Balint 2.0: A virtual Balint group for doctors around the world.

Objective Balint groups have shown promise in addressing clinician-patient relationships, clinician burnout, referral practices, and psychological mindedness. However, their traditional format of in-person sessions limits their ability to meet the needs of clinicians practicing in locations without trained Balint leaders. We report on a pilot of an international, internet-based Balint group in collaboration between the World Organization of Family Doctors regional Young Doctors Movements and the International Balint Federation. Method Balint 2.0 arose through interest of the Young Doctors Movements leadership, who approached the International Balint Federation for assistance. Initial discussions and some trialing of videoconference platforms led to monthly group meetings over the internet. Surveys evaluated each individual session as well as quarterly progress of the group. Survey items were borrowed from existing surveys in use by the American and German Balint Societies. Results Session surveys demonstrated the effectiveness of the videoconferencing platform for convening a Balint group, with a majority of participants expressing agreement with survey items evaluating each session. Quarterly survey responses were more positive reflecting agreement with outcomes seen from in-person Balint groups. Conclusions The Balint 2.0 pilot has demonstrated the ability of a Balint group to successfully convene over the internet and reach the common outcomes of a Balint group meeting in-person. The Young Doctors Movements and International Balint Federation plan to expand this work based on this successful pilot. We hope that others may also be able to build on this success with the result that Balint groups are available to clinicians in areas where they might not otherwise be accessible.

Healthcare hashtag index development: Identifying global impact in social media.

PURPOSE: Create an index of global reach for healthcare hashtags and tweeters therein, filterable by topic of interest. MATERIALS AND METHODS: For this proof-of-concept study we focused on the field of Primary Care and Family Medicine. Six hashtags were selected based on their importance, from the ones included in the 'Healthcare Hashtag Project'. Hashtag Global Reach (HGR) was calculated using the additive aggregation of five weighted, normalized indicator variables: number of impressions, tweets, tweeters, user locations, and user languages. Data were obtained for the last quarter of 2014 and first quarter of 2015 using Symplur Signals. Topic-specific HGR were calculated for the top 10 terms and for sets of quotes mapped after a thematic analysis. Individual Global Reach, IGR, was calculated across hashtags as additive indexes of three indicators: replies, retweets and mentions. RESULTS: Using the HGR score we were able to rank six selected hashtags and observe their performance throughout the study period. We found that #PrimaryCare and #FMRevolution had the highest HGR score in both quarters; interestingly, #FMChangeMakers experienced a marked increase in its global visibility during the study period. "Health Policy" was the commonest theme, while "Care", "Family" and "Health" were the most common terms. DISCUSSION: This is the first study describing an altmetric hashtag index. Assuming analytical soundness, the Index might prove generalizable to other healthcare hashtags. If released as a real-time business intelligence tool with customizable settings, it could aid publishing and strategic decisions by netizens, organizations, and analysts. IGR could also serve to augment academic evaluation and professional development. CONCLUSION: Our study demonstrates the feasibility of using an index on the global reach of healthcare hashtags and tweeters.

Diagnostic delays in breast cancer among young women: An emphasis on healthcare providers.

Despite advances in breast cancer care, breast cancer in young women (BCYW) faces unique challenges, diagnostic delays, and limited awareness in many countries. Here, we discuss the challenges and consequences associated with the delayed diagnosis of BCYW. The consequences of delayed diagnosis in young women - which generally varies among developed, developing, or underdeveloped countries - are severe due to a faster breast tumor growth rate than tumors in older women, also contributing to advanced cancer stages and poorer outcomes. Though there are many underlying reasons for diagnostic delays due to age, the article delves explicitly deep into the diagnostic delay of BCYW, focusing on healthcare providers, potential contributing factors, its consequences, and the urgent need to start minimizing such incidences. The article suggests several strategies to address these issues, including increasing awareness, developing educational programs for healthcare providers to identify signs and symptoms in young women, developing clear diagnostic guidelines, and improving screening strategies.

