RESUMO
Aim of the study was to analyse the Ministry of Health's (MINSAL) administrative database of the Universal Health Coverage (UHC) program for First Episode of Schizophrenia Spectrum Disorders (FEP-SSD). The database included every case registered in the program between 2004 and 2017. According to the timeframes established for permanence in the program, cases were defined as Suspected, FEP in diagnostic observation and FEP-SSD. Only first registers were analysed. We compared gender, age at entry, level of care and region where the case was registered. Denominator data for estimation of incidence rates were obtained from the last census. We adjusted incidence rate ratios by age, gender, and region. During the studied period, 33.207 suspected cases were registered. 27.006 (81%) were confirmed as FEP and after 6-month follow-up, 22.701 (68%) were confirmed as FEP-SSD. The median age at entry was 24 years, males entering at younger age. Male proportion was higher than female in all groups. 46.9% of all cases were detected in primary care. FEP-SSD cases were six years younger and had a higher proportion of males than discarded cases (62.6 vs 53.2%). During 169.4 million person-years at risk, crude incidence for suspected cases was 19.58 per 100.000 person-years; for FEP, 15.92 per 100.000 person-years and for FEP-SSD, 13.38 per 100.000 person-years. Chile has lower incidence of FEP-SSD compared to current world estimations but gender proportions are comparable. This UHC program has allowed early access through the integration of mental health to the health network at all levels of care.
Assuntos
Esquizofrenia , Cobertura Universal do Seguro de Saúde , Chile/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Masculino , Esquizofrenia/epidemiologia , Esquizofrenia/terapia , Adulto JovemAssuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Educação de Graduação em Medicina , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Estudantes de Medicina , COVID-19 , Competência Clínica , Infecções por Coronavirus/prevenção & controle , Educação de Graduação em Medicina/métodos , Educação de Graduação em Medicina/normas , Fidelidade a Diretrizes , Humanos , México , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , SARS-CoV-2RESUMO
Students that enroll in a vocational orientation program develop an early interest in the profession. Their involvement generates a higher sense of personal wellbeing, as well as positive academic and professional outcomes. A program was developed for high school students to experience first-hand what it means to work on health sciences. Two years after, the effects of the vocational program were assessed to analyze students' motivation and satisfaction with their professional orientation.
RESUMO
Research is a particularly underexplored professional activity for physicians, leaving many medical students compelled to pursue a clinical career. However, the XXI century requires that physicians innovate and perform research that fuels their practice; students should have early exposure to research to explore it as a career path. It should be encouraged in the undergraduate program by having students take part in case reports, short communication presentations, and research seminars. As part of an educational strategy, students worked with faculty members to deliver a gynecologic oncology pathology case report as a poster for the Oncology Conference of Medical Students. We used a quantitative approach with a descriptive and cross-sectional design to assess the effect of poster presentations on developing student's research skills. The sample comprised 118 medical students enrolled in the Pathology courses that presented a total of 23 posters. The judges who assessed had a medical specialty in Pathology, Radio-oncology, and Gynecologic Oncology. The results show that students exceeded expectations on the use of language, as it was both formal and technical; and they used relevant bibliographic support and references. However, students performed less well in the clinical case summary. The judges found that although it was coherent and chronologically ordered, they did not include all the relevant laboratory tests and analyses, nor a full description of the diagnosis. This educational strategy has proven to be valuable in promoting Pathology and Oncology Research in students; it allowed participants to adopt a systematic approach and methodologies to document, analyze, and share knowledge.
