Determinantes de la elección del primer nivel de atención en medicina como ámbito de formación y laboral: un estudio cualitativo

ObjetivoExplorar los determinantes de la elección del primer nivel de atención como ámbito laboral y de formación para las y los profesionales de la salud.DiseñoEstudio cualitativo.EmplazamientoCuatro universidades del Área Metropolitana de Buenos Aires, Argentina.ParticipantesEstudiantes de medicina y médicos recientemente egresados.MétodoCon base en la teoría fundamentada constructivista se realizaron entrevistas semiestructuradas y grupos focales para la recolección y subsecuente análisis de datos.ResultadosSe realizaron 31 entrevistas y tres grupos focales durante 2019-2020. Se organizaron los conceptos emergentes en ejes temáticos de análisis. Se identificaron experiencias positivas y negativas en relación a la atención primaria de la salud (APS) en espacios curriculares y rotaciones prácticas, y un importante desconocimiento de los alcances de la misma. Para la elección de especialidades médicas son importantes los intereses personales, las proyecciones a futuro, el prestigio social, los ingresos económicos y los conocimientos de un área específica de la medicina. Existe una desvalorización en cuanto al rol y la capacidad resolutiva de la APS, y también se la asocia como más ligada a la asistencia de las poblaciones de bajos recursos socioeconómicos.ConclusionesEl desconocimiento de la APS, su desprestigio y la remuneración insuficiente de los profesionales del primer nivel de atención fueron identificados como principales barreras para la elección de la APS como lugar de trabajo y formación. En contrapartida, el compromiso social, la posibilidad de tener un mejor estilo de vida y el tipo de relación médico-paciente aparecen como principales facilitadores.Palabras clave: Atención primaria de la salud, Medicina familiar, Educación médica     

城乡社区精神分裂症患者家属的家庭负担对照研究

为了了解城乡结合区精神分裂症患者家庭负担现状及城乡患者之间家庭负担的区别，采用ＦＩＳ和ＤＡＳ量表分别对病例组和对照组患者及其主要照顾者进行调查，分析，结果发现，病例组家庭负担明显高于对照组，经济负担农村高于城市，而主观负担城市高于农村，病例组ＦＩＳ与ＤＡＳ密切相关，某些ＦＩＳ单项分布与病程相关，表明精神分裂患者确实给家庭带来明显的客观和主观负担，客观负担与患者的社会功能密切相关，主观负担与家属的态     

Preconception alanine aminotransferase concentrations and risk of preterm birth in rural Chinese women aged 20–49 years: a population-based cohort study

Background

Previous studies have shown maternal hepatitis B virus infection is associated with preterm birth. However, whether liver dysfunction caused by hepatitis B virus infection or other factors can lead to preterm delivery needs further exploration. Serum alanine aminotransferase (ALT) is a sensitive indicator of liver function, but few studies have investigated the association between serum ALT concentrations and preterm birth. We aimed to examine the relationship between maternal preconception ALT concentration and risk of preterm birth.

先天性外胚层发育不全无汗综合征家系报告及文献复习

目的通过一个家系分析,探讨先天性外胚层发育不全疾病的遗传方式。方法现场对一个无汗先天性外胚层发育不全家系四代27例家庭成员进行调查,并对1例患者进行医学分析。结果患者主要表现为头发稀疏,无牙,无体毛,无汗等症状。家系遗传分析表明该疾病属于X连锁隐性遗传疾病。结论本病发病机制与X染色体上的基因缺陷有关,如ED1、NEMO等,据此可开展进一步基因突变检测。     

Health literacy and cancer communication with older adults

OBJECTIVE: The physiological, cognitive, language and communicative changes that take place as we enter into old age have become quite well documented within the social scientific literature. Many of these changes lead in some way to a lessening of previous interactive abilities and competencies. The new mantra for gerontologists attempting to help older adults compensate for these potential losses is to develop strategies to maintain existing abilities as long as possible. METHODS: A literature review using online databases was performed. RESULTS: Older adults who are diagnosed with cancer or help care for an individual coping with cancer must confront a health care system that demands a high level of health literacy to successfully manage the disease. Older adults may be at a distinct disadvantage in their ability to successfully cope with cancer because of age-related physiological, cognitive, psychological and communicative factors. CONCLUSION: This paper highlights the relevant research findings and theoretical positioning that points not only to possible pragmatic dilemmas faced by those adapting to cancer but also highlights streams of research that scholars may wish to focus upon to better understand how older adults and their formal and informal caregivers can improve their cancer health literacy. PRACTICE IMPLICATIONS: Providers, patients, and caregivers must all participate in creating a health care environment of shared meaning and understanding of health messages tailored to the aging patient diagnosed with cancer. Health communication scholars have various theoretical, methodological, and pragmatic communication-based approaches that provide important contributions to the complexities of caring for the aging patient.     

