Study of the risk factors of erectile dysfunction and phospho diestrase type 5 inhibitors usage among Egyptian population with erectile dysfunction: A cross-sectional survey.

OBJECTIVES: We aimed to study the risk factors of erectile dysfunction (ED) and different patterns of phosphodiestrase type 5 inhibitors (PDE5is) usage among Egyptian patients. PATIENTS AND METHODS: One thousand five hundred consecutive Egyptian patients complaining of ED were included in this cross-sectional study from July (2014) to October (2015). Patients were requested to answer the international index of erectile function questionnaire (IIEF-5). Statistical differences between groups were tested using Chi square test and Spearman's rho correlation coefficient for qualitative variables. RESULTS: Remarkably, significant associations between IIEF scores and aging and diabetes mellitus (DM) and hypertension (HTN) and ischaemic heart disease (IHD) and hyperlipidaemia were shown in the studied patients (p<.0001, p<.0001, p<.0001, p<.0001, p<.0001, respectively). Eventually, our study showed significant correlations between different age groups and morning erection and lower urinary tract symptoms and HTN and IHD and DM where the severity of ED was directly proportional to the absence or decreased strength of morning erection with aging and the increased incidence of LUTS and HTN and IHD and DM with aging (p<.0001; p=.001; p<.0001; p<.0001; p<.0001, respectively). CONCLUSION: Our study demonstrated that aging; DM, HTN and hyperlipidaemia are potential major risk factors of ED in Egypt for further validation. In addition, most of the participants used PDE5is without prior medical consultation together with concomitant administration of illicit drugs.

Análisis de la distribución geografía de la inequidad en salud mediante accesibilidad a consultas médicas ambulatorias / Analysis of the geographic distribution of health inequity through accessibility to outpatient medical consultations

INTRODUCCIÓN: Escasos estudios han relacionado a nivel nacional la inequidad geográfica de acceso a la salud por intermedio de las consultas médicas ambulatorias (CMA) en el sector oficial. El objetivo de la presente investigación fue describir, evaluar y medir la situación del acceso a la salud referente a las CMA en Argentina en 2017. MÉTODOS: Se realizó un estudio descriptivo de corte transversal. La unidad analizada fue la CMA en Argentina en 2017. Se calcularon las tasas de CMA a nivel nacional, provincial y para la población potencialmente usuaria que concurre a establecimientos oficiales (PPUsEO). RESULTADOS: Las mayores tasas de CMA de PPUsEO por habitante se dieron en Tierra del Fuego (9,1), La Pampa (10,0), Buenos Aires (10,2) y Ciudad Autónoma de Buenos Aires (13,6), todas en el cuarto cuartil (Q4); las que presentaron menores tasas, situadas en el primer cuartil (Q1), fueron Santiago del Estero (2,3), Córdoba (2,7), Santa Fe (3,0), Corrientes (3,4), Catamarca (3,5) y Formosa (3,7). DISCUSIÓN: La mayor inequidad geográfica de acceso a la salud respecto de las CMA de PPUsEO en el sector oficial se dio en el centro norte del país, con tasas que oscilaron entre 2,3 y 13,6. En lo que se refiere al crecimiento de la atención en las consultas no médicas de los últimos años, la variación entre 2010 y 2017 mostró un incrementó de 966,8%, en contraposición con las CMA, que aumentaron apenas el 7,4% en el mismo periodo

Healthcare on the Endocrinology and Nutrition ward in Castille-La Mancha (the AAPENCAM study). / Actividad asistencial en planta de Endocrinología y Nutrición en Castilla-La Mancha (estudio AAPENCAM).

INTRODUCTION: The activity of an Endocrinology and Nutrition (E&N) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the E&N departments of a public health system has not been studied in Spain. MATERIAL AND METHODS: This was a retrospective study of hospital ward activity during 2018 of the E&N departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the E&N departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to E&N and a 10% sample of those treated through interconsultation were analysed. RESULTS: 261 admissions were recorded for Castilla-La Mancha Public Health Service E&N departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1±6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%). CONCLUSIONS: The inpatient care activity of the E&N departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition.

