Síntomas de ansiedad y depresión en personal de salud que trabaja con enfermos de COVID-19 / Anxiety and depression symptoms in health personnel who work with COVID-19 patients

El personal de salud pública que se enfrenta a la COVID-19, está expuesto a múltiples riesgos entre ellos los trastornos psicológicos. El objetivo de este estudio fue determinar la presencia de síntomas asociados a ansiedad y depresión en personal de salud que trabaja con enfermos de la COVID-19. Se realizó un estudio descriptivo de corte transversal en el que participaron 61 profesionales y técnicos de atención sanitaria, que trabajaban directamente con pacientes con COVID-19, a los cuales se les consultó acerca de la presencia de síntomas asociados a la depresión y ansiedad, sus principales preocupaciones y el tiempo de trabajo continuo para evitar la aparición de síntomas psicológicos. El 64,1% de los participantes relató nerviosismo y 59,2% cansancio, para el 90,16% la principal preocupación fue el fallecimiento del paciente y el 60,66% de los participantes indicó que el período ideal, de atención continua de pacientes COVID-19, para evitar la aparición de síntomas psicológicos era de 7 días. Nuestros resultados sugieren que es necesario elaborar estrategias de trabajo para disminuir la aparición de síntomas asociados al deterioro de la salud mental de los profesionales de la salud que atienden pacientes COVID-19

Public health personnel facing COVID-19 are exposed to multiple risks including psychological disorders. The goal of this study was to determine the presence of symptoms associated with anxiety and depression in health personnel working with COVID-19 patients. A descriptive cross-sectional study involving 61 health care professionals and technicians was conducted, working directly with COVID-19 patients, who were consulted about the presence of symptoms associated with depression and anxiety, their main concerns and ongoing working time to avoid the onset of psychological symptoms. 64.1% of participants reported nervousness and 59.2% tiredness, for 90.16% the main concern was the patient's death and 60.66% of participants indicated that the ideal period, of continuous care of COVID-19 patients, to prevent the onset of psychological symptoms was 7 days. Our results suggest that work strategies need to be developed to decrease the onset of symptoms associated with deteriorating mental health of health professionals caring for COVID-19 patients

Community and health staff perceptions on non-communicable disease management in El Salvador's health system: a qualitative study.

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.

Preocupación por el bienestar de residentes, un tema presente en la Conferencia Latinoamericana en Educación de Residentes (LACRE) 2017 / Concern for residents' wellbeing, an issue discussed at the latin american conference on resident education (LACRE) 2017

At the end of May 2017, the third version of the Latin American Conference on Resident Education, LACRE, was held in Chile; it convened 433 people from 14 regional countries. Chronic stress and emotional exhaustion of residents was one of the topics discussed. Reports from different countries documented that about half of residents suffer from burnout. This is, they are emotionally drained, indifferent towards their patients and with a sense of low personal fulfillment at work. This article describes the contributions presented in LACRE about interventions or institutional programs designed to reduce burnout and promote self-care of residents. The relevance of these initiatives is discussed in the current global context, considering the available evidence on the effectiveness of interventions to promote well-being among residents. International experts are making renewed and eloquent calls to medical educators and organizations to get involved in the solution of the erosion of resident wellbeing during the residence.

Transtorno do espectro autista: onde estamos e para onde vamos / Autism spectrum disorders: where we are and where we are going / Trastorno de espectro autista: dónde estamos y hacia dónde vamos

A ampliação do conhecimento científico sobre o autismo pode ser identificado pelo aumento na produção de pesquisas sobre este transtorno nas últimas décadas, implicando atualizações recentes em sua classificação, compreensão e intervenção. O objetivo deste artigo é apresentar uma revisão da literatura sobre o autismo, apontando como os avanços investigativos recentes têm lançado luz sobre a compreensão do transtorno. Relata historicamente como os critérios para o diagnóstico nos manuais médicos de classificação foram aprimorados, complementados e suplantados com base em evidências até o atual DSM-5. É realizada uma revisão das contribuições teóricas e empíricas que impulsionaram essas mudanças para sintetizar o que tem sido considerado como aspectos centrais desse transtorno como espectro dimensional. Problematiza o aumento do número de diagnósticos a partir dos dados epidemiológicos atuais, destacando o que as pesquisas multidisciplinares têm identificado como fatores etiológicos e prognósticos para a vida adulta. Por fim, revisa brevemente o panorama dos principais programas e modelos de intervenção baseados em evidências para pessoas com autismo nas áreas da saúde e educação, para então apontar os atuais desafios neste contexto.