家庭教育对精神分裂症患者配偶生活质量的影响

目的 探讨家庭教育对精神分裂症患者配偶生活质量的影响.方法 将符合人组条件的116例精神分裂症患者配偶随机分为观察组和对照组,每组58例.两组患者均维持原抗精神病(折合氯丙嗪剂量≤300mg/d)治疗,同时对观察组患者配偶实施每月1次的家庭教育,为期1年.对照组不实施家庭教育.采用生活质量综合评定问卷(CQOU)对两组精神分裂症患者配偶分别于家庭教育前及结束时各评定1次.结果 家庭教育结束时,观察组患者配偶的GQOLI总分及躯体功能、心理功能、社会功能3个维度评分均显著高于对照组(P均＜0.01).结论 家庭教育能有效地提高精神分裂症患者配偶的生活质量.     

人工流产后计划生育服务对避孕措施的近期及远期影响分析

目的:探讨人工流产后实施计划生育服务对避孕措施的近期和远期影响。方法:选取医院2014年1月至2014年6月100例人工流产后的女性为研究对象,将其按照随机数字表法分为干预组与对照组,各50例。干预组给予计划生育服务,而对照组给予常规流产后的服务,观察两组女性近期和远期的避孕措施情况。结果:干预组避孕措施落实率96.0%和正确避孕率98.0%均明显的高于对照组的避孕措施落实率72.0%和正确避孕率70.0%,两组的临床数据差异有统计学意义(P0.05);干预组避孕知识掌握评分(89.5±4.6)分,明显的高于对照组(77.2±2.9)分,差异有统计学意义(P0.05);干预组避孕依从性94.0%,明显的高于对照组64.0%,两组数据差异有统计学意义(P0.05);干预组再次意外妊娠率0,对照组4.0%,两组的数据差异不具有统计学意义(P0.05)。结论:临床中对于人工流产后女性实施计划生育服务可以提高避孕依从性和避孕知识的掌握情况,并在避孕近期和远期中具有较好的优越性,值得临床中应用。     

Fibrinogen in the offspring of men with premature coronary artery disease

We examined whether the levels of fibrinogen are elevated inthe offspring of middle-aged coronary patients. One hundredand seventy-six young subjects were divided into two groups.Group A consisted of 100 children and youngsters (mean age 17±6years) whose fathers had sustained a myocardial infarction underthe age 55 years without associated history of diabetes mellitusor hypertension. Seventy-six healthy young subjects (mean age18±5 years) matched for gender, dietary and smoking habitswithout familial history of coronary artery disease, diabetesmellitus or hypertension served as the control group (groupB). Fibrinogen, total cholesterol, triglycerides, high and lowdensity lipoprotein cholesterol, apolipoprotein A-1, apolipoproteinB and lipoprotein (a) were measured. Sons and daughters with a history of premature paternal myocardialinfarction had higher levels of fibrinogen compared with controlsubjects (304·1±60 vs 274±53 mg. dl^–1,P<0·001). This difference was maintained when theabove groups were divided into single sex groups. Total cholesterol,low density lipoprotein cholesterol, apolipoprotein B and lipoprotein(a) were also significantly higher in group A. Children of affectedindividuals who had a good lipid profile also had significantlyhigher fibrinogen levels compared to control group. The results support the hypothesis that the higher plasma levelsoffibrinogen in the offspring of middle-aged coronary men couldpartially explain their predisposition for coronary artery disease.Since the levels offibrinogen have a major genetic component,they could be a useful marker in ident children at high riskfor coronary artery disease, especially among those with nolipid abnormalities.     

疾病家庭负担量表应用于晚期血吸虫病的信度和效度

目的 评价疾病家庭负担量表(family burden scale of diseases,FBS)应用于晚期血吸虫病(晚血)的信度和效度,为晚血家庭负担评价工具的选择提供科学依据.方法 在湖南省汉寿县及湖北省江陵县,以FBS作为测评工具对晚血患者家属进行入户调查,评价其应用于晚血的信度和效度.结果共调查家属318名,...