RESUMO
Introducción: La práctica de la prevención cuaternaria lleva a evitar intervenciones sanitarias innecesarias. Objetivo: Evaluar la relevancia dada a los conceptos de prevención cuaternaria (P4), describir la influencia de entrenamiento en Medicina Basada en Evidencia su práctica y presentar las barreras y facilitadores de la práctica de la P4. El estudio: estudio de métodos mixtos durante 2018 y 2019. Se encuestaron 133 médicos que laboran en atención primaria y se realizaron entrevistas semi-estructuradas a 20 participantes. Se utilizó los principios de la fenomenología para el análisis de los transcritos. Hallazgos: 94% consideran importante la práctica de la P4. A partir de nuestras entrevistas se identificaron barreras y facilitadores para la práctica de la P4 en el primer nivel de atención. Conclusión: Los médicos consideran importante la práctica de la prevención cuaternaria. Las barreras y facilitadores relevantes son las características específicas del sistema sanitario, del paciente y de los médicos.
Background:Thepracticeofquaternarypreventionleadstoavoid unnecessary health interventions.To evaluate the relevance given Objective:to the concepts of quaternary prevention (P4), to describe the influence of training in Evidence Based Medicine on its practice and to present the barriers and facilitators of the practice of P4. Mixed methods study during The Study:2018 and 2019. We surveyed 133 physicians working in primary care and conducted semi-structured interviews with 20 participants. The principles of phenomenology were used for transcript analysis. 94% consider the Findings:practice of P4 to be important. From our interviews, barriers, and facilitators for the practice of P4 at the first level of care were identified. Conclusion:Physicians consider the practice of quaternary prevention to be important. Relevant barriers and facilitators are the specific characteristics of the healthcare system, the patient, and the physicians.
RESUMO
BACKGROUND: As the disease caused by the novel coronavirus has spread globally, there has been significant economic instability in the healthcare systems. This reality was especially accentuated in Ecuador where, the shortage of healthcare workers combined with cultural and macroeconomic factors has led Ecuador to face the most aggressive outbreak in Latin America. In this context, the participation of final-year medical students on the front line is indispensable. Appropriate training on COVID-19 is an urgent requirement that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes, and practices of Ecuadorian final-year medical students that could potentially guide the design of better medical education curricula regarding COVID-19. METHODS: This was a cross-sectional 33-item online survey conducted between April 6 to April 2020 assessing the knowledge, attitudes, and practices toward the diagnosis, treatment, prevention, and prognosis toward COVID-19 in Ecuadorian final-year medical students. It was sent by email, Facebook, and WhatsApp. RESULTS: A total of 309 students responded to the survey. Out of which 88% of students scored high (≥ 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID-19 and volunteering during the outbreak in Ecuador (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment. The latter finding was significantly associated with negative attitudes. CONCLUSIONS: Although a large number of students displayed negative attitudes, the non-depreciable percentage of students who were willing to volunteer and the coexisting high level of knowledge displayed by students, suggests that Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Not having personal protective equipment was significantly associated to negative attitudes. Providing the necessary tools and creating a national curriculum may be one of the most effective ways to ensure all students are trained, whilst simultaneously focusing on the students' most pressing concerns. With this additional training, negative attitudes will improve and students will be better qualified.