Assuntos
Pesquisa Biomédica/educação , Escolha da Profissão , Educação de Graduação em Medicina/métodos , Oncologia/educação , Patologia/educação , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Estudantes de MedicinaRESUMO
Learning about forensic sciences is a crucial part of the formation of professionals working in medicine and health areas; this includes a range of coverage from legal-medical cases to forensic autopsies. However, knowledge of forensics by medical students is limited, because the teaching focus has been on the fundamentals of procedures in this field. To develop the necessary skills, specific support, and targeted learning tasks should be designed to enable the integration of interdisciplinary work in processes, infrastructure, and equipment used in a high-quality-forensic investigation. The innovative educational experience of the Crime Scene Investigation CSI Lab was a week-long activity using the pedagogical strategy of Challenge-Based Learning. It addresses the problem that students need training in an authentic setting. The intervention, in September 2017, included 33 students from different disciplines such as medicine, law, and marketing. They participated in various learning settings in multidisciplinary teams and were challenged by experts from the State Institute for Forensic Sciences to analyze specific processes. The outcomes of the CSI Lab implementations provided evidence of how the students benefited from the experience. The results showed that 80% of the teams had an excellent approach to the solution, justification of the proposal and feasibility assessment. However, only 60% achieved a solution that met the requirements. The educational process was assessed by their perceptions of the educational strategy of the CSI Lab experience. The results indicated that 88.9% of the students believed that the experience broadened their perspectives on forensic sciences. 73.1% thought that the design of the activities, visits, and plenaries added value to their academic training, and 88.9% found it to be interesting. Regarding whether or not the activities helped the participants to understand and perform a legal-medicine investigation, 92.6% believed that it did help them recognize and understand the interventional areas and processes necessary for the investigation. CONCLUSION: Students demonstrated high acceptance of the context-rich design of the practical activities and educational experiences that were grounded in active learning. The effect on curriculum design is that the interactions and interdisciplinarity of the programs must be assessed, as these experiences could motivate them to engage in solving the social challenges of the 21st century.
Assuntos
Medicina Legal/educação , Modelos Educacionais , Aprendizagem Baseada em Problemas , Estudantes , Avaliação Educacional , Processos Grupais , Humanos , México , Projetos Piloto , UniversidadesRESUMO
BACKGROUND: Heterotaxy refers to the abnormal arrangement of organs across the left-right axis and is typically associated with complex cardiovascular malformations. OBJECTIVE: To characterise the range of cardiac and extracardiac CT angiography findings in children with heterotaxy using the latest nomenclature consensus and to compare the different types of isomerism. MATERIALS AND METHODS: We retrospectively analysed the data of 64 consecutive paediatric patients referred to our tertiary paediatric cardiovascular centre who underwent CT angiography for the evaluation of known or suspected heterotaxy within a 52-month period. RESULTS: Right atrial isomerism was identified in 44 (69%) children, while left atrial isomerism was identified in 18 (28%) children. Atrial appendage anatomy and situs could not be determined in 2 children (3%). Associated heart defects included complete atrioventricular canal (CAVC) in 51 (80%) children, total anomalous pulmonary venous return in 43 (67%) and pulmonary atresia in 23 (36%). The bronchial branching pattern corresponded to atrial appendage morphology in all children except in the two in whom atrial appendage morphology could not be defined. In children with right atrial isomerism, the most common associated abnormalities were CAVC (n=41, 93%) and asplenia (n=34, 77%), while in those with left atrial isomerism, the most common associated abnormalities were polysplenia (n=17, 94%) and an interrupted inferior vena cava with azygos continuation (n=15, 83%). CONCLUSION: CT angiography provides useful cardiovascular and extracardiac data on heterotaxy, which frequently involves a pattern of side-related findings but has great anatomical variability.
Assuntos
Angiografia por Tomografia Computadorizada/métodos , Síndrome de Heterotaxia/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
Previous research reports a significant prevalence of child depression worldwide and self-concept as a predictor of depression and suicide behavior. Although suicide in children is an increasing problem in Mexico, there are scarce studies reporting risk factors and none of children in foster care institutions. This was a comparative, ex post facto study whose aim was to analyze associations between suicidal ideation, depression, and self-concept in two paired samples of Mexican children (83 institutionalized and 83 noninstitutionalized). Results show 16% of the children reported suicidal ideation and statistically significant differences among variables in both samples. Suggestions are made to address this problem from early ages.
