RESUMO
OBJECTIVES: To put forth the concept of highly specialized medical care, in agreement with the nature of its practice, and evaluate the feasibility of creating a support service network. METHODS: Qualitative study of the current practice and requirements for 39 selected medical specialties, using the technique of focused groups of experts in each specialty. In accordance with the "Grounded Theory", variables were systematized and categorized and then compared in order to identify relationships between categories and link them to consensus testimonial references. On the basis of the characteristics of each kind of practice, one key expert integrated and validated service portfolios. RESULTS: We developed an integrated a concept for highly specialize medical care with 39 operational catalogs of those diagnoses that belong to each specialty, along with catalogs of the resources required by each specialty. CONCLUSIONS: Highly specialized care is a desirable model for clinical practice, but does not constitute a different level of care. Currently, medical practice is constrained by the lack of well-defined boundaries and scarcity of resources in order to be conceptualized as high specialty. It is therefore more convenient to strengthen the concept of third level of care in order to identify opportunities for the establishment of high specialty areas that will in turn serve as the focal points for medical innovation.
Assuntos
Atenção à Saúde , Especialização , Humanos , MéxicoRESUMO
BACKGROUND: two attitudes were considered about sexual practice; one is centered in the reproduction, attaching to as a natural thing and intolerance to different expressions of sexuality. The other view according to prevent damage and sexual practices without guilt, bashful attitudes and intolerance. Our objective was to evaluate the effect of an educational intervention, upon the development of the position on sexuality in health care providers. METHODS: study of comparative intervention. Two experimental groups and one control group with initial and final measurements were used. To compare two groups we used the U tests of Mann-Whitney and Kruskal-Wallis. RESULTS: the initial median of the experimental group 1 (GE1) and the witness (GT) were equal and significantly different from the experimental group 2 (GE2); in this one, only 31% of its members initiated without position, as opposed to the 100% of the GE1, and of 93 % of the GT. CONCLUSIONS: a high proportion of health care providers had no posture on sexuality. A position was not reached with the accumulating information; it develops through the questioning of their experience, the educational perspective being an essential factor to achieving it.
Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/educação , Comportamento Sexual , HumanosRESUMO
INTRODUCTION: Ischemic heart disease is the first cause of death in the world in both genders between 30 and 40 years of age. It has been proposed that socioeconomic status could affect the prevalence of cardiovascular risk factors (CVRF), as well as cardiovascular disease incidence and mortality. The purpose of this work was to compare the frequency of CVRF in two groups of women with different educational level. RESULTS: A higher frequency of visceral obesity was identified in the women with lower educational level and hypo-HDL-C in the group of women with higher educational level. Correlation between age and modifiable CVRF was different between the studied groups. A larger proportion of women with higher educational level than those with lower educational level drank alcoholic beverages and smoked cigarettes. DISCUSSION: Frequency of identified modifiable CVRF was similar to that found in other Hispanic-American populations. The inverse relationship between CVRF and educational level, a commonly used measure of socioeconomic status, and prevalence of CVRF informed in English and American studies was not observed in this investigation; probably because social and cultural conditions could affect the educational level in a different manner. Health education programs must take into account the cultural processes of each country, city, or community, regardless of the socioeconomic status, based on social and cultural backgrounds of each group.
Assuntos
Doenças Cardiovasculares/epidemiologia , Adulto , Estudos Transversais , Escolaridade , Feminino , Humanos , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
INTRODUCTION: Ischemic heart disease is the first cause of death in the world in both genders between 30 and 40 years of age. It has been proposed that socioeconomic status could affect the prevalence of cardiovascular risk factors (CVRF), as well as cardiovascular disease incidence and mortality. The purpose of this work was to compare the frequency of CVRF in two groups of women with different educational level. RESULTS: A higher frequency of visceral obesity was identified in the women with lower educational level and hypo-HDL-C in the group of women with higher educational level. Correlation between age and modifiable CVRF was different between the studied groups. A larger proportion of women with higher educational level than those with lower educational level drank alcoholic beverages and smoked cigarettes. DISCUSSION: Frequency of identified modifiable CVRF was similar to that found in other Hispanic-American populations. The inverse relationship between CVRF and educational level, a commonly used measure of socioeconomic status, and prevalence of CVRF informed in English and American studies was not observed in this investigation; probably because social and cultural conditions could affect the educational level in a different manner. Health education programs must take into account the cultural processes of each country, city, or community, regardless of the socioeconomic status, based on social and cultural backgrounds of each group.
Assuntos
Adulto , Feminino , Humanos , Adulto Jovem , Doenças Cardiovasculares , Estudos Transversais , Escolaridade , Fatores de Risco , Fatores SocioeconômicosRESUMO
BACKGROUND: One problem in rural population is the gap between coverage of contraception and scant masculine participation, which could be due to lack of information of to other sociocultural factors. METHODS: We investigated, in two stages, the characteristics or the profile of the sexual and reproductive behavior of males in an exploratory study by means of focus groups to determine their relevant motivations and characteristics and subsequently, a structured questionnaire to ascertain the magnitude of the factors explored. The population corresponded to zones of rural hospital medical services zones of medical services in seven ethnic groups of the Mexican Republic and included men who accepted and who rejected vasectomy. RESULTS: The profile of males who accepted vasectomy allowed to determine that there exist a unsatisfied demand for contraceptive protection and the desire of not having additional children; in addition, we found that the decision to accept vasectomy is determined to a greater extent for reasons different from that of information on the contraceptive method. The important proportion of males who were non-users of contraceptive methods who accepted vasectomy supposed information on contraception to be the most consistent reason; nonetheless, this information was not considered sufficient and timely; thus, adverse economic situation, a certain condition related with the couple such as health or love for the female partner are the more weighty reasons for deciding to accept vasectomy, while the fear of poor sexual performance is the most powerful factor for rejection of vasectomy. CONCLUSIONS: Masculine participation in family planning is a factor that conditions contraceptive coverage and its respective benefits. The profile of the male who accepts vasectomy aids in identifying candidates forthe procedure and in reducing unsatisfied demand. Greater diffusion of information of the contraceptive method of vasectomy, greater links between male needs and vasectomy, and maintaining or increasing access to family planning are required.
Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , População Rural/estatística & dados numéricos , Vasectomia/estatística & dados numéricos , Adolescente , Adulto , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To evaluate the development through time of the clinical aptitude in physicians of the first level of attention and the influence of categories of first level physicians. MATERIAL AND METHODS: In a cross-section design the clinical aptitude was studied in three categories of physicians of the first level of attention: general practitioners with functions of family medicine, family physicians, and family physicians working as head of a clinical department in Family Medicine Units with 10 or more consulting rooms. To evaluate the clinical aptitude, an instrument with 12 real clinical cases and 412 questions was used with nine indicators; this instrument was validated in a previous study. RESULTS: 499 physicians of the three categories were included, the scores range was between 52 and 245, with an average of 169 (41%). When comparing the categories of physicians, significant differences were found, in favor of the physicians with a specialty. There were no differences among heads of clinical departments and family physicians. In the global analysis among indicators no differences were found. When correlating the clinical aptitude with the years of experience, without considering the category, a correlation of 0.02 was obtained. CONCLUSIONS: Experience seems to have no influence in the development of clinical aptitude; passive continuing education seems to have little influence in the physicians deepening into frequent health-problem solving in their practice.