Creencias actitudinales sobre el comportamiento suicida en profesionales de salud del área de emergencias en un hospital público de Lima, Perú

Introducción: Cada año se producen unas 800 000 muertes por suicidio, superando el número de personas que mueren por homicidio y guerras en todo el mundo. En 2016, el suicidio fue la segunda causa de muerte entre las personas de 15 a 29 años en todo el mundo. Objetivo: Describir las creencias actitudinales sobre el comportamiento suicida en los profesionales de salud del área de emergencias de un hospital público. Metodología: Investigación con enfoque cuantitativo, de tipo descriptivo y de corte transversal. La población estuvo conformada por profesionales que laboraban en el área de emergencias de un hospital público en Lima. Se empleó una muestra no probabilística por conveniencia que estuvo conformada por 93 participantes. Se utilizó el Cuestionario de creencias actitudinales sobre el comportamiento suicida, compuesto por cuatro factores con una confiabilidad de 0,87. Resultados: Participaron 93 profesionales de salud. La edad promedio fue de 35,6 años. El Factor 1: Legitimación del suicidio y el Factor 4: El propio suicidio, son los que presentaron actitudes de rechazo al comportamiento suicida; mientras que el Factor 2: Suicidio en enfermos terminales y el Factor 3: Moral del suicidio, evidenciaron actitudes a favor. Las puntuaciones en los cuatro factores y en el puntaje total del cuestionario, para el grupo de médicos y otros profesionales, no mostraron diferencias significativas. El 51,6% (n=48) pertenecen al percentil 50, que tiene actitudes y creencias indiferentes para el suicidio y el 34,7% (n=23) al percentil 75, que tiene actitudes y creencias a favor de este. Discusión: La mayoría de los participantes mostraron actitudes y creencias neutrales para el suicidio. Solo se evidenciaron actitudes a favor del suicidio en los factores de moral y enfermos terminales. Las creencias actitudinales para los médicos y otros profesionales de la salud no mostraron diferencias significativas.

Introduction: Each year there are some 800,000 deaths by suicide, exceeding the number of people who die by homicide and wars throughout the world. In 2016, suicide was the second leading cause of death among people aged 15-29 worldwide. Objective: To describe attitudinal beliefs about suicidal behavior in health professionals in the emergency area of a public hospital. Methods: Quantitative, descriptive, and cross-sectional research. The population consisted of professionals who worked in the emergency department of a public hospital in Lima. A non-probabilistic convenience sample of 93 participants was used. The Attitudinal Beliefs Questionnaire on suicidal behavior, composed of four factors with a reliability of 0.87, was used. Results: 93 health professionals participated. The average age was 35.6 years. Factor 1: Legitimization of suicide and Factor 4: Suicide itself, showed attitudes of rejection of suicidal behavior, while Factor 2: Suicide in terminally ill patients and Factor 3: Morality of suicide, showed attitudes in favor. The scores in the four factors and in the total score of the questionnaire for the group of physicians and other professionals did not show significant differences. The 51.6% (n=48) belong to the 50th percentile, who have indifferent attitudes and beliefs for suicide and 34.7% (n=23) to the 75th percentile, who have attitudes and beliefs in favor of it. Discussion: Most of the participants showed neutral attitudes and beliefs for suicide. Attitudes in favor of suicide were only evident in the morale and terminally ill factors. Attitudinal beliefs for physicians and other health professionals showed no significant differences.

Personal and familial factors associated with toilet training

ABSTRACT Purpose: Toilet training (TT) is an important marker in a child's physical and psychosocial development. The present study aimed to evaluate aspects associated to delayed TT. Material and Methods: We interviewed 372 parents of children who had completed TT up to 48 months before the interview. The questionnaires were applied at school exits when parents went to pick their children up and at public parks. Questions included demographics, aspects related to TT, dysfunction voiding symptom score and evaluation of constipation. Results: The interviews were performed at a mean of 15.3±10.4 (0 to 47) months after the end of TT. Girls accounted for 53% of the sample. The mean age at finishing TT was 31.6±9.3 months and similar in both genders (p=0.77). TT occurred before school entry in 45.7% of the children and medical advice for TT was sought only by 4.8% of the parents. No association was observed of age at completing TT and presence of lower urinary tract symptoms (LUTS) (p=0.57) and/or constipation (p=0.98). In the univariate analysis, prematurity (OR=2.7 [95% CI 2.3-3.1], p <0.0001) and mothers who work outside their household (OR=1.8 [95% CI 1.4-2.3], p <0.0001) were associated to delayed TT. Conclusion: Children completed TT at a mean of 2 years and 7 months of age. The age of completing TT was not related to LUTS and/or constipation. Premature children and those whose mothers work outside the home finish TT later.

