RESUMO
Introducción: la colecistitis aguda es una inflamación de la pared vesicular. El tratamiento para esta patología es netamente quirúrgico, y la colecistectomía laparoscópica es el procedimiento de elección. Esta puede sufrir conversión intraoperatoria debido a las complicaciones propias de la intervención, los factores del paciente o los asociados con el cirujano. Objetivo: el objetivo del estudio es establecer la frecuencia y la asociación de conversiones en colecistectomía laparoscópica, basándonos en los exámenes de laboratorio hematológicos y la ecografía abdominal, así como en los factores sociodemográficos. Materiales y métodos: se realizó un estudio descriptivo, de corte transversal, observacional y retrospectivo, durante el período comprendido entre el 1 de enero y el 3 de noviembre de 2015. Se revisaron historias clínicas con diagnóstico de patología vesicular benigna de pacientes sometidos a procedimiento quirúrgico vesicular. Resultados: al 35,5% de los pacientes se les realizó una colecistectomía laparoscópica (CL), en la que fue necesario convertir a cirugía convencional al 42,8% de los pacientes. La mayoría de los pacientes intervenidos fueron mujeres (72,8%), aunque la conversión predominó en el sexo masculino. El diagnóstico preoperatorio más frecuente fue la colelitiasis (98,3%). La edad mayor de 50 años presentó un odds ratio de 0,55, mientras que la leucocitosis presentó un odds ratio de 0,40; ambas variables fueron estadísticamente significativas (p ≤0,05). Conclusiones: se determinó que una edad mayor de 50 años y/o un valor de leucocitos mayor de 10 000 mm3 son factores de riesgo para que una colecistectomía laparoscópica falle; además, deben tenerse en cuenta los factores propios del cirujano
Acute cholecystitis is an inflammation of the vesicular wall whose treatment is purely surgical: a laparoscopic cholecystectomy is the procedure of choice. This can be converted intraoperatively due to complications of the intervention, patient factors or factors associated with the surgeon. The aim of this study was to establish the frequency and the association of conversions of laparoscopic cholecystectomies based on hematological laboratory tests and abdominal ultrasound as well as sociodemographic factors. Materials and Methods: This is a descriptive, cross-sectional, observational and retrospective study that was carried out from January 1 to November 3, 2015. Clinical histories of patients who had been with diagnosed with benign vesicular pathologies who underwent vesicular surgical procedures were reviewed. Results: Of the cases reviewed, 35.5% patients underwent laparoscopic cholecystectomies, and of these cases 42.8% of the procedures were converted to conventional surgery. The majority of the patients were women (72.8%), but conversions were most frequent among men. The most frequent preoperative diagnosis was cholelithiasis (98.3%). Age greater than 50 years presented an odds ratio of 0.55, while leukocytosis had an odds ratio of 0.40, both variables were statistically significant (P = <0.05). Conclusions: It was determined that ages over 50 years and/or a leukocyte count over 10,000 mm3 are risk factors for failure of laparoscopic cholecystectomies. In addition, factors related to the surgeon must be taken into account
Assuntos
Colecistectomia , Colecistectomia Laparoscópica , Conversão para Cirurgia Aberta , LeucócitosRESUMO
OBJECTIVE: To describe sedation with continuous perfusion of propofol in critically ill children. DESIGN: A retrospective, descriptive observational study was carried out. SETTING: A pediatric intensive care unit. PATIENTS: Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. INTERVENTIONS: None. DATA COLLECTED: Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. RESULTS: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1 mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. CONCLUSIONS: Propofol at a dose of 1 to 4 mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile.
