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BACKGROUND: Non-communicable Diseases (NCDs) are the leading cause of global mortality and disability with a rising burden in low- and middle-income countries. Their multifactorial aetiology, and their requirement of long-term care, implies the need for comprehensive approaches. From 2009, the Ministry of Health (MoH) in El Salvador has developed a national public health system based on comprehensive primary health care. This study aims to describe the different stakeholders' perceptions about the management of NCDs along the pathways of care in this health system. METHODS: During three fieldwork periods in 2018, three complementary qualitative data collection methods were deployed and conducted in settings with high prevalence of NCDs within El Salvador. First, illness narrative methodology was used to document the life histories of people living with a chronic disease and being treated in second and third level health facilities. Second, through social mapping, support resources that NCD patients used throughout the process of their illness within the same settings were analysed. Third, semi-structured interviews were conducted in the same locations, with both chronic patients and health personnel working at different levels of the primary health care setting. Participants were recruited through purposive and snowball sampling, and a deductive approach was implemented for coding during the analysis phase. After grouping codes into potential themes, a thematic framework was developed using a reflexive approach and following triangulation of the data. RESULTS: This innovative approach of combining three well-defined qualitative methods identified key implications for the implementation of a comprehensive approach to NCD management in resource-poor settings. The following elements are identified: 1) social risk factors and barriers to care; 2) patient pathways to NCD care; 3) available resources identified through social connections mapping; 4) trust in social connections; and 5) community health promotion and NCD prevention management. CONCLUSIONS: The Salvadoran public health system has been able to strengthen its comprehensive approach to NCDs, combining a clinical approach - including long-term follow-up - with a preventive community-based strategy. The structural collaboration between the health system and the (self-) organised community has been essential for identifying failings, discuss tensions and work out adapted solutions.
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Atenção à Saúde , Gerenciamento Clínico , Corpo Clínico/psicologia , Doenças não Transmissíveis/terapia , El Salvador , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Assistência Médica , Atenção Primária à Saúde , Pesquisa QualitativaAssuntos
Reforma dos Serviços de Saúde , Papel (figurativo) , Justiça Social , El Salvador , HumanosRESUMO
En la actualidad la investigación y el desarrollo de nuevos productos se orientan a la producción de alimentos saludables destinados a la prevención de enfermedades crónicas no transmisibles El objetivo del trabajo fue formular y caracterizar sensorialmente dos muestras de bizcochos artesanales saludables. Se elaboraron con una mezcla de harina integral, salvado de avena 70:30, levadura y aceite de girasol alto oleico como ingredientes básicos, a una muestra (BS) se le incorporó mezcla de semillas (chía, sésamo y lino) y a la otra (BH) albahaca deshidratada. Se estimó la composición química comparándose con la de los bizcochos convencionales. La aceptabilidad global se evaluó en 128 consumidores, con una escala hedónica de 9 puntos y la preferencia con la prueba de comparación pareada simple. Se midió la calidad sensorial con un panel de 8 evaluadores entrenados utilizando la prueba de puntaje compuesto, estableciéndose para cada atributo un valor máximo y además se empleó la metodología de pregunta CATA para ampliar la descripción de las características sensoriales. Los resultados de aceptabilidad se analizaron estadísticamente a través de t de Student y los de CATA con la Q de Cochran, empleando el programa Infostat v. 2010. Se obtuvo una reducción del valor calórico de 9 y 11%; y de 36 y 39% en grasas totales, en las muestras BH y BS respectivamente en relación al convencional. Además, un aumento considerable del contenido de fibra alimentaria y elevada reducción del porcentaje de sodio. No se encontraron diferencias estadísticamente significativas (p<0,05) entre los promedios de aceptabilidad, ubicándose en la categoría ôMe gusta levementeõ y no se estableció preferencia significativa entre las muestras. Las características sensoriales: fracturable, aromático, olor y sabor a hierbas presentaron diferencias estadísticas entre ambas muestras...
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Humanos , Alimentos Formulados , Ocimum basilicum , Sementes , Sensação , Alimentos IntegraisRESUMO
Resumen La gerencia de este siglo debe estar plenamente identificada con la administración para planear, organizar, decidir y obtener resultados definidos, evaluados y alcanzados a través de las personas. Para poder gerenciar el cuidado se debe saber administrar. El objetivo de enfermería es cuidar; el objetivo de la gerencia es la conducción de la producción de bienes o servicios en las organizaciones. La gerencia del cuidado implica: motivación, creatividad, responsabilidad y ética por parte del cuidador y de quien cuida, claridad de actitud frente al ser y al qué hacer por parte del cuidador. Se puede concluir que la gerencia (administración), el cuidado (producto de calidad), el servicio (valor intangible, querer servir) son un trinomio que deben ir de la mano de manera integrada para el logro de los objetivos propuestos por la organización de salud y de enfermería.