Empowerment-based nutrition interventions on blood pressure: a randomized comparative effectiveness trial.

Introduction: Empowerment lifestyle programs are needed to reduce the risk of hypertension. Our study compared the effectiveness of two empowerment-based approaches toward blood pressure (BP) reduction: salt reduction-specific program vs. healthy lifestyle general program. Methods: Three hundred and eleven adults (median age of 44 years, IQR 34-54 years) were randomly assigned to a salt reduction (n = 147) or a healthy lifestyle program (n = 164). The outcome measures were urinary sodium (Na+) and potassium (K+) excretion, systolic (SBP) and diastolic (DBP) blood pressure, weight, and waist circumference. Results: There were no significant differences in primary and secondary outcomes between the two program groups. When comparing each program to baseline, the program focused on salt reduction was effective in lowering BP following a 12-week intervention with a mean change of -2.5 mm Hg in SBP (95% CI, -4.1 to -0.8) and - 2.7 mm Hg in DBP (95% CI, -3.8 to -1.5) in the intention-to-treat (ITT) analysis. In the complete-case (CC) analysis, the mean change was -2.1 mm Hg in SBP (95% CI, -3.7 to -0.5) and - 2.3 mm Hg in DBP (95% CI, -3.4 to -1.1). This effect increases in subjects with high-normal BP or hypertension [SBP - 7.9 mm Hg (95% CI, -12.5 to -3.3); DBP - 7.3 mm Hg (95% CI, -10.2 to -4.4)]. The healthy lifestyle group also exhibited BP improvements after 12 weeks; however, the changes were less pronounced compared to the salt reduction group and were observed only for DBP [mean change of -1.5 mm Hg (95% CI, -2.6 to -0.4) in ITT analysis and - 1.4 mm Hg (95% CI, -2.4 to -0.3) in CC analysis, relative to baseline]. Overall, improvements in Na+/K+ ratio, weight, and Mediterranean diet adherence resulted in clinically significant SBP decreases. Importantly, BP reduction is attributed to improved dietary quality, rather than being solely linked to changes in the Na+/K+ ratio. Conclusion: Salt-focused programs are effective public health tools mainly in managing individuals at high risk of hypertension. Nevertheless, in general, empowerment-based approaches are important strategies for lowering BP, by promoting health literacy that culminates in adherence to the Mediterranean diet and weight reduction.

Primary health care for 21st century: first results of the new financing model. / Atenção primária à saúde para o século XXI: primeiros resultados do novo modelo de financiamento.

Since 1994, Brazil has been offering Primary Health Care (PHC) services based on the Family Health Strategy. The ESF has achieved important results. During this period, the PHC financing model did not undergo major methodological changes. In this article, the results of the new financing model for PHC approved in a tripartite manner in 2019, Previne Brasil, are laid out, which is composed of (i) weighted capitation, (ii) incentives for specific and strategic actions and, (iii) payment for performance. These first results reveal the increase of more than 50 million people with qualified and unique registration, associated with the record number of more than 52 thousand FH / eAP teams financed by the Ministry of Health, with more than 35 thousand of which (67%) using electronic medical records . In addition, the registration of people and professionals of the Brazilian PHC, together with SISAB, is the largest set of demographic and clinical health data in the world. These advances favor the overcoming of difficulties to achieve greater access, longitudinality and coordination of care, qualifying the Brazilian PHC in search of better health outcomes.