The diffusion of scientific knowledge about autism can be explained trough the increasing number of researches on this disorder in the last decades, implying in recent updates in its classification, understanding and intervention. The purpose of this paper is to present a literature review on autism highlighting how the recent investigative advances that have shed light on the understanding ofthe disorder. It reports historically how the first diagnostic criteria were being improved, supplemented and supplanted in the medical classification manuals, based on research until DSM-5. A review of empirical researches that drove these changes is performed to synthesize what has been considered as core aspects of this disorder as a dimensional spectrum. Discusses the increasing number of diagnoses, emphasizing the points that the multidisciplinary research has identified as possible causes, and the knowledge about the development expectations for adulthood. Finally, it reviews the landscape of the main programs and intervention models for people with autism in health and education fields, to point out to the current challenges and those to be addressedin the future

El propósito de este artículo es presentar una revisión de la literatura sobre el autismo señalando los avances recientes de investigación resultantes que han arrojado luz sobre la comprensión del trastorno. Informa históricamente como los criterios para este diagnóstico en la clasificación de los manuales de medicina se están siendo avanzados, complementados y suplantados con base en la investigación por la corriente del DSM-5. Se realiza una revisión de las investigaciones empíricas que impulsó a estos cambios para sintetizar lo que se ha considerado como aspectos centrales de este trastorno como un espectro dimensional. Se analiza el creciente número de diagnósticos, enfatizando o que las investigaciones multidisciplinares han identificado como posibles causas, y lo que se sabe acerca de las expectativas de desarrollo para la edad adulta. Por último, revisa el panorama de los principales programas y modelos de intervención para las personas con autismo en las áreas de salud y educación, para apuntar a los retos actuales en este contexto y aquellos que se abordarán en el futuro.

[Concern for residents' wellbeing, an issue discussed at the latin american conference on resident education (LACRE) 2017]. / Preocupación por el bienestar de residentes, un tema presente en la Conferencia Latinoamericana en Educación de Residentes (LACRE) 2017.

At the end of May 2017, the third version of the Latin American Conference on Resident Education, LACRE, was held in Chile; it convened 433 people from 14 regional countries. Chronic stress and emotional exhaustion of residents was one of the topics discussed. Reports from different countries documented that about half of residents suffer from burnout. This is, they are emotionally drained, indifferent towards their patients and with a sense of low personal fulfillment at work. This article describes the contributions presented in LACRE about interventions or institutional programs designed to reduce burnout and promote self-care of residents. The relevance of these initiatives is discussed in the current global context, considering the available evidence on the effectiveness of interventions to promote well-being among residents. International experts are making renewed and eloquent calls to medical educators and organizations to get involved in the solution of the erosion of resident wellbeing during the residence.

[Characteristics of employment and wellbeing among physicians working in Santiago, Chile]. / Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana.

BACKGROUND: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. AIM: To describe the characteristics of employment in a representative sample of Chilean physicians. MATERIAL AND METHODS: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. RESULTS: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. CONCLUSIONS: The number of jobs is inversely related to the general wellbeing of physicians.

Características del empleo y bienestar subjetivo en médicos de la Región Metropolitana / Characteristics of employment and wellbeing among physicians working in Santiago, Chile

Background: Profound changes have been observed in medical practice during the last thirty years. This may be understood as a result of the influence of economic variables in health services management, among other probable causes. At the same time, doctors' work has been diversified, and a tendency to work in several paid jobs simultaneously has been observed. Aim: To describe the characteristics of employment in a representative sample of Chilean physicians. Material and Methods: A probabilistic sample of 414 physicians residing in Metropolitan Santiago answered a survey about their number and type of jobs and completed the BIS UMED questionnaire that measures the subjective wellbeing of physicians. Results: Forty percent of surveyed physicians had three or more jobs (36.3% of men and 47.5% of women). There was a significant inverse association between the number of jobs, general wellbeing and facing medicine from a new perspective. Conclusions: The number of jobs is inversely related to the general wellbeing of physicians.