Abstract The management of this century must be fully identified with management to plan, organize, decide and get defined, evaluated and reached through those results. to manage care, you should know how to manage. The goal of nursing is to care, the objective of management is driving the production of goods or services in organizations. care management involves: Motivation, creativity, responsibility and ethics by the caregiver and the caregiver, clarity of attitude to be and what to do by the caregiver. it can be concluded that management (administration), care (product quality), service (intangible value, want to serve), is a trio that must go hand in an integrated manner to achieve the goals set by the organization health and nursing.
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Food allergy poses a major problem during childhood. Component-resolved diagnosis detects allergy to proteins isolated in food. This descriptive study analyzes the use of customized and standardized recommendations in a sample made up of 22 children aged 2 to 16 years old with plant food allergy and assesses sensitivity to four plant panallergens. According to component-resolved diagnosis results, therapy was personalized, guidelines on what foods or components to avoid were provided, and co-factors that may favor food allergic reactions were explained. No new reactions were referred by 20/22 cases. Oral allergy syndrome developed in 2/22 patients with allergy to profilin because they did not follow the recommendations. Component-resolved diagnosis was useful for the diagnosis and management of these children. Standardized recommendations, based on each patient's component-resolved diagnosis, prevented severe food allergic reactions.
Introducción. En la práctica clínica, hemos observado una concentración elevada de interleucina 6 (IL-6) en los casos de septicemia por gramnegativos. Objetivo. Investigar la relación entre las concentraciones de IL-6 y proteína C-reactiva (PCR) y la determinación temprana de la septicemia neonatal por gramnegativos o grampositivos. Población y métodos. Se compararon el recuento de leucocitos y las concentraciones de IL-6 y PCR entre los distintos grupos. Resultados. Los grupos de infección por gramnegativos, infección por grampositivos y micosis estaban formados por 73, 82 y 15 pacientes, respectivamente. Los valores de corte ideales de IL-6 entre el grupo de infección por gramnegativos y el de infección por grampositivos y el de micosis eran 202 pg/ml y 57 pg/ml, respectivamente. En el grupo de micosis se observaron concentraciones de PCR más altas que en los grupos de infección por gramnegativos e infección por grampositivos. Conclusiones. Hasta donde sabemos, este es el estudio de mayor envergadura notificado con el objetivo de determinar los valores de corte de IL-6 para diferenciar la etiología de la septicemia neonatal. Los microorganismos gramnegativos provocaron una producción de IL-6 diez veces mayor. La evaluación de IL-6 y PCR resulta útil para diagnosticar, y asimismo diferenciar, la etiología de la septicemia neonatal.
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Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/terapia , Plantas/efeitos adversos , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Cooperação do Paciente , Medicina de PrecisãoRESUMO
Introducción: la utilización del software educativo en Medicina está muy difundida. El proyecto Galenomedia se crea por el Ministerio de Salud Pública con el objetivo de confeccionar hiperentornos de aprendizaje curriculares para esta carrera, que sean generalizados a todas las facultades del país. La asimilación de la Informática Médica II es compleja para los estudiantes, esta asignatura los prepara para la labor investigativa a la que se tendrán que enfrentar, por lo que contar con medios de enseñanza que hagan más asequible el contenido es muy importante. Objetivo: elaborar un hiperentorno de aprendizaje para el tema Muestreo y Estimación de la asignatura Informática Medica II. Metodología: primeramente se realizó una modelación previa del proyecto, y trabajo de mesa con los especialistas. Se determinó el guión. Para la confección de la aplicación se utilizó el soporte SADHEA, herramienta interactiva cubana para la creación de software libre disponible en la Web. Resultados: el programa elaborado está compuesto por temas, contenidos, ejercicios, juegos y un glosario de términos para la enseñanza aprendizaje de Informática Médica II. Permite acceder al conocimiento y realizar ejercicios de múltiples tipologías que disponen de retroalimentación y brinda la posibilidad de consultar otras referencias bibliográficas. Se aplicó una encuesta a tres grupos de estudiantes que valoró como bueno el hiperentorno. Conclusiones: el hiperentorno de aprendizaje para el tema Muestreo y Estimación de la asignatura Informática Médica II elaborado contribuye al desarrollo de una cultura en la gestión del conocimiento, propiciando el aprendizaje del tema por los estudiantes de medicina(AU)
