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Introdução: na atenção primária à saúde, a atuação de médicos generalistas é importante no rastreamento e no acompanhamento dos estágios iniciais da doença renal crônica devido à alta prevalência, à falta de especialistas, ao impacto na morbimortalidade e qualidade de vida e ao elevado custo aos sistemas de saúde. O uso de aplicativos móveis tornou-se importante na medicina contemporânea por facilitar o acesso à informação, o que otimiza a prestação de cuidados à saúde.Objetivos: desenvolver e validar um aplicativo móvel sobre testes laboratoriais na doença renal crônica para médicos generalistas. Métodos: estudo na modalidade de produção tecnológica, com desenvolvimento de software a partir de revisão da literatura, com validação por especialistas (nefrologistas) e por médicos generalistas. A validação se deu através de respostas a questionários, que avaliaram conteúdo, compreensão, linguagem e apresentação gráfica do aplicativo. Para a análise da consistência interna dos questionários foi utilizado o coeficiente alfa de Cronbach e para avaliar a concordância dos médicos sobre aspectos do aplicativo utilizou-se o Índice de Validade de Conteúdo. O valor adotado para o Índice de Validade de Conteúdo foi maior do que 80%. Resultados: as respostas dos nefrologistas (n=9) e dos médicos generalistas (n=13) foram, respectivamente, medianas de idade de 40 (35-71) anos e 45 (30-50) anos; sexo feminino 5 (55%) e 7 (54%); coeficiente alfa de Cronbach de 0,8025 e 0,9145; Índice de Validade de Conteúdo Global de 95,6% e 92,1%. Conclusão: a confiabilidade das respostas aos questionários mostrou-se boa e houve excelente concordância entre os juízes sobre os aspectos do aplicativo móvel

Introduction: in primary health care, the performance of general practitioners is important in tracking and monitoring the early stages of chronic kidney disease, due to the high prevalence, lack of specialists, impact on morbidity and quality of life and the high cost to health systems. The use of mobile applications has become important in contemporary medicine because it facilitates access to information, which optimizes the provision of health care. Objectives: to develop and validate a mobile application on laboratory tests in chronic kidney disease, for general practitioners. Methods: study in the technological production modality, with software development based on a literature review, with validation by specialists (nephrologists) and by general practitioners. Validation took place through answers to questionnaires, which evaluated content, understanding, language and graphic presentation of the mobile application. Cronbach's alpha coefficient was used to analyze the internal consistency of the questionnaires, and the Content Validity Index was used to assess physicians' agreement on aspects of the app. The value adopted for the mobile application was greater than 80%. Results: the responses of nephrologists (n=9) and general practitioners (n=13) were, respectively, median age 40 (35-71) years and 45 (30-50) years, 5 (55%) and 7 (54%) were female, Cronbach's alpha coefficient of 0.8025 and 0.9145, Global Content Validity Index of 95.56% and 92.13%. Conclusion: the reliability of the responses to the questionnaires was good and there was excellent agreement between the judges on aspects of the mobile application

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RESUMO Objetivo: Avaliar a acurácia de médicos generalistas em reconhecer a retinopatia diabética por meio da retinografia colorida, com um curso de capacitação com duração de 2 horas, comparando a capacidade de rastrear e classificar a retinopatia diabética em relação ao exame presencial com oftalmologista. Métodos: No primeiro braço do estudo, de 142 pacientes diabéticos incluídos, avaliaram-se 274 olhos, em que esses pacientes foram examinados com oftalmoscópio binocular indireto e classificados quanto ao grau da retinopatia diabética. No segundo braço do estudo, 14 médicos não especialistas em oftalmologia receberam um treinamento de 2 horas para o diagnóstico de retinopatia diabética com a retinografia colorida e se aferiu a acurácia desses profissionais em rastrear a retinopatia diabética antes e depois do curso de capacitação, utilizando as retinografias obtidas na primeira frente do estudo. Resultados: Verificou-se aumento significativo da sensibilidade (82% para 99%) e da especificidade (44% para 83%) na detecção da retinopatia diabética pelos médicos generalistas, com o curso de capacitação. Conclusão: O médico generalista capacitado pode avaliar a retinopatia diabética por meio da retinografia colorida, sendo o programa de rastreamento dessa complicação do diabetes uma proposta viável e benéfica ao país.

ABSTRACT Objective: To assess the accuracy of general practitioners in recognizing diabetic retinopathy through color retinal retinography, with a two-hour training course, by comparing the capacity of screening and classifying diabetic retinopathy. Methods: In the first arm of the study, of 142 diabetic patients included, 274 eyes were evaluated, and these patients were examined with an indirect binocular ophthalmoscope and classified according to the degree of diabetic retinopathy. In the second arm of the study, 14 physicians who are not specialists in ophthalmology received two-hour training to diagnose diabetic retinopathy with color retinography, and the accuracy of these professionals in screening for diabetic retinopathy before and after the training course was measured using the photographic images obtained on the first front of the study. Results: There was a significant increase in sensitivity (82% to 99%) and specificity (44% to 83%) in detecting diabetic retinopathy by general practitioners, after attending the training. Conclusion: Qualified general practitioners can assess diabetic retinopathy through color retinography, and the screening program for this diabetes complication is a viable and beneficial proposal for the country.