A clínica na carne: subjetividade, corpo e transe em psicoterapia / The clinic in the flesh: subjectivity, body, and trance in psychotherapy / La clínica en la carne: subjetividad, cuerpo y trance en psicoterapia

Este trabalho busca, numa perspectiva da subjetividade, uma compreensão sobre a experiência de mundo do sujeito em termos de corpo e transe em psicoterapia. Partindo de dois casos clínicos, busca transcender dicotomias comuns no pensamento psicológico (como mente-corpo, indivíduo-social, real-imaginário), chegando a uma noção complexa dessa experiência que envolve a produção de sentidos, imagens, enredos simbólicos, personagens, relações e crenças que habitam o espaço vivido onde o corpo ocupa um lugar central. Em ambos os casos, o transe é concebido como uma forma de acesso a esse mundo simbólico que também proporciona às pacientes a possibilidade da mudança. O trabalho é concluído destacando os processos de imaginação e memória vividos ligados a determinadas partes do corpo e as possibilidades terapêuticas proporcionadas pelo transe, quando este é considerado em termos da experiência de mundo do sujeito...

This paper seeks to understand the subject's world in terms of body and psychotherapy trance from a subjectivity perspective. Two clinical cases are presented in an endeavor to go beyond common dichotomies found in psychological thought (such as mind-body, individual-social, realimaginary) and reach more complex perspectives that involve producing feelings, images, symbolic themes, characters, relationships, and beliefs that inhabit life experiences in which the body is central. In both cases trance was used as a way to access these symbolic worlds that can help patients change. The conclusion highlights imagination and memory processes experienced in connection with certain parts of the body and the therapeutic possibilities enabled by trance that takes the subject's life experience into consideration...

El presente trabajo pretende, en una perspectiva de subjetividad, una comprensión sobre la experiencia de mundo del sujeto en términos de cuerpo y trance en la psicoterapía. Partiendo de dos casos clínicos, pretende trascender dicotomías comunes en el pensamiento psicológico (como mente-cuerpo, individuo-social, real-imaginario) llegando a una noción compleja de esa experiencia que envuelve la producción de sentidos, imágenes, enredos simbólicos, personajes, relaciones y creencias que habitan el espacio vivido donde el cuerpo ocupa un lugar central. En ambos casos, el trance es concebido como una forma de acceso a ese mundo simbólico que también proporciona a las pacientes la posibilidad de cambio. El trabajo es concluido destacando los procesos de imaginación y memoria vividos vinculados a determinadas partes del cuerpo y las posibilidades terapéuticas proporcionadas por el trance, cuando éste es considerado en términos de experiencia de mundo del sujeto...

A clínica na carne: subjetividade, corpo e transe em psicoterapia / The clinic in the flesh: subjectivity, body, and trance in psychotherapy / La clínica en la carne: subjetividad, cuerpo y trance en psicoterapia

Este trabalho busca, numa perspectiva da subjetividade, uma compreensão sobre a experiência de mundo do sujeito em termos de corpo e transe em psicoterapia. Partindo de dois casos clínicos, busca transcender dicotomias comuns no pensamento psicológico (como mente-corpo, indivíduo-social, real-imaginário), chegando a uma noção complexa dessa experiência que envolve a produção de sentidos, imagens, enredos simbólicos, personagens, relações e crenças que habitam o espaço vivido onde o corpo ocupa um lugar central. Em ambos os casos, o transe é concebido como uma forma de acesso a esse mundo simbólico que também proporciona às pacientes a possibilidade da mudança. O trabalho é concluído destacando os processos de imaginação e memória vividos ligados a determinadas partes do corpo e as possibilidades terapêuticas proporcionadas pelo transe, quando este é considerado em termos da experiência de mundo do sujeito.(AU)

This paper seeks to understand the subject's world in terms of body and psychotherapy trance from a subjectivity perspective. Two clinical cases are presented in an endeavor to go beyond common dichotomies found in psychological thought (such as mind-body, individual-social, realimaginary) and reach more complex perspectives that involve producing feelings, images, symbolic themes, characters, relationships, and beliefs that inhabit life experiences in which the body is central. In both cases trance was used as a way to access these symbolic worlds that can help patients change. The conclusion highlights imagination and memory processes experienced in connection with certain parts of the body and the therapeutic possibilities enabled by trance that takes the subject's life experience into consideration.(AU)

