ABSTRACT
Resumen: Se describe el desarrollo del Hospital Regional de Tacuarembó (HRT), situado en una ciudad mediana del norte de Uruguay, que lo condujo a convertirse en un referente dinamizador de la salud regional, con una atención médica moderna y eficaz, así como de servicio a la comunidad y a la salud nacional. Todo ello logrado a través de una gestión ambiciosa y optimista en los objetivos, basada en esfuerzos colectivos e individuales así como en apoyos institucionales nacionales y de organismos internacionales. Ese papel dinamizador e influyente a nivel regional, e inclusive nacional, está basado, por una parte, en una gran mejora de su base logística, es decir, el propio hospital, en cuanto a instalaciones, equipamientos y ampliación de las capacidades de atención médica; pero también en un gran apoyo e impulso a la Atención Primaria en Salud, no solo en la ciudad de Tacuarembó, sino a nivel departamental. Además, el HRT ha jugado un papel importante en el control de dos zoonosis parasitarias de importancia nacional: la enfermedad de Chagas y la equinococosis quística. Esa acción dinamizadora ha consistido en plantear al hospital como una "organización de salud", considerando el contexto de un territorio particular junto a los determinantes del sistema nacional de salud. Se puede considerar al HRT como una organización innovadora liderada por "emprendedores sociales" dentro de un marco de emprendimiento social partiendo de un hospital departamental o provincial.
Summary: The study presents the case of the Hospital de Tacuarembó (HRT), located in a medium-size city in the north of Uruguay, which turned into a reference in terms of the dynamization of regional health, offering modern and effective healthcare services, serving the community and contributing to the improvement of national health. All of this was possible as a result of an ambitious and optimistic management of objectives, based on collective and individual effort, as well as relying on the support of national and international bodies. This dynamizing and influential role played by the Hospital de Tacuarembó is based, on the one hand on a great improvement of its logistical base - that is, the hospital itself - in terms of its premises, equipment and upscaling of medical services, and on the other hand on the major support and stimulus to Primary Healthcare Services, not only in the city of Tacuarembó, but also throughout the entire province. Likewise, the HRT has played a significant role in the control of two parasite zoonoses that are extremely important for Uruguay: Chagas disease and cystic echinococcosis. This dynamizing actions have consisted in regarding the hospital as a "health organization" within the context of a certain territory, along with factors defined by the national health system. HRT may be considered as an innovative organization led by "social entrepreneurs" within the framework of social entrepreneurship, stemming from a departmental or province hospital.
Resumo: Descreve-se o desenvolvimento do Hospital Regional de Tacuarembó (HRT), localizado em uma cidade de médio porte do norte do Uruguai, o que o tornou uma referência dinâmica de saúde regional, com atendimento médico moderno e eficaz, além de atendimento à comunidade e a saúde nacional. Tudo isto alcançado através de uma gestão ambiciosa e otimista dos objectivos, baseada no esforço coletivo e individual, bem como no apoio institucional nacional e de organismos internacionais. Este papel dinâmico e influente a nível regional, e mesmo nacional, está baseado, por um lado, numa grande melhoria da sua base logística, ou seja, do próprio hospital, ao nível das instalações, equipamentos e ampliação das capacidades de assistência médica; mas também num grande apoio e dinamização da Atenção Primária à Saúde (APS) não só na cidade de Tacuarembó mas também a nível departamental. Além disso, o HRT tem desempenhado um papel importante no controle de duas zoonoses parasitárias de importância nacional: a doença de Chagas e a equinococose cística. Essa dinâmica de ação consistiu em considerar o hospital como uma "organização de saúde", considerando o contexto de um determinado território e os determinantes do sistema nacional de saúde. O HRT pode ser considerado uma organização inovadora liderada por "empreendedores sociais" dentro de um quadro de empreendedorismo social a partir de um hospital departamental ou provincial.