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INTRODUCTION: Job satisfaction has been shown to have important effects at the organizational level. In various corners of the world, physicians are obliged to perform a period of social service, generally at the first level of care in rural or remote areas. OBJECTIVE: To describe the level of job satisfaction and perceptions of Ecuadorian rural physicians regarding compulsory social service. METHODOLOGY: A descriptive, cross-sectional study was conducted based on a self-administered online questionnaire from February to March 2022, in Ecuadorian rural physicians who were performing their compulsory social service. Participants were invited through official outreach groups. A total of 247 surveys were included in this study. We assessed job satisfaction by means of the S20/23 job satisfaction questionnaire and compared these results with sociodemographic variables and job characteristics of the participants. We performed the reliability test (Cronbach's alpha) to find the validity of the S20/23 questionnaire in physicians performing compulsory social service. RESULTS: The majority of participants were women (61.0%), and overall job satisfaction was 4.1/7.0 pts. "indifferent." The only satisfaction factor in which a predominance of dissatisfaction was found related to benefits/remuneration (43.3%). Participants' perceptions of wrong academic guidance during training, insufficient induction, and negative experiences during work were related to higher levels of dissatisfaction (P < .05). CONCLUSION: The level of job satisfaction of Ecuadorian rural physicians during their compulsory social service was low and graduates indicated a neutral attitude toward job satisfaction in general. Negative perceptions with respect to training and expectation formation prior to and during the mandatory social service generated greater dissatisfaction. The Ministry of Health of Ecuador, as an organizational entity, should implement improvements to increase the job satisfaction of recently graduated physicians, given the implications that this experience may have for their professional future.

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This qualitative study researched the determinants influencing family physician's decision on benzodiazepine prescription in a primary care setting, in the city of Rio de Janeiro. An analysis was sought to be elaborated, on how the prescription is negotiated between physician and user. Twelve general practitioners settled in primary care were recruited, gave acceptance signing free and informed consent form, responding to a semi-structured questionnaire that was recorded and transcribed verbatim for analysis, from August to December 2017. The questionnaire addressed physicians' perception of complaints in benzodiazepines users, and alternatives offered instead of medicines. Anxiety and insomnia were cited as the most frequent reasons for use. There was also mention of nonspecific somatic complaints, chronic pain, arterial hypertension, and dependence. Most physicians proposed the therapeutic alliance as a mechanism for offering alternatives to reduce the chronic use of benzodiazepines, despite this intervention achieving a low success rate. Longitudinal care was evidenced as a guiding principle. The analysis of the meanings attributed to BZD, as unveiled in this work, promotes a discussion about the place of medication in culture and its consequences in the approach to psychological and mental suffering.

Este estudio cualitativo investigó los determinantes que pesan sobre la decisión de la prescripción de benzodiacepinas por médicos de familia, en el contexto de la atención primaria del municipio de Río de Janeiro. Con el fin de elaborar un análisis sobre cómo la prescripción es negociada entre médico y usuario, se reclutaron 12 médicos de familia de inserción en la estrategia salud de la familia. Los candidatos convocados aceptaron firmando el formulario de consentimiento informado y respondieron un cuestionario semiestructurado, que fue grabado y transcripto para su análisis, en el período de agosto a diciembre de 2017. El cuestionario abordó la percepción del médico sobre el uso de benzodiacepinas y las alternativas al mismo. Los entrevistados relataron predominio de prescripción de repetición, preocupación por la optimización y reducción de la dosis, cuando era posible. Se evidenció como motivo de uso: ansiedad, insomnio y síntomas depresivos. Quejas somáticas, dolor crónico, hipertensión arterial y dependencia se encontraron como motivos relacionados. La mayoría de los médicos propuso la alianza terapéutica como mecanismo para ofrecer alternativas que permitieran reducir el uso crónico de benzodiacepinas, a pesar de esta intervención alcanzar una baja tasa de éxito. Por tanto, los médicos entrevistados mostraron un compromiso con el uso racional y preocupación con el uso indiscriminado. La longitudinalidad en el cuidado se evidenció como principio directriz. El análisis de los efectos atribuidos a las BZD, como se devela en este dispositivo, promueve una discusión sobre el lugar de los medicamentos en la cultura y sus consecuencias en el abordaje del sufrimiento psíquico y mental.

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Introducción: La Medicina Familiar cubana se enfrenta hoy a nuevos retos para su perfeccionamiento, esto implica realizar un fortalecimiento del primer nivel de atención para garantizar mejoría en la calidad de los servicios para lo cual la intersectorialidad se ha consolidado como pilar fundamental. Objetivo: Diseñar y evaluar una estrategia de intervención intersectorial para perfeccionar el programa del médico y la enfermera de la familia. Métodos: Se realizó un estudio cuasi experimental de intervención a través de una estrategia intersectorial para perfeccionar el programa del médico y enfermera de la familia, en el período de diciembre de 2019 a diciembre de 2022 en la provincia Las Tunas. El universo estuvo conformado por 867 trabajadores del cual se seleccionó una muestra de 330. Se realizó en cuatro etapas: diagnóstica, de intervención, validación y de evaluación. Se empleó como medida de resumen para variables cualitativas el porcentaje, para la validación estadística de los cambios antes y después la prueba de Mc Nemar y para la validación teórica de la estrategia intersectorial se utilizó la matriz de Chanlat. Resultados: La aplicación de la estrategia mejoró el nivel de conocimientos en los equipos básicos de salud y en los actores sociales, se revitalizaron el 93,5 % de las acciones comunitarias e intersectoriales, se modificó el cuadro de salud en el 89,4 % y se elevó en un 94,1 % el nivel de satisfacción de la comunidad con los servicios prestados por el consultorio médico de la familia. Se demostró que es pertinente la aplicación de la estrategia en la práctica social mediante los resultados de la efectividad esperada. Conclusiones: La estrategia permitió perfeccionar el programa del médico y enfermera de la familia a través de la puesta en práctica de un programa intersectorial de forma integral, consciente, participativo y sistemático.