Assuntos
Cuidados Críticos/métodos , Estado Terminal , Hipnóticos e Sedativos/administração & dosagem , Unidades de Terapia Intensiva Pediátrica , Propofol/administração & dosagem , Analgesia Epidural/estatística & dados numéricos , Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Criança , Pré-Escolar , Dipirona/administração & dosagem , Dipirona/uso terapêutico , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Fentanila/administração & dosagem , Fentanila/uso terapêutico , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Lactente , Infusões Intravenosas , Masculino , Midazolam/administração & dosagem , Midazolam/uso terapêutico , Nutrição Parenteral Total , Piperidinas/administração & dosagem , Piperidinas/uso terapêutico , Propofol/efeitos adversos , Propofol/uso terapêutico , Remifentanil , Estudos Retrospectivos , Espanha , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêuticoRESUMO
Desde la perspectiva de la salud pública se requiere abordar con mayor interés los problemas de salud bucal y la identificación de sus principales determinantes. Una de estas enfermedades, es el cáncer oral. Se realizó una revisión narrativa de literatura incorporando algunos elementos críticos y de opinión. Se destaca cómo las desigualdades en salud oral son aún poco comprendidas, en especial las relacionadas con el cáncer oral. El cáncer oral se caracteriza principalmente por ser acumulativo y más prevalente en adultos mayores. Esta población en países en vías de desarrollo se encuentra en desventaja social por la futura transición demográfica, el gradiente social y las deficiencias en la detección temprana, temas que son abordados en esta revisión. Es de vital importancia comprender el diagnóstico tardío del cáncer oral desde los determinantes sociales con el objetivo de fortalecer la política pública que se teje alrededor del cáncer.
A public health-based perspective is required to approach, with greater interest, both oral health problems and the identification of their main determinant factors. One of such problems is oral cancer. In this study, a narrative literature review was conducted while including some elements of critique and opinion. We highlight the fact that inequalities in oral health are yet to be completely understood, especially those related to oral cancer. The main characteristics of oral cancer are its accumulative nature and its prevalence in the elderly. In developing countries, this population is at social disadvantage, mainly because of the future demographic transition, the social gradient and a failure to detect the condition early. This review approaches these topics. Accordingly, it is very important to understand the causes of oral cancer's late diagnosis in terms of its social determinants in order to strengthen the public policies regarding cancer in general.
Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Envelhecimento , Neoplasias Bucais , Diagnóstico Tardio , Diagnóstico PrecoceRESUMO
Introducción: las instituciones prestadoras de servicios odontológicos incorporan cada vez más la evaluación de la satisfacción del usuario como componente de la calidad. El objetivo de este estudio fue evaluar la satisfacción de los estudiantes de la Universidad de Antioquia, sede Medellín, con los servicios odontológicos prestados por la Institución Prestadora de Servicios de Salud (IPS) de la misma Universidad, desde la perspectiva del usuario y el profesional que brinda atención. Métodos: se llevó a cabo un estudio descriptivo por medio de técnicas cualitativas y cuantitativas como una encuesta realizada en 98 estudiantes sobre aspectos tales como el trato del personal, la eficacia en la atención recibida, información, accesibilidad, oportunidad, seguridad, opinión sobre las instalaciones, satisfacción global; y se complementó con entrevistas semiestructuradas a los profesionales y a los mismos estudiantes. Resultados: se encontró una alta satisfacción global (95,9 porciento), acompañada de elementos que resaltan la confianza técnica y profesional del personal odontológico y de la institución en sí (promedios en las variables estudiadas por encima de 7 y porcentajes de alta satisfacción por encima del 50 porciento); con algunos elementos críticos en la atención que deben mejorarse como la privacidad y la oportunidad en el servicio. Conclusiones: la satisfacción del usuario es alta en comparación con otros estudios locales, y depende de factores como el sexo, la edad, el estrato socioeconómico, la institución y la relación profesional-paciente. Se sugiere avanzar en la construcción de propuestas investigativas en el componente satisfacción del usuario en otras instituciones y en la construcción de escalas de satisfacción del usuario ante los servicios de atención en salud bucal con validación de constructo para ser utilizadas en el medio.