Management of patients diagnosed or suspected with Covid-19 in cardiorespiratory arrest: a scoping review / Manejo de pacientes diagnósticos o sospechosos de Covid-19 en la parada cardiorrespiratoria: revisión de alcance / Manejo de pacientes diagnosticados ou com suspeita de Covid-19 em parada cardiorrespiratória: scoping review

ABSTRACT Objective: to map the production of knowledge about the recommendations that can be applied in managing patients diagnosed or suspected with COVID-19 in cardiorespiratory arrest. Method: a scoping review, according to the Joanna Briggs Institute (2020) guidelines. Search was performed in ten data sources, and two electronic search engines were used; from 2001 to 2020. Results: of the 547 studies found, 14 met the inclusion and exclusion criteria. Most studies were published in 2020 (35.7%), and most studies were conducted in Canada (21.4%). It is observed the use of a systematized care to identify the possible means of care that should be provided to patients who suffer a cardiorespiratory arrest in hospitals, such as the monitoring of suspected cases by assessing the victim's breathing and pulse and identifying arrhythmias and shockable rhythms quickly. Personal protective equipment must be used to protect against droplets and aerosols and respiratory etiquette. Conclusion: managing patients in cardiorespiratory arrest suspected or diagnosis with COVID-19 requiring cardiopulmonary resuscitation should be performed in isolation areas and with the use of adequate protective equipment. There are gaps in scientific productions so that they address more clearly and instructively management when performing cardiopulmonary resuscitation in patients suspected or diagnosed with COVID-19.

RESUMEN Objetivo: mapear la producción de conocimiento sobre las recomendaciones que se pueden aplicar en el manejo de un paciente diagnosticado o sospechoso de tener COVID-19 en paro cardíaco. Método: se trata de una revisión de alcance, de acuerdo con las directrices del Instituto Joanna Briggs (2020). La búsqueda se realizó en diez fuentes de datos y se utilizaron dos buscadores electrónicos; período de tiempo de 2001 a 2020. Resultados: de las 547 publicaciones encontradas, 14 cumplieron los criterios de inclusión y exclusión. La mayoría de los estudios se publicaron en el año 2020 (35,7%) y la mayoría de los estudios se realizaron en Canadá (21,4%). Se observa el uso de una atención sistemática para identificar las posibles vías de asistencia que se deben brindar a los pacientes que sufren una parada cardiorrespiratoria en el ámbito hospitalario, como monitorear los casos sospechosos de la enfermedad mediante la evaluación de la respiración y el pulso de la víctima e identificar rápidamente arritmias y ritmos desfibrilables. Cabe mencionar el uso de equipo de protección personal para protegerse de gotitas y aerosoles y conductas respiratorias específicas para estos casos. Conclusión: el manejo de pacientes en parada cardiorrespiratoria con COVID-19 sospechado o diagnosticado que requieran reanimación cardiopulmonar debe realizarse en áreas de aislamiento y con el uso de equipo de protección adecuado. Se observó que existen lagunas en las producciones científicas, por lo que se abordan de forma más clara e instructiva sobre el manejo al realizar reanimación cardiopulmonar en pacientes con sospecha o diagnóstico de COVID-19.

