[Participation of female dentists in the evolution of dental specialties. a cross-sectional study]. / Participación de las odontólogas en la evolución de las especialidades odontológicas. estudio transversal.

Objective: To determine the participation of female dentists in the evolution of dental specialties in Peru and establish the gender distribution in each specialty. Materials and Methods: A descriptive and retrospective cross-sectional study was conducted using data from the National Registry of Specialists of the Peruvian College of Dentists in August 2023. The relative frequency of female gender and the femininity index were calculated in the total population of specialists and in each specialty to assess their respective evolution over the last 25 years. Results: Currently, 51.74% of the 3,827 specialty registrations correspond to female dentists, with a femininity index of 1.072. Nine specialties with a female predominance were identified, including Pediatric Dentistry, Family and Community Health in Dentistry, and Restorative and Esthetic Dentistry. On the other hand, areas with a higher male presence are Orthodontics and Maxillary Orthopedics, and Oral and Maxillofacial Surgery. Upon analyzing the temporal evolution, a shift from the historical male majority to the current female predominance in the last fifteen years is observed, and gender parity was reached in 2019. Conclusion: There is evidence of a change in the gender composition of Peruvian dental specialties, currently with a female predominance.

Changes in Televisit Modalities Due to the COVID Pandemic in Chile: A Comparison of Patient Satisfaction.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted healthcare guidelines and modalities of patient consultation worldwide. The frequent cycles of quarantine confinement in Chile have caused mobility restrictions for patients and physicians, forcing the Hospital Las Higueras de Talcahuano (HHT) to replace the assisted televisit modality with a more classic televisit program. Here we have described if this change in televisit modality and type of outpatient may have impacted patients' satisfaction. METHODS: The patient's perception of satisfaction was evaluated through self-administered survey questionnaires previously validated in Spanish. Cohorts were grouped according to the following two relational models: (i) assisted televisit, 503 neurology patients from 2018 to 2019, and (ii) televisit, 831 patients from different specialties treated during 2020. Perception of satisfaction was compared by gender, age, and type of televisit, and internal consistency (Cronbach alpha) and reliability (factorial analysis of principal components) were assessed. Finally, we compared the patient satisfaction of both modalities. RESULTS: Questionnaires showed excellent internal consistency; all items showed point biserial correlations greater than 0.30. Assisted televisit and televisit cohorts comprised 64.2% and 67.6% females, respectively, and patients under the age of 65 years were 62.2% and 75%, respectively. Assisted televisit patients showed very high 94.4% (n=475) and high 5.2% (n=26) satisfaction levels, while televisit patients showed very high 22.3% (n=185), high 63.9% (n=531), and moderate 13.1% (n=109) satisfaction levels; this difference was statistically significant at p<0.001. CONCLUSION: Lower perception of satisfaction due to the change in televisit relational modality underscores the importance of primary care professionals who support the specialist in the assisted televisit model. However, the televisit modality showed high patient satisfaction and suggested that this modality can be a plausible alternative according to each location's reality. The results of this study indicate that both assisted televisit and televisit contribute to delivering an integrative solution that helps to alleviate the system's fragmentation.

Clínicas Populares de Saúde a partir da perspectiva de empresários e de representantes da classe médica / Popular Health Clinics from the perspective of entrepreneurs and representatives of the medical profession

Resumo Este artigo pretende compreender a perspectiva de empresários de Clínicas Populares de Saúde (CPS) e representantes da classe médica sobre serviços ofertados pelo setor; impactos decorrentes da pandemia covid-19; e futuro do mercado de trabalho médico. Trata-se de pesquisa qualitativa, da área de saúde coletiva, com enfoque nas representações sociais. Foram realizadas entrevistas semiestruturadas, entre março e julho de 2021, com quatro empresários locais e três representantes de classe médica de uma cidade da região Nordeste do Brasil. As CPS ofertam serviços assistenciais restritos a consultas e exames e com estratégias de lógica financeirizada; se apresentam como "alternativa" ao SUS, uma suposta "lacuna" entre planos de saúde privados e serviços públicos, e como "novo" trabalho médico. As empresas ofertam consultas com especialistas a preços "populares" e sem fila de espera. A assistência prestada é restrita e os profissionais não têm garantia de direitos trabalhistas. Para os entrevistados, o acesso à saúde representa acessibilidade geográfica e temporal de serviço a preço reduzido. O direito universal à saúde e princípios do SUS são confrontados com a defesa da autonomia dos clientes e dos profissionais visando suas necessidades: saúde e trabalho.

Abstract The objective is to understand the perspective of entrepreneurs from Popular Health Clinics (PHC) and representatives of the medical profession on services offered by the sector; impacts resulting from the COVID-19 pandemic; and future of the medical job market. This is a qualitative research, in the area of collective health, focused on social representations. Semi-structured interviews were carried out, from March to July 2021, with four local entrepreneurs and three representatives of the medical profession from a municipality in the Northeast region of Brazil. PHC offer assistance services restricted to consultations and exams and with financialized logic strategies. The PHC are presented as an "alternative" to the SUS, a supposed "gap" between private health plans and public services, and as a "new" medical work. Companies offer consultations with specialists at "popular" prices and without a waiting list. The assistance provided is restricted and professionals have no guarantee of labor rights. For those interviewed, access to healthcare represents geographic and temporal accessibility of services at a reduced price. The universal right to health and SUS principles are confronted with the defense of the autonomy of clients and professionals targeting their needs: health and work.