O curso de medicina como fonte de ansiedade / The medical course as a source of anxiety

O curso de medicina pode ser fonte de ansiedade? Várias são as situações a que o estudante de medicina é exposto, e que são de elevada tensão, como: a singularidade de cada paciente; a verdade relativa e provisória em medicina, o que obriga a convivência com dúvidas e incertezas; a imensidão de conhecimentos necessários em reduzido tempo de formação; a inexistência e ineficácia de tratamento específico para várias doenças, o que exige que atue de forma a aliviar o sofrimento, e pouca influência sobre a evolução da história natural da enfermidade. Cada estudante, entretanto, reage a essas tensões de acordo com sua maturidade emocional, e muitas delas são inevitáveis e se dissipam naturalmente, sem maior consequência, à medida que avança no curso. É importante que o estudante seja provocado a desenvolver juízo crítico e discernimento, para que não se limite à objetividade da medicina, nem aceite passivamente esquemas, normas, diretrizes, e que esse desafio o projete para sua inserção decisiva em defesa do bem-estar do paciente. (AU)

Can medical school be a source of anxiety? There are several situations to which the medical student is exposed, and which are of high tension, such as: the singularity of each patient; the relative and provisional truth in medicine, which requires the coexistence with doubts and uncertainties; the immensity of knowledge required in a short period of training; the inexistence and inefficacy of specific treatment for various diseases, which requires that it act in a way to relieve suffering, and little influence on the evolution of the natural history of the disease. Each student, however, reacts to these tensions according to their emotional maturity, and many of them are inevitable and dissipate naturally, without further consequence, as the course progresses. It is important that the student be challenged to develop critical judgment and discernment, so that it is not limited to the objectivity of medicine, or passively accepted schemes, norms, guidelines, and that this challenge projects him to his decisive insertion in defense of the well-being of the patient. (AU)

Relato de um encontro clínico "fora dos padrões" / Reportofan "out ofthe box" clinical meeting

O relacionamento médico-paciente requer não só o conhecimento das técnicas da entrevista clínica, mas, também, é preciso ter a consciência de que o mundo do paciente e sua família, pode ser tão diverso daquele domédico, que a comunicação só será possível se souberusar a principal qualidade do método clínico, a sua flexibilidade. (AU)

The doctor-patient relationship requires not only the knowledge of the techniques of clinical interview, but also, it is necessary to be aware that the world of the patient and his family may be so different from that of the doctor, that communication will only be possible if able to use the main quality of the clinical method, its flexibility. (AU)

Trayectorias sanitarias de madres e hijos a 4 años de la detección de drogas ilícitas en orina. Estudio de cohorte retrospectivo / Health trajectories of mothers and children 4 years after the detection of illicit drugs in urine. Retrospective cohort study

INTROUCCIÓN El consumo de drogas ilícitas durante el embarazo constituye un problema en ascenso, de importancia para la Salud Pública mundial. Los binomios expuestos pueden presentar un amplio rango de complicaciones, aunque los conocimientos sobre la evolución son escasos. OBJETIVO Describir y analizar las trayectorias sanitarias de binomios expuestos y no expuestos durante 4 años. MÉTODOS Estudio de cohorte retrospectivo con grupo de comparación constituido por 2 binomios no expuestos por cada binomio expuesto. Los binomios expuestos fueron detectados en neonatología de un Hospital público con estudio en orina entre 2009 y 2013. REULTADOS Se evaluaron 29 binomios expuestos y 58 no expuestos. Las principales drogas ilícitas detectadas en el grupo expuesto fueron marihuana, cocaína, y ambas. La mayoría de las mujeres fueron policonsumidoras, combinando drogas ilícitas y lícitas. Se observaron diferencias significativas entre grupos en la mayoría de las variables evaluadas (p menor a 0.05). En las madres del grupo expuesto; mayor frecuencia de gestas, abortos, pareja consumidor de drogas, algún padre preso, antecedentes de violencia en su infancia. En los niños del grupo expuesto; menor frecuencia de controles de salud, mayor frecuencia de consultas en emergencias, principalmente por cuadros respiratorios, y de enfermedad pulmonar obstructiva crónica. En el grupo expuesto hubo 3 muertes en el grupo familiar directo durante el período de estudio, todas violentas; no hubo ninguna muerte en el grupo no expuesto. DISCUSIÓN Los binomios expuestos a drogas ilícitas en el embarazo, con detección de marihuana y/o cocaina en orina, constituyen un grupo muy alto riesgo de morbi mortalidad a corto plazo. Es de importancia saber que es altamente probable que no concurran a citaciones de control de salud, y que cambien de domicilio con frecuencia