Introduction: Cuban Family Medicine faces today new challenges for its improvement; this implies strengthening the first level of care to guarantee improvement in the quality of services for which intersectorality has been consolidated as a fundamental pillar. Objective: To design and to evaluate an intersectoral intervention strategy to improve the program of the family doctor and nurse. Methods: A quasi-experimental intervention study was carried out through an intersectoral strategy to improve the family doctor and nurse program, from December 2019 to December 2022 in Las Tunas. The universe consisted of 867 workers from which a sample of 330 was selected. It was carried out in four stages: diagnostic, intervention, validation and evaluation. The percentage was used as a summary measure for qualitative variables, for the statistical validation of the changes before and after the Mc Nemar test and for the theoretical validation of the intersectoral strategy the Chanlat matrix was used. Results: With the application of the strategy, the level of knowledge in the basic health teams and in the social actors was improved, 93.5 % of the community and intersectoral actions were revitalized, modified the health picture in 89.4 % and the level of satisfaction of the community with the services provided by the CMF increased by 94.1 %. It was demonstrated that the application of the strategy in social practice through the results of the expected effectiveness of the strategy. Conclusions: The strategy made it possible to improve the family doctor and nurse program through the implementation of an intersectoral program in a comprehensive, conscious, participatory and systematic way.

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Introducción. El entrenamiento en cirugía mínimamente invasiva y la definición de las actividades profesionales específicas, socialmente responsables y seguras para el paciente, son un desafío y un deber en la educación médica. Nuestro objetivo es argumentar a favor de esta intervención y describir las especificaciones, alcances y limitaciones de las actividades profesionales confiables a este nivel, así como su lugar en un modelo de aprendizaje experiencial en cirugía mínimamente invasiva para toda la vida. Métodos. Se evalúa el contexto de la actividad quirúrgica asistencial de los médicos generales, con relación a su participación en el equipo quirúrgico y la necesidad de incorporación en su perfil profesional de unas competencias propias de la cirugía mínimamente invasiva, acorde con su nivel y funciones. Mediante una postura académica y reflexiva, se identifican vacíos y oportunidades de avanzar en el tema. Resultados. El perfil profesional de un médico general debe contemplar la cirugía mínimamente invasiva como una competencia dentro de su formación, de manera análoga a las propias de la cirugía tradicional abierta. Para ello, se requiere afrontar coherentemente el cambio de teoría y educación quirúrgica, el cambio en la demanda de servicios quirúrgicos y procedimientos, así como fortalecer el rol activo del médico general en el equipo quirúrgico. Conclusiones. Es necesario modificar el paradigma educativo en cirugía, desde la formación médica en el pregrado. Se plantea un modelo de aprendizaje experiencial de cirugía mínimamente invasiva, y se establecen las competencias fundamentadas en actividades profesionales confiables, necesarias para el perfil profesional de un médico general del siglo XXI.

Introduction. Training in minimally invasive surgery and the definition of specific, socially responsible and safe professional activities for the patient are a challenge and a duty in medical education. Our objective is to argue in favor of this intervention and describe the specifications, scope and limitations of trustworthy professional activities at this level, as well as its place in an experiential learning model in minimally invasive surgery for life.Methods. The context of the surgical care activity of general practitioners is evaluated, in relation to their participation in the surgical team and the need to incorporate in their professional profile some competencies of minimally invasive surgery, according to their level and functions. Through an academic and reflective posture, gaps and opportunities to advance the subject are identified. Results. The professional profile of a general practitioner should consider minimally invasive surgery as a skill within their training, in a similar way to those of traditional open surgery. For this, it is necessary to coherently face the change in surgical theory and education, the change in the demand for surgical services and procedures, as well as strengthening the active role of the general practitioner in the surgical team.Conclusions. It is necessary to modify the educational paradigm in surgery from undergraduate medical training. An experiential learning model of minimally invasive surgery is proposed, and the skills based on reliable professional activities, necessary for the professional profile of a general practitioner of the 21st century, are established