RESUMO Objetivo: mapear a produção de conhecimento sobre as recomendações que podem ser aplicadas no manejo de paciente diagnosticado ou com suspeita de COVID-19 em Parada Cardiorrespiratória. Método: trata-se de uma revisão de escopo, de acordo com as orientações do Instituto Joanna Briggs (2020). Realizada busca em dez fontes de dados, e utilizados dois buscadores eletrônicos; recorte temporal de 2001 a 2020. Resultados: das 547 publicações encontradas, 14 atenderam aos critérios de inclusão e exclusão. A maior parte dos estudos foi publicada no ano de 2020 (35,7%), e a maioria dos estudos foi realizada no Canadá (21,4%). Observa-se o uso de um cuidado sistematizado para identificação das possíveis vias de assistência que deverão ser prestadas a pacientes que sofrem uma parada cardiorrespiratória no ambiente hospitalar, como o monitoramento de casos suspeitos da doença através da avaliação da respiração e pulso da vítima e identificação das arritmias e de ritmos chocáveis de forma rápida. Vale salientar o uso de equipamentos de proteção individual para proteção contra gotículas e aerossóis e condutas respiratórias específicas para estes casos. Conclusão: o manejo do paciente em parada cardiorrespiratória com suspeita ou diagnóstico de COVID-19 que necessita de reanimação cardiopulmonar deve ser realizado em áreas de isolamento e com a utilização de equipamentos de proteção adequados. Foi visto que existem lacunas nas produções científicas, para que abordem de maneira mais clara e instrutiva sobre o manejo ao realizar ressuscitação cardiopulmonar em pacientes com suspeita ou diagnóstico de COVID-19.

Percepción del usuario sobre la relación médico-paciente en un servicio público / Perception of user on the medical-patient relationship in a public service

Introducción: Se presenta un análisis sobre la relación que establece el médico con su paciente, en el servicio de salud pública más importante de la provincia de Chimborazo. Es posible evidenciar claramente el trato inadecuado del profesional al paciente, determinar si repercute de manera negativa sobre la salud de estos, y el efecto sobre la cobertura del profesional y por ende de la unidad de salud a la que se pertenece, son las interrogantes de investigación. Metodología: Es un estudio de campo, descriptivo, de corte transversal, con una muestra de 1200 personas que acuden al servicio de consulta externa en el Hospital General Docente de Riobamba. Esta presentación se deriva de un estudio con más de 2600 individuos involucrados en tres servicios de salud privados y públicos. Se trabaja sobre variables específicas como respeto, sensibilidad, capacidad profesional, explicación del procedimiento, consejería del médico, y conformidad de la atención por parte del paciente. Además, se recolectan datos generales del paciente y del médico como sexo, edad y número de consultas que determinan el tipo de relación entre el profesional y la población. Resultados: De manera general existe un alto grado de satisfacción de pacientes atendidos. No obstante, existe evidencia sobre la falta de comprensión del paciente, poca sensibilidad del profesional y la inadecuada explicación sobre procedimientos, lo cual lleva a una atención insuficiente. Conclusión: La relación médico paciente es un conjunto de actividades que van, desde contacto visual, empatía, respeto y conocimiento adecuado hasta la manera de agendar una nueva cita.

Introduction: An analysis is presented on the relationship established by the doctor with his patient, in the most important public health service in the province of Chimborazo. It is possible to clearly demonstrate the inadequate treatment of the professional to the patient, determine if it negatively affects their health, and the effect on the coverage of the professional and therefore of the health unit to which it belongs, are the questions of investigation. Methodology: This is a cross-sectional, descriptive field study with a sample of 1200 people who attend the outpatient service in the General Teaching Hospital of Riobamba. This presentation is derived from a study with more than 2,600 individuals involved in three private and public health services. We work on specific variables such as respect, sensitivity, professional capacity, explanation of the procedure, doctor's advice, and compliance of the patient's care. In addition, general data of the patient and the doctor are collected as sex, age and number of consultations that determine the type of relationship between the professional and the population. Results: In general there is a high degree of satisfaction of patients attended. However, there is evidence of lack of understanding of the patient, poor sensitivity of the professional and inadequate explanation of procedures, which leads to insufficient attention. Conclusion: The patient doctor relationship is a set of activities ranging from eye contact, empathy, respect and adequate knowledge to the way of scheduling a new appointment.