O Brasil, desde 1994, oferta serviços de atenção primária à saúde (APS) a partir da Estratégia Saúde da Família (ESF). A ESF alcançou resultados importantes. Nesse período, o modelo de financiamento da APS não sofreu alterações metodológicas importantes. Neste artigo, descreve-se os resultados do novo modelo de financiamento para APS aprovado de forma tripartite em 2019, o "Previne Brasil", que é composto por (i) capitação ponderada, (ii) incentivos a ações específicas e estratégicas e (iii) pagamento por desempenho. Esses primeiros resultados revelam o incremento de mais de 50 milhões de pessoas com cadastro qualificado e único, associado ao número recorde de mais de 52 mil equipes de Saúde da Família/Equipe de Atenção Primária (EAP) financiadas pelo Ministério da Saúde, sendo mais de 35 mil (67%) com uso de prontuário eletrônico. Além disso, o cadastro das pessoas e dos profissionais da APS brasileira junto ao Sistema de Informação em Atenção Básica (SISAB) se configura como o maior conjunto de dados demográficos e clínicos de saúde do mundo. Esses avanços favorecem a superação das dificuldades para o alcance de maior acesso, longitudinalidade e coordenação do cuidado, qualificando a APS brasileira em busca de melhores resultados em saúde.

New funding for a new Brazilian Primary Health Care. / Novo financiamento para uma nova Atenção Primária à Saúde no Brasil.

This paper aims to present a debate on the new Brazilian Primary Health Care (PHC) funding policy. We consulted the national and international literature, and we involved municipal, state, and federal PHC managers to develop the payment method. The proposed final model is based on weighted capitation, payment-for-performance, and incentive for strategic actions. Capitation is weighted by the socioeconomic vulnerability, demographic aspects, and municipal adjustment, the payment-for-performance consists of an entire set of 21 indicators, and incentives for strategic actions were facilitated from the maintenance of some specific programs. The results of the simulations pointed to low registration (90 million Brazilians) for the currently estimated coverage (148,674,300 Brazilians). Moreover, they showed an immediate increase in financial resources for 4,200 Brazilian municipalities. We observed that the funding proposal brings Brazilian PHC into the 21st century, points to the strengthening of PHC attributes, and materializes the principles of universality and equity of the Unified Health System.

O objetivo desse artigo é apresentar um debate sobre a nova política de financiamento para Atenção Primária à Saúde (APS) no Brasil. Para desenvolvimento do método de pagamento foi realizado consulta da literatura nacional e internacional, além do envolvimento de gestores municipais, estaduais e federais da APS. O modelo final proposto é baseado em Capitação ponderada; Pagamento por desempenho; Incentivo para Ações Estratégicas. A capitação é ponderada por vulnerabilidade socioeconômica, aspectos demográficos e ajuste municipal, o pagamento por desempenho composto por um conjunto total de 21 indicadores e incentivos a ações estratégicas foi possível a partir da manutenção de alguns programas específicos. Os resultados das simulações apontaram para um baixo cadastro (90 milhões de brasileiros) para a cobertura estimada atual (148.674.300 milhões de brasileiros). Além disso, demonstraram um incremento imediato de recursos financeiros para 4.200 municípios brasileiros. Observa-se que a proposta do financiamento traz a APS brasileira para o século XXI, aponta para o fortalecimento dos atributos da APS e torna concreto os princípios de universalidade e equidade do Sistema Único de Saúde.

Effect of bisphosphonates on pain and quality of life in patients with bone metastases.

Bone is the most common organ for tumor metastasis, especially in patients with cancers of the breast or prostate. Bone metastases disrupt skeletal metabolism and result in considerable skeletal morbidity, including intractable, chronic bone pain, hypercalcemia of malignancy, pathologic fracture and spinal-cord compression. In addition to the chronic pain caused by bone metastases, skeletal-related events (SREs) such as pathologic fractures and spinal-cord compression can result in acute increases in pain. These effects can severely impair mobility and contribute to a general decrease in quality of life. Palliative options to treat bone metastases include radiotherapy, analgesics, surgery and bisphosphonates. These drugs bind to the surface of the bone and impair osteoclast-mediated bone resorption, and reduce the tumor-associated osteolysis that is initiated by the development of skeletal metastases. In addition to preventing SREs, bisphosphonates can palliate bone pain caused by a variety of solid tumors. This Review summarizes the clinical trial data of bisphosphonates for the prevention of SREs and the palliation of bone pain. Among these agents, nitrogen-containing bisphosphonates are recognized as the most effective, and zoledronic acid has demonstrated the broadest clinical utility.