Introduction: the use of educational software in Medicine is widespread. The project Galenomedia was created by the Ministry of Public Health with the aim of building learning hyperenvironment for this career, to be generalized to all colleges of the country. The assimilation of Medical Informatics II is complex for students; this course prepares them for doing the research they will face. Objective: to develop a learning hyperenvironment on the topic Sampling and Estimation, from the subject Medical Informatics II. Methodology: modeling was performed prior to the project. We determined the script. For the preparation of the application was used SADHEA support, a Cuban free interactive tool to create software (available on the web). Results: the program includes contents, exercises, games and a glossary of terms. It provides access to knowledge and exercise of multiple type feedback technologies available and offers the possibility to consult other references. A survey was applied to three groups of students who rated the hyperenvironment as good. Conclusions: the learning hyperenvironment developed contributes to the development of a culture in knowledge management, fostering the learning of the subject by students of medicine(AU)
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Humanos , Masculino , Feminino , Adulto Jovem , Faculdades de Medicina , Aplicações da Informática Médica , Multimídia , Hipermídia , Design de SoftwareRESUMO
INTRODUCTION: An appropriate localization of ictal onset zone in refractory temporal lobe epilepsy favors an adequate outcome associated with surgical treatment. When video-electroencephalogram (video-EEG) and magnetic resonance imaging do not provide accurate data to locate ictal onset zone, the use of subdural or deep intracranial electrodes is indicated. Hippocampal electrode placement could generate functional changes in an unaffected hippocampus. AIM: To describe mnesic changes in patients admitted for epilepsy surgery, with previous bilateral hippocampal implantation using depth electrodes. PATIENTS AND METHODS: We identified eight patients undergoing video-EEG using bilateral hippocampal electrodes. Verbal and nonverbal mnesic performance was evaluated before/after the procedure. The following aspects were considered for the analysis: memory lateralization according to intracarotid amobarbital test (Wada test), invasive ictal onset zone, side of resection and pattern of electrocorticographic dissemination. RESULTS: In patients with memory dominance, contralateral to the ictal onset zone, there was an improvement in verbal and nonverbal memory, suggesting that invasive recordings did not impair mnesic skills of the unaffected hippocampus. In patients with bilateral representation of memory, ipsilateral mnesic impairment was associated with the resection. Contralateral improvement in memory was seen when the right side was resected, as opposed to no changes with resections made on the left side, indicating that electrode implantation of unaffected hippocampus did not generate a functional decline. CONCLUSIONS: Based on the preservation of verbal and nonverbal memory after depth electrode placement, invasive recordings of the hippocampus seem to be safe.
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Eletrodos Implantados , Epilepsia do Lobo Temporal/cirurgia , Hipocampo/cirurgia , Transtornos da Memória/prevenção & controle , Rememoração Mental/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Aprendizagem Verbal/fisiologia , Adulto , Idoso , Amobarbital , Lobectomia Temporal Anterior , Artéria Carótida Interna , Dominância Cerebral , Eletrodos Implantados/efeitos adversos , Eletroencefalografia , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/psicologia , Feminino , Lateralidade Funcional , Hipocampo/fisiopatologia , Humanos , Injeções Intra-Arteriais , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/fisiopatologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/psicologia , Adulto JovemRESUMO
BACKGROUND: The management of operable locally advanced N2 non-small cell lung cancer (NSCLC) is a controversial topic. Concurrent chemoradiation (CT-RT) is considered the standard of care for inoperable or unresectable patients, but the role of trimodality treatment remains controversial. We present our institution's experience with the management of stage III (N2) NSCLC patients, analyzing whether the addition of surgery improves survival when compared with definitive CT-RT alone. METHODS: From 1996 to 2006, 72 N2 NSCLC patients were treated. Thirty-four patients received cisplatin-based induction chemotherapy, followed by paclitaxel-cisplatin CT-RT, and 38 patients underwent surgery preceded by induction and/or followed by adjuvant therapy. Survival curves were estimated by Kaplan-Meier analysis, and the differences were assessed with the log-rank test. RESULTS: Most of the patients (87 %) were men. The median age was 59 years. A statistically significant association between T3-T4c and definitive CT-RT as well as between T1-T2c and surgery was noted (p < 0.0001). After a median follow-up period of 35 months, the median overall survival (OS) was 42 months for the surgery group versus 41 months for the CT-RT patients (p = 0.590). The median progression-free survival (PFS) was 14 months after surgery and 25 months after CT-RT (p = 0.933). Responders to radical CT-RT had a better OS than non-responders (43 vs. 17 months, respectively, p = 0.011). No significant differences were found in the OS or PFS between the pN0 [14 (37.8 %) patients] and non-pN0 patients at thoracotomy. Three treatment-related deaths (7.8 %) were observed in the surgical cohort and none in the CT-RT group. CONCLUSIONS: The addition of surgery did not render a median OS or PFS benefit when compared with CT-RT alone in our series of stage III-N2 NSCLC patients, in accordance with previously published data. However, responses to CT-RT had a greater impact in terms of OS and PFS. Although the patients selected for management including surgery showed a favorable T clinical staging in comparison to patients exclusively treated with definitive CT-RT, similar survival outcomes were found.