Subject(s)
Public Health , Hospitals , UruguayABSTRACT
Cystic echinococcosis (CE) or hydatidosis, a parasitic zoonosis caused by a cestode of the family Taeniidae, species Echinococcus granulosus, is endemic in Argentina, Chile, Peru, Uruguay, and southern Brazil. This report presents CE figures for these five countries in 2009 - 2014 and proposes indicators to measure national control programs. Nearly 5 000 new CE cases were diagnosed annually in the five countries during the study period. The average case fatality rate was 2.9%, which suggests that CE led to approximately 880 deaths in these countries during the 6-year period. CE cases that required secondary or tertiary health care had average hospital stays of 10.6 days, causing a significant burden to health systems. The proportion of new cases (15%) in children less than 15 years of age suggests ongoing transmission. Despite figures showing that CE is not under control in South America, the long-standing implementation of national and local control programs in three of the five countries has achieved reductions in some of the indicators. The Regional Initiative for the Control of CE, which includes the five countries and provides a framework for networking and collaboration, must intensify its efforts.
Subject(s)
Echinococcosis/epidemiology , Echinococcosis/prevention & control , Humans , Incidence , Prevalence , South America/epidemiology , Time FactorsABSTRACT
Cystic echinococcosis (CE) or hydatidosis, a parasitic zoonosis caused by a cestode of the family Taeniidae, species Echinococcus granulosus, is endemic in Argentina, Chile, Peru, Uruguay, and southern Brazil. This report presents CE figures for these five countries in 2009 – 2014 and proposes indicators to measure national control programs. Nearly 5 000 new CE cases were diagnosed annually in the five countries during the study period. The average case fatality rate was 2.9%, which suggests that CE led to approximately 880 deaths in these countries during the 6-year period. CE cases that required secondary or tertiary health care had average hospital stays of 10.6 days, causing a significant burden to health systems. The proportion of new cases (15%) in children less than 15 years of age suggests ongoing transmission. Despite figures showing that CE is not under control in South America, the long-standing implementation of national and local control programs in three of the five countries has achieved reductions in some of the indicators. The Regional Initiative for the Control of CE, which includes the five countries and provides a framework for networking and collaboration, must intensify its efforts.
La equinococosis quística o hidatidosis, zoonosis parasitaria causada por un cestodo de la especie Echinococcus granulosus, familia Taeniidae, es endémica en Argentina, Chile, Perú, Uruguay y el sur del Brasil. En este informe se presentan datos sobre la equinococosis quística registrados en estos cinco países entre los años 2009 y 2014, y se proponen indicadores para medir el desempeño de los programas nacionales de control. Durante el período de estudio, en los cinco países se diagnosticaron casi 5 000 casos nuevos por año. La tasa de letalidad promedio fue del 2,9 %, lo que indica que la equinococosis quística causó aproximadamente 880 defunciones en estos países en el período de 6 años estudiado. Los casos que debieron recibir atención de salud secundaria o terciaria tuvieron una estadía hospitalaria promedio de 10,6 días, lo que ha generado una carga significativa para los sistemas de salud. La proporción de casos nuevos de niños menores de 15 años (15 %) indica que la transmisión no se ha interrumpido. A pesar de que los datos muestran que la enfermedad no está controlada en América del Sur, tres de los cinco países disponen de programas nacionales y locales de control desde hace muchos años, los que han logrado reducir algunos de los indicadores. Es preciso que la Iniciativa Sudamericana para el Control de la Equinococosis Quística, que incluye a los cinco países y contribuye con un marco para la formación de redes y la colaboración, redoble sus esfuerzos para lograr el control de la enfermedad.
A equinococose cística ou hidatidose, zoonose parasitária causada por um céstodo da família Taeniidae e espécie Echinococcus granulosus, é endêmica na Argentina, Chile, Peru, Uruguai e no sul do Brasil. Neste artigo são apresentadas as estimativas da hidatidose nos cinco países de 2009 a 2014 e propostos indicadores para avaliar os programas nacionais de controle. Cerca de 5 mil casos novos de hidatidose foram diagnosticados por ano nos cinco países no período de estudo. A taxa de letalidade média foi de 2,9%, o que indica que esta doença causou aproximadamente 880 mortes nestes países no período de 6 anos. Nos casos de hidatidose que precisaram de atenção de saúde secundária ou terciária, a duração média da internação hospitalar foi de 10,6 dias, representando uma sobrecarga considerável aos sistemas de saúde. O percentual de novos casos (15%) em indivíduos menores de 15 anos de idade indica transmissão contínua. Apesar de as estimativas mostrarem que a hidatidose não está controlada na América do Sul, a execução permanente de programas municipais e nacionais de controle em três dos cinco países tem redundado na redução de alguns dos indicadores. A Iniciativa Regional para Controle da Hidatidose, que integra os cinco países em uma estrutura para trabalho em conjunto e colaboração, deve redobrar os seus esforços.
