Una propuesta de política pública: programa de cultura de donación de órganos en Morelia, Michoacán, México / A public policy proposal: organ donation culture program in Morelia, Michoacán, México

Resumen El trasplante de órganos en nuestros tiempos es un procedimiento médico de rutina y, en muchos casos, representa la única alternativa para que los pacientes en listas de espera puedan continuar su vida. Pese a eso, la problemática en la ciudad de Morelia, Michoacán, es similar a la presentada alrededor del mundo, pues la escasa cultura de donación de órganos impide a quienes la apoyan llevar a la práctica su deseo, porque, al momento de solicitar el consentimiento de donación post mortem prevalece un alto porcentaje de negativas familiares. Este trabajo tuvo por objetivo diseñar una política pública desde un enfoque racional, utilizando la metodología del marco lógico, del cual resultó una propuesta de programa de cultura de donación de órganos post mortem en la ciudad de Morelia, Michoacán, a fin de contrarrestar dichas negativas y potencializar las donaciones y los trasplantes de órganos.

Percepción de médicos que realizan el Servicio Rural y Urbano-Marginal de salud en Perú sobre el primer nivel de atención / Effect of Rural and Marginal Urban Health Service on the physicians' perception of primary health care in Peru

RESUMEN Objetivo: Determinar la percepción de los médicos que realizan el Servicio Rural y Urbano Marginal de Salud (SERUMS) en Perú sobre el trabajo en el primer nivel de atención (PNA) y sus factores asociados. Materiales y métodos: Se realizó un análisis secundario de datos de una muestra de médicos que realizaron el SERUMS el 2016. Para evaluar la variable de interés se utilizó la escala de «Percepción sobre el trabajo en el PNA¼, cuyos puntajes más altos indican una peor percepción del trabajo en el PNA. Se aplicó una encuesta basal (antes del SERUMS) y una encuesta de seguimiento (8-12 meses de iniciado el SERUMS) y se evaluaron las diferencias en los puntajes. Resultados: De los 780 encuestados, 215 (27,6%) completaron la encuesta basal y de seguimiento. La media del puntaje incrementó considerablemente (de 3,4 a 6,7; p < 0,001), lo que indica una peor percepción del trabajo en el PNA tras iniciar el SERUMS. De los tres dominios de la encuesta, el de las percepciones sobre el médico que trabaja en el PNA y el de las percepciones sobre el trabajo asistencial en el PNA incrementaron los puntajes de percepción sobre el trabajo en el PNA. No se encontraron variables sociodemográficas asociadas al cambio en los puntajes. Conclusiones: La percepción de los médicos sobre el trabajo en el PNA se deteriora luego de iniciar el SERUMS. Se deben promover estrategias que incentiven el interés de los médicos en este nivel de atención.

ABSTRACT Objective: To determine the effect of the Rural and Marginal Urban Health Service (SERUMS) on the physicians' perception of work in the primary health care (PHC) setting and its associated factors. Materials and methods: A secondary data analysis of a sample of physicians who performed the SERUMS in 2016 was carried out. To evaluate the variable of interest, the scale "Perception of work in the PHC setting" was used, higher scores indicated a negative perception of work in the PHC setting. A baseline survey (before the SERUMS) and a follow-up survey (8-12 months after starting the SERUMS) were applied and differences in both scores were evaluated. Results: Of the 780 respondents, 215 (27.6%) completed the baseline and follow-up survey. The average score increased considerably (from 3.4 to 6.7; p < 0.001), which shows a negative perception of work in the PHC setting after participating in the SERUMS. Of the three parts of the survey, the one regarding perceptions by the physicians working in the PHC and the one about perceptions of medical work in the PHC setting increased the perception scores. No sociodemographic variables were found to be associated with the change in scores. Conclusions: Physicians' perception about work in the PHC setting deteriorated after participating in the SERUMS. Therefore, strategies to encourage physicians' interest in working at this level of healthcare should be promoted.

