RESUMO
Background: Many differences exist in postgraduate surgical training programmes worldwide. The aim of this study was to provide an overview of the training requirements in general surgery across 23 different countries. Methods: A collaborator affiliated with each country collected data from the country's official training body website, where possible. The information collected included: management, teaching, academic and operative competencies, mandatory courses, years of postgraduate training (inclusive of intern years), working-hours regulations, selection process into training and formal examination. Results: Countries included were Australia, Belgium, Canada, Colombia, Denmark, Germany, Greece, Guatemala, India, Ireland, Italy, Kuwait, the Netherlands, New Zealand, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, UK, USA and Zambia. Frameworks for defining the outcomes of surgical training have been defined nationally in some countries, with some similarities to those in the UK and Ireland. However, some training programmes remain heterogeneous with regional variation, including those in many European countries. Some countries outline minimum operative case requirement (range 60-1600), mandatory courses, or operative, academic or management competencies. The length of postgraduate training ranges from 4 to 10 years. The maximum hours worked per week ranges from 38 to 88 h, but with no limit in some countries. Conclusion: Countries have specific and often differing requirements of their medical profession. Equivalence in training is granted on political agreements, not healthcare need or competencies acquired during training.
Antecedentes: Existen muchas diferencias entre los programas de formación quirúrgica de posgrado del mundo. El objetivo de este estudio fue proporcionar una visión general de los requisitos formativos en cirugía general en 23 países diferentes. Métodos: En cada uno de los países participantes, un colaborador recopiló datos de la página web del organismo oficial encargado de la formación, si era posible. La información incluyó: gestión, formación, competencias académicas y operatorias, cursos obligatorios, años de formación de postgrado (que incluía el período de internado), regulaciones sobre las horas de trabajo, proceso de selección para la formación y existencia de un examen final. Resultados: Se incluyeron los datos de Australia, Bélgica, Canadá, Colombia, Dinamarca, Alemania, Grecia, Guatemala, India, Irlanda, Italia, Kuwait, Países Bajos, Nueva Zelanda, Rusia, Arabia Saudita, Sudáfrica, Corea del Sur, Suecia, Suiza, Reino Unido, Estados Unidos de América y Zambia. En algunos países existen los marcos normativos para definir los resultados del programa de formación, con ciertas semejanzas a los del Reino Unido e Irlanda. Sin embargo, algunos programas de formación, incluso en muchos países europeos, son muy heterogéneos con variaciones regionales. Pocos países describen el número mínimo de procedimientos quirúrgicos (rango 60 a 1.600), los cursos obligatorios o competencias quirúrgicas, académicos o de gestión exigidos. La duración de la formación postgraduada osciló de los 4 a los 10 años. El número de horas trabajadas máximas por semana oscilaron entre 38 y 88, sin límite en algunos países. Conclusión: Cada país tiene unos requisitos específicos, a menudo diferentes, para la formación de sus médicos. La convalidación se otorga por acuerdos políticos, más que por las necesidades médicas o por las competencias adquiridas durante la formación.
Assuntos
Currículo/normas , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Preceptoria/estatística & dados numéricos , Austrália , Canadá , Colômbia , Currículo/tendências , Europa (Continente) , Guatemala , Humanos , Índia , Kuweit , Nova Zelândia , Preceptoria/tendências , República da Coreia , Federação Russa , Arábia Saudita , Análise de Pequenas Áreas , África do Sul , Reino Unido , Estados Unidos , ZâmbiaRESUMO
Female preference for local cultural traits has been proposed as a barrier to breeding among animal populations. As such, several studies have found correlations between male bird song dialects and population genetics over relatively large distances. To investigate whether female choice for local dialects could act as a barrier to breeding between nearby and contiguous populations, we tested whether variation in male song dialects explains genetic structure among eight populations of rufous-collared sparrows (Zonotrichia capensis) in Ecuador. Our study sites lay along a transect, and adjacent study sites were separated by approximately 25 km, an order of magnitude less than previously examined for this and most other species. This transect crossed an Andean ridge and through the Quijos River Valley, both of which may be barriers to gene flow. Using a variance partitioning approach, we show that song dialect is important in explaining population genetics, independent of the geographic variables: distance, the river valley and the Andean Ridge. This result is consistent with the hypothesis that song acts as a barrier to breeding among populations in close proximity. In addition, songs of contiguous populations differed by the same degree or more than between two populations previously shown to exhibit female preference for local dialect, suggesting that birds from these populations would also breed preferentially with locals. As expected, all geographic variables (distance, the river valley and the Andean Ridge) also predicted population genetic structure. Our results have important implications for the understanding whether, and at what spatial scale, culture can affect population divergence.