Assuntos
Serviços de Saúde , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Qualidade da Assistência à SaúdeRESUMO
El desplazamiento forzado por la violencia es uno de los fenómenos sociales que ha tenido mayor trascendencia en el campo de la salud pública, por la relación que tiene con las condiciones sociales y con los determinantes que afectan la situación de salud. La salud bucal no es ajena a esta situación, por tanto, se requiere investigar qué está pasando en grupos específicos de población. Se realizó un estudio descriptivo en un asentamiento de pobladores desplazados y destechados, teniendo en cuenta algunas variables sociodemográficas, así como la morbilidad percibida en salud bucal y el uso de los servicios relacionados. Se encontraron deficientes condiciones de vida, manifestadas en desempleo, falta de oportunidades educativas, dificultades económicas, de acceso a servicios de salud, alta morbilidad bucodental percibida y desconocimiento de los derechos en salud. Se requiere avanzar en la construcción de propuestas de intervención acordes a su problemática específica, teniendo en cuenta que la calidad de vida y el bienestar son ejes fundamentales de vida digna y de salud integral.
Assuntos
Serviços de Saúde Bucal , Morbidade , Saúde Bucal , Pobreza , Odontologia em Saúde Pública , Populações VulneráveisRESUMO
Una de las poblaciones más afectadas por los problemas de salud bucal es la infantil, por lo tanto se realizó la presente investigación, enfocada en los conocimientos, actitudes, prácticas y algunas expectativas frente a la salud bucal, medios de comunicación, y mercadeo social en los niños de 7 a 12 años de la escuela Rafael Uribe Uribe de la ciudad de Medellín. Para ello se diseñó un formato de entrevista estructurada con 31 preguntas que indagaron acerca del tema, y luego se hizo un análisis por categorías establecidas entre los objetivos de la investigación. Los resultados muestran como los escolares tienen algunos conocimientos con relación al papel del odontólogo cómo un ser integral en la promoción de la salud bucal, la prevención y la rehabilitación; algunos saberes previos y asociaciones con la caries dental, una percepción muy positiva ante la consulta odontológica y buena autoestima ante sus dientes. En cuanto a sus prácticas; los escolares han recibido instrucción en salud bucal tanto por el personal odontológico como de su familia y utilizan los elementos básicos para su higiene. También reconocen elementos informativos y comunicativos en el consultorio odontológico y en menor medida en la institución educativa; resaltan como importante para impartir mensajes en salud bucal a través de la charla con el odontólogo y manifiestan ciertos gustos y preferencias con medios de comunicación y publicidad en la radio, la televisión y otros. Esta información permitió el diseño de estrategias para campañas de promoción de la salud bucal, donde se tuvieron en cuenta otras disciplinas como la comunicación, la psicología y el mercadeo social como alternativas para contribuir al posicionamiento de la salud bucal en la población estudiada. Así, se constituye un marco de referencia para futuros proyectos de intervención en poblaciones específicas que involucren alto componente educativo y comunicativo.
Assuntos
Cárie Dentária , Saúde BucalRESUMO
Leishmaniasis in Colombia has traditionally been seen as a health risk for adult males, as they become infected when they enter the vector's biotopes to tap natural resources. National health statistics seem to confirm this theory. However, during field studies, the Program for the Study and Control of Tropical Diseases (PECET) observed both equal proportions of men and women with active leishmaniasis and delayed hypersensitivity skin tests and equal proportions of males and females having had contact with the parasite from early childhood. Several factors that have not been analyzed in depth in Colombia thus far appear to distort the disease's epidemiological pattern in the country, and gender-linked differences in access to health care appear to exist. As a consequence, no relief is provided for this source of human suffering, and socioeconomic repercussions for households are significant. Preventive measures by the Colombian Ministry of Health (MOH) systematically underestimate the magnitude of intra- and peridomiciliary transmission, and female patients are excluded from active case detection. Further research should be devoted to this phenomenon. The MOH should be encouraged to improve leishmaniasis control programs, especially with regard to active case detection, training, and teaching, so that quicker diagnosis can be performed. Meanwhile, the MOH should retrain its health personnel.