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Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Quimioterapia Adjuvante , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Introducción: A pesar de la alta frecuencia del síndrome de apnea - hipopnea obstructiva del sueño y de sus graves complicaciones perioperatorias, el riesgo de estos pacientes se subestima. Caso clínico: Hombre de 54 años, propuesto para herniorrafia incisional, con antecedentes de SHAOS y tratamiento con CPAP nasal; 6 puntos en la Escala de somnolencia de Epworth, obeso, fumador, consumidor frecuente de bebidas alcohólicas y dislipidémico; elementos clínicos de posible vía de aire difícil. Escala de evaluación de riesgo perioperatorio en pacientes con SAHOS 8 puntos (riesgo elevado). Se administró anestesia general balanceada (fentanilo, halotano, atracurio) y analgesia multimodal: morfina y bupivacaína por catéter epidural, nolotil y diclofenaco intravenosos. Tiempo quirúrcico 150 min. Se extubó y se colocó CPAP nasal en el postoperatorio inmediato. Se transfirió a Cuidados Intensivos por 24 hrs. La analgesia posoperatoria resultó satisfactoria y no se presentaron complicaciones; alta hospitalaria al sexto día de la cirugía. Desarrollo: Al elegir el método anestésico son varios los factores que influyen en la decisión y pocas las evidencias que fundamentan la superioridad de uno respecto a los demás. La experiencia del anestesiólogo, el tipo y localización de la intervención quirúrgica, la gravedad del SAHOS y la disponibilidad de recursos para atender a este tipo de pacientes durante todo el perioperatorio son claves para la elección. La consulta de los protocolos de actuación en pacientes con SHAOS permitió prever sus riesgos potenciales para la cirugía y seleccionar el plan anestésico, que adaptado a nuestras condiciones evitó posibles complicaciones.
Introduction: Despite the high frequency of the obstructive sleep apnea-hypopnea syndrome and of its perioperative severe complications, the risk of these patients is underestimated. Clinical case: Man aged 54, candidate to incisional herniorrhaphy with a history of sleep obstructive apnea and treatment with nasal continuous positive airway pressure six points in Epworth’s somnolence scale, obese, smoker, frequent consumer of alcohol and dyslipemic; clinical elements of possible difficult airway. The assessment scale of perioperative risk in SAHOS patients was of 8 points (high risk). Balanced general anesthesia was administered (fentanyl, halothane, atracurio) and multimodal analgesia” morphine and bupivacaine by epidural catheter, i.v. nolotil and diclofenac. Surgical time 150 min. Patient was extubated and placed in nasal CPAP during the immediate postoperative time. He was transferred to Intensive Care Unit for 24 hrs. Postoperative analgesia was satisfactory without complications; the hospital discharge was at sixth day postoperative. Development: Selecting the anesthetic method are some factors influencing in decision and not much evidences supporting the superiority of one regarding the others. The experience of the anesthesiologist, the type and location of surgical intervention, severity of SAHOS and availability of resources to care this type of patient over the perioperative time are key for choice. Consultation of performance protocols in patients presenting with SHAOS allowed to prevent its potential risks for surgery and to select the anesthetic plan, which adapted to our conditions avoided possible complications.