Subject(s)
Zoonoses , Echinococcosis , Echinococcus granulosus , South America , ZoonosesABSTRACT
Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community’s participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.
Subject(s)
Humans , Animals , Dogs , Dog Diseases/prevention & control , Echinococcosis/prevention & control , Dog Diseases/parasitology , Echinococcosis/epidemiology , Echinococcosis/veterinary , National Health Programs , Uruguay/epidemiologyABSTRACT
Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community's participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.
Subject(s)
Dog Diseases/prevention & control , Echinococcosis/prevention & control , Animals , Dog Diseases/parasitology , Dogs , Echinococcosis/epidemiology , Echinococcosis/veterinary , Humans , National Health Programs , Uruguay/epidemiologyABSTRACT
A pesar de los adelantos logrados en el tratamiento de las colangitis agudas bacterianas, éstas continúan teniendo una alta morbilidad y mortalidad (20 por ciento) y plantean, muchas veces, un problema terapéutico. Los autores ponen a prueba un método de estimar la severidad de estos pacientes e investigar al rol patogénico, pronóstico de las lesiones anatómicas y la disfunción hepática. Se analiza una serie de 130 pacientes de los cuales se seleccionaron 59 por protocolo. La falla hepatocítica fue hallada en 57 por ciento de los casos, y en orden decreciente falla renal (37 por ciento), falla hemodinámica (33 por ciento), falla hematológica (33 por ciento), falla encefálica (27 por ciento) y falla respiratoria (5 por ciento). Las alteraciones anatomopatológicas se clasificaron en 4 grados de severidad creciente presentándose 22 por ciento como grado I, 27 por ciento como grado II, 50 por ciento como grado III y 0 por ciento como grado IV.Las lesiones anatomopatológicas y la insuficiencia hepática, surgen como elementos pronósticos fundamentales en el determinismo de la morbimortalidad de estos pacientes
Subject(s)
Humans , Cholangitis , Multiple Organ Failure , Cholangitis/surgery , Multiple Organ Failure/diagnosisSubject(s)
Aged , Humans , Male , Echinococcosis, Hepatic , Echinococcosis, Hepatic/surgery , Echinococcosis, Hepatic/diagnosisSubject(s)
Child , Adolescent , Adult , Humans , Male , Spleen/surgery , Wounds and Injuries , Spleen/injuries , Surgical Procedures, OperativeSubject(s)
Humans , Female , Lymphatic Metastasis , Breast Diseases , Breast Neoplasms , Breast , Neoplasm StagingSubject(s)
Adult , Middle Aged , Humans , Male , Female , Bile/microbiology , Biliary Tract Diseases , Biliary Tract/microbiology , Blood/microbiology , Bacteroides , Cholelithiasis , Escherichia coli , Gallstones , Pancreatic Neoplasms , Portal Vein/microbiologySubject(s)
Aged , Humans , Female , Paget Disease, Extramammary , Anal Canal , Paget Disease, Extramammary/pathology , PolypsABSTRACT
Se denomina dolor abdominal agudo no específico, a aquel que es imposible determinar a que entidad conocida corresponde. Su frecuencia, comprendida entre el 24 y el 49%, de las estadísticas consultadas, es tal, que debe ser tenido en cuenta, por las decisiones a adoptar. Esta surgirá de un completo examen clínico del enfermo y una valoración juiciosa de los métodos auxiliares, que permitirán una disminución de intervenciones innecesarias. Ciertos axiomas intervencionistas en el abdomen agudo, deberían ser replanteados, frente a la elevada morbimortalidad de las laparotomias en blanco