Atenção primária à saúde para o século XXI: primeiros resultados do novo modelo de financiamento / Primary health care for 21st century: first results of the new financing model

Resumo O Brasil, desde 1994, oferta serviços de atenção primária à saúde (APS) a partir da Estratégia Saúde da Família (ESF). A ESF alcançou resultados importantes. Nesse período, o modelo de financiamento da APS não sofreu alterações metodológicas importantes. Neste artigo, descreve-se os resultados do novo modelo de financiamento para APS aprovado de forma tripartite em 2019, o "Previne Brasil", que é composto por (i) capitação ponderada, (ii) incentivos a ações específicas e estratégicas e (iii) pagamento por desempenho. Esses primeiros resultados revelam o incremento de mais de 50 milhões de pessoas com cadastro qualificado e único, associado ao número recorde de mais de 52 mil equipes de Saúde da Família/Equipe de Atenção Primária (EAP) financiadas pelo Ministério da Saúde, sendo mais de 35 mil (67%) com uso de prontuário eletrônico. Além disso, o cadastro das pessoas e dos profissionais da APS brasileira junto ao Sistema de Informação em Atenção Básica (SISAB) se configura como o maior conjunto de dados demográficos e clínicos de saúde do mundo. Esses avanços favorecem a superação das dificuldades para o alcance de maior acesso, longitudinalidade e coordenação do cuidado, qualificando a APS brasileira em busca de melhores resultados em saúde.

Abstract Since 1994, Brazil has been offering Primary Health Care (PHC) services based on the Family Health Strategy. The ESF has achieved important results. During this period, the PHC financing model did not undergo major methodological changes. In this article, the results of the new financing model for PHC approved in a tripartite manner in 2019, Previne Brasil, are laid out, which is composed of (i) weighted capitation, (ii) incentives for specific and strategic actions and, (iii) payment for performance. These first results reveal the increase of more than 50 million people with qualified and unique registration, associated with the record number of more than 52 thousand FH / eAP teams financed by the Ministry of Health, with more than 35 thousand of which (67%) using electronic medical records . In addition, the registration of people and professionals of the Brazilian PHC, together with SISAB, is the largest set of demographic and clinical health data in the world. These advances favor the overcoming of difficulties to achieve greater access, longitudinality and coordination of care, qualifying the Brazilian PHC in search of better health outcomes.

New Zealand among global social media initiative leaders for primary care advocacy.

The international '#1WordforFamilyMedicine' initiative explores the identity of General Practitioners (GPs) and Family Physicians (FPs) by allowing the international Family Medicine community to collaborate on advocating for the discipline via social media. The New Zealand version attracted 83 responses on social media. Thematic analysis was performed on the responses and a 'word cloud' image was created based on an image identifying the country around the world - that of the silver fern. The '#1WorldforFamilyMedicine' project was promoted by WONCA (World Organisation of Family Doctors) globally to help celebrate World Family Doctor Day on 19 May 2015. To date, over 80 images have been created in 60 different countries on six continents. The images represent GPs' love for their profession and the community they serve. We hope that this initiative will help inspire current and future Family Medicine and Primary Care providers.

Organization and implementation of a cardio-oncology program. / Organização e implementação de uma consulta de cardio-oncologia.