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BACKGROUND: The Center of Molecular Immunology of Cuba has developed a programme for the conducting of multicentre oncology clinical trials in primary healthcare centres since 2009. AIM: To evaluate the ability to conduct oncology clinical trials in primary health care. DESIGN & SETTING: A longitudinal, prospective, analytical study was developed between July 2010 and August 2020 in the Villa Clara province. METHOD: Structure, process, and outcome indicators were evaluated by the methods of a structured interview, direct observation, documentary observation, and databases analysis. The investigators' curricula vitae, the investigator site file, minutes of workshops, the monitoring reports, the clinical trial training records, and databases were employed as sources of information. The following criteria were considered adequate: when the indicator met the standard; and not adequate: when the indicator did not meet the standard. RESULTS: The six structure indicators reached adequate results and showed that the programme has allowed building of capacities to conduct clinical trials in primary care. The eight processes indicators and two outcome indicators were considered adequate too. Trials conducted in primary care showed better indicators of patient recruitment than secondary care. Both scenarios showed similar behaviour for the process indicators: retention, protocol compliance, and safety. Survival and satisfaction with health services were also comparable in both scenarios. CONCLUSION: The evaluation of the programme showed adequate indicators for conducting oncology clinical trials in primary care in Villa Clara and these were comparable to those determined in the secondary care.

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ABSTRACT Introduction: Musculoskeletal disorders (MSD) are the second leading cause of disability worldwide. There are difficulties in the early diagnosis and therapeutic approach to these pathologies, with a negative impact on their outcomes. Access to rheumatology is limited, with a low supply in the face of growing demand, which makes the general practitioner the first contact for care. Objectives: Describe the perception and confidence that general practitioners have regarding the training in rheumatology received at undergraduate level. Materials and methods: Observational cross-sectional study, with a Likert-type survey tool being used. The study included general practitioners graduated from the Colombian Medicine program between 2009 and 2019. The variables studied were those related to the curriculum, acquired knowledge or skills, and proficiency in content in rheumatol ogy compared to practice. Subjects who attended a specialist or who had an employment relationship with a specialist rheumatology centre were excluded. Results and Conclusions: A total of 102 physicians were surveyed, and 86 completed ques tionnaires were included in the final analysis. Of these, 83.4% were graduates of private universities. Over two-thirds (37%9) had a formal subject in rheumatology, 16% received training with specific strategies, 54% expressed security when performing the MS physical examination, and 47% were sure in the diagnostic approach, and prescription of disease-modifying drugs. In order to strengthen the training in rheumatology required by the undergraduate, a joint effort is required with the medical schools in defining the competen cies and skills of the primary care physician, together with the health needs and available educational strategies.

RESUMEN Introducción: Las enfermedades musculoesqueléticas (ME) son la segunda causa de discapa cidad mundial. Se presentan dificultades en el enfoque diagnóstico y terapéutico temprano de estas enfermedades, lo cual tiene un impacto negativo en sus desenlaces. El acceso a Reumatología es limitado, con una baja oferta frente a la creciente demanda, lo que convierte al médico general en el primer contacto de atención. Objetivos: Describir la percepción y la confianza que tienen los médicos generales respecto a la formación en reumatología recibida en el pregrado. Materiales y métodos: Estudio observacional de corte transversal en el cual se indagó a médi cos generales, egresados de programas de medicina colombianos entre el 2009 y 2019, mediante un cuestionario con respuesta tipo Likert, sobre variables relacionadas con el planteamiento curricular, los conocimientos o habilidades adquiridas y la suficiencia en el contenido en reumatología con respecto a la práctica. Se excluyó a los sujetos que cur saran algún programa de especialización o que tuvieran relación laboral con un centro especializado de Reumatología. Resultados y conclusiones: Se encuestó a 102 médicos; 86 encuestas fueron incluidas en el análisis final. El 83,4% de ellos eran egresados de universidades privadas, el 37% contó con una asignatura formal de reumatología, el 16% recibió formación con estrategias específicas, el 54% manifestó seguridad al realizar el examen físico musculoesquelético, el 47% expresó sentirse seguro en el enfoque diagnóstico y la prescripción de medicamentos modificadores de la enfermedad. Es necesario fortalecer la formación en Reumatología en el pregrado; se requiere un trabajo conjunto con las facultades de medicina en la definición de competen cias del médico de Atención Primaria, alineado con las necesidades de salud y las estrategias educacionales disponibles.

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Abstract: Introduction: Since the National Curricular Guidelines for the Medicine course were implemented, with emphasis on the training of professionals with a generalist profile, the factors that may contribute to the interest in professional practice are unknown. Objective: This study aimed to analyze the perception of medical students regarding their generalist training and the factors that influence the desire for professional practice. Methodology: Descriptive and analytical cross-sectional study of qualitative and explanatory character with 523 students from different medical courses in the city of Salvador-Bahia, who answered an online survey after signing the informed consent form. The sample was categorized into interest in Immediate Specialization (IS) and among those who intend to Act as a Generalist (AG). The age and period of the course were also categorized into groups. Results: The age of the sample was 18 to 25 years in 83.7% (n = 438), with 72.5% (n = 380) being female, attending 69% of the 4º to 9º semesters (n = 363). The Immediate Specialization group represented 27.2% (95% CI: 35% -73%) and the group that intends to Act as a Generalist, 72.8% (95% CI: 68% -76%). General training did not influence the option for professional practice with RR = 0.81 (95% CI: 0.55-1.20) p = 0.308. The factors associated with AG were believing in the generalist's resolution capacity and SUS guidelines (p <0.001), the desire to contribute to society (p = 0.005) and society's credibility (p = 0.044). Conclusion: Students perceive that the curriculum includes general training, however it did not influence the interest in professional practice. The desire to act as a generalist is present in a significant number among them, driven by altruism and the desire to contribute to society, supported by the organic laws that underlie the SUS Guidelines, while not feeling valued and having its credibility, questioned by society, only stimulates professional practice on a temporary basis.