Comportamiento humano de los presidentes de los comités académicos de las especialidades médicas / Human Behavior in the Chairpersons to the Academic Committees of Medical Specialties

Introducción: Para las ciencias médicas resulta clave el papel del presidente del Comité Académico de la especialidad por lo complejo que resulta la conducción de los procesos de formación de los residentes, dada la diversidad de las especialidades, los escenarios docentes y la creciente matrícula. Objetivo: Identificar las potencialidades y debilidades en el comportamiento humano de los presidentes de los comités académicos de las especialidades médicas en la Facultad de Ciencias Médicas Calixto García. Métodos: Se realizó un estudio de desarrollo de corte educacional. Se emplearon métodos teóricos y empíricos, acompañados por un conjunto de procesos lógicos del pensamiento: análisis, síntesis, abstracción, generalización, entre otros. Resultados: Mediante la triangulación de los resultados de los indicadores evaluados, se identificaron como potencialidades el dominio de la lógica del plan de estudio y los elementos que integran el programa de formación; entre las debilidades educativas, el nivel para realizar la preparación de los profesores sobre el sistema de evaluación en el régimen de residencia; y, dentro de las debilidades organizativas, el nivel de aplicación de los documentos rectores para la formación de residentes. Conclusiones: Se realizó la identificación del estado del comportamiento humano de los presidentes de los comités académicos de las especialidades médicas en la Facultad de Ciencias Médicas Calixto García, lo que constituye el punto de partida para el diseño de actividades educativas continuas, permanentes y contextualizadas a la práctica pedagógica de los presidentes, encaminados al mejoramiento del comportamiento humano(AU)

Introduction: For medical sciences, the role of a Chairperson to the Academic Committee of any specialty is paramount, due to the complexity of conducting the training of residents, given the diversity of specialties, the teaching scenarios and the growing enrollment. Objective: To identify the potentialities and weaknesses in the human behavior of the chairpersons to the academic committees of medical specialties at Facultad de Ciencias Médicas Calixto García. Methods: An educational development study was carried out. Theoretical and empirical methods were used, accompanied by a set of logical thought processes: analysis, synthesis, abstraction, generalization, among others. Results: Through the triangulation of the results of the evaluated indicators, the mastery of the logic of the study plan and the elements making up the training program were identified as potentialities; together with, among the educational weaknesses, the level to carry out the training of professors concerning the evaluation system in the residence regime; as well as, within the organizational weaknesses, the level of application of the guiding documents for the training of residents. Conclusions: The state of human behavior in the chairpersons to the academic committees of medical specialties at Facultad de Ciencias Médicas Calixto García was identified, being the starting point for the design of continuous and permanent educational activities contextualized according to the pedagogical practice of the chairpersons, aimed at the improvement of human behavior(AU)

Factores de prescripción antibiótica en infección urinaria en un hospital de Huánuco / Antibiotic Prescription Factors in Urinary Tract Infection in a Hospital in Huánuco

Introducción: La infección del tracto urinario tiene impacto mundial por ser causa común de prescripción antibiótica empírica, por lo que la elección del tratamiento representa un desafío para el médico. Objetivos: Identificar los factores asociados a una adecuada prescripción antibiótica empírica en pacientes con infección del tracto urinario. Métodos: Se realizó un estudio analítico transversal. Se revisaron 275 resultados de urocultivos positivos de febrero a octubre del 2019, se excluyeron 97 debido a que no cumplieron los criterios de selección, quedaron 178 como población elegible. Se revisaron las historias clínicas de estos pacientes diagnosticados en los consultorios externos del Hospital Regional Hermilio Valdizán, Perú. Para el análisis bivariado se utilizó el test estadístico ji al 2, prueba de Fisher, la razón de prevalencia (RP), intervalos de confianza al 95 por ciento y p 0,05). Conclusiones: La prescripción antibiótica empírica en infecciones urinarias a menudo es inadecuada, por la complacencia durante el tratamiento. La prescripción empírica de antibióticos es adecuada en pacientes con diabetes y con riesgo de infección por el uropatógeno Klebsiella, ya que los pacientes con diabetes tienen riesgo de infección con cepas resistentes y los médicos son más cautelosos al recetar antibióticos(AU)

Introduction: Urinary tract infection has a global impact as it is a common cause of empirical antibiotic prescription, so the choice of treatment represents a challenge for the doctor. Objective: To identify the factors associated with an adequate empirical antibiotic prescription in patients with urinary tract infection. Methods: A cross-sectional analytical study was carried out in 275 positive urine culture results, which were reviewed from February to October 2019. Ninety-seven were excluded because they did not meet the selection criteria, 178 remained as an eligible population. The medical records were reviewed for these patients diagnosed in the outpatient clinics of Hermilio Valdizán Regional Hospital, Peru. For the bivariate analysis, chi-2 statistical test, Fisher's test, the prevalence ratio (PR) were used. 95percent confidence intervals and p 0.05). Conclusions: Empirical antibiotic prescription in urinary infections is often inadequate, due to complacency during treatment. Empirical prescription of antibiotics is appropriate in patients with diabetes and at risk of infection with the uropathogen Klebsiella, since patients with diabetes are at risk of infection with resistant strains and physicians are more cautious when prescribing antibiotics(AU)