Assuntos
Criança Institucionalizada/psicologia , Transtorno Depressivo/psicologia , Hispânico ou Latino/psicologia , Autoimagem , Ideação Suicida , Criança , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etnologia , Feminino , Humanos , Masculino , México , Prevalência , Fatores de RiscoRESUMO
Acute pancreatitis is a known complication of choledochal cysts. It is associated with changes in the biliopancreatic junction and with intra-cystic gallstones. We describe a case of pancreatitis and biliary obstruction caused by choledochal cyst type IVa complicated with obstruction by biliary stones in a 2 year old infant.
Assuntos
Cisto do Colédoco/diagnóstico , Cálculos Biliares/diagnóstico , Pancreatite/etiologia , Doença Aguda , Pré-Escolar , Cisto do Colédoco/complicações , Cálculos Biliares/complicações , Humanos , Pancreatite/diagnósticoRESUMO
La pancreatitis aguda es una complicación evolutiva de los quistes de colédoco, se asocia a alteraciones de la unión biliopancreática y litiasis intra-quística. Se describe un caso de pancreatitis y obstrucción de vía biliar por quiste de colédoco tipo IVa complicado por cálculos enclavados, en infante de 2 años...
Acute pancreatitis is a known complication of choledochal cysts. It is associated with changes in the biliopancreatic junction and with intra-cystic gallstones. We describe a case of pancreatitis and biliary obstruction caused by choledochal cyst type Iva complicated with obstruction by biliary stones in a 2 year old infant...
Assuntos
Humanos , Masculino , Pré-Escolar , Litíase , Pancreatite , Cisto do ColédocoRESUMO
Objetivo. Establecer las concentraciones de plomo (Pb) en sangre en niños escolares de 1998 y 2008, así como su asociación con factores de riesgo. Material y métodos. Se llevó a cabo un monitoreo de Pb en sangre de niños de entre 6 y 12 años que cursan educación primaria en 17 escuelas diferentes, ubicadas en distintas zonas del área metropolitana de Monterrey, de 1998 a 2008. Resultados. Se obtuvieron niveles séricos de 9.6 ± 3.0 (µg/dL rango de 3.18 a 20.88) en 1998 y de 4.5±4.8 µg/dL (rango de 3.3 a 53.7) en 2008, lo que mostró una disminución de 2.1 veces en nivel de Pb (p<0.01). Conclusiones. La reducción de los niveles séricos de Pb demuestran los mejores controles ambientales e industriales y probablemente el éxito de retirar el Pb de la gasolina durante los años noventa.
Objective. To establish the blood lead concentration and associated risk factors in schoolchildren during 1998 and 2008. Materials and methods. A blood lead screening was conducted in schoolchildren of 6-12 years of age, enrolled in 17 elementary schools of the metropolitan area of Monterrey, México, during 1998 and 2008. Results. The mean blood lead level were 9.6 ± 3.0 (µg/dL range of 3.18 to 20.88) in 1998 and 4.5±4.8 µg/dL (range of 3.3 to 53.7) showing a 2.1-times reduction in blood lead levels (p<0.01). Conclusions. This reduction in blood lead levels demonstrate environmental and industrial control improvements and the benefits of fading out the leaded gasoline during the 1990's.
Assuntos
Durapatita/química , Fluoretos Tópicos/química , Fluoretos/química , Compostos de Amônio Quaternário/química , Ácido Silícico/química , Fluoreto de Fosfato Acidulado/química , Apatitas/química , Cristalografia por Raios X , Fluoreto de Sódio/química , Solubilidade , Espectroscopia de Infravermelho com Transformada de FourierRESUMO
OBJECTIVE: To establish the blood lead concentration and associated risk factors in schoolchildren during 1998 and 2008. MATERIALS AND METHODS: A blood lead screening was conducted in schoolchildren of 6-12 years of age, enrolled in 17 elementary schools of the metropolitan area of Monterrey, México, during 1998 and 2008. RESULTS: The mean blood lead level were 9.6 ± 3.0 (µg/dL range of 3.18 to 20.88) in 1998 and 4.5±4.8 µg/dL (range of 3.3 to 53.7) showing a 2.1-times reduction in blood lead levels (p<0.01). CONCLUSIONS: This reduction in blood lead levels demonstrate environmental and industrial control improvements and the benefits of fading out the leaded gasoline during the 1990's.