Considerable advances in cancer therapies in recent decades have reshaped the prognosis of cancer patients. There are now estimated to be over 20 million cancer survivors in the USA and Europe, numbers unimaginable a few years ago. However, this increase in survival, along with the aging of the patient population, has been accompanied by a rise in adverse cardiovascular effects, particularly when there is a previous history of heart disease. The incidence of cardiotoxicity continues to grow, which can compromise the effectiveness of cancer therapy. Cardiotoxicity associated with conventional therapies, especially anthracyclines and radiation, is well known, and usually leads to left ventricular dysfunction. However, heart failure represents only a fraction of the cardiotoxicity associated with newer therapies, which have diverse cardiovascular effects. There are few guidelines for early detection, prevention and treatment of cardiotoxicity of cancer treatments, and no well-established tools for screening these patients. Echocardiography is the method of choice for assessment of patients before, during and after cancer treatment. It therefore makes sense to adopt a multidisciplinary approach to these patients, involving cardiologists, oncologists and radiotherapists, collaborating in the development of new training modules, and performing clinical and translational research in a cardio-oncology program. Cardio-oncology is a new frontier in medicine and has emerged as a new medical subspecialty that concentrates knowledge, understanding, training and treatment of cardiovascular comorbidities, risks and complications in patients with cancer in a comprehensive approach to the patient rather than to the disease.

Prevention of Nausea and Vomiting in Patients Undergoing Oral Anticancer Therapies for Solid Tumors.

Chemotherapy-induced nausea and vomiting (CINV) is still a common and debilitating side effect despite recent advances in its prevention and treatment. The intrinsic emetogenicity of chemotherapy agents allowed grouping into four risk groups (high, moderate, low, and minimal risk of emetogenicity). The prevention of acute and delayed CINV for intravenous agents and one day regimens is well studied, although, there are few data about management of CINV induced by oral cytotoxic agents and targeted therapies, usually administered in extended regimens of daily oral use. Until now treatment of nausea and vomiting caused by oral antineoplastic agents remains largely empirical. The level of evidence of prophylactic antiemetics recommended for these agents is low. There are differences in the classification of emetogenic potential of oral antineoplastic agents between the international guidelines and different recommendations for prophylactic antiemetic regimens. Herein we review the evidence for antiemetic regimens for the most used oral antineoplastic agents for solid tumors and propose antiemetic regimens for high to moderate risk and low to minimal risk of emetogenicity.

APOLLO I: Anticoagulation control in atrial fibrillation.

INTRODUCTION AND AIMS: Anticoagulation control as assessed by time in therapeutic range (TTR) correlates positively with the safety and efficacy of thromboprophylaxis in atrial fibrillation. We set out to assess TTR in our unit and to investigate determinants of better control. METHODS: This was a case series study of atrial fibrillation patients anticoagulated with warfarin or acenocoumarol at the Family Health Unit of Fânzeres. Sociodemographic and clinical data were collected and TTR was calculated by the Rosendaal method, based on international normalized ratio tests performed in external laboratories in the preceding six months. SPSS 21.0 was used for the statistical analysis, with descriptive statistics, Spearman's correlation, and the Mann-Whitney U and Kruskal-Wallis tests. RESULTS: Of the 106 eligible patients, 70% participated in the study. Median TTR was 65.3% (P25=48.3%, P75=86.8%). We found a positive association between this variable and duration of atrial fibrillation (ρ=0.477, p<0.001, r(2)=0.116) and with duration of anticoagulation (ρ=0.5, p<0.001, r(2)=0.087). No association was found with age, gender, educational level or existence of a caregiver (p>0.05). CONCLUSIONS: Median TTR in our unit is similar to that in southern European countries and close to the good control threshold (70%) proposed by the European Society of Cardiology. The duration of atrial fibrillation and of anticoagulation explains only a small part of the measure's variability. Other determinants of anticoagulation control must be investigated in future studies and comparative studies should be carried out in family health units monitoring anticoagulation on the premises.