Resumo: Introdução: Desde que foram implantadas as Diretrizes Curriculares Nacionais para o curso de Medicina com ênfase à formação de profissionais com perfil generalista desconhece-se os fatores que podem contribuir com o interesse pelo exercício profissional. Metodologia: Estudo transversal descritivo e analítico de caráter qualitativo explanatório com 523 acadêmicos dos diversos cursos de medicina da cidade de Salvador-Bahia, que responderam um questionário online após assinatura do TCLE. A amostra foi categorizada em interesse na Especialização Imediata (EI) e entre aqueles que pretendem Atuar como Generalistas (AG). A idade e o período do curso também foram categorizados em grupos. Resultados: A idade da amostra era de 18 a 25 anos em 83,7% (n=438), sendo 72,5% (n=380) do sexo feminino, cursando do 4º ao 9º semestre em 69% (n=363). O grupo Especialização Imediata representou 27,2% (IC95%: 35%-73%) e o grupo que pretende Atuar como Generalista, 72,8% (IC95%: 68%-76%). A formação generalista não influenciou a opção pelo exercício profissional com RR=0,81 (IC95%: 0,55-1,20) p=0,308. Os fatores associados a AG foram: pertencer a instituição pública (p=0,041) acreditar na capacidade de resolubilidade do generalista e nas diretrizes do SUS (p<0,001), o desejo de contribuir com a sociedade (p=0,005) e a credibilidade da sociedade (p=0,044). Conclusão: Os estudantes percebem que a grade curricular contempla a formação generalista, no entanto não influenciou o interesse pelo exercício profissional. O desejo de atuar como generalista está presente em um número expressivo entre eles, movido pelo altruísmo e o desejo de contribuir com a sociedade, respaldados pelas leis orgânicas que fundamentam as Diretrizes do SUS, ao mesmo tempo em que não se sentir valorizado e ter sua credibilidade questionada pela sociedade, estimulam ao exercício profissional apenas de modo temporário.

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El objetivo fue describir las características socioeconómicas y condiciones de empleo del personal médico en México. Estudio transversal con base en la Encuesta Nacional de Ocupación y Empleo (ENOE) de México, de los 4 trimestres de 2019 y el primer trimestre de 2020. Incluimos a todos los médicos con estudios universitarios concluidos. La variable precariedad laboral acumulada fue construida como la suma de cinco variables binarias relacionadas con el salario mínimo, jornada laboral, carencias de contrato, de seguridad y de prestaciones sociales. Con esta suma no ponderada, clasificamos las condiciones laborales en baja (1), media (2 a 3), alta (4 a 5), y ausencia de precariedad laboral (0). En el sector público, 13,4% y 3,3% de los médicos tienen precariedad laboral media y alta, respectivamente; los porcentajes son mayores en el sector privado, 38,5% y 7,7% (p < 0,01), respectivamente, debido principalmente a las carencias de contrato escrito y seguro médico. Estas condiciones se exacerban en las mujeres que trabajan en los consultorios médicos de las empresas del sector privado donde 75,2% y 6% de ellas tienen precariedad media y alta, respectivamente, mientras que en los hombres los porcentajes son 15,6 y 7,7%, respectivamente, (p < 0,01). Existe precariedad laboral en el sector salud mexicano; las condiciones laborales de los médicos del sector privado son más precarias que en el sector público, particularmente en los consultorios del sector privado, donde las mujeres están más expuestas a empleos precarios.

The study aimed to describe the socioeconomic characteristics and job conditions of medical personnel in Mexico. This was a cross-sectional study based on the Mexican National Occupational and Employment Survey (ENOE) for all four quarters of 2019 and the first quarter of 2020. We included all physicians who had concluded their university training. The variable "cumulative precarious labor" was constructed as the sum of five binary variables related to minimum wage, workweek, and lack of employment contract, job security, and labor benefits. Using this unweighted sum, we classified their labor conditions as absence of (0) or low (1), medium (2 to 3), or high (4 to 5) precarious labor. In the public sector, 13.4% and 3.3% of physicians were engaged in medium or high precarious labor, respectively; the percentages were higher in the private sector, with 38.5% and 7.7% (p < 0.01), respectively, due mainly to the lack of formal contracts and medical insurance. These conditions were exacerbated in women working in medical offices in private-sector companies, where 75.2% and 6% worked in medium or high precarious conditions, respectively, while the proportions in men were 15.6% and 7.7%, respectively (p < 0.01). Precarious labor exists in the Mexican health sector; labor conditions for physicians are more precious in the private sector than in the public sector, especially in private-sector offices where female physicians are more exposed to precarious employment.