Assuntos
COVID-19/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , SARS-CoV-2 , Estudantes de Medicina/psicologia , Adulto , Atitude do Pessoal de Saúde , COVID-19/diagnóstico , COVID-19/terapia , Estudos Transversais , Equador/epidemiologia , Feminino , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Humanos , Masculino , Equipamento de Proteção Individual/estatística & dados numéricos , Prognóstico , Estudantes de Medicina/estatística & dados numéricos , Voluntários/estatística & dados numéricos , Adulto JovemRESUMO
La conspiración de silencio es una barrera en torno a la verdad, que puede definirse como el acuerdo tanto implícito como explícito al que llega la familia, el entorno o los profesionales de la salud, de cambiar la información que se le brinda al paciente con la finalidad de ocultarle el diagnóstico, la gravedad y el pronóstico de la situación clínica por la que está atravesando. El rol de la familia del paciente con enfermedad terminal debe ser considerado punto sumamente importante en las decisiones y acciones del personal de salud, ya que de ella depende el apoyo físico, material, psicosocial y espiritual del enfermo. La comunicación adecuada con la familia debe establecerse desde la primera consulta, aun antes de arribar a un diagnóstico, ya que permite cumplir con los objetivos del manejo multidimensional e integral de todo paciente. Es importante definir con la mayor claridad posible la información al paciente y su familia sobre el diagnóstico, enfermedad y pronóstico, y debe ejercerse receptividad plena a sus dudas, creencias, expectativas y aun los mitos o fabulaciones que todos ellos tengan respecto a la enfermedad diagnosticada. Es vital que los médicos estén adecuadamente entrenados en el manejo de información y que desarrollen habilidades de comunicación que favorezcan la adecuada adaptación del paciente y la familia al proceso clínico, desde el diagnóstico inicial hasta el duelo que sigue a la muerte del paciente, evitando de esta forma el surgimiento y desarrollo de una conspiración de silencio y sus negativas consecuencias sobre todos los involucrados
The conspiracy of silence is a barrier to the truth that can be defined as both the implicit and explicit agreement arrived at by the patient's family, his/her surroundings and the health professionals involved, changing the information provided to patients and, thus, hide the diagnosis, severity and prognosis of the disease. The role of the terminal patient´s family is essential for the health staff's decisions and actions as they are a decisive factor in the provision of physical, material, psychosocial and spiritual support. The communication between family and health professionals must be adequate from the beginning even before arriving at a diagnosis, as it will allow to comply with the objectives of a multidisciplinary and integrated management. It is important to find out what the patient and his/her family know about the diagnosis, disease and prognosis and the staff must be receptive to all their doubts, beliefs, expectations, and even myths and fabulations about the terminal disease. It is vital for physicians to be properly trained on information management, favoring the adequate family and patient´s adaptation to the disease process and the subsequent grief process in order to avoid the development of the conspiracy of silence and its negative consequences on all involved.
RESUMO
La enfermedad de Huntington (EH) es una enfermedad neurodegenerativa devastadora, hereditaria, caracterizadapor s¡ntomas progresivos motores, cognitivos y psiquitricos, los cuales aparecen mayormente durante la vida adulta. Su curso cl¡nico produce consecuencias físicas, emocionales, cognitivas, sociales y económicas gravesen el paciente y cuidadores. Su prevalencia a nivel mundial se estima en 7-10 por 100000 habitantes pero, en lazona del Valle de Ca¤ete en nuestro pa¡s, se estableció en m s de 40 por 100,000. Actualmente no existe curapara la EH; sin embargo, se dan opciones terapéuticas para el alivio de s¡ntomas con el fin de mejorar la calidadde vida del paciente. Es en este rubro donde radica la importancia de los Cuidados Paliativos, definidos por laOrganización Mundial de la Salud como un enfoque de atención que, mediante medidas de prevenci¢n y alivio delsufrimiento, asiste eficazmente a las personas enfermas y a sus familiares en el afronte de problemas asociados con enfermedades mortales. A pesar del impacto que genera esta patolog¡a en nuestra población, nuestro pa¡s carece de recursos suficientes para el tratamiento integral de los pacientes. Mejorar la atención al final de la vida es un reto moderno que requiere incrementar la formación de los profesionales de la salud y la comunidad, mayor financiaci¢n para la atención y desarrollo de pol¡ticas pertinentes.
Huntingtons disease (HD) is a devastating neurodegenerative disease, hereditary in nature, characterized byprogressive motor, cognitive, and psychiatric symptoms which appear mainly in adulthood and result in seriousphysical, emotional, cognitive, social, and economic consequences in patients and caregivers. Its global prevalenceis estimated in 7-10 per 100000 population, but in the Ca¤ete Valley of Per£, it has reached up to 40 per 100,000 inhabitants. The cure for HD is not yet available but there are many treatment options for symptomatic relief aimed at improving the patients quality of life. It is in this context that palliative care measures emerge as a relevantalternative; defined by the World Health Organization as a set of care approaches that, through preventive andsuffering attenuation, assist efficaciously both, patients and their relatives, in facing the problems associated with life-threatening diseases. Despite the importance of involving the population in the research of this disease, our country lacks adequate resources for treatment and patient support. Improving end of life care is a modern challenge that requires increasing the training of health and community professionals, increased funding for the care and development of relevant policies.