General principles of medical interconsultation for hospitalised patients.

Medical interconsultation for hospitalised patients is a regular activity among internal medicine specialists. However, despite its growing impact and importance, a model that defines its characteristics, objectives and information has not been established. This study, conducted by the Shared Care and Interconsultations Group of the Spanish Society of Internal Medicine, proposes a number of general recommendations concerning the method for requesting and responding to hospital medical interconsultations, as well as a format for these interconsultations.

Absence of routine medical consultation among hypertensive and/or diabetic elders: an epidemiological study based on the Brazilian National Household Survey 2008 / Ausência de consulta médica de rotina entre idosos hipertensos e/ou diabéticos: um estudo epidemiológico baseado na Pesquisa Nacional por Amostra de Domicílios 2008

This exploratory study aimed to investigate the predisposing, enabling and health need characteristics associated with lack of medical visits in the last 12 months, among 23,620 elderly hypertensive and/or diabetic individuals.

O presente estudo, de caráter exploratório, teve como objetivo investigar as características predisponentes, facilitadoras e de necessidades de saúde associadas à não realização de consulta médica nos últimos 12 meses, junto a 23.620 idosos hipertensos e/ou diabéticos.

Redução das desigualdades no uso de consultas médicas no Brasil: análise das regiões Nordeste e Sudeste entre 2003 e 2008 / Reduction of inequalities in medical visits in Brazil: analysis of the Northeastern and Southeastern regions between 2003 and 2008

OBJETIVO: Analisar as desigualdades socioeconômicas na utilização de consultas médicas (CM) no último ano no Brasil. MÉTODOS: Dados da Pesquisa Nacional por Amostra de Domicílios (≥ 20 anos de idade) das Regiões Nordeste (2003, n = 75.652 e 2008, n = 79.779) e Sudeste (2003, n = 76.029 e 2008, n = 79.356) foram analisados segundo CM. Compararam-se as prevalências de CM segundo as variáveis exploratórias demográficas e de saúde no primeiro (D1) e último (D10) decil de renda familiar per capita. As análises consideraram o desenho amostral complexo. RESULTADOS: A proporção de pessoas com CM aumentou no período na Região Nordeste (61,2 para 66,9%) e Sudeste (67,9 para 73,5%). A diferença absoluta de CM, segundo D1 e D10 no período, foi de 6,4 pontos percentuais (pp) no Nordeste e 4,2 pp no Sudeste. Houve importante redução das desigualdades entre os homens; naqueles sem doenças crônicas; naqueles que tinham uma percepção positiva da sua saúde e naqueles sem plano de saúde com direito a CM. A Região Sudeste ainda apresentou redução entre aqueles com apenas uma morbidade autorreferida (8 pp) e com percepção negativa da saúde (6 pp). CONCLUSÃO: Houve aumento de CM no Brasil. Observa-se ainda persistente desigualdade entre os mais pobres e os mais ricos, maior no Nordeste do que no Sudeste. Políticas para a redução da desigualdade em saúde mais eficazes e equânimes devem ser adotadas no Brasil. .