Rheumatoid arthritis: profile of patients and burden of caregivers / Artrite reumatoide: perfil de pacientes e sobrecarga de cuidadores

Abstract Objective: to describe the profile of patients with Rheumatoid Arthritis (RA) and their caregivers receiving care at the Rheumatology Outpatient Clinic of a teaching hospital, and evaluate the burden of the caregivers. Method: a cross-sectional study was performed with 41 patients with RA and their caregivers using a questionnaire to identify sociodemographic variables; the Burden Interview Scale and the Stanford Health Assessment Questionnaire. Descriptive analyzes and comparison between clinical-demographic variables and the functional status of patients were performed and the correlation between sociodemographic variables and levels of burden of caregivers was tested. Results: there was a prevalence of female patients (87.8%); a mean age of 64.4 years (±12.9); a mean time for the diagnosis of RA of 13.5 years (±8.5), a prevalence of moderate disability (39.0%); lower disability in the Hygiene domain (1.6; ±0.5) and greater disability in the Other Activities of Daily Life (2.1; ±0.6), Reach (2.0; ±0.7) and Grip (2.0; ±0.7) domains. The caregivers were women (73.2%); aged between 17 and 81 years (mean: 46.8; ±15.1); with a high school education (41.4%). The degree of kinship was 56.2% offspring and 36.6% spouses. Eighteen (44.0%) caregivers suffered burden, nine (22.0%) of whom had mild burden and nine (22.0%) of whom suffered intense burden. There was a higher incidence of intense burden among spouses (12.2%) and mild burden among children (12.2%). Conclusion: the low occurrence of burden among caregivers may be related to the profile of the patients, who presented good levels of independence for self-care. The profile of caregivers and the prevalence of overburdened spouses and offspring shows the need and importance of the implementation of caregiver training by health service professionals to improve care for RA patients. AU

Resumo Objetivo: Descrever o perfil de pacientes com Artrite Reumatoide (AR) e seus cuidadores, atendidos no Ambulatório de Reumatologia de um hospital de ensino, e avaliar sobrecarga dos cuidadores. Método: Estudo transversal com 41 pacientes e seus cuidadores, utilizando-se questionário de identificação com variáveis clínico-demográficas; Escala de Sobrecarga do Cuidador de Zarith e Health Assessment Questionnaire. Realizaram-se análises descritivas, comparação entre variáveis clínico-demográficas e estado funcional dos pacientes, correlação entre variáveis sociodemográficas e níveis de sobrecarga dos cuidadores. Resultados: Prevalência de pacientes do sexo feminino (87,8%); média de idade de 64,4 anos (±12,9); tempo médio de diagnóstico da AR de 13,5 anos (±8,5); predomínio de deficiência moderada (39,0%); menor deficiência no domínio Higiene (1,6;±0,5) e maior deficiência nos domínios Outras atividades do dia a dia (2,1;±0,6), Alcance (2,0;±0,7) e Pegada (2,0;±0,7). Os cuidadores eram mulheres (73,2%); faixa etária entre 17 e 81 anos (média: 46,8; ±15,1); ensino médio completo (41,4%); grau de parentesco: 56,2% filhos e 36,6% cônjuges. Dezoito (44,0%) cuidadores apresentaram sobrecarga, sendo 9 (22,0%) com sobrecarga ligeira e 9 (22,0%) com sobrecarga intensa. Maior incidência de sobrecarga intensa entre cônjuges (12,2%) e sobrecarga ligeira entre filhos (12,2%). Conclusão: A baixa ocorrência de sobrecarga entre cuidadores pode estar relacionada ao perfil dos doentes, que apresentaram bons níveis de independência para o autocuidado. O perfil dos cuidadores e prevalência de cônjuges e filhos com sobrecarga evidencia a necessidade e a importância de os profissionais do serviço implementarem ações de capacitação dos cuidadores, para melhorar a assistência aos pacientes com AR. AU

Risk factors of new-onset diabetes among senior public officials in Chengdu / 中华全科医师杂志

The consecutive data of 822 senior public officials in Chengdu undergoing health checkup from 2011 to 2016 were retrospectively reviewed.Among them,56 new cases of diabetes was diagnosed with a cumulative incidence of 6.81％.Fifty six age-and sex-matched healthy subjects served as controls,the risk factors of new-onset diabetes were analyzed with multivariate logistic regression.The results showed that BMI (OR =1.82,95％ CI:1.27-2.59,P =0.00) and fasting plasma glucose (OR =13.63,95％ CI:2.71-68.43,P =0.00) were independent risk factors of new-onset diabetes in senior public officials.