O objetivo era descrever as características socioeconômicas e as condições de emprego dos médicos no México. Estudo transversal com base na Pesquisa Nacional de Ocupação e Emprego (ENOE) do México, nos quatro trimestres de 2019 e no primeiro trimestre de 2020. Incluímos todos os médicos com estudos universitários concluídos. A variável da precariedade laboral acumulada foi construída como a soma de cinco variáveis binárias relacionadas com o piso salarial, a jornada de trabalho, a falta de contrato, segurança e benefícios sociais. Com esta soma não ponderada, classificamos as condições de trabalho em baixa (1), média (2 a 3), alta (4 a 5), e ausência de precariedade laboral (0). No setor público, 13,4% e 3,3% dos médicos estão em situação de precariedade laboral média e alta, respectivamente; os percentuais são mais elevados no setor privado, com 38,5% e 7,7% (p < 0,01), respectivamente, devido principalmente à inexistência de contrato escrito e de seguro médico. Estas condições se agravam para as mulheres que trabalham nos consultórios médicos das empresas do setor privado, onde 75,2% e 6% delas sofrem precariedade média e alta, respectivamente, ao passo que para os homens, os percentuais são de 15,6% e 7,7%, respectivamente, (p < 0,01). Existe precariedade laboral no setor da saúde mexicano; as condições de trabalho dos médicos do setor privado são mais precárias do que no setor público, em especial, nos consultórios do setor privado onde as mulheres estão mais expostas a empregos precários.

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Existen múltiples técnicas y procedimientos quirúrgicos en la práctica clínica que todo médico general debería conocer y manejar ante una situación de urgencia que involucre la resolución inmediata. El no actuar en una situación emergente, ya sea por inexperiencia o desconocimiento puede poner en riesgo la vida del paciente. Entre estos procedimientos, podemos encontrar las suturas (y sus distintos tipos), la paracentesis, la apendicectomía (abierta y laparoscópica), la punción lumbar y la cesárea. Es por esto que se creó este artículo de educación médica utilizando un método explicativo de las principales técnicas quirúrgicas de forma resumida y concisa, basado en la literatura disponible, con el fin de servir como guía de bolsillo y revisión rápida para estudiantes, internos y médicos que deben enfrentarse a un procedimiento quirúrgico que no puede ser diferido.

There are multiple surgical techniques and procedures in the day to day clinical practice that every general practitioner should know how to do and handle in an emergency situation that requires immediate resolution. Failure to act in an emergent situation, either due to inexperience or ignorance, can put a patient's life at risk. Between these procedures there are sutures (and its variations), paracentesis, appendectomy (open and laparoscopic), lumbar puncture and cesarean delivery. That is why this medical education article was developed using an explicative method of the main surgical techniques in a summarized and concise way, based on the available literature, in order to serve as a pocket guide and quick review for students, interns and doctors who must face a surgical procedure that cannot be deferred.

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Early dementia diagnosis has many benefits and is a priority. In Brazil, most cases are diagnosed by a specialist. OBJECTIVE: We aimed to study the average time from disease onset to specialist assessment and related factors; we also propose potential strategies to deal with this delay. METHODS: This was a cross-sectional database study in 245 patients with dementia from an outpatient clinic in a tertiary university hospital in Southern Brazil, which only assesses individuals from the Unified Health System (SUS). The outcome was time from symptoms onset to specialist assessment, reported by the informants. Individuals were separated into two groups: less and more than 1 year to specialist assessment. Multivariable analysis was used to test the potential related factors associated with delayed specialist assessment. RESULTS: Mean±SD of time from symptoms onset to specialist assessment was 3.3±3.3 years. In the unadjusted analysis, individuals who were assessed before 1 year were more often diagnosed with vascular dementia, had more sudden and subacute onset, neuropsychiatric symptoms at presentation, rapid progression, and alcohol and antipsychotics use (p<0.05). In multivariate analysis, the effects of personality changes and onset presentation persisted, even when controlling for other variables. CONCLUSION: We found a long time from disease onset to specialist assessment, and those with personality changes and faster presentation were referred earlier. Improving the diagnostic capability of general practitioners, mass educational campaigns and transmission of knowledge by experts are some potential strategies to deal with delay of dementia diagnosis.

O diagnóstico precoce de demência tem muitos benefícios e deve ser uma prioridade. No Brasil, ele é feito por especialistas na maioria dos casos. OBJETIVO: O objetivo deste estudo foi avaliar o tempo médio entre o início da doença até a avaliação com especialista e seus possíveis fatores relacionados; também propomos estratégias potenciais para lidar com esse atraso. MÉTODOS: Trata-se de um estudo transversal de base de dados com 245 pacientes com demência atendidos em ambulatório de um hospital universitário do sul do Brasil, que avalia indivíduos provenientes do Sistema Único de Saúde (SUS). O desfecho principal foi o tempo entre o início dos sintomas até a avaliação com o especialista, relatados pelos informantes. Os indivíduos foram separados em dois grupos: tempo até a consulta com o especialista menor e maior que 1 ano. A análise multivariável foi usada para testar os possíveis fatores relacionados à avaliação tardia pelo especialista. RESULTADOS: O tempo médio±DP entre o início dos sintomas e a avaliação com o especialista foi de 3,3±3,3 anos. Na análise não ajustada, os indivíduos que chegaram para avaliação antes de 1 ano do início da doença foram diagnosticados com mais frequência com demência vascular, tiveram início do quadro mais repentino e subagudo, sintomas neuropsiquiátricos na apresentação, progressão rápida, uso de álcool e antipsicóticos (p<0,05). Na análise multivariada, apenas alterações de personalidade e início rápido dos sintomas mostraram-se preditores para chegada mais precoce ao especialista, mesmo controlando possíveis confundidores. CONCLUSÃO: Encontramos um longo tempo entre o início da doença até a avaliação do especialista e indivíduos com alterações de personalidade e apresentação mais rápida foram encaminhados mais precocemente. Melhorar a capacidade diagnóstica do médico de família, campanhas educacionais em massa e transmissão de conhecimento por especialistas são algumas estratégias potenciais para lidar com o atraso do diagnóstico de demência.