El presente trabajo pretende, en una perspectiva de subjetividad, una comprensión sobre la experiencia de mundo del sujeto en términos de cuerpo y trance en la psicoterapía. Partiendo de dos casos clínicos, pretende trascender dicotomías comunes en el pensamiento psicológico (como mente-cuerpo, individuo-social, real-imaginario) llegando a una noción compleja de esa experiencia que envuelve la producción de sentidos, imágenes, enredos simbólicos, personajes, relaciones y creencias que habitan el espacio vivido donde el cuerpo ocupa un lugar central. En ambos casos, el trance es concebido como una forma de acceso a ese mundo simbólico que también proporciona a las pacientes la posibilidad de cambio. El trabajo es concluido destacando los procesos de imaginación y memoria vividos vinculados a determinadas partes del cuerpo y las posibilidades terapéuticas proporcionadas por el trance, cuando éste es considerado en términos de experiencia de mundo del sujeto.(AU)

They say it runs in the family: diabetes and inheritance in Oaxaca, Mexico.

The globalization of genetic discourses, especially where ethnicity is treated as a "risk factor" for disease, deserves special attention and concern. In countries such as Mexico, with large indigenous populations, the consequences of the Thrifty Genotype hypothesis and/or the attribution of type 2 diabetes to "family history" may be especially detrimental to poor rural communities, playing as they do into existing racial hierarchies. Based on semi-structured interviews with doctors and patients in a public clinic in a community near Oaxaca, Mexico, the study examines etiologies for type 2 diabetes. While notions of genetic inheritance and family history figure prominently in government and public health discourse, the "explanatory model" of patients places most emphasis on strong emotions, traumatic events, and dietary factors. Clinic doctors emphasize diet and lifestyle factors. The diffusion of "genetic risk" has had little impact on doctor-patient interactions in this community, but can be clearly seen in academic research, government policy, and medical specialties in the region, raising concerns about whether or not interventions will be directed at the social determinants of this growing health concern.

Family Health Strategy doctors and nurses' perceptions of complementary therapies.

OBJECTIVE: To analyze Estratégia de Saúde da Família (Family Health Strategy) professionals' perception of complementary and integrative therapies. METHODS: A study with 177 doctors and nurses was conducted in 2008, based on a self-administered questionnaire. The outcome variables were "interest in complementary and integrative therapies" and "agreement with the National Policy on Complementary and Integrative Therapies. Sex, age, graduate level of education, postgraduate level of education, length of time since graduation, length of time of work, having children, providing complementary and integrative therapies in the workplace, and using homeopathy or acupuncture comprised the independent variables. Data were analyzed using Chi-square test and Fisher's exact test. RESULTS: A total of 17 health centers provided complementary and integrative therapies; 12.4% of professionals had a specialization in homeopathy or acupuncture; 43.5% of doctors were specialists in family and community medicine/family health. Of all participants, 88.7% did not know the national directives for this area, although 81.4% agreed with their inclusion in the Sistema Único de Saúde (Unified Health System). The majority (59.9%) showed an interest in qualifications and all agreed that these therapies should be approached during the graduate course. Agreement with the inclusion of such therapies was significantly associated with the fact of being a nurse (p = 0.027) and using homeopathy for oneself (p = 0.019). Interest in complementary therapies was associated with the use of homeopathy for oneself (p = 0.02) and acupuncture by family members (p = 0.013). CONCLUSIONS: Complementary and integrative therapies are accepted by the professionals studied. This acceptance is associated with previous contact with such therapies and, probably, with residency/specialization in family and community medicine/family health.

Cuban medical cooperation in Haiti: one of the world's best-kept secrets.

This article analyzes Cuba's medical role in Haiti since Hurricane Georges in 1998, with particular emphasis on the Cuban government's response to the 2010 earthquake. The article examines two central themes. First, it assesses the enormous impact on public health that Cuba has made since 1998, and second, it provides a comparative analysis of Cuba's medical role since the earthquake.

Repercussions of violence on the mental health of workers of the Family Health Program.