Projeto Terapêutico Singular: reflexões para a enfermagem em saúde coletiva / Personalized Therapy Plan: reflections for nursing in public health / Proyecto Terapéutico Singular: reflexiones para la enfermería en salud colectiva

Objetivo: compreender o Projeto Terapêutico Singular (PTS) a partir dos conceitos de sujeito da assistência à saúde, prática profissional, profissional de saúde e processo saúde-doença e discutí-los conforme os achados da literatura científica nacional. Método: pesquisa documental, descritiva, qualitativa, realizada em 2015. Foi direcionada por documentos norteadores do Ministério da Saúde, como base reflexiva para a discussão de bibliografias brasileiras. Desenvolveu-se análise de conteúdo orientada pela perspectiva de sistematização temático-categorial. Resultados: foram identificados dois agrupamentos temáticos, destacando que a compreensão do PTS, pela discussão dos seus elementos constituintes, corrobora a articulação com a enfermagem e sua aplicabilidade no cotidiano da atenção à saúde. Conclusão: o PTS representa uma importante contribuição para a reflexão das práticas de cuidado, pois favorece a articulação entre os diversos saberes existentes e a construção de possíveis espaços de diálogo com as necessidades de saúde dos indivíduos e seus projetos de emancipação.

Objective: to understand the Personalized Therapy Plan (Projeto Terapêutico Singular, PTS) by applying the concepts subject of health care, professional practice, health personnel and health-disease process, and discuss them in view of the findings of Brazilian scientific literature. Method: conducted in 2015, this descriptive, qualitative documentary study was informed by Ministry of Health guideline documents as a basis for reflective discussion of Brazilian bibliographies. Content analysis was applied on the principle of thematic category systemization. Results: two thematic groupings were identified, which underscored that discussing the constituents of PTS leads to an understanding that corroborates its interrelation with nursing and its applicability to healthcare routines. Conclusion: PTS makes an important contribution to thinking about care practices, because it favors coordination among the various existing bodies of expertise, and construction of potential spaces for dialogue with individuals' health needs and plans for empowerment.

Objetivo: comprender el Proyecto Singular Terapéutico Singular (PTS) a partir de los conceptos de sujeto de la asistencia a la salud, la práctica profesional, el profesional de salud y el proceso salud-enfermedad y discutirlos según los hallazgos de la literatura científica nacional. Método: investigación documental, descriptiva, cualitativa, realizada en 2015. Fue guiada siguiéndose los documentos del Ministerio de Salud, como base de reflexión para la discusión de la bibliografía brasileña. Se ha desarrollado el análisis de contenido guiado por la perspectiva de la sistematización temático-regional. Resultados: se han identificado dos agrupaciones temáticas, destacando que la comprensión del PTS, por la discusión de sus elementos constituyentes, corrobora la articulación de la enfermería y su aplicabilidad en la rutina de atención a la salud. Conclusión: PTS representa una importante contribución a la reflexión de las prácticas de cuidado ya que favorece la articulación entre los diversos conocimientos y la construcción de posibles espacios de diálogo con las necesidades de salud de los individuos y sus proyectos de emancipación.

Health vulnerabilities: the diagnosis of freshmen from a Portuguese University / Vulnerabilidades en salud: el diagnóstico de estudiantes de primer año de una Universidad Portuguesa / Vulnerabilidades em saúde: o diagnóstico dos caloiros de uma Universidade Portuguesa

The start of university is presented as a crucial stage in the life of the student. If, on the one hand, it is a period of increased autonomy and freedom, on the other, it is a period that also increases the sense of responsibility and self discipline. In this study, based on a quantitative approach, we identified the main risk situations experienced by freshmen at the University of Evora, by applying a questionnaire developed for this purpose and the Beck inventory. Key findings are highlighted, such as the consumption of harmful substances (tobacco, alcohol and illicit drugs), whose values exceed the average population. The consumption of alcoholic beverages begins early and is continuous and excessive. Also, the presence of symptoms compatible with dysphoria and depression is noted in about 9% of students. Self-medication practices were found in 58.7% of the freshmen. Our findings reveal the need for preventive intervention by health professionals, due to these young people's great exposure to health risks.