Assuntos
Leishmaniose Cutânea/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Colômbia/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/transmissão , Masculino , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
Parasitologic confirmation of cutaneous leishmaniasis is obligatory before chemotherapy can be considered. Direct microscopic examination of scrapings taken from indurated borders of ulcers has been routinely used as primary method of diagnosis. In this report we compared the sensitivity of examination of dermal scrapings taken from the bottoms of ulcers (BDS) with that of dermal scrapings taken from indurated active margins of lesions (MDS) in a total of 115 patients. The sensitivities of the microscopic examination were 90.4 and 78.3% for BDS and MDS samples, respectively. When the PCR method was used with a group of 40 patients, we also observed a higher sensitivity when BDS samples were examined (80.8% in BDS samples versus 57.7% in MDS samples). The improvement of the diagnostic sensitivity in the BDS samples appears to be related to the higher parasite load and more easily detectable morphology of amastigotes in the centers of the ulcers. Other parasitologic diagnostic methods, such as culture and histopathologic examination of biopsies, are less sensitive (67.5 and 64.3%, respectively). Aspirate culture, however, was shown to be the most sensitive method for the diagnosis of patients with chronic ulcers. When microscopic examinations of both MDS and BDS samples are combined, the sensitivity of diagnosis may rise up to 94%. We therefore recommend this method as a primary routine procedure for diagnosis of cutaneous leishmaniasis.
Assuntos
Leishmaniose Cutânea/diagnóstico , Úlcera Cutânea/patologia , Animais , Biópsia , Colômbia , Humanos , Leishmania/classificação , Leishmania/isolamento & purificação , Leishmaniose Cutânea/patologia , Reação em Cadeia da Polimerase/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Pele/patologia , Testes Cutâneos , Úlcera Cutânea/parasitologiaRESUMO
The safety and immunogenicity of an intramuscular (i.m.) and intradermal (ID) formulation of autoclaved Leishmania (Leishmania) amazonensis vaccine was evaluated in 296 volunteers in a randomized, placebo-controlled, double-blind trial in Colombia. There were 4 vaccination groups: i.m. vaccine, i.m. placebo, ID vaccine, and ID placebo. The ID formulations were mixed with BCG as adjuvant at the time of injection. For each group, 3 vaccinations were given with a 20-day interval between injections, and adverse events were monitored at 20 min, and at 2, 7 and 21 days after each injection. BCG-induced adverse reactions resulted in cancellation of the third vaccine administration in the ID groups. Antibody titres did not differ significantly between the groups. Montenegro skin-test conversion was achieved by 86.4% and 90% of the i.m. vaccine group and by 25% and 5% of the i.m. placebo group 80 days and 1 year after vaccination, respectively. A significant increase in mean Leishmania-antigen lymphocyte proliferation indexes was observed after i.m. vaccine immunization, but not after i.m. placebo immunization, 80 days and 1 year after vaccination. Significant levels of IFN gamma but not IL-10 were observed 1 year after vaccination in the i.m. vaccine group compared to the i.m. placebo group. The good safety profile and evidence of Th1 immune reactions due to i.m. vaccination in this phase-I/II study suggest that a population-based phase-III efficacy trial of the i.m. vaccine should be initiated.
Assuntos
Leishmania mexicana/imunologia , Leishmaniose Cutânea/prevenção & controle , Vacinas de Produtos Inativados , Adjuvantes Imunológicos , Animais , Formação de Anticorpos , Método Duplo-Cego , Seguimentos , Humanos , Leishmaniose Cutânea/imunologiaRESUMO
Canine dirofilariasis is widespread in urban areas of central and northern Colombia. Previously we detected specific antibodies against complex antigens from Dirofilaria immitis adult worms in individuals from an isolated Tikuna Indian community in the Colombian Amazon. In this study a 56 kDa polypeptide from the adult D. immitis excretory/secretory (E/S) products is identified by Western blot, isolated by elution from polyacrilamide gels and applied in an ELISA-based test for the detection of specific IgG. Eleven of 74 serum samples analysed were positive by ELISADi56. Positive individuals came from five different areas of Colombia. The highest number of positives was found in the Amazon (4), followed by Bogotà (3). The physicians of the area must be alerted regarding the existence of human D. immitis infections and include dirofilariasis in the differential diagnosis of pulmonary nodules.