OBJECTIVE: To analyze the socioeconomic inequalities in medical visits (MV) in the past year in Brazil. METHODS: Data from adults aged ≥ 20 years old who participated in the Brazilian National Household Surveys and living in the Northeastern (2003; n = 75,652 and 2008, n = 79,779) and Southeastern (2003; n = 76,029 and 2008; n = 79,356) regions were analyzed according to MV. We compared MVs according to demographic and health variables in the first (D1) and last (D10) per capita family income deciles. All analyses considered the complex cluster design. RESULTS: The proportion of people who had MV during this period increased in the Northeastern (from 61.2 to 66.9%) and the Southeastern (from 67.9 to 73.5%) regions. The absolute difference (AD) in the use of MV, according to D1 and D10 in this period, was equal to 6.4 percentage points (pp) in the Northeastern and 4.2 pp in the Southeastern regions. Significant reduction in inequalities was observed among men without chronic diseases, in those who had a positive perception of their health, and among those without health insurance which included MV. The Southeastern region has also showed significant reduction among those with chronic disease (8 pp) and with negative health self-perception (6 pp). CONCLUSION: The increasing number of MVs was found in Brazil. However, persistent inequalities were observed between the poorest and the richest, higher in the Northeastern than in the Southeastern region. More effective and equitable policies to reduce health inequalities should be adopted in Brazil. .

Instrument of nursing consultation with regard to people with spinal cord injuries: a methodological study

Problem: Spinal cord injury is a public health issue, and a specific instrument to guide nursing consultations for those affected does not exist. Aim: To develop and validate an Instrument of Nursing Consultation for Home Visits to People with Spinal Cord Injuries (INCEVDOP-LM, in Portuguese), based on the Self-Care Deficit Theory. Method: This is a study of methodological development, created in the Family Health Units of the city of Natal, with nurses, judging nurses, and people with spinal cord injuries, between 2012 and 2013. There will be two phases: I - Identification of the necessities of self-care through a Socio-Demographic Questionnaire and a Scale of Evaluation of Competency to Self-Care; II - Development and validation of INCEVDOP-LM based on presentation, content and reliability (the first two criteria will be based on the opinion from judging nurses and a Kappa test, and the last criterion will be examined by the Cronbach?s Alpha test). Consultations using or not using the INCEVDOP-LM will be filmed. These recordings will be analyzed using a scale of evaluation and Chi-square and Fisher tests...

Aspectos subjetivos implicados en la demanda de consulta médica frecuente / Subjective aspects implicated in the demand for frequent medical consult

Este artículo contiene los resultados de una investigación realizada con el n de acercarse a la comprensión de los aspectos subjetivos implicados en el pedido de consulta médica de consultantes frecuentes. Se utilizó un diseño cualitativo, la metodología fue el estudio de casos y la técnica de recolección de información fue la entrevista semiestructurada a profundidad. La muestra correspondió a nueve consultantes frecuentes de una institución de salud de Medellín. Los resultados sugieren que existe una búsqueda de alivio y control en la consulta médica por parte de los consultantes frecuentes, motivada por el sufrimiento que manifiestan y padecen. Aspectos como el vínculo con el médico, la demanda del paciente y las representaciones sociales que construyen son determinantes para la percepción de control y alivio de este sufrimiento y el inicio y mantenimiento de la consulta frecuente en salud.

This article contains the results of a study made with the purpose of getting close to the understanding of subjective aspects that underlay the frequent demand of medical appointments, by patients. The research design was qualitative, the methodology was case studies and the information recollection technique was the in depth semi-structured interview. Nine samples were taken from frequent medical consultants of a health institution in Medellin. The results suggest that there is a search for relief and control in the medical appointment made by the frequent consultants, motivated by the suffering they manifest and have. Aspects like the tie with the doctor, patient demand and the social representations constituted are decisive for the perception of control and relief of this suffering and the beginning and maintenance of the frequent medical consultant.