Câncer de boca no Estado do Rio de Janeiro: cuidado e rede de atenção a partir do Centro de Especialidades Odontológicas (CEO) / Oral cancer in the state of Rio de Janeiro: care and care network from the Dental Specialties Center (DSC)

O câncer (CA) de boca representa um problema de saúde pública a nível mundial, com altas taxas de morbimortalidade. A desvalorização das lesões iniciais pelo profissional, somada à incapacidade técnica de reconhecimento dessas lesões, a demora do atendimento, erros no diagnóstico inicial, assim como a ausência de campanhas sobre a doença e seus fatores de risco, são fatores que diminuem as chances de diagnóstico do CA de boca em seus estágios iniciais. Para realização do diagnóstico precoce das lesões potencialmente malignas ou suspeitas de malignidade, é fundamental contar com uma rede de atenção à saúde estruturada e organizada, com profissionais capacitados para identificar as lesões em estágio inicial e realizar a biópsia para fins diagnósticos e posterior análise em laboratório que possua profissional especializado em anatomia patológica. O presente estudo teve como objetivo discutir o papel e desempenho dos Centros de Especialidades Odontológicas (CEOs) em relação ao procedimento de coleta de biópsia de tecidos moles da boca no Estado do Rio de Janeiro, com finalidade diagnóstica, considerando seu papel na oferta deste procedimento. Trata-se de uma pesquisa descritiva e exploratória acerca do papel e desempenho dos CEOs com foco na oferta do exame de diagnóstico do CA de boca por estes centros, no período de 2017 a 2019. Os resultados apontam que os CEOs possuem um papel central para o diagnóstico do câncer de boca, mas aquém do que potencialmente poderia ofertar já que não houve produção de biópsias em 47 (57%) dos 82 CEOs existentes, no período analisado. Um dos limites do trabalho foi a incapacidade de avaliação dos sistemas de apoio, assim como a contribuição dos serviços de saúde das universidades para as análises desses exames devido a insuficiência de dados públicos sobre os exames anatomopatológicos específicos para o câncer de boca. Tais resultados buscam fornecer subsídios para que os gestores de saúde possam otimizar o fluxo dos usuários através da organização e do fácil acesso à rede, identificando e solucionando dificuldades enfrentadas por estes centros para a realização destes procedimentos, reduzindo atrasos na investigação diagnóstica e no tratamento desta patologia. (AU)

Mouth cancer (CA) represents a public health problem worldwide, with high morbidity and mortality rates. The devaluation of initial injuries by the professional, combined with the technical inability to recognize these injuries, as well as the delay in public assistance, errors in the initial diagnosis, as well as the lack of campaigns about the disease and its risk factors, are factors that reduce the chances diagnosis of oral CA in its initial stages. To carry out early diagnosis of potentially malignant and suspected malignant lesions, it is essential to have a structured and organized health care network, with professionals trained to identify lesions at an early stage and perform biopsy for diagnostic purposes and subsequent analysis in the laboratory. that has a professional specialized in pathological anatomy. In this sense, the present study aimed to discuss the role and performance of Dental Specialty Centers (CEOs) in relation to the procedure for collecting soft tissue biopsies from the mouth in the State of Rio de Janeiro, with diagnostic purposes, considering their role in offering this procedure. The study is a descriptive and exploratory research on the role and performance of CEOs with a focus on offering diagnostic examinations for oral CA by these centers, from 2017 to 2019. The results indicate that CEOs have a central role in the diagnosis of oral cancer, but below what they could potentially offer as there was no production of biopsies in 47 CEOs (57%) of the 82 existing CEOs in the period analyzed. One of the limits of the work was the inability to evaluate support systems, as well as the contribution of university health services to the analysis of these exams due to insufficient public data on specific anatomopathological exams for oral cancer. Such results seek to provide support so that health managers can optimize the flow of users through the organization and easy access to the network, identifying and resolving difficulties faced by these centers in carrying out these procedures, reducing delays in diagnostic investigation and treatment of this condition. (AU)

Regulation of dental consultations in primary health care and performance of services in dental speciality centers.

OBJECTIVE: This study analyzed the regulation of dental specialty centers (CEOs) coordinated exclusively by Primary Health Care (PHC) in four primary outcomes: access and dental consultation, reception services, bonding and responsibility, and social participation. METHODS: A cross-sectional study was carried out using secondary data from the National Program for the Improvement of Access and Quality of Dental Specialty Centers (PMAQ-CEO): second cycle, using multilevel logistic regression to calculate the odds ratio (OR) and individual covariates. RESULTS: The analytical sample consisted of 9,599 CEO users who had completed all the variables analyzed. Of these, 63.5% were referred to the CEO by PHC. Dental care regulated by PHC was related to better access (OR 1.36, CI 95% 1.10-1.68), better reception (OR 1.33, CI 95% 1.03-1.71), better bonding and responsibility (OR 1.36, CI 95% 0.91-2.04), and social participation (OR 1.13, CI 95% 0.93-1.35) compared to those not regulated by primary health care as the exclusive pathway. CONCLUSION: The regulation of access to the CEO coordinated by PHC presented the best performance. It is suggested that this form of PHC regulation, as a route for dental specialty centers, can be established in the national oral health care policy for better service performance.