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Introducción: Los médicos que se preparan para rendir el examen de residencia médica, están expuestos a estrés laboral, debido a que adicionalmente tienen que trabajar para poder solventar sus estudios. Objetivos: Determinar la prevalencia del síndrome de burnout en médicos generales que se preparan para el examen de residencia médica. Métodos: Se realizó un estudio descriptivo y transversal, se aplicó el cuestionario Maslach Burnout Inventory (MBI) a médicos generales que trabajaban y que se preparaban para rendir el examen de residencia médica, que voluntariamente aceptaron participar en el estudio. Se realizó estadística univariada y bivariada; los cálculos fueron realizados con un nivel de confianza del 95 por ciento. Resultados: Se incluyó a un total de 306 médicos. El 56,9 por ciento fueron de sexo femenino y el promedio de edad fue de 28,5 ± 4,3 años. El 2,3 por ciento (7) de los médicos presentaron síndrome de burnout; las subescalas de despersonalización (42,2 por ciento) y agotamiento emocional (32 por ciento) tuvieron mayores porcentajes de índices altos. Conclusiones: La prevalencia de síndrome de burnout fue baja en los médicos generales que se preparan para el examen de residencia médica. Las subescalas con mayores índices fueron despersonalización y agotamiento emocional(AU)

Introduction: Doctors who are preparing to take the medical residency exam are exposed to work stress, because they have to work to pay their studies. Objectives: To determine the prevalence of Burnout syndrome in general practitioners preparing for the residency exam. Methods: A descriptive and cross-sectional study was carried out, the Maslach Burnout Inventory (MBI) was applied in general practitioners who worked and were preparing to take the medical residency exam were included, who voluntarily agreed to participate in the study. Univariate and bivariate statistics were performed, the calculations were performed with a confidence level of 95 percent. Results: A total of 306 general practitioners were included. 56,9 percent were female and the average age was 28,5 ± 4,3 years. 2,3 percent (7) of the doctors had Burnout syndrome, the subscales of depersonalization (42,2 percent) and emotional exhaustion (32 percent) had higher percentages of high indexes. Conclusions: The prevalence of Burnout syndrome was low in general practitioners preparing for the medical residency examination. The subscales with the highest indices were depersonalization and emotional exhaustion(AU)

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ABSTRACT. Early dementia diagnosis has many benefits and is a priority. In Brazil, most cases are diagnosed by a specialist. Objective: We aimed to study the average time from disease onset to specialist assessment and related factors; we also propose potential strategies to deal with this delay. Methods: This was a cross-sectional database study in 245 patients with dementia from an outpatient clinic in a tertiary university hospital in Southern Brazil, which only assesses individuals from the Unified Health System (SUS). The outcome was time from symptoms onset to specialist assessment, reported by the informants. Individuals were separated into two groups: less and more than 1 year to specialist assessment. Multivariable analysis was used to test the potential related factors associated with delayed specialist assessment. Results: Mean±SD of time from symptoms onset to specialist assessment was 3.3±3.3 years. In the unadjusted analysis, individuals who were assessed before 1 year were more often diagnosed with vascular dementia, had more sudden and subacute onset, neuropsychiatric symptoms at presentation, rapid progression, and alcohol and antipsychotics use (p<0.05). In multivariate analysis, the effects of personality changes and onset presentation persisted, even when controlling for other variables. Conclusion: We found a long time from disease onset to specialist assessment, and those with personality changes and faster presentation were referred earlier. Improving the diagnostic capability of general practitioners, mass educational campaigns and transmission of knowledge by experts are some potential strategies to deal with delay of dementia diagnosis.

RESUMO. O diagnóstico precoce de demência tem muitos benefícios e deve ser uma prioridade. No Brasil, ele é feito por especialistas na maioria dos casos. Objetivo: O objetivo deste estudo foi avaliar o tempo médio entre o início da doença até a avaliação com especialista e seus possíveis fatores relacionados; também propomos estratégias potenciais para lidar com esse atraso. Métodos: Trata-se de um estudo transversal de base de dados com 245 pacientes com demência atendidos em ambulatório de um hospital universitário do sul do Brasil, que avalia indivíduos provenientes do Sistema Único de Saúde (SUS). O desfecho principal foi o tempo entre o início dos sintomas até a avaliação com o especialista, relatados pelos informantes. Os indivíduos foram separados em dois grupos: tempo até a consulta com o especialista menor e maior que 1 ano. A análise multivariável foi usada para testar os possíveis fatores relacionados à avaliação tardia pelo especialista. Resultados: O tempo médio±DP entre o início dos sintomas e a avaliação com o especialista foi de 3,3±3,3 anos. Na análise não ajustada, os indivíduos que chegaram para avaliação antes de 1 ano do início da doença foram diagnosticados com mais frequência com demência vascular, tiveram início do quadro mais repentino e subagudo, sintomas neuropsiquiátricos na apresentação, progressão rápida, uso de álcool e antipsicóticos (p<0,05). Na análise multivariada, apenas alterações de personalidade e início rápido dos sintomas mostraram-se preditores para chegada mais precoce ao especialista, mesmo controlando possíveis confundidores. Conclusão: Encontramos um longo tempo entre o início da doença até a avaliação do especialista e indivíduos com alterações de personalidade e apresentação mais rápida foram encaminhados mais precocemente. Melhorar a capacidade diagnóstica do médico de família, campanhas educacionais em massa e transmissão de conhecimento por especialistas são algumas estratégias potenciais para lidar com o atraso do diagnóstico de demência.