Salud mental en médicos que realizan el servicio rural, urbano-marginal en salud en el Perú: Un estudio de línea base / Mental health in physicians doing the rural and suburban health service in Peru: a baseline study

Las condiciones poco favorables que el médico joven encara durante el Servicio Rural, Urbano Marginal en Salud (SERUMS) pueden incrementar el riesgo de enfermedades mentales. El objetivo del estudio es establecer la línea base sobre niveles de depresión y uso problemático de alcohol en aquellos médicos que realizarán dicho servicio durante el periodo 2011-2012. Se aplicó como herramientas de tamizaje la escala del Centro de Estudios Epidemiológicos para depresión y el Test para la Identificación de Trastornos por Uso de Alcohol, a 493 médicos. Se encontró que 26 por ciento de las mujeres y 14,5 por ciento de los varones puntuaron en el rango de depresión; 22 por ciento de mujeres y 26 por ciento de varones lo hicieron para uso problemático de alcohol. 39 por ciento puntuó para cualquiera de ambas entidades. Los problemas de salud mental son comunes entre los médicos que se disponen a migrar para realizar el SERUMS, lo cual debe ser atendido para evitar mayores riesgos.

The disadvantageous conditions in which young physicians have to do their rural and sub-urban health service (SERUMS) may put them in a high risk for mental disorders. This study aims to establish the baseline levels of depression and alcohol use problems among those physicians scheduled to complete their SERUMS during the period 2011-2012. The Center for Epidemiologic Studies Depression Scale (CES-D) and the Alcohol Use Disorders Identification Test (AUDIT) were administered as screening tests to 493 physicians. Depression scores were met by 26 percent females and 14.5 percent males, and alcohol use problem scores were met by 22 percent females and 26 percent males. Overall, 39 percent persons scored for either of both mental health entities. Mental health problems seem to be common among young physicians scheduled to migrate to their SERUMS. These problems must be addressed to avoid greater risks.

Health follow-up of children in poverty situation: between the routine and eventuality of daily care

This study aimed to identify how child care is delivered to children under two in their daily routine. Based on a qualitative approach, the study addresses the care site in the child care, through non-structured interviews with mothers and professionals from two health units in peripheral areas of Ribeirão Preto, SP, Brazil. Results point aspects of how professionals view the mothers and their families, how the child's health, the routine and eventuality of care are followed. Adherence is important in the child's follow up, the longitudinality of care and, mainly, the concern with the mothers' and families' values. Child care in primary health care has a contingency character; it must deal with eventuality, uncertainty and events linked to experiences, integrating practical and technical knowledge.

Este estudo tem por objetivo identificar o modo como a assistência em puericultura destinada às crianças menores de dois anos de idade é realizada no cotidiano. Baseado em abordagem qualitativa, o estudo tematiza o lugar da assistência em puericultura no cuidado em saúde, utilizando entrevistas não estruturadas com mães e profissionais de duas unidades de saúde de áreas periféricas de Ribeirão Preto-SP-Brasil. Os resultados apontam aspectos do modo como os profissionais vêem as mães e famílias, o modo como a saúde da criança é acompanhada, a rotina e a eventualidade dos cuidados. No seguimento da criança é importante a adesão ao acompanhamento da saúde, a longitudinalidade dos cuidados e, sobretudo, a preocupação com valores das mães e famílias. O cuidado da criança na atenção primária à saúde tem um caráter contingencial, deve lidar com a eventualidade, incerteza e acontecimentos vinculados às experiências, integrando saberes práticos e saberes técnicos.