Assuntos
Anticorpos Anti-Helmínticos/sangue , Dirofilaria immitis/imunologia , Dirofilariose/epidemiologia , Animais , Western Blotting , Colômbia/epidemiologia , Doenças do Cão/epidemiologia , Cães , Ensaio de Imunoadsorção Enzimática , HumanosRESUMO
Three cases of coinfection with Leishmania and Sporothrix spp in the same lesion are described. The patients had ulcers with erythematous borders and regional lymphadenopathy. The diagnosis of leishmaniasis was accomplished by direct visualization of the amastigotes or culture of the promastigotes, or both. The diagnosis of sporotrichosis was proved in two cases by culture of Sporothrix schenckii and by the histopathologic features in one case. All patients had a positive sporotrichin test. Two patients responded successfully to oral potassium iodide. One patient received oral itraconazole 100 mg/day because of intolerance to iodides and was cured. To our knowledge coinfection with Leishmania and Sporothrix spp has not been reported. The use of empirical treatments for leishmaniasis such as poultices or puncturing of the lesion with thorns or woods splinters might introduce Sporothrix and explain the coinfection.
Assuntos
Leishmaniose Cutânea/complicações , Esporotricose/complicações , Adulto , Feminino , Humanos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Esporotricose/diagnóstico , Esporotricose/tratamento farmacológicoAssuntos
Dirofilariose/epidemiologia , Doenças do Cão/epidemiologia , Indígenas Sul-Americanos/estatística & dados numéricos , Adolescente , Adulto , Animais , Anticorpos Anti-Helmínticos/sangue , Criança , Colômbia/epidemiologia , Dirofilaria immitis/imunologia , Dirofilaria immitis/isolamento & purificação , Cães , Ensaio de Imunoadsorção Enzimática , Fezes/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In a nonblinded, therapeutic trial conducted in Colombia, 1.25-1.5 grams of mefloquine base given as a single oral dose or as 250 mg a day for 5-6 consecutive days was not efficacious in the treatment of New World cutaneous leishmaniasis. The drug had cured only 30.8 % of patients with leishmaniasis skin lesions by the 10th week after start of therapy as compared with a 27.9% complete cicatrization rate in historical controls treated with placebo tablets and an 86.3% cicatrization rate in historical controls who received meglumine antimoniate, 20 mg/ kg/day intramuscularly for 20 days, with no upper limit to daily dose. It is concluded that a single course treatment with mefloquine is not indicated as monotherapy in the treatment of Colombian cutaneous leishmaniasis primarily due to L. panamensis.
Assuntos
Antimaláricos/uso terapêutico , Leishmaniose Cutânea/tratamento farmacológico , Mefloquina/uso terapêutico , Adolescente , Adulto , Feminino , Humanos , Masculino , Mefloquina/efeitos adversos , Pessoa de Meia-IdadeRESUMO
In Colombia, violence seems uncontrollable. Along with massacres and group killings of astonishing cruelty, there are also kidnappings and disappearances, abuse of children and the elderly, and rape of young adolescents. Every day, without respite, Columbians are witnesses or victims of street crimes as well as racial, sexual, and socioeconomic discrimination. Unwillingly, they become agents of aggression in public transport, at home, at school, and at work. Colombia has the highest rates of mortality from homicide in the world. Apart from the enormous institutional burden that violence imposes on the health services and forensic medicine, it now constitutes the principal public health problem in the country. To confront it, the health sector must develop policies and finance actions, develop innovative ways to train personnel, implement public education processes, and devote more effort and greater creativity to research, which up to now has provided some, but not enough, important answers. Violence, which is the substitution of force for any type of dialogue, must be considered within the context of life and health. This it not merely an attempt to rationalize violence, much less to substitute words or reflection for action, but rather an attempt to understand it in depth in order to search for alternatives. With that goal, this article analyzes the subject of violence in Colombia, principally from the perspective of its effect on the health of the citizens and its implications for the health sector. The author fully recognizes the subjectivity and limitations of the views he expresses herein.