Consideraciones acerca del informe operatorio / Considerations about the operation note

El informe operatorio es un documento oficial que forma parte indispensable de la historia clínica. A pesar de que se le atribuyen funciones médicas (asistencial, docente e investigativa), legal y administrativas, con frecuencia no cumple las especificidades requeridas en la redacción. El permanente y continuo mejoramiento del desempeño profesional de los cirujanos demanda el rescate de las especificidades para la confección de tan importante documento. Es considerada una habilidad profesional específica de los médicos de las especialidades quirúrgicas, al ser parte de la práctica quirúrgica habitual e incluye aspectos cuantitativos (formales y sustanciales) y cualitativos (contenido informativo), de obligatorio cumplimiento por especialistas y residentes en formación. Constituye una responsabilidad individual que debe ser controlada por directivos y docentes de cada servicio quirúrgico. Este trabajo expresa la posición de la autora sobre el necesario rescate de la calidad de la confección del informe operatorio como parte indispensable de la seguridad del enfermo quirúrgico(AU)

The operation note is an official document that is an indispensable part of the clinical history. Despite the fact that medical (care, teaching and investigative), legal and administrative functions are attributed to it, it frequently does not meet the specificities required in the wording. The permanent and continuous improvement of the professional performance of surgeons demands the rescue of the specificities for the preparation of such an important document. It is considered a specific professional skill for physicians in surgical specialties, as it is part of routine surgical practice and includes quantitative (formal and substantial) and qualitative (informational content) aspects, of mandatory compliance by specialists and residents in training. It constitutes an individual responsibility that must be controlled by directors and teachers of each surgical service. This work expresses the author's position on the necessary rescue of the quality of the preparation of the operation note as an essential part of the safety of the surgical patient(AU)

Preference of medical specialties among medical students in a Chilean university. / Preferencia de especialidades médicas en estudiantes de medicina de una universidad chilena.

This study describes medical specialty preferences expressed by medical students at a regional university in northern Chile. This descriptive study is based on primary information with a sample of 266 valid responses and a response rate of 58.7%. The information was collected through a Google Forms questionnaire before voluntary consent of participation from May to July 2022. We found that the medical specialties preferred by the Universidad Católica del Norte students were clinical specialties, including internal medicine, and medical-surgical specialties, including emergency medicine and gynecology-obstetrics. Women markedly predominated in child and adolescent psychiatry, gynecology-obstetrics, pediatric surgery, pediatrics, and family medicine, while men predominated in radiology and anesthesiology, both associated with indirect patient interaction. We also found that surgical specialties, traditionally preferred by men, could be in the process of generational change, as there is an increase in the presence of women, especially in general surgery.

En este trabajo se describen las preferencias de elección de especialidad médica que manifiestan los estudiantes de la carrera de medicina de una universidad regional del norte de Chile. Se trata de un estudio descriptivo basado en información primaria con una muestra de 266 respuestas válidas, con una tasa de respuesta de 58,7%. La información se recogió a través de un cuestionario disponible en Google Forms, previo consentimiento voluntario de participación, durante los meses de mayo a julio de 2022. Se encontró que las especialidades médicas preferidas por los estudiantes de la Universidad Católica del Norte fueron las especialidades clínicas como medicina interna y las médico-quirúrgicas como medicina de urgencias y ginecología-obstetricia. Además, existen especialidades con un claro predominio femenino como psiquiatría infanto-adolescente, ginecología-obstetricia, cirugía pediátrica, pediatría y medicina familiar, mientras que el predominio masculino destaca en radiología y anestesiología, ambas asociadas a un trato indirecto con el paciente. Se observó que las especialidades quirúrgicas, tradicionalmente preferidas por hombres, podrían estar en proceso de cambio generacional, aumentando la presencia femenina en ellas, sobre todo en cirugía general.

Preferencia de especialidades médicas en estudiantes de medicina de una universidad chilena / Preference of medical specialties among medical students in a Chilean university

En este trabajo se describen las preferencias de elección de especialidad médica que manifiestan los estudiantes de la carrera de medicina de una universidad regional del norte de Chile. Se trata de un estudio descriptivo basado en información primaria con una muestra de 266 respuestas válidas, con una tasa de respuesta de 58,7%. La información se recogió a través de un cuestionario disponible en Google Forms, previo consentimiento voluntario de participación, durante los meses de mayo a julio de 2022. Se encontró que las especialidades médicas preferidas por los estudiantes de la Universidad Católica del Norte fueron las especialidades clínicas como medicina interna y las médico-quirúrgicas como medicina de urgencias y ginecología-obstetricia. Además, existen especialidades con un claro predominio femenino como psiquiatría infanto-adolescente, ginecología-obstetricia, cirugía pediátrica, pediatría y medicina familiar, mientras que el predominio masculino destaca en radiología y anestesiología, ambas asociadas a un trato indirecto con el paciente. Se observó que las especialidades quirúrgicas, tradicionalmente preferidas por hombres, podrían estar en proceso de cambio generacional, aumentando la presencia femenina en ellas, sobre todo en cirugía general.