Assuntos
Genética Populacional , Pardais/genética , Vocalização Animal , Animais , Equador , Feminino , Geografia , MasculinoRESUMO
Introduction: Obesity is a public health problem and Chile prevalence has increased in recent years, showing a higher percentage of overweight in adult men and of obesity in adult women. In this context, bariatric surgery appears to be a feasible, alternative. Objective: To describe meanings and experiences of adult patients who have undergone bariatric surgery in private clinics. Method: A qualitative approach based on Grounded Theory was used. The sample selection was made trough key informants and snowball, and was composed of 8 women and 3 men. To collect data semi-structured in depth interviews were used, and data analysis was performed trough open coding. Results: Three categories emerge from descriptive analysis: 1) Motivations and expectations regarding bariatric surgery; 2) Experiences in relation to overweight, and 3) Experiences in relation to food. Conclusions: Further investigation is needed from the subjectivity of the patients themselves, given the impact that obesity and bariatric surgery hason peoples lives.
Introducción: La obesidad es un problema de salud pública y en Chile ha ido en aumento en los últimos años, observándose mayor porcentaje de sobrepeso en adultos hombres y de obesidad en adultas mujeres. En este contexto, la cirugía bariátrica surge como posible alternativa. Objetivo: Describir los significados y vivencias de pacientes adultos que han sido sometidos a cirugía bariátrica en clínicas privadas. Método: Se usó un enfoque cualitativo, basado en la Teoría Fundamentada. La selección de la muestra se realizó a través de informantes clave y bola de nieve, y quedó conformada por 8 mujeres y 3 hombres. Para recoger los datos se utilizaron entrevistas en profundidad semi-estructuradas, y para el análisis se usó la codificación abierta. Resultados: Del análisis descriptivo se obtuvieron tres categorías: 1) Motivaciones y expectativas en relación a la cirugía bariátrica; 2) Vivencias en relación al sobrepeso, y 3) Vivencias en relación a la comida. Conclusiones: Es necesario continuar investigando desde la subjetividad de los propios pacientes dado el impacto que la obesidad y la cirugía bariátrica tienen en la vida de las personas.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Cirurgia Bariátrica/psicologia , Obesidade/cirurgia , Obesidade/psicologia , Gastrectomia/psicologia , Entrevistas como Assunto , Pesquisa QualitativaRESUMO
Obesity appears to be a complex condition. Current treatments are based on simple models of input and output power with regular short-term results. It is possible that changing the model of understanding long-term, better results are achieved. Neurobiological research proposes to consider the existence of an Adaptative Obesogenic Pattern (AOP) where the functioning of the nervous system is organized to increase intake. AOP is proposed as an early and maladaptive response establishing that the reward systems can modulate the axis HPA (hypothalamic pituitary adrenal axis) in the absence of sufficient social regulation. This would facilitate the reverberation of the reward system by exposing it to addictions. Based on the failure of integration between axis HPA a model is presented. Child and adolescent observational grid is proposed to evaluate AOP during the current clinical interview.
La obesidad parece ser una condición compleja. Los tratamientos actuales se basan en modelos simples de entrada y salida de energía con regulares resultados a corto plazo. Es posible que cambiando el modelo de comprensión se logren resultados a más estables en el tiempo. A través de la neurobiología se propone considerar la posible existencia de un patrón adaptativo obesogénico (PAO) donde el funcionamiento del Sistema Nervioso se organizaría tempranamente aumentando la ingesta como principal regulador del estrés. Se propone el PAO como un modelo de comprensión basado en la falla de integración precoz entre los diversos sistemas que regulan el eje HPA. Sería una respuesta maladaptativa establecida tempranamente que liga preferentemente los sistemas de recompensa a la modulación del eje HPA (hipotálamo-pituitaria-adrenal) en ausencia de suficiente regulación social y que podría explicar la obesidad temprana infantil. Se propone una forma para evaluarlo basada en la observación de la relación madre-hijo en la consulta clínica habitual.