Assuntos
Chumbo/sangue , Poluentes Atmosféricos/efeitos adversos , Anemia/sangue , Anemia/epidemiologia , Criança , Estudos Transversais , Avaliação Educacional , Exposição Ambiental/estatística & dados numéricos , Feminino , Contaminação de Alimentos , Gasolina , Hematócrito , Humanos , Indústrias , Intoxicação por Chumbo/sangue , Intoxicação por Chumbo/epidemiologia , Intoxicação por Chumbo/etiologia , Masculino , México/epidemiologia , Estudos Prospectivos , Estudos de Amostragem , População Urbana/estatística & dados numéricos , Emissões de Veículos/legislação & jurisprudência , Poluentes Químicos da Água/efeitos adversosRESUMO
La intoxicación por drogas y alcohol es una entidad cada vez más frecuente y motivo de consulta en las salas de urgencias. Estamos comunicando el caso de un paciente joven, con antecedente de intoxicación aguda por etanol y cocaína que sufre accidente de tránsito con traumatismo maxilofacial y columna lumbar. En el posoperatorio requirió de asistencia respiratoria mecánica y presentó cuadro de excitación psicomotriz. En el proceso de destete presenta dolor precordial, taquicardia, hipertensión y edema agudo de pulmón, con cambios isquémicos en cara inferior e hipoquinesia inferior. Se inició furosemida y nitroglicerina, con mejoría del cuadro agudo. Se realizó coronariografía que mostró coronarias normales. Ante la presencia de un paciente joven con dolor precordial y alteraciones en el electrocardiograma, hiperactividad adrenérgica, crisis hipertensiva, arritmias cardíacas y hasta shock cardiogénico, se debe investigar el uso de cocína y alcohol en forma separada o de ambas a la vez y descartar la presencia de isquemia miocárdica asociada por coronariografía
Assuntos
Cocaína , Vasoespasmo Coronário , Isquemia MiocárdicaRESUMO
Demyelinating disease presenting as a solitary contrast-enhancing mass poses a diagnostic challenge for both radiologists and surgical pathologists. We report the cases of two female patients, aged 23 and 37 years, who exhibited the clinical and radiologic features of a space-occupying mass strongly suggestive of neoplasia. In both patients, magnetic resonance imaging showed a ring-enhancing parietal lesion. Intraoperative frozen sections in both patients displayed histologic features strongly suggestive of a glial neoplasm, including marked hypercellularity, a prominent astrocytic component, and easily identifiable mitotic figures. However, permanent sections showed additional and helpful histologic findings that included Creutzfeldt astrocytes and granular mitoses. Subsequent immunostaining showed that the hypercellularity was principally caused by macrophage infiltration (HAM-56 and CD68) and an associated reactive astrocytosis (glial fibrillary acidic protein). Additional confirmatory tests included special stains for myelin (Luxol-fast-blue), which demonstrated focal, sharply marginated loss of myelin, and for axons (silver stain for axons and neurofilament protein immunohistochemistry), which showed relative preservation of axons in areas of myelin loss. Together, the special stains confirmed the demyelinating nature of the lesions. The keys to avoiding misdiagnosing a demyelinating pseudotumor as a diffuse glioma include a general awareness of this potential pitfall, including the radiologic appearance of demyelinating pseudotumors as contrast-enhancing solitary masses that mimic tumor; knowledge of the characteristic histologic features, including Creutzfeldt astrocytes and granular mitoses; and a high index of suspicion for macrophage infiltration combined with a willingness to use appropriate confirmatory immunohistochemical studies in suspicious or uncertain cases. This approach will minimize the chance of misdiagnosis and subsequent use of inappropriate and deleterious therapies.
Assuntos
Neoplasias Encefálicas/patologia , Doenças Desmielinizantes/patologia , Glioma/patologia , Adulto , Astrócitos/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/metabolismo , Diagnóstico Diferencial , Feminino , Glioma/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , RadiografiaRESUMO
Dicho proyecto pretende ser un estudio coherente de las posibilidades económicas y técnicas de la implementación de la que es una fabrica de pinturas latex