This study describes medical specialty preferences expressed by medical students at a regional university in northern Chile. This descriptive study is based on primary information with a sample of 266 valid responses and a response rate of 58.7%. The information was collected through a Google Forms questionnaire before voluntary consent of participation from May to July 2022. We found that the medical specialties preferred by the Universidad Católica del Norte students were clinical specialties, including internal medicine, and medical-surgical specialties, including emergency medicine and gynecology-obstetrics. Women markedly predominated in child and adolescent psychiatry, gynecology-obstetrics, pediatric surgery, pediatrics, and family medicine, while men predominated in radiology and anesthesiology, both associated with indirect patient interaction. We also found that surgical specialties, traditionally preferred by men, could be in the process of generational change, as there is an increase in the presence of women, especially in general surgery.

Overview on and Contextual Determinants of Medical Residencies in North Brazil.

The aim of this study was to analyze the scenario of medical residency programs (MRPs) in the north region of Brazil as well as the contextual determinants (socioeconomic, structural, and epidemiological) influencing the number of MRPs in this region. An ecological study was conducted using MRPs data from 2022. This study used multiple data sources. MRP indicators were described based on the Brazilian state and specialty. The dependent variable was the number of MRPs. The independent variables included sociodemographic, structural, and epidemiological factors. Poisson regression was performed to analyze the association between contextual variables and the number of MRPs. The results showed that only 3.6% of the municipalities had authorized MRPs. The idleness rate in the region was 46.0%, with family and community medicine as the specialties with the greatest idleness. The total density of authorized vacancies in the MRPs was 14.0 vacancies per 100,000 inhabitants. The models showed that with each increase of one unit of the vulnerability index (Socioeconomic Index in the Geographic Context for Health Studies-GeoSES), the number of MRPs increased, ranging from 8122 (p value < 0.001) to 11,138 (p value < 0.001). With each increase in undergraduate degrees in medicine, the number of MRPs increased by 0.945 (p value < 0.001). With each increase of 1 physician per 1000 population, the number of MRPs increased from 0.537 (p value < 0.001) to 0.845 (p value < 0.001). With each increase of one unit in general hospitals, specialized hospitals, teaching hospitals, and primary healthcare units, the number of MRPs increased by 0.176 (p value < 0.001), 0.168 (p value < 0.001), 0.022 (p value < 0.001) and 0.032 (p value < 0.001), respectively. Finally, with each increase of one death per 100,000 inhabitants, the overall mortality rate increased, ranging from 0.006 (p value < 0.001) to 0.022 (p value < 0.001). The study showed a low supply of MRPs in the northern region, a high rate of idleness, and important socioeconomic, structural, and epidemiological determinants of the number of MRPs.

Variables, indicadores y criterios de evaluación del servicio médico como escenario de formación de especialistas

La calidad de la educación de posgrado concebida estratégicamente como la integración de la pertinencia social y la excelencia académica, deviene esencial en la gestión de las instituciones docente-asistenciales del sector salud. Sus múltiples dimensiones deben ser contextualizadas y son susceptibles de análisis y perfeccionamiento en cada servicio médico donde se desarrolla el proceso de formación de especialistas. Se utilizaron métodos teóricos y empíricos, para la identificación de las dificultades y la elaboración de la nueva propuesta. Se obtuvieron criterios sobre los servicios médicos como escenarios de formación, en los que se identificaron los problemas relativos a la actividad de posgrado. La propuesta consideró las directrices estratégicas, la población objeto de atención y los diferentes ámbitos temporales y espaciales identificados, con lo que pretende el fortalecimiento y desarrollo de la formación de posgrado en las Universidades de Ciencias Médicas en Cuba.

The quality of postgraduate education, strategically conceived as the integration of social relevance and academic excellence, becomes essential in the management of teaching-assistance institutions in the health sector. Its multiple dimensions must be contextualized and are susceptible to analysis and improvement in each medical service where the specialist formation process takes place. Theoretical and empirical methods were used, for the identification of the difficulties and the elaboration of the new proposal. Criteria on medical services were obtained as training scenarios, in which problems related to postgraduate activity were identified. The objective of the work is to expose a proposal of variables, indicators and evaluation criteria in the service as a scenario the specialist's formation. The proposal was considered the strategic guidelines, the target population and the different temporal and spatial areas identified, with which it intends to strengthen and develop postgraduate training in the Medical Sciences Universities in Cuba.

Propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología / A proposal of specific professional competences for the training of gastroenterology specialists

Introducción: La formación con calidad del capital humano en el sector salud constituye un reto para la educación médica cubana contemporánea. La formación académica, en particular la especialidad, tiene el cometido de formar un profesional con alta competencia y avanzadas capacidades para el desempeño especializado, solidez de los principios ético-morales y elevada calificación científico-técnica, por lo que el desarrollo de competencias profesionales resulta una prioridad para la formación de los especialistas biomédicos. Objetivo: Elaborar una propuesta de competencias profesionales específicas para la formación de los especialistas en gastroenterología. Métodos: Se realizó un estudio educacional, de investigación aplicativa, bajo el enfoque general dialéctico-materialista, con fundamento en teorías y enfoques filosóficos, psicológicos y legales de las leyes de la educación, y de la educación médica en particular. Asimismo, se utilizaron métodos teóricos, empíricos y estadístico-matemáticos. Resultados: Se elaboró una definición operativa de competencias profesionales específicas en gastroenterología, a partir del estudio del sistema de competencias y de la sistematización de los documentos rectores en dicha formación. También se identificaron y definieron las competencias profesionales específicas en las áreas asistencial, docente, investigativa y de dirección, que posibilitaron la mejora en el desempeño profesional de los futuros especialistas. Conclusiones: La formación basada en el desarrollo de competencias profesionales específicas constituye una prioridad para la educación médica y la salud pública cubana contemporánea, en aras de elevar la calidad del proceso formativo en la especialidad de gastroenterología y la atención médica que brindan estos galenos en los niveles de atención en salud(AU)

