El análisis del discurso como perspectiva metodológica para investigadores de salud / Discourse analysis: a methodological perspective for health researchers

El discurso se considera algo más que el lenguaje oral o escrito, se refiere a cómo se usa el lenguaje en la realidad de los contextos sociales. Esta revisión narrativa del Análisis del Discurso (AD), que emerge de las ciencias sociales aborda el lenguaje como un evento comunicativo dentro de un contexto social en donde se sitúan las interacciones humanas. De este modo, el AD explora las relaciones entre los textos y la realidad haciendo visibles los discursos, sus puntos de origen, como ellos fluyen, y que los acompañan. Hay varias perspectivas teóricas que proveen de diferentes tipos de análisis. El AD, así, es un fértil campo metodológico para investigadores de las ciencias de la salud dado por las prácticas discursivas específicas en las cuales el lenguaje se manifiesta dentro de los contextos institucionales de salud en la sociedad.

Discourse is something else that language in oral or text forms, it's how language is used in social contexts. This narrative review of Discourse Analysis (DA), which comes from social sciences disciplines to approach language as a communicative event embedded in social context where human interactions occurred. In this sense, DA explores the relationships between texts and reality making visible the discourses, their start point, their flow and everything else that goes with them. There is a variety of theoretical perspectives which providing different approaches methods for analysis. Thus, DA is a rich methodological field for health sciences researchers because of the variety of discourses practices where language is emerged as part of the institutional health contexts in society.

Análisis de las derivaciones desde Atención Primaria a Salud Mental / Clinical and welfare anlysis of Mental Health referrals from Primary Care

Objetivo: Análisis clínico y asistencial de los pacientesderivados desde Atención Primaria (AP) a SaludMental (SM).Material y método: Se estudian los casos nuevos ynuevos episodios derivados consecutivamente duranteun periodo de 3 años (n = 1202). Se recogen variablessociodemográficas, clínicas y asistenciales.Resultados: En adultos predomina el sexo femenino(57,6%) y los diagnósticos más frecuentes son trastornosadaptativos (25,6%), ansiosos (20,8%) y afectivos(17,6%). Un 10,7% no posee patología psiquiátrica. Enpoblación infanto-juvenil, predomina el sexo masculino(57,4%) y el diagnóstico más frecuente es el código Zde la CIE-10 (48,7%). En general, sólo el 47,2% de lasderivaciones son ordinarias. La demora para la primeraconsulta ordinaria es de 49,09 (± 31,94) días y de 14,16(± 18,65) días para la preferente. El 13,6% de la muestrareinicia tratamiento en SM.Conclusiones: Existe una elevada proporción dederivaciones preferentes, cuando la mayoría de las patologíasson menores, y un porcentaje no desdeñable noposee diagnóstico psiquiátrico

Objective: Clinical and welfare analysis of thepatients referred from Primary Care (PC) to a MentalHealth Centre (MHC).Method: Study of new cases and new episodes consecutivelyreferred during a 3-years period (n=1202).Sociodemographic, clinical and welfare variables werecollected.Results: In adults, it predominates female sex(57.6%) and the most frequent diagnoses are adaptive(25.6%), anxiety (20.8%) and affective (17.6%) disorders.A 10,7% of the adult sample do not have apsychiatric disorder. In childhood, it predominates malesex (57.4%) and the most frequent diagnoses is Z CIE-10 code. In general, only a 47.2% of the referrals areordinary. The delay for the first ordinary consultation is49.09 (± 31.94) days and 14.16 (± 18.65) days for thehigh-priority one. The 13.6% of the total sample havereturned to the MHC.Conclusions: A high proportion of high-priorityreferrals exists, when it predominates minor pathology,and a non despicable percentage does not have apsychiatric disorder

Orogenital transmission of Neisseria meningitidis serogroup C confirmed by genotyping techniques.

Urethritis caused by Neisseria meningitidis in heterosexual patients is presumed to occur via orogenital contact, but confirmation has not been possible in most cases. Presented here is a case of urethritis caused by N. meningitidis, serogroup C, and the isolation of the same microorganism from the nasopharynx and endocervix of the patient's sexual partner. The similarity of the urethral and nasopharyngeal isolates' electrophoretic patterns, obtained using pulsed-field gel electrophoresis, proves the infection was transmitted via orogenital contact.

[Current use of penicillin in community-acquired pneumococcal pneumonias]. / Actualidad de la penicilina en las neumonías neumocócicas extrahospitalarias.

BACKGROUND: A retrospective study was performed to know the clinical and microbiologic aspects of community-acquired pneumococcal pneumonia in adult patients admitted to a general hospital from 1990-1992. METHODS AND RESULTS: The medical records of 55 patients, aged 20-86 years (man age: 58 year) were reviewed. Streptococcus pneumoniae was isolated from blood in 45 cases (81.8%), transparietal lung puncture in 5 (9.1%), pleural fluid 3 (5.5%) and protected specimen brushing (> 1,000 UFC/ml) in 2 (3.6%) Most isolated (80%) were sensitive to penicillin (CIM < 0.1 microgram/ml); intermediate (CIM > or = 0.1 microgram/ml) 9 (16.4%) and resistant (> 1 microgram/ml) 2 (3.6%). Underlying diseases were present in 39 (70.9%) cases. All patients received empiric treatment with one or more antibiotics effective against Streptococcus pneumoniae. Only in 2 of the 9 cases treated with erythromycin the microorganism was resistant to this drug. Eleven patients died (20%), 5 died before to the fifth day of admission. Mortality was influenced by involvement of 2 or more lobes and immunosuppression (p < 0.05). CONCLUSIONS: This study suggests that 80% of the community-acquired pneumococcal pneumonia in a population with a high prevalence rate of disease requiring hospital admission are very sensitive in vitro to penicillin in contrast with its seldom clinical use in the authors environment. No microorganism presented with CIM above 2 micrograms/ml. Mortality was not due to inadequate therapy but rather to the severity of the underlying disease.