El objetivo de este estudio es identificar el modo como la atención en puericultura a niños menores de dos años de edad es realizada en el cotidiano. Basado en aproximación cualitativa, el estudio trata del sitio de la atención en puericultura en el cuidado en salud, utilizando entrevistas no estructuradas con madres y profesionales de dos unidades de salud de Ribeirão Preto-SP-Brasil. Los resultados apuntan aspectos sobre el modo como los profesionales ven a los sujetos, el modo como la salud del niño es acompañada, la rutina y la eventualidad de los cuidados. En el seguimiento del niño, es importante la adhesión al acompañamiento de la salud, la longitudinalidad de los cuidados y, sobre todo, la preocupación con valores de las madres y familias. El cuidado del niño en la atención primaria a la salud tiene carácter contingencial, debe lidiar con la eventualidad, incertidumbre y con acontecimientos vinculados a las experiencias, integrando saberes prácticos y saberes técnicos.

Antibiotic prescription practices in six primary health centers in South Sumatra.

Drug utilization study, especially antibiotic usage in therapy of mild acute upper respiratory infections and acute diarrheas has been conducted in six Primary Health Center (PHC) in urban, suburban and rural area in the Province of South Sumatra. We conducted systematic random sampling during which 15% of patients in each PHC were taken. We collected information about drug utilization from medical record of out patient in each PHC for three months period (January to March 1997). We recorded the characteristics of patients, the diagnosis, the number and type of drug (including injection) used. The number of cases studied was 1781, with the average number of drug per prescription being 2.7; the percentage of cases receiving an injection was 43%, and the percentage of cases receiving antibiotic was 48%. Sixty-four percent of 1277 acute respiratory tract infections (common cold), and 79% of 140 cases of acute diarrhea received antibiotic. This study showed that there is overuse or inappropriate use of drugs, especially antibiotic for acute nonspecific diarrhea and mild acute respiratory tract infections.

Health status of the aged in a selected rural and semi-urban area in the Kadugannawa M.O.H. Division

A questionnaire to assess the health status was administered to a sample of rural and semi-urban elders at Kadugannawa MOH area. The demographic pattern of the study groups was similar to the national situation except for the ethnic and religious distribution. Although several of the elders were impaired in the performance of day to day activities, only a few could not attend to personal care activities . A high percentage were having poor hearing, poor vision and chronic diseases. Only a small percentage of them were found to be having seveere degree of dementia and depression. But a significant proportion of them had the milder forms of those conditions. Their social status was very poor and a very high percentage of them had low level of contact with social activities except for the religious activities. Chronic diseases, poor ,mental status and lower social contacts were more marked in semi-urban areas than that of rural areas. A majority of them preferred Government Institutions for treatment. Although a considerable number utilized the private sector, very few get treatment from the indigenous sector. Also, the health and social workers contact with the elders was found to be very poor.

A Study of some characteristics of women seeking menstrual regulation from a clinic in a provincial town

The objective of the study was to asses the factors that influence wome to seek menstrual regulation in a provincial town. Their socio demographic factors, obstetrics history, reason for seeking menstrual regulation and their attitude towards abortions were studied. Their knowledge and practice abour contraceptive methods were also assessed. A systematic sample of 122 women were interviewed during 6 weeks period. Majority of the women were married and was in the age group 0f 25-35 years. But there were 23.77 percent inmarried women also. Commonest reason for seeking menstrual regulation was the young age of the last child. there was a statistically significant association between the age of the last child being below 2 years and mothers reason for menstrual regulation being the "small last child". Majority of women were referred by qualified medical practitioners. 32.95percenthad come for repeat termination of pregnancy. there was a statistically significant association between the history of previous abortions and the marital status. Also there was a significant association between history of previous abortion and number of pregnancies. Major proiportion of women had undergone some other method to terminate pregnancy before menstrual regulation. Contraceptive prevalance in the study group had been low. But awareness about contraceptive methods were even more than that was in 1982 contraceptive prevalence survey. News papers and periodicals had been the major source of information. Therewas a statistically significant association between the level of education and ability to explain the meaning of sage period. 70 percent wanted to use a contraceptive method after the procedure.