Assuntos
Violência/tendências , Colômbia , Saúde , Homicídio/estatística & dados numéricosRESUMO
BACKGROUND: Hundreds of thousands of cases of cutaneous leishmaniasis occur each year worldwide. Available therapies are parenteral, moderately toxic, and costly. OBJECTIVE: To determine the efficacy of and tolerance for oral allopurinol as monotherapy for cutaneous leishmaniasis. DESIGN: Randomized, controlled trial. SETTING: Outpatient clinics in 11 regions of Colombia in which cutaneous leishmaniasis is endemic. PATIENTS: 187 otherwise healthy adults with cutaneous leishmaniasis. Eighty-four percent of patients were infected with or were from regions with Leishmania panamensis; 16% were infected or were from regions with L. braziliensis. INTERVENTION: Patients were randomly assigned to one of three treatment groups. The first group received allopurinol, three 100-mg tablets four times daily (20 mg/kg of body weight per day) for 28 days. The second group received three placebo tablets four times daily for 28 days. The third group received Glucantime, 20 mg of intramuscular antimony/kg per day for 20 days. MEASUREMENT: Complete cure was defined as complete clinical reepithelialization of all lesions at 3 months and no relapse during 12 months of follow-up. RESULTS: Of 182 patients whose data could be analyzed, 157 (86%) were evaluated. In the allopurinol group, 18 of 55 (33% [95% CI, 21% to 47%]) patients were cured; in the placebo group, 17 of 46 patients (37% [CI, 23% to 52%]) were cured (difference, 4% [CI, -14% to 22%]; P = 0.68); and in the Glucantime group, 52 of 56 patients (93% [CI, 83% to 98%]) were cured (P < 0.001 compared with the allopurinol and placebo groups combined). In most cases, therapy was considered to have failed because the lesion did not reepithelialize by 1.5 months after the end of therapy. Three cases of relapse (two in the allopurinol group and one in the placebo group) at the nasal mucosa (mucosal leishmaniasis) had occurred by the end of 12 months of follow-up. CONCLUSIONS: Allopurinol monotherapy has no effect on Colombian cutaneous disease primarily caused by L. panamensis and therefore is unlikely to be effective against cutaneous leishmaniasis in other endemic regions.
Assuntos
Alopurinol/uso terapêutico , Antimetabólitos/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmaniose Cutânea/tratamento farmacológico , Adulto , Alopurinol/efeitos adversos , Antimetabólitos/efeitos adversos , Antimônio/uso terapêutico , Antiprotozoários/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Compostos Organometálicos/uso terapêutico , Falha de TratamentoRESUMO
Violence is one of the most serious problems that society, and the public health sector in particular, has to deal with today. This article begins with a discussion of the concept of violence itself, bringing out its historical and cultural dimensions and emphasizing its essential relationship to the exercise of force in the interest of power under conditions of inequality. Violence must be seen as a process that includes its origins, the conditions that allow it to happen, its different forms of expression, and its individual and collective consequences. The violence-health relationship is seen as having different levels: violence threatens or denies not only health but the entire vital human process. The author analyzes the different forms of violence: violence that impairs health (torture, disappearances, rape, child abuse, elderly abuse) and violence that kills (suicide, homicide, war). Recent data show that the problem is on the increase and pervades everyday life. The author then examines the mechanisms by which violence impinges on health care institutions, especially the health services, training institutions, and agencies responsible for orienting and financing the sector. Finally, the health sector is revealed as not only a victim or patient of violence, but, unfortunately, sometimes an agent of violence, which means that changes are needed in approaches, attitudes, and behavior.
PIP: This article presents a discussion on violence in its historical and cultural contexts while emphasizing its essential relationship to the exercise of force in the interest of power under conditions of inequality. Violence is not merely the bodily or psychological harm that is caused, or the instance of its materialization; it is a process that includes its origins, the conditions that allow it to happen, its different forms of expression, and its individual and collective consequences. Every violent process that becomes concretized or becomes the norm constitutes an interference in the vital human process in its various instantiations: it threatens life, alters health, produces disease, and presents death as a reality or an immediate possibility. Different forms of violence are analyzed: violence that impairs health (torture, disappearances, rape, child abuse, elderly abuse) and violence that kills (suicide, homicide, war). Recent data show that the problem of violence is increasing and pervades in everyday life. This paper also analyzes the impact of the increasing trend of violence on health institution particularly in health services, training institutions and agencies responsible for orienting and financing these institutions. In conclusion, the health institution is presented not just as a victim of violence, but as an agent as well. Modifications within the health sector are needed in the approach, attitude, and behavior towards violence.