OBJECTIVE: To describe forms of external and indirect violence that affect the mental health of workers of the Programa Saúde da Família (Family Health Program), as well as the strategies developed by these workers to enable their work and to be psychologically protected. METHODS: Qualitative study on the Programa Saúde da Família work process, performed in the cities of São Paulo, Ribeirão Preto and Embu (Southeastern Brazil) in 2005. Theoretical approach of psychodynamics of work, which proposes the formation of reflection groups with workers, was employed. Subjective aspects of work, situations of psychological suffering and strategies used by workers to deal with suffering and continue to work were sought to be identified. RESULTS: The Program's work organization exposed workers to the following: situations of violence, invisible at times; feeling of impotence in the face of precarious situations; lack of acknowledgement of efforts made; lack of borders between professional and personal aspects; intense experiences of social and domestic violence; fear of risk of exposure; feeling of moral and physical integrity being threatened; and fear of reprisal. Situations of psychological suffering resulting from violence in the workplace were observed. These became more intense in the Programa Saúde da Família due to regular contact with situations of violence that cause fear and a feeling of vulnerability. CONCLUSIONS: Psychological repercussions caused by violence in the workplace, not always expressed in the form of psychological disorders, were observed in situations of intense suffering. Workers develop strategies to minimize suffering, protect themselves psychologically and continue to work; and seek to create solidarity and protection networks with the population, aiming to reduce vulnerability. With the experience gained, they learn to detect high-risk situations, avoiding those they believe to be threatening.

Understanding the provision of palliative care in the context of primary health care: qualitative research findings from a pilot study in a community setting in Chile.

UNLABELLED: This pilot study looked at the provision of palliative care in the context of primary health care in a developing setting in Chile. RESEARCH OBJECTIVES: The study aimed to delineate the experience of palliative care from the perspective of patients and health care professionals; to examine primary health care as a propitious milieu for palliative care in developing countries; and to generate opportunities for international collaboration between Chile and Canada. METHODOLOGY: The study followed tenets of hermeneutic phenomenology and participatory research. Research activities included audio-taped, in-depth individual interviews and participant observation in the home. RESULTS: Patients expressed contentment with the services provided by the program. The support of family members, friends, neighbours, and the palliative team was critical to their home care. Health care professionals showed great enthusiasm for keeping the palliative care program going in the primary health care setting despite limited resources. They followed WHO and national guidelines for symptom relief and involved families in the care of the sick person. CONCLUSION: The provision of palliative care through primary health care increases access in developing countries.

Burnout en médicos: aproximaciones teóricas y algunos diagnósticos diferenciales / Burnout in doctors: theoretical approaches and some differential diagnoses

En las últimas tres décadas muchos autores e investigadores han hecho sus aportes al Síndrome de Burnout o agotamiento profesional, principalmente en médicos por ser esta una de las poblaciones más afectadas. Es necesario diferenciar el Burnout de otros conceptos que se pueden solapar con él, como depresión, estrés e insatisfacción laboral, reconociendo que este síndrome puede provocar el suficiente deterioro físico y mental en el personal de salud hasta el punto de poder interferir gravemente en su trabajo cotidiano y ocasionar, en consecuencia, importantes daños a la salud de sus pacientes. Por lo que es de vital importancia hacer conciencia de la necesidad de prevención en los aspectos que se pueden corregir o de la identificación del proceso de Burnout una vez instaurado.

In last the three decades many authors and investigators have made their contributions to the Syndrome of Burnout or professional exhaustion, mainly in doctors, being this one of the affected populations. It is necessary to differentiate the Burnout from other concepts that can be overlapped with it like depression, stress and labor dissatisfaction, recognizing that this syndrome can cause the sufficient physical and mental deterioration in the health personnel to the point of being able to interfere seriously in their daily work and to cause, consequently, important damages the health of their patients. This is why it is of vital importance to make conscience of the necessity of prevention in the aspects that can be corrected or of the identification of the process of Burnout once restored.

[The professional wearing down or syndrome of welfare labor stress ("burnout") among health professionals in the city of Cordoba]. / El desgaste profesional o síndrome de estrés laboral asistencial ("burnout") entre los profesionales de la salud de la ciudad de Córdoba.

With the intention of quantifying what occurs, between the members of the equipment of health in the public and deprived scope of the city of Cordoba, the present investigation is carried out. Comparative cross-sectional design observacional on stratified sample of doctors and fisioterapeutas. The data collection was made by means of survey of car-reports of "Maslach Burnout Inventory" (MBI). 479 professionals were studied, 22.3% (107) they were Fisioterapeutas and Kinesiólogos and 77.7% (372) Doctors of different specialties. It is possible to be concluded that in the public scope, the values of emotional fatigue are in the published ranks, despersonalizaci6n and lack of personal accomplishment is smaller. Between the hospitals they do not differ significantly. In the General Hospital of the Provincial scope, the Burnout is similar to the one of other countries and superior to the one of both local. In the private scope the levels of emotional fatigue are significantly greater than in the public, in the Service of Emergency the values exceed the published ranks. Between Pre-Residentes, the stress levels are moderate and they do not seem to vary; the Burnout would be below the awaited levels. Stress average of fisioterapeutas and kinesiólogos is in moderate levels and is smaller to the one of doctors of the public scope of the city of Cordova, but comparable to the one of the clinical residents and. The specialists Legal Medicine of the Fiscal Public Ministry, present/display the highest percentage of syndrome of complete Burnout.