La concurrencia de transición se presenta como una etapa crucial en la vida del estudiante que entra en la universidad. Si, por un lado, se trata de un período de mayor autonomía y libertad, por el otro, es un período que también aumenta el sentido de responsabilidad y autodisciplina. En este estudio, basado en un enfoque cuantitativo, se identificaron las situaciones de riesgo principales experimentados por estudiantes de primer año en la Universidad de Évora, mediante la aplicación de un cuestionario elaborado para tal efecto y el inventario de Beck. De relieve los principales hallazgos como el consumo de sustancias nocivas (tabaco, alcohol y drogas ilícitas), cuyos valores superan la media de la población. El consumo de bebidas alcohólicas comienza temprano y es un consumo continuo y excesivo. Tenga en cuenta también la presencia de síntomas compatibles con disforia y depresión en alrededor del 9% de los estudiantes. También los valores obtenidos con la práctica de la automedicación muestra que si existe una situación por encima de los valores encontrados en otros estudios. Nuestros resultados revelan la necesidad de intervención preventiva de los profesionales de la salud.

O ingresso na universidade apresenta-se como uma fase crucial na vida do estudante, fase em que há aumento da autonomia e liberdade, do sentido de responsabilidade e a da autodisciplina, mas propicia mais acesso aos riscos à saúde. Como o objetivo de identificar as situações de risco experenciadas pelos caloiros de Universidade de Évora, desenvolveu-se um estudo quantitativo cujos dados foram coletados mediante a aplicação de um questionário e do inventário de Beck. Destaca-se o consumo de substâncias nocivas (tabaco, álcool e drogas ilícitas), cujos valores superam a média da população portuguesa e a presença de sintomatologia compatível com disforia e depressão em cerca de 9% dos estudantes. Verificou-se a prática da auto-medicação em 58,7% dos ingressantes. Os achados deste estudo revelam a necessidade de uma intervenção preventiva por parte dos profissionais de saúde devido a alta exposição aos riscos de saúde destes jovens.

Study of the individualized health management of senile mental disorders / 中华老年医学杂志

Objective To evaluate the effect of the individualized health management on senile mental disorders.Methods 421 patients with senile mental disorders were randomized into two groups:the intervention group (n =213) received routine antipsychotic drugs treatment,health education and individual health management,and the control group(n=208) received only population health education and routine drug antipsychiatric treatment.Results The Brief Psychiatric Rating Scale (BPRS) scores in two group were significantly higher after treatment than before treatment (all P＜0.01).The BPRS score in each period after treatment were significantly higher in intervention group than in control group (all P＜0.01).The mini mental state examination (MMSE) score in two treatment groups were significantly higher after treatment than before treatment (all P＜0.01).The MMSE score in each period after treatment were significantly higher in intervention group than in control group (all P＜0.05).Conclusions The individualized health management in senile mental disorders is not only feasible,but also effective.

Telecare System for Cardiac Surgery Patients: Implementation and Effectiveness / 대한의료정보학회지

OBJECTIVES: To manage a patient's blood pressure and recovery, and to reduce unnecessary hospital visits after heart surgery, we developed and established a telecare service. METHODS: We established and test-operated the system that enabled biometric data to be measured and monitored at home, and directed connections to the video consultation with monitoring personnel and medical staff when abnormal symptoms were detected. RESULTS: As a result of using the telecare service with patients discharged from the hospital after undergoing heart surgery, the patients were mostly satisfied with the service and use of the equipment, and some patients wanted to actually receive the service continuously along with a device which could be more easily used. CONCLUSIONS: Telecare services are greatly needed for patients discharged after heart surgery for a certain period of time. A model should be developed which provides devices necessary for each disease in package form and customizes the content and services in one package.