[Disease caused by Mycobacterium kansasii in patients with HIV infection]. / Enfermedad por Mycobacterium kansasii en pacientes con infección por VIH.

BACKGROUND: To describe the clinical features and response to therapy in Mycobacterium kansasii disease among HIV infected patients, an increasing problem in our setting. METHODS: A retrospective survey of all charts from patients with HIV infection with Mycobacterium kansasii infection recorded between April 1985 and December 1991. RESULTS: A total of 13 patients were identified. All of them had clinically significant respiratory tract samples with a definite M. kansasii isolation. Only three had disseminated disease. In all but two cases, CD4 cell count at diagnosis time was lower than 200/mm3. Chest X-ray films showed interstitial pattern (8 cases) or alveolar condensation (3 cases) and lung cavities were seen in 4 patients. All patients with lung disease and one with disseminated disease responded well to anti-tuberculous therapy. CONCLUSION: Mycobacterium kansasii produces disease in advances stages of HIV-induced immunosuppression. The most common primary location is pulmonary, but disseminated forms can also be seen. The infection can be controlled with standard anti-tuberculous therapy.

[Tuberculosis and AIDS. Study of 54 patients]. / Tuberculosis y SIDA. Estudio de 54 pacientes.

We present 54 cases of tuberculosis (TBC) and Acquired Immunodeficiency Syndrome (AIDS) that were observed during five years and represent 37% of our AIDS patients. TBC was diagnosed before AIDS in 7, after AIDS in 5 and simultaneously in 42. Eighty-seven per cent were intravenous drug users (IVDU) and no hemophilia cases were recorded. The tuberculin skin test (PPD) showed a reaction greater than 5 mm in 43%. Prophylaxis has not been used in any patient. TBC was localized in 39% and disseminated in 61%; the lung was the main organ involved. Diagnosis was established by culture in 42 cases and by pathology exam in 12 cases. Eighteen patients had multiple isolations, while 36 had a single one. Co-occurrence with other opportunistic infections was observed in 27 cases. Death related to TBC was seen in 3 patients, and there were no differences in survival between disseminated and localized presentations. Compliance of treatment was very low and follow-up was not achieved in large number of patients.

[Evaluation of bronchoalveolar lavage in the microbiological diagnosis of pneumonia in patients at risk]. / Valoración del lavado broncoalveolar en el diagnóstico microbiológico de neumonías en pacientes de riesgo.

Bronchoalveolar washout was performed in 130 patients with pneumonia during a period of 28 months. Microbiological investigation involved common bacteria, Legionella, fungi, viruses (Cytomegalovirus, herpes, RSV), Mycobacterium, and Pneumocystis carinii. Infection HIV was present in 75% of patients. The remaining patients had malignant diseases or severe pneumonia. The overall sensitivity of the technique was 65.4% and the positive predictive value was 92%. The technique was less sensitive in cases of bacterial pneumonia (sensitivity = 34.4%). This was attributed to the fact that 82.8% of these cases received antibiotic therapy. Pneumocystis carinii and Mycobacterium tuberculosis were the most common agents (44.8% and 34.5%, respectively). In seven instances the clinical picture was related to cytomegalovirus, although this diagnosis can not be easily done.

[Microbiological diagnosis of patients undergoing ambulatory peritoneal dialysis]. / Diagnóstico microbiológico de pacientes sometidos a diálisis peritoneal ambulatoria.

A prospective study was performed to evaluate two culture methods for the diagnosis of bacterial peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD): a total bag volume method, and culture of 50 ml with prior saline wash. Peritonitis was present in 45 patients (47.4%). The wash method was more sensitive (80%) than bag culture method (62.2%), specially in patients with antimicrobial drugs therapy (p < 0.05). Therefore, specificity was greater for the bag procedure (78% vs. 62%).

Analysis by coagglutination of the distribution of a 24,000-dalton surface protein in Yersinia isolates.

The presence of a 24,000-dalton surface protein in 215 isolates of Yersinia enterocolitica and related species was examined. By coagglutination with the specific antiserum, a 100% correlation with the pathogenic biogroups was found. Thus, this method is useful for the rapid screening of potential pathogenic Y. enterocolitica isolates.

Characterization of a Yersinia enterocolitica antigen common to enterocolitis-associated serotypes.

Yersinia enterocolitica synthesized an exocellular antigen common to the serotypes associated with enterocolitis but absent from other serotypes or from other Yersinia species. Both virulent Ca2+-dependent and avirulent Ca2+-independent isogenic pairs derived from the enterocolitis-associated serotypes synthesized the common antigen. Requirements for the synthesis of this common antigen were (i) the presence of metabolizable sugars and (ii) growth on a solid medium at 37 degrees C. The antigen was identified as a 24,000-dalton protein loosely associated with the cell surface but absent from either the cell envelope or the cytoplasmic fraction.