Avaliação das dificuldades enfrentadas pelo paciente para realização de uma consulta médica de nível terciário / Evaluation of the difficulties faced by the patient to obtain a medical appointment on last referraal levels

Objetivo: identificar as dificuldades de acesso ao serviço de saúde, no nível superior, enfrentadas pelo paciente e como elas interferem no prognóstico e tratamento de sua doença. Método: foram entrevistados 205 pacientes usuários do Hospital de Base do Distrito Federal, no período de agosto de 2007 a julho de 2008. Resultados: 52,5% dos pacientes não faz acompanhamento regular no nível de atenção primária. O tempo de espera para o atendimento do paciente foi superior a 2 meses em 91,8% dos casos e 7,4% dos usuários ainda não haviam sido atendidos após 12 meses. Pacientes atendidos com menos de um mês de espera não tiveram nenhuma repercussão em sua vida (73,9%), sendo que a partir de dois meses de espera, 54,9% apresentaram algum comprometimento (psicológico, social ou biológico). Discussão: mais da metade dos pacientes atendidos em nível terciário no Distrito Federal não faz consulta regular em nível primário de atenção o que reforça a necessidade de fortalecimento das atividades de atenção primária. A demora para atendimento resultou em piora da saúde, repercussões psicológicas e sociais nos pacientes.

Objective: to identify the difficulties of access to health care faced bypatients and how they impact on prognosis and treatment of their disease.Methods: 205 patients of the Hospital de Base do Distrito Federal were interviewed from August 2007 to July 2008.Results: 52.5% of patients were not regularly monitored by primarycare. They waited over 2 months in 91.8% of cases for a last referral level medical appointment and 7.4% of users had not been assisted after 12 months. Patients treated with less than a month of waiting had no impact on their life (73.9%), and from two months of waiting, 54.9% had some involvement (psychological, social or biological).Discussion: more than half of patients treated at tertiary level in the Federal District does not have a regular follow-up in primary care which reinforces the need to strengthen primary health care activities. The delay in care resulted in worsening health, psychological and socialconsequences for patients.

Reasons for medccal consultation and causes of uthanasia of dogs in montevideoo city (Uruguay): a survey of veterinary practitioners. implications of behavioral problems / Motivo de consullta médica y causas de eutanasia de peros en la ciudaad de montevideo (Uruguay): una encuesta a médicos veterinarios. implicancia de los problemas de comportamiento

In Latin America there is little information about the frequent reasons of medical consultation and euthanasia in dogs, and the implications of behavior problems. Especially in Uruguay there isn't information about it. The aim of this study was to know the most frequent reasons for medical consultation and euthanasia of dogs in Montevideo city through a survey of veterinary practitioners and the implications of behavioral problems. A survey to veterinary practitioners from one hundred (n = 100) randomly sampled veterinary clinics in the city of Montevideo was carried out. The most frequent reasons for medical consultation about dogs in veterinary practioners are consultations of skin affections, followed by digestive and respiratory affections, and less frequently infections, accidents and neoplasias (p < 0.0001). The behavioral problems occupied only the 1% of the reasons for medical consultation in dogs. The most frequent reasons for euthanasia of dogs were by elderly dog and neoplasias, followed by kidney affections, infections and accidents (p < 0.0001). Only 35% of veterinarians performed euthanasia for behavioral problems in their clinics. Among them, the euthanasia for behavior problems accounted for only 2%. Although euthanasia is carried out in Uruguay for behavior problems, it is so in a very low percentage.

En América Latina existe poca información acerca de los motivos frecuentes de consulta médica y eutanasia en perros, así como de las implicaciones de los problemas de comportamiento. Especialmente en Uruguay no hay información al respecto. El objetivo de este estudio fue conocer las causas más frecuentes de consulta médica y eutanasia de los perros en la ciudad de Montevideo a través de una encuesta a los médicos veterinarios, y la implicancia de los problemas de comportamiento. Se realizó una encuesta a una muestra aleatoria (n = 100) de médicos veterinarios de clínicas de Montevideo. Las causas más frecuentes de consulta médica por dueños de perros son las afecciones de la piel, seguido de afecciones digestivas y respiratorias, y menos frecuentemente las infecciones, los accidentes y los neoplasias (p < 0,0001). Los problemas de conducta ocupan solo el 1% de los motivos de consulta. Las razones más frecuentes para la eutanasia de perros fueron por edad (ancianos) y por neoplasias, seguidas por afecciones renales, infecciones y accidentes (p < 0,0001). Solo el 35% de los veterinarios ha llevado a cabo eutanasias en sus clínicas; entre ellas, la eutanasia por los problemas de conducta representó apenas el 2%. Aunque en Uruguay se realizan eutanasias por problemas de comportamiento, las mismas se dan en un muy bajo porcentaje.