Introduction: The quality training of human capital in the health sector is a challenge for contemporary Cuban medical education. Academic training, particularly the residence, has the task of training a professional with high competence and advanced capabilities for specialized performance, solid ethical-moral principles and high scientific-technical qualification; therefore, the development of professional competences is a priority for the training of biomedical specialists. Objective: To elaborate a proposal of specific professional competences for the training of gastroenterology specialists. Methods: An educational study of applicative research was carried out under the general dialectical-materialistic approach and based on philosophical, psychological and legal theories and approaches of the laws of education and, particularly, of medical education. Theoretical, empirical and statistical-mathematical methods were also used. Results: An operational definition of specific professional competences in gastroenterology was elaborated, based on the study of the system of competences and the systematization of the guiding documents for such training. Specific professional competences were also identified and defined in the care, teaching, research and management areas, which allowed to improve the professional performance of future specialists. Conclusions: Training based on the development of specific professional competences is a priority for contemporary Cuban public health and medical education, in view of raising the quality of the training process in the specialty of gastroenterology and the medical care provided by these physicians at the levels of healthcare(AU)

Specialized Dental Care in the Brazilian Unified National Health System (SUS)

ABSTRACT Objective: To analyze specialized dental care through access, demand and the work processes provided by the CEO's, using secondary data from the cycles of the PMAQ-CEO. Material and Methods: Cross-sectional study using public domain data. Variables of interest were selected from the external evaluation instrument data matrices and were grouped in categories. The categories were geographic distribution, structural, human resources, work processes and access and coordination. Results: The total of 932 CEO's were evaluated in 2014 and 1,042 in 2016, most of them type II, present in the Northeast region. In both cycles, the highest average of dentists worked in the endodontic specialty (2.4 professionals per CEO) and the lowest in oral medicine (0.8 professionals per CEO). Of the two cycles, 91.5% of the CEO's had a manager, 79.5% performed action planning activities and 74.5% realized internal self-assessment processes. There was an increase in the mean number of days to be seen at the CEO in all analyzed specialties (p<0.001) and 85.2% of the CEO's managers reported that there is a reference for oral cancer confirmed cases. Conclusion: Between the PMAQCEO cycles the number of CEO has increased, but there are still a big pent-up demand and the presence of care gaps. However, an expansion and improvement of the CEO's actions was evidenced, mainly related to the work processes.

Intenções de graduandos de Medicina em face dos preditores de fixação: Programa Mais Médicos na Bahia / Medicine graduates intentions in the face of establishment predictors: Bahia's Mais Médicos Program

Resumo: Introdução: O déficit quantitativo e as desigualdades na distribuição de médicos agravam a crise global da força de trabalho em saúde. Muitas políticas têm sido adotadas para enfrentamento do problema, destacando-se pela sua abrangência o Programa Mais Médicos. Objetivo: Este estudo objetivou caracterizar, entre graduandos de Medicina do estado da Bahia, as intenções de especialidade médica futura e de fixação em áreas prioritárias definidas pelo Programa Mais Médicos, conforme os preditores apontados na literatura. Método: Trata-se de um estudo de corte transversal com caráter exploratório, realizado com estudantes dos cursos de Medicina de quatro universidades federais da Bahia. Resultado: Predominaram estudantes de 20 a 24 anos, com perfil socioeconômico mais baixo em relação aos estudos anteriores, naturais dos pequenos e médios municípios baianos, que afirmaram, em sua maioria, a opção pela residência médica em especialidades de outras áreas, que não as áreas básicas, após a graduação. Verificou-se uma disparidade entre o percentual de estudantes com intenção de trabalhar na atenção primária à saúde e aqueles que desejaram especialidades básicas, sendo ainda consideravelmente menor a opção pela medicina de família e comunidade. As estudantes do sexo feminino predominaram de modo evidente entre aqueles que desejaram as especialidades de áreas básicas e que vislumbraram um futuro trabalho na atenção primária à saúde, nesse estado. De modo contrário, os estudantes do sexo masculino escolheram, na sua maioria, especialidades de outras áreas, especialmente aqueles que tiveram os aspectos financeiros como motivação principal para escolha de carreira. Conclusão: O estudo acrescentou conhecimento ao corpo de literatura sobre as mudanças na formação médica no país e os efeitos de políticas indutoras de um perfil profissional generalista que atenda às necessidades sociais da população.

