profissionais especializados voltados ao setor público de saúde.

The Multiprofessional Residency Programs in Health (RMS in Portuguese) are regulated by the Ministries of Education and Health, and aimed at promoting assistance to the population and at training professionals of excellence to work, according to local health needs. The objective of this study was to analyze the insertion of the RMS at the university hospital of the Federal University of Mato Grosso do Sul. Under a prospective design, we analyzed the assistance provided by residents of physical therapy, nursing, dentistry, pharmacology and nutrition in the first seven months of implementation of the program. Data were collected from the medical record books and analyzed according to: profile and the number of assisted patients; amount of assistance provided by specialty; and outcome of cases. In the statistical analysis, we applied the chi-square and Mann-Whitney U tests, with 5% significance. Forty-six patients were treated by the team during the period, amounting to 1,979 assistances (an average of 43.02 assistances/patient). There was no difference between the amount of assistance provided by each area (p = 0.89). The implementation of RMS in that hospital was positive and provided support and comfort to patients. Establishing multiple scenarios of integrated practice is crucial to the training of specialized professionals aimed at the public health sector.

Experiencia del Ministerio de Salud en la implementación de las brigadas de médicos especialistas en las zonas de Aseguramiento Universal en Perú, 2009-2010 / Implementation of medical specialists brigades in the areas of Universal Health coverage: the peruvian Ministry of Health experience, 2009-2010

Perú tiene alto grado de inequidad reflejado en la distribución de morbilidad-mortalidad, concordante con la inaccesibilidad a atención de salud y déficit de recursos humanos, especialmente en zonas alejadas de la capital. El Ministerio de Salud de Perú, reconociendo el derecho de toda la población a salud de calidad, inició el Aseguramiento Universal en Salud (AUS), en este marco, incrementó el acceso a atención especializada en zonas pilotos del AUS, mediante brigadas de médicos especialistas. Este artículo ofrece una aproximación a esta estrategia; presenta los procesos de gestión e implementación, hace un análisis cuantitativo con indicadores de producción/eficiencia, y brinda una mirada cualitativa desde la perspectiva de los brigadistas. Sus principales conclusiones inciden en la falta de gestión eficaz y eficiente, traducida en ausencia de: metas de producción, planes de trabajo, trabajo coparticipativo con actores locales, monitoreo y supervisión efectivos, reincidente escasez de recursos humanos y tecnológicos, y elevados costos.

Peru has a high degree of inequity reflected in the distribution of morbidity and mortality, consistent with the inaccessibility to health care and human resource gap, especially in remote areas of the capital. The Peruvian Ministry of Health, recognizing the right of all people to quality health care, initiated the Universal Health Insurance (AUS), and in this context, increased access to specialized care in pilot AUS areas by brigades of specialist doctors. This article offers an approach to this strategy presents the management and implementation processes, a quantitative analysis with indicators of output / efficiency, and provides a qualitative look from the perspective of the members of the brigades. Its main findings reflect the lack of effective and efficient management, translated in the absence of: production goals, work plans, working partnerships with local stakeholders, monitoring and effective supervision, recurrent shortages of human and technological resources, and high costs.

História da Saúde na Bahia: Instituições e patrimônio arquitetônico (1808-1958)

Compreender a relação entre ciência médica e arquitetura, em perspectiva histórica, é um dos objetivos centrais do livro – uma verdadeira cartografia que revela como a Bahia construiu sua rede de assistência à saúde, materializada em instituições públicas, privadas, de caridade, filantrópicas, de investigação e de difusão científica. O caso da Santa Casa da Misericórdia da Bahia, o papel das instituições de saúde na consolidação da arquitetura moderna no estado, as transformações pelas quais passou a assistência à saúde em Salvador ao longo da Primeira República e o atendimento às crianças são temas em destaque. A obra apresenta o estudo e a identificação do patrimônio arquitetônico e documental de hospitais e outros institutos de assistência médica e pesquisa científica. Acompanha o livro um CD-ROM com dados de 37 dessas instituições ainda existentes na capital baiana. Pertence à coleção História & Patrimônio da Saúde

Perspectivas actuales en la asistencia sanitaria al adulto mayor / Current perspectives on health care for the older adult

Standing up to the challenges of aging requires a coordinated strategy, disseminating a geriatric focus among all the specialty areas that serve the older adult. This article addresses the reasons that justify this focus and covers the objectives, goals, and methods currently being proposed to develop the approach. Preventive and curative actions, but most importantly, the overall care of seniors and improvements to their functional status, are priorities for securing a better quality of life in old age.

Analysis of Policies in Activating the Infectious Disease Specialist Network (IDSN) for Bioterrorism Events / 예방의학회지

Bioterrorism events have worldwide impacts, not only in terms of security and public health policy, but also in other related sectors. Many countries, including Korea, have set up new administrative and operational structures and adapted their preparedness and response plans in order to deal with new kinds of threats. Korea has dual surveillance systems for the early detection of bioterrorism. The first is syndromic surveillance that typically monitors non-specific clinical information that may indicate possible bioterrorismassociated diseases before specific diagnoses are made. The other is infectious disease specialist network that diagnoses and responds to specific illnesses caused by intentional release of biologic agents. Infectious disease physicians, clinical microbiologists, and infection control professionals play critical and complementary roles in these networks. Infectious disease specialists should develop practical and realistic response plans for their institutions in partnership with local and state health departments, in preparation for a real or suspected bioterrorism attack.

Unidades de Pediatría Ambiental / Environmental Pediatric Units

A Pediatric Environmental Unit is a structure with defined roles, situated preferentially in a established Health Center specialized in children diseases related to the environment. These centers give advice, information and management of clinical cases, train professionals, instruct the general public and deliver reports to relevant authorities. The personnel of these centers is specifically trained on environmental issues, including pediatricians, toxicologists, nurses, family physicians, obstetricians, public health experts, occupational physicians, social workers, engineers and professionals of other relevant areas. This type of multidisciplinary team reflexes the complexity of environmental health and the unique vulnerability of children to the environment. These centers are able to recognize, determinate and treat child diseases related to the environment and train healthcare providers on the subject. They were created in the USA by the ATSDR (Agency for Toxic Substances and Disease Registry) from the Department of Health and Human Services of the U.S. Environmental Protection Agency (USEPA).

Se considera que una Unidad de Pediatría Ambiental es una estructura con roles claramente definidos, situada preferentemente en un centro de salud, especializada en afecciones pediátricas, relacionadas al ambiente. Estos centros pueden proporcionar asesoramiento, información y tratamiento, promover la investigación, entrenar a profesionales, educar al público e informar a las autoridades responsables. Su personal, especialmente entrenado en problemas ambientales, incluye: pediatras, toxicólogos, enfermeras y enfermeros, médicos de familia, obstetras, expertos de la salud pública, médicos ocupacionales, trabajadores sociales, ingenieros y consejeros de otras áreas relevantes. Solamente este tipo de equipo multidisci-plinario, ayuda a capturar la complejidad de la salud ambiental y la vulnerabilidad única de los niños/ adolescentes frente a los peligros de sus entornos. Estos centros, capaces de reconocer, determinar y manejar enfermedades infantiles relacionadas al ambiente y de proporcionar educación y entrenamiento, fueron creados en los EE.UU. por la Agencia para las Sustancias Tóxicas y el Registro de las enfermedades (ATSDR) del Departamento de los Servicios Humanos y de Salud de la Agencia de Protección del Medio Ambiente de los EE.UU. (USEPA).

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