Novo financiamento para uma nova Atenção Primária à Saúde no Brasil / New funding for a new Brazilian Primary Health Care

Resumo O objetivo desse artigo é apresentar um debate sobre a nova política de financiamento para Atenção Primária à Saúde (APS) no Brasil. Para desenvolvimento do método de pagamento foi realizado consulta da literatura nacional e internacional, além do envolvimento de gestores municipais, estaduais e federais da APS. O modelo final proposto é baseado em Capitação ponderada; Pagamento por desempenho; Incentivo para Ações Estratégicas. A capitação é ponderada por vulnerabilidade socioeconômica, aspectos demográficos e ajuste municipal, o pagamento por desempenho composto por um conjunto total de 21 indicadores e incentivos a ações estratégicas foi possível a partir da manutenção de alguns programas específicos. Os resultados das simulações apontaram para um baixo cadastro (90 milhões de brasileiros) para a cobertura estimada atual (148.674.300 milhões de brasileiros). Além disso, demonstraram um incremento imediato de recursos financeiros para 4.200 municípios brasileiros. Observa-se que a proposta do financiamento traz a APS brasileira para o século XXI, aponta para o fortalecimento dos atributos da APS e torna concreto os princípios de universalidade e equidade do Sistema Único de Saúde.

Abstract This paper aims to present a debate on the new Brazilian Primary Health Care (PHC) funding policy. We consulted the national and international literature, and we involved municipal, state, and federal PHC managers to develop the payment method. The proposed final model is based on weighted capitation, payment-for-performance, and incentive for strategic actions. Capitation is weighted by the socioeconomic vulnerability, demographic aspects, and municipal adjustment, the payment-for-performance consists of an entire set of 21 indicators, and incentives for strategic actions were facilitated from the maintenance of some specific programs. The results of the simulations pointed to low registration (90 million Brazilians) for the currently estimated coverage (148,674,300 Brazilians). Moreover, they showed an immediate increase in financial resources for 4,200 Brazilian municipalities. We observed that the funding proposal brings Brazilian PHC into the 21st century, points to the strengthening of PHC attributes, and materializes the principles of universality and equity of the Unified Health System.

Walytopias brutalistas: operações para uma clínica selvagem / Brutalists Walytopias: operations for a savage clinic / Walytopias brutalistas: operaciones para una clínica salvaje

O processo civilizatório tem se sustentado sob o pressuposto de que a constituição de Aparelhos de Estado são conquistas evolutivas do ponto de vista dos coletivos. Tal premissa desqualifica os modos de organização dos chamados "bárbaros" ou "selvagens", em seu funcionamento dispersivo, descentralizado e assimétrico. No que tange à emergência da clínica psicológica, especialmente na sua interface com as políticas públicas voltadas para as pessoas em situação de "risco" ou "vulnerabilidade social", vemos operar um princípio similar. Apresentamos nesse texto uma abordagem crítica dessa distinção hierárquica, tomando como inspiração alguns operadores artístico-poéticos enunciados por Waly Salomão e Hélio Oiticica, notadamente a chamada "polinização cruzada" e o "pan-cinema permanente", no intuito de apontar possibilidades para um encontro entre prática clínica psicológica e políticas públicas que esteja mais próximo de uma "clínica comum" do que de uma razão civilizatória

The civilizational process is based upon the assumption that the constitution of State's Apparatus is an evolution achievement of collectiveness. This premise underrates the organization way of the "barbarians" or "savages" in its dispersive, non-centralistic and asymmetrical forms. Concerning the psychological clinic moreover in its connections with the public policies for those in the so called "risk situation" or "social vulnerability", a similar perspective persists. We present in this text a critical approach to this hierarchical distinction, inspired by some artistic-poetical operators stated by WalySalomão and Hélio Oiticica, notably the "cross-pollination" and the "permanent pan-cinema", aiming to point options for an encounter between psychological clinic and public policies closer to a "common clinic" then to a civilizational rationality