Relación médico-paciente: un buen negocio / Physician-patient relationship: a good business

Este artículo expresa las vivencias de la rotación de consulta externa en el año de internado, donde se atendieron pacientes adultos de diferente sexo, nivel socioeconómico y patología. Durante la consulta se practicó una buena relación médico paciente, de donde se sacaron varias conclusiones importantes; además se realizó una búsqueda de literatura sobre relación médico paciente, con el fin de identificar problemas y ofrecer recomendaciones prácticas a los estudiantes de Medicina para su desempeño futuro en la atención de pacientes, las cuales consideramos si se aplican de manera rutinaria lograrán un bienestar físico, psicológico y social tanto al paciente como al médico.

This article expresses the experiences of the external consult rotation in the internship year, where adult patients of different sex, socioeconomical level and pathologies were attended. During the consultation a good physician-patient relationship was practiced, from this different important conclusions were raised; additionally a literature search about physician-patient relationship was done, in order to identify problems and offer practical recommendations to medical students for their future performance in patients attention, which we considered if the apply in a routinary way, will achieve a physical benefit, as well psychological and social for both patient and physician.

Tempo decorrido desde a última consulta: análise de um modelo estatístico aplicado ao caso das mulheres na Espanha / Time elapsed since the last medical visit: analysis of a statistical model applied to the case of Spanish women

OBJETIVO: Os objetivos deste artigo são dois: I) Desenvolver um modelo que caracterize a distribuição da variável "tempo decorrido desde a última consulta médica" e II) testar empiricamente esse modelo. MÉTODOS: Para desenvolver o modelo teórico, recorrerá a uma demonstração de natureza estatística. Para testar o modelo teórico serão usados os dados da "Encuesta Nacional de Espana" de 2006, referentes ao gênero feminino. RESULTADOS: Os resultados alcançados mostram que a distribuição do tempo decorrido desde a última consulta médica segue uma distribuição de Poisson. Empiricamente, foi validada essa conclusão e adicionalmente verificou-se que algumas condicionantes aumentam a probabilidade de uma mulher espanhola recorrer a consulta médica, nomeadamente, a situação de inatividade, a residência em lugares de menor densidade e idade superior. CONCLUSÃO: O trabalho conclui que o tempo decorrido desde a última consulta médica, seguindo uma distribuição de Poisson, revela implicitamente que a ida a uma consulta é ainda encarada como um fenômeno raro para as mulheres na Espanha. Cruzando esta evidência com os resultados, salienta-se que maior razão de clínicos por população, maior disponibilidade temporal de cada mulher (sobretudo em situações de inatividade laboral) e maior conhecimento pessoal poderão levar a maior uso das consultas médicas, diminuindo, assim, o tempo decorrido desde a última consulta.

OBJECTIVE: This study aims at two objectives: I) to develop a model capable of predicting the statistical distribution of the variable "time elapsed since the last medical visit"; II) to empirically test the theoretical model. METHODS: To develop the theoretical model, the author will use a demonstration that is statistical in nature. In order to test the theoretical distribution, the 2006 Encuesta Nacional de España data regarding females will be used. RESULTS: The results found show that the distribution of the time elapsed since the last medical visit follows a Poisson distribution. This conclusion was empirically validated, and additionally, a few determinants were found that increase the likelihood that Spanish women will resort to a doctor, namely, inactivity, residence in small places and being older. CONCLUSION: The study concluded that the time elapsed since the last medical visit follows a Poisson distribution; thus, going to a medical appointment is still seen as a rare phenomenon for Spanish women. By comparing this data with our results, we found that a higher ratio of physicians to population, a higher time availability for each woman (especially in a labor inactivity setting) and strong personal relationships can lead to a higher medical visit rate, thus reducing the time elapsed since the last visit.