Abstract: Introduction: The quantitative deficit and inequalities in the distribution of doctors exacerbate the global health workforce crisis. Many policies have been adopted to face the problem, with the 'Mais Médicos' Program standing out due to its scope. Objective: This study aimed to characterize, among undergraduate medical students in the state of Bahia, the intentions of future medical specialty and professional retention in priority areas defined by the More Doctors Program (PMM), according to the predictors indicated in the literature. Methods: This is a cross-sectional exploratory study conducted with medical students from four federal universities in the state of Bahia. Results: The study predominantly included students aged 20 to 24 years, with a lower socioeconomic profile in relation to previous studies, born in small and medium-sized municipalities in the state of Bahia, who mostly stated their option for medical residency in specialties other than the basic areas after graduation. An inequality was observed between the percentage of students who intended to work in Primary Care and those who wanted basic specialties, with the option for Family and Community Medicine being even lower. Female students clearly predominated among those who desired basic specialties and who envisioned a future employment in Primary Care in this state. Conversely, male students mostly chose specialties in other areas, especially those who had financial aspects as the main motivation for career choice. Final considerations: The study added knowledge to the body of literature on changes in medical training in the country and the effects of policies leading to a generalist professional profile that meets the social needs of the population.

Vivencias y experiencias en las relaciones sociales durante la formación académica de médicos especialistas

Introducción: La formación académica en las especialidades médicas es un proceso continuo de entrenamiento teórico y práctico en el que las y los residentes interactúan constantemente con los coordinadores del programa, con residentes de diferentes programas y las y los trabajadores de los escenarios de prácticas. Se investigó por medio de entrevistas las relaciones que se presentan en diferentes especialidades. Objetivo: Conocer las vivencias y experiencias de la jerarquía de las y los residentes durante su proceso de formación en los escenarios de prácticas. Método: Estudio cualitativo de corte fenomenológico que aplicó entrevistas semi-estructuradas a 42 estudiantes de especialidades médico-quirúrgicas como: cirugía plástica, ginecología, medicina crítica, medicina interna, neurología, pediatría y psiquiatría, revisando de la batería de riesgo psicosocial el dominio de relaciones sociales y liderazgo. Resultados: Las y los entrevistados expresaron 195 referencias relacionadas con sus experiencias en las que el liderazgo de los coordinadores del programa es descrito como una interacción significativa que genera malestar psicológico o protección, junto con 158 referencias de estilo de retroalimentación en algunas vivencias, escaso o centrado en una nota cuantitativa, y 156 referencias de cómo veían la relación con sus residentes mayores desde una perspectiva jerárquica. Conclusiones: Las características de la jerarquía durante la residencia están determinadas por el estilo de liderazgo del coordinador del programa y los residentes replican el mismo modelo con sus compañeros de mismo año, superiores y residentes menores.

Introduction: Academic training in medical specialties is a continuous process of theoretical and practical training where residents constantly interact with program coordinators, residents of different programs and workers in internship scenarios; the relationships that occur in different residences were investigated through interviews. Objective: To know the life experiences of the hierarchy of resident doctors during their training process in the practice settings. Method: Qualitative phenomenological study that uses semi-structured interviews with 42 students of medical-surgical specialties such as: plastic surgery, gynecology, critical medicine, internal medicine, neurology, pediatrics and psychiatry, reviewing the psychosocial risk battery domain of social relations and leadership. Results: The interviewees expressed 195 references related to their experiences where the leadership of the program coordinators is described as a significant interaction generating psychological or protective discomfort, along with 158 references of feedback style in some experiences, scarce or focused on a quantitative note and 156 references of how they saw the relationship with their older residents from a hierarchical perspective. Conclusions: The characteristics of the hierarchy in the residence are determined by the leadership style of the program coordinator and the residents replicate the same model with their peers of the same year, superiors and minor residents.

Inteligencia artificial en medicina y procedimientos quirúrgicos: impacto en la toma de decisiones y la salud / Artificial Intelligence in Medicine and Surgical Procedures: Impact on Decision Making and Health

Introducción: Las revisiones sistemáticas de la literatura constituyen una herramienta metodológica práctica para la búsqueda de información sobre investigaciones clínicas, aplicaciones tecnológicas y la toma de decisiones de impacto en la salud. Objetivo: Describir cómo influye la inteligencia artificial en la toma de decisiones médicas según el grado de concordancia entre estas evidencias y los sistemas expertos aplicados en las especialidades clínicas y quirúrgicas de impacto en la salud, según reportes entre 2010 y 2019. Métodos: Se realizó una revisión sistemática con el uso de un modelo de bases de datos relacional y un modelo de entidad relación para garantizar la entidad referencial de la que hacen parte las bases de datos y los artículos, así como la calidad de cada uno de los artículos mediante clasificación por grados de concordancia entre muy concordante o no concordante con la temática de interés y la toma de decisiones de impacto en la salud. Conclusiones: Las aplicaciones como los sistemas expertos, los aprendizajes de máquinas y la robótica aportan innovación a las instituciones y un cambio revolucionario en lo académico, clínico y epidemiológico(AU)

Introduction: Systematic reviews of the literature constitute a practical methodological tool for the search of information on clinical research, technological applications and health impact decision-making. Objectives: To describe how artificial intelligence influences medical decision-making according to the degree of agreement between this evidence and the expert systems applied in clinical and surgical specialties with an impact on health, according to reports from 2010 to 2019. Methods: A systematic review was conducted with the use of a relational database model and a relationship entity model to guarantee the referential entity of which the databases and articles are part, as well as the quality of each of the articles classified by degrees of agreement between very concordant or not concordant with the topic of interest and the decision making of impact on health. Conclusions: Applications such as expert systems, machine learning and robotics bring innovation to institutions and a revolutionary change in academic, clinical and epidemiological areas(AU)

Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas / Care models at the second level: Experience of the Medical Specialties Unit

Resumen Objetivo: Reportar la implementación y los beneficios del Modelo de atención integral en el segundo nivel: Experiencia de la Unidad de Especialidades Médicas, su utilidad en el manejo y seguimiento de los pacientes con enfermedades crónicas. Material y métodos: Se lograron implementar 9 consultorios de atención médica de la siguiente forma, 2 de Endocrinología, 3 consultorios de Clínica de Enfermedades Crónicas, uno de educación en diabetes e hipertensión, así como 3 de apoyo nutricional. Se midió valores absolutos del número de consultas durante los años 2017, 2018, 2019 y parte del 2020. Así mismo se buscó identificar las patologías más prevalentes con la idea en tener un mejor control y seguimiento de los pacientes, con una mejor organización de personal de atención médico y de enfermería. Resultados y discusión: Se lograron incrementar los números de consulta, con un control y seguimiento más estricto de los pacientes, además de los beneficios en cuanto a la formación y capacitación de médicos residentes, generales tanto militares como profesionales de la salud civiles para enfrentar estos padecimientos prevalentes en nuestro país.

Abstract Objective: To report the implementation as well as the benefits of the Comprehensive Care Model at the second level: Experience of the Medical Specialties Unit, and assess its usefulness in the management and monitoring of patients with chronic diseases. Material and methods: 9 medical care clinics were implemented as follows, 2 for Endocrinology, 3 Clinics for Chronic Diseases, one for education in diabetes and hypertension, as well as 3 for nutritional support. Absolute values of the number of consultations were measured during the years 2017, 2018, 2019 and part of 2020. Likewise, it was sought to identify the most prevalent pathologies with the idea of having a better control and monitoring of patients, with a better organization of medical and nursing care personnel. Results and discussion: It was possible to increase the consultation numbers, with a stricter control and monitoring of patients, in addition to the benefits in terms of training and training of resident doctors, both military generals and civilian health professionals to face these prevalent conditions in our country.

Valoraciones sobre el procesamiento de información en investigaciones asociadas a especialidades médicas / Assessments on the processing of information in research associated with medical specialties

RESUMEN El presente trabajo tiene como objetivo valorar las regularidades de los principales problemas que se evidencian en el uso y empleo de la dinámica del procesamiento de la información en investigaciones asociadas a especialidades médicas, a partir de una selección de tesis vinculadas a la especialidad de Medicina General Integral y de otras especialidades médicas defendidas en los últimos 5 años en la Universidad de Ciencias Médicas de Camagüey. Los principales resultados de la revisión documental se centran en deficiencias en la presentación e interpretación de la naturaleza de las relaciones entre las variables del diseño metodológico y las técnicas estadísticas que se utilizan desde el diseño, ejecución y presentación del resultado científico.

SUMMARY The present work aims to assess the regularities of the main problems that are evidenced in the use and employment of the dynamics of information processing in research associated with medical specialties, from a selection of theses linked to the specialty of Comprehensive General Medicine and other medical specialties defended in the last 5 years at the University of Medical Sciences of Camagüey. The main results of the documentary review focus on deficiencies in the presentation and interpretation of the nature of the relationships between the variables of the methodological design and the statistical techniques that are used from the design, execution and presentation of the scientific result.

Posicionamiento conceptual metodológico para el examen estatal en anatomía humana / A conceptual-methodological stance for the state examination of human anatomy

Introducción: El examen estatal en las especialidades médicas cubanas es un garante de calidad en las competencias y el desempeño profesional. Su calidad técnica y metodológica debe ser objeto de perfeccionamiento permanente como acción responsable hacia la excelencia académica. Objetivo: Promover un posicionamiento conceptual metodológico para el perfeccionamiento del examen teórico práctico de la especialidad anatomía humana. Métodos: Se emplearon el analítico sintético, la observación participativa y la revisión documental. Resultados: Se obtuvo una propuesta valorativa en el contexto de la especialización en anatomía humana, con acciones específicas para el perfeccionamiento del examen práctico y teórico de esta especialidad. Conclusiones: Los fundamentos teóricos y prácticos presentados son pertinentes para superar debilidades en los exámenes estatales anteriores, y favorecer en el residente de anatomía humana el desarrollo de un pensamiento holístico durante su proceso de formación, con beneficio de mayores competencias y mejor desempeño docente e investigativo(AU)

Introduction: The state examination in Cuban medical specialties ensure quality in competences and professional performance. Its technical and methodological quality should be subjected to permanent improvement as a responsible action towards academic excellence. Objective: To promote a conceptual-methodological stance for the improvement of the practical-theoretical examination of the Human Anatomy specialty. Methods: The methods of analysis-synthesis, participative observation and documental review were used. Results: An assessment proposal was obtained in the context of the specialization in Human Anatomy, with specific actions for the improvement of the practical and theoretical examination of this specialty. Conclusions: The theoretical and practical foundations presented are pertinent to overcome weaknesses of previous state examinations, as well as to favor, in the Human Anatomy resident, the development of a holistic thinking during her or his training process, with the benefit of greater competences and better teaching and research performance(AU)