El proceso civilizatorio se ha sostenido bajo el supuesto de que la constitución de Aparatos de Estado son conquistas evolutivas desde el punto de vista de los colectivos. Tal premisa descalifica los modos de organización de los llamados "bárbaros" o "salvajes", en su funcionamiento dispersivo, descentralizado y asimétrico. En lo que se refiere a la clínica psicológica, especialmente en su interfaz con las políticas públicas dirigidas a las personas en situación de "riesgo" o "vulnerabilidad social", vemos operar un principio similar. En este texto se presenta un enfoque crítico de esta distinción jerárquica, tomando como inspiración algunos operadores artístico-poéticos enunciados por Waly. Salomão y Hélio. Oticica, especialmente la llamada "polinización cruzada" y el "pan-cine permanente", con el fin de apuntar posibilidades para un encuentro entre práctica clínica psicológica y políticas públicas que esté más cerca de una "clínica común" que de una razón civilizatoria

Impact of skeletal complications on patients' quality of life, mobility, and functional independence.

INTRODUCTION: Skeletal-related events (SREs) from malignant bone disease cause considerable morbidity and can dramatically reduce patients' quality of life. DISCUSSION: Pathologic fractures often require surgical intervention and palliative radiotherapy. Thus, patients suffer impaired mobility, loss of functional independence, and diminished health-related quality of life (HRQOL). Bisphosphonates can delay the onset and reduce the incidence of SREs and have become the standard of care for the treatment of malignant bone disease; however, minimal information on the effects of bisphosphonate treatment on HRQOL is available. Targeted HRQOL assessments for patients with malignant bone disease are currently under development and are discussed herein.

[Guidelines for prevention of febrile neutropenia]. / Orientações para a prevenção da neutropenia febril em doentes submetidos a quimioterapia.

Neutropenia and febrile neutropenia are common consequences of some cytotoxic chemotherapy regimens. This situation leads to modifications of the therapeutic regimen, conducting to either dose reduction or cycle delays. Granulocyte colony stimulating factors are commonly used to minimize chemotherapy cytotoxic effect on the granulocytic series. The objective of this study is to assess the available evidence in what concerns the efficacy and safety of granulocyte colony stimulating factors, in several settings of their use. An extensive bibliographic review was performed, including clinical trials, observational studies, systematic reviews, and international guidelines for neutropenia prophylaxis, which aims to establish recommendations on their use, in adequacy to the National reality.

Estudo da anatomia interna e do comprimento dos pré-molares inferiores humanos / Study of the internal anatomy and the lenght of human inferior premolars

Estudou-se a anatomia interna dos pré-molares inferiores por meio da descalcificação-diafanização e observou-se que 27,45 por cento dos primeiros pré-molares inferiores apresentaram dois canais (22,33 por cento com dois canais e dois forames e, 5,12 por cento com dois canais e um forame). Apenas 9,67 por cento dos segundos pré-molares inferiores analisados apresentaram dois canais (5,32 por cento com dois canais e dois forames e 4,35 por cento com dois canais e um forame). A incidência de três canais com três forames foi bastante baixa (0,46 por cento), em ambos os tipos de dentes estudados. Quanto ao comprimento dos pré-molares inferiores, os primeiros apresentaram: 26,80 mm de valor máximo, 18,10 mm de valor mínimo e o valor médio real ficou compreendido entre os valores de 21,52 mm e 21,91 mm. Os segundos pré-molares apresentaram um valor máximo de 27,70 mm, um valor mínimo de 16,10 mm e o valor médio real compreendido entre os valores de 21,81 mm e 22,06 mm

El sector salud en Chile y su rol frente a emergencias y desastres naturales 1991 / The health sector in Chile and its role in emergencies and natural disasters 1991

Este trabajo presenta una síntesis del Sistema de Protección Civil de Chile, especialmente en relación con el manejo de emergencia y desastre en el sector salud. Se exponen algunas características generales del país, la organización del Sistema de Protección Civil, la misión y organización de la Oficina Nacional de Emergencia (ONEMI), la organización del Ministerio de Salud y sus servicios de salud dependientes. Explica la misión y organización del Departamento Asuntos de Emergencia y Catástrofe del Ministerio de Salud. Por último se dan algunas conclusiones sobre el sistema en general y cómo este ha funcionado en desastres que han afectado al país en los últimos años