A consulta ginecológica na adolescência sob a ótica dos ginecologistas e das adolescentes / Gynecological e consultation in adolescence from the viewpoint of gynecologists and girls

O atendimento ginecológico de qualidade na adolescência vem se tornando cada vez mais necessário na atualidade devido à ocorrência mais precoce da atividade sexual, com consequente aumento das gestações não planejadas, das doenças sexualmente transmissíveis e da probabilidade de câncer de colo uterino. Este estudo teve como objetivo avaliar a consulta ginecológica sob a ótica dos médicos e das adolescentes. Foi desenvolvido um estudo de corte transversal através de questionário estruturado aplicado a 191 ginecologistas filiados à Associação de Ginecologia e Obstetrícia do Estado do Rio de Janeiro e a 418 estudantes do ensino médio de escolas estadual, federal e privada da cidade do Rio de Janeiro. Os médicos responderam questões sobre dados pessoais, qualificação profissional, condutas na culsuta ginecológica e sobre a necessidade de capacitação para o atendimento de adolescentes. Para as colegiais foram abordados aspectos sócio-demográficos, comportamento sexual e avaliação da consulta ginecológica. Para a análise dos dados utilizou-se o teste qui-quadrado e o t de student. Os resultados mostraram que não houve diferenças significativas entre as escolares do ensino privado e da escola pública federal que, no entanto, apresentaram características distintas quando comparadas às estudantes da instituição estadual. Estas eram predominantemente da raça negra, com responsáveis de menor escolaridade e tinham piores condições de moradia. Apesar do maior número de parceiros, gestações e de abortamentos, além de histórico de violência sexual, foram à consulta ginecológica em idade mais tardia, devido à dificuldade de acesso a serviços de saúde sexual e reprodutiva. Os três grupos de estudantes manifestaram, em comum, o desejo de que o profissional investisse mais tempo, paciência e disponibilidade no atendimento ginecológico. Quanto aos profissionais, foi constatado que os mais jovens e as do sexo feminino apresentaram atitudes consideradas menos conservadoras...

The qualified gynecological consultation with adolescents has become an increasing necessity nowadays due to the early occurrence of sexual activity and as consequence, the increase of umplanned pregnancies, STD and the probability of cervical cancer. This study had the objective of evaluating the gynecological consultation under the doctors' and adolescents' point of view. Investigations with qualitative and quantitative methods were made to achieve it, with the predominance of the latter. In the qualitative method, we conducted an analysis of the phenomenon in-depth studies during the interviews with adolescents and gynecologists. A cross-sectional study was developed by structured questionary applied to 191 gynecologists from the Associação de Ginecologia e Obstetrícia do Estado do Rio de Janeiro and to 418 high school students (Federal, State and Private) from Rio de Janeiro. Data collected included personal information, professional qualification, procedures during gynecological consultation and about the necessity of specific training for the adolescents' consultations. The students' interview dealt with social and demographic aspects, sexual behavior and evaluation of gynecological consultation. To analyze the data we used the Chi-square test and the Student's t. The results showed no significant differences between students from private and federal schools, but presented distinct characteristics when compared to the state school girls' answers. The latter, with the predominance of afro-descendents, their parents had lower education levels, and worse house conditions. These students prsented a higher number of pregnancies, abortions and sexual partners, and sexual violence history, they had later contact with gynecological consultation due to the difficulty of access to sexual and reproductive health outpatient clinic. The three groups of students showed the common wish for more time with the physicial, patience and availability...