El estrés laboral y el síndrome de Burnout en el cuerpo médico: una perspectiva ergonómica y clínica: revisión / Job stress and Burnout syndrome of physicians: a clinical and ergonomic perspective: review

Hoy los fenómenos globalizadores con una suerte compleja de red interaccional, mediatizan los instrumentos de cultura de los países, generando nuevas expectativas y nuevos valores en el inconsciente colectivo. La celeridad del cambio, exige rápidas adaptaciones, con costo social, biológico y psicológico para las personas de todos los niveles ocupacionales (Estrés) que puede llegar a determinar no sólo trastornos en la esfera mental, sino también en lo físico, determinando la aparición o agravación de enfermedades bien definidas, como la diabetes, dislipidemias, hipertensión arterial, etc (Distres o Carga Alostatica) y la consecuente incapacidad laboral temporal o permanente. Hoy numerosas encuestas mundiales dan cuenta que entre un 38 y un 45 por ciento de los trabajadores perciben su trabajo como estresante; en este contexto los profesionales de la salud se encuentran en una tremenda dualidad de rol; el rol del salvador y el rol de victima. Así, en medio de este conflicto, surge el Síndrome de Burnout que afecta, en mayor o menor grado, a un 70 por ciento de los médicos. El Burn-out tiene importantes consecuencias tanto en la salud de los profesionales que la sufren, como en la calidad de la atención que pueden prestar a sus paciente. Se le han atribuido el desarrollo de cambios conductuales, la aparición de hábitos de vida no saludables y de actitudes defensivas y el aumento del absentismo laboral.

[In contact with genetic diseases: norm and reason as cultural traditions in medical staff discourse at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil]. / Em contato com as doenças genéticas: a norma e a razão como tradições culturais presentes no discurso de profissionais médicos do Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

This study aims to detect the influence of deeply rooted traditions on physicians' discursive constructions concerning children with genetic diseases involving malformations and mental retardation. It also aims to capture the reflections resulting from the professional care for (and contact with) these children. All the physicians work at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil. Data were collected using oral interviews (in the form of conversational narratives) and were submitted to semiotic analysis. Four traditions were found in the medical discourse: norm, reason, family, and religion. This article focuses exclusively on norm and reason, highlighting how dismorphism, congenital malformations, and mental retardation associated with genetic diseases defy the established norms of perfection, beauty, and productivity. Therefore, feelings of uneasiness, powerlessness, and frustration are increased. The article also discusses how reason, one of the most important cultural traditions organizing modern thought, shapes medical discourse on genetic syndromes associated with mental retardation.

Implantaçäo de prontuário eletrônico em um hospital de grande porte: estudo de caso / Implantation of electronic records in a large hospital: a case study

Analisa um caso de implantaçäo de prontuário eletrônico em um hospital brasileiro privado e de grande porte, que presta assistência de alta complexidade. Relata que a pesquisa exploratória serviu-se de uma metodologia qualitativa, que investigou o primeiro ano de funcionamento do prontuário eletrônico e os respectivos antecedentes e se centrou nas percepçöes expressas, através de entrevistas, por profissionais de nível superior que atuam no referido hospital (implantadores, usuários administrativos e usuários clínicos). Enfatiza que o objetivo foi entender as mudanças decorrentes da implantaçäo do prontuário eletrônico no hospital e examinar resistências. Fornece uma perspectiva histórica do processo de informatizaçäo hospitalar e do desenvolvimento de sistemas de prontuário eletrônico.

[Delphi technique: identifying the generic competence required for doctors and nurses working in a primary health care]. / Técnica Delphi: identificando as competências gerais do médico e do enfermeiro que atuam em atenção primária de saúde.

This study aims to identify the generic competence required of doctors and nurses working in a primary health care. It was based on a series of 3 round of the Delphi technique which identified 8 generic competencies: ability to communicate, ability to be community oriented, ability in teamwork, management skills, educational skills, ability to problem solving, professional skills, ability to make-decision. Only the competence management skills there was not consensus by doctors. They disagree that this competence is required by them working in primary health care.