Fatores associados à utilização de serviços de saúde em Municípios Maranhenses / Factors associated to the use of health service in municipalities of Maranhão / Factores asociados al uso de los servicios de salud en Municípios Maranhenses

Este estudo analisou fatores associados à realização de consulta médica pelos adultos, por meio de estudo transversal com 1.059 pessoas na faixa etária de 20 a 59 anos. Utilizou dados amostrais de inquérito populacional realizado em outubro 2006 a fevereiro 2007, nos municípios de São Luís, Imperatriz, São José de Ribamar, Timon, Codó, Caxias do estado do Maranhão. Foram calculadas razões ajustadas de prevalência e intervalos de confiança de 95 porcento, utilizando-se regressão de Poisson. Consulta médica nos últimos 15 dias foi a variável dependente e fatores socioeconômicos renda familiar mensal, escolaridade, beneficiário de plano de saúde, demográficos sexo, idade e cor da pele, uso de medicamentos, automedicação, cobertura pelo Programa de Saúde da Família PSF e autoavaliação do estado de saúde, as independentes. As razões de prevalência mostraram que referir morbidade e possuir plano de saúde aumentaram a probabilidade de consulta. A automedicação apresentou alta prevalência e associou-se negativamente ao desfecho. Entretanto, dos que referiram morbidade, 78,3 porcento não consultaram, sugerindo barreiras de acesso. Não houve associação com as variáveis idade, sexo, cor da pele, uso de medicamento, escolaridade e renda familiar, assim como cobertura pelo PSF, o que sugere dificuldade de acesso até na atenção básica. A autoavaliação do estado de saúde não mostrou associação.

The objective was to analyze factors associated to heath services use by adults. A cross-sectional study comprising 1,059 people, age-group 20 to 59 with sample data of health surveys carried on from September 2006 to February 2007, in São Luís, São José de Ribamar, Imperatriz, Timon, Codó and Caxias, municipalities of Maranhão State, Brazil. Demographic, socioeconomic, health needs and doctor consultation in last 15 days were studied. Adjusted prevalence ratios and 95 percent confidence intervals were calculated using Poisson regression. The dependent variable was doctor consultation in the last 15 days and the independent variables were socioeconomic factors family monthly income, level of education and health plan coverage, demographic factors gender, age and race, use of medication, self-medication, self-reported morbidity, PSF coverage, health self assessment. Adjusted prevalence showed that self- reported morbidity and having health care plan increased the probability of consultation. Self-medication showed high prevalence and had a negative association to the outcome. Nevertheless, from the people with self-reported morbidity 78.3 percent did not have a consultation, which suggests an access barrier. Gender, skin color, age, use of medication, level of education, family monthly income, and PSF coverage did not have an association with health services use, which suggests an access barrier in basic care. Health self assessment not show an association in this study.

Este estudio examinó los factores asociados a la realizacion de visitas médicas por parte de adultos, a través de un estudio transversal con 1.059 personas de 20 a 59 años. Se utilizaron datos de la muestra de un cuestionario poblacional realizado de Octubre de 2006 a febrero de 2007, en las ciudades de Sao Luis, Imperatriz, Sao José de Ribamar, Timón, Codó, Caxias, del estado de Maranhão. Se calcularon las tasas ajustadas de prevalencia e intervalos de confianza del 95 por ciento, utilizando la regresión de Poisson. La variable dependiente fue la consulta médica en los últimos 15 días y la independiente, los factores socioeconómicos ingreso familiar, escolaridad y el beneficiario del plan de salud, demográficas sexo, edad y color de la piel), el uso de medicinas, automedicación, la cobertura del Programa del Salud PSF y la auto-evaluación del estado de salud. Razones de prevalencia muestran que referirse a morbilidad y poseer planes de salud han aumentado la probabilidad de consulta. La automedicación presentó una alta prevalencia y se asoció negativamente con el resultado. Sin embargo, aquellos que reportaron la morbilidad, el 78,3 por ciento no se consultaron, lo que sugiere barreras de acceso. No hubo asociación con las variables edad, sexo, raza, uso de medicinas, escolaridad e ingreso familiar así como la cobertura por el PSF, lo que sugiere la dificultad de acceso a la atención básica. La auto-evaluación de estado de salud no mostró asociación.