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RESUMEN Fundamento: las urgencias médicas son causa frecuente de consulta en la atención primaria de salud, lo que constituye un reto para el médico general. Objetivo: diseñar un sistema de talleres docentes dirigido a la preparación del médico general, para la atención al paciente con urgencias médicas en la atención primaria de salud. Métodos: se realizó un estudio descriptivo con enfoque cualitativo en el Hospital General Docente Dr. Agostinho Neto durante el curso académico 2019-2020. Se emplearon los siguientes métodos: analítico-sintético, inductivo-deductivo, enfoque sistémico, modelación, análisis documental, prueba de desempeño, encuesta a docentes, análisis de frecuencia, prueba de los signos y el método Delphi. Se modeló el antedicho proceso de preparación del médico general y se implementaron talleres docentes dirigidos a este fin, los que se validaron con la cooperación de un grupo de profesores (n=16), seleccionados con intencionalidad. Resultados: el 100 % de los profesores consideró que el modelo y el sistema de talleres propuesto poseen posibilidades de aplicarse en la práctica pedagógica. Conclusiones: se modeló desde una perspectiva didáctica, la preparación de este profesional para la atención al paciente con urgencias médicas en la atención primaria de salud, que sustentó el diseño de un sistema de talleres docentes para este propósito, que según los profesores es viable su aplicación en la práctica pedagógica, para que desarrolle modos de actuación ante una urgencia médica.

ABSTRACT Background: medical emergencies are a frequent cause of consultation in primary health care, which is a challenge for this general doctor. Objective: to design a system of educational workshops to the preparation of the general doctor for the attention to the patient with medical emergency in the primary health care. Method: a descriptive study with qualitative focus was carried out in the Hospital Dr. Agostinho Neto during the course 2019-2020. The following methods were used: analytic-synthetic, inductive-deductive, systemic focus, modeling, documental analysis, proves of acting, interviews, analysis of frequency, proves of the signs and the Delphi method. The above process of the general doctor's preparation was modeled, and were implemented the educational shops for this end, those that were validated with the cooperation of a group of professors (n=16), selected with premeditation. Results: 100% of the professors consider that the model and the proposed system of workshops possess possibilities to be applied in the pedagogic practices. Conclusion: it was modeled from a didactic perspective, this professional's preparation for the attention to the patient with medical emergencies in the primary health care, that sustain the design of a system of educational workshops for this purpose, that is viable according to the professors its application in the pedagogic practices so that it develops ways of professional performance in a medical emergency.

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RESUMEN Objetivos: medir el impacto en la calidad de la prescripción antibiótica empírica en los médicos generales luego de la implementación de un sistema de evaluación y retroalimentación. Métodos: estudio cuasiexperimental con pre y postintervención en una clínica de tercer nivel en Medellín. Se revisó las prescripciones de un grupo de antibióticos por un médico internista, un epidemiólogo y un infectólogo. Se midió el consumo de antibióticos, las retroalimentaciones realizadas, el diagnóstico de la sepsis, tiempo de inicio de los antibióticos en el servicio de urgencias y la prevalencia de Escherichia coli productora de betalactamasa de espectro extendido. Resultados: el número de retroalimentaciones descendió de 10,9 a 2 %. Se redujo el consumo de ceftriaxona (p = 0,04), piperacilina tazobactam (p = 0,01), cefepime (p = 0,04) y ciprofloxacina (p = 0,01). Se evidenció una tendencia a la reducción en la prevalencia de E. coli BLEE (p = 0,3). La intervención no produjo un retraso en el inicio de antibióticos en el servicio de urgencias. Conclusión: una estrategia de auditoría y retroalimentación a los médicos generales, referente a la calidad de la prescripción antibiótica, reduce el consumo de antibióticos sin afectar la oportunidad del diagnóstico de sepsis o el inicio de su tratamiento y puede impactar favorablemente en el perfil de resistencia de la flora microbiana institucional.

SUMMARY Objectives: To measure the impact on the quality of the empirical antibiotic prescription in general practitioners, after the implementation of an evaluation and feedback system. Methods: Quasi-experimental study with pre- and post-intervention in a tertiary care center in Medellín. The prescriptions of a group of antibiotics were reviewed by an internist, an epidemiologist and an infectologist. When failures were found, prescribing doctors were informed. Subsequently, antibiotic consumption, feedbacks, sepsis diagnosis, start time of antibiotics in the emergency department and monthly incidence of Escherichia coli producing extended spectrum betalactamase were measured. Results: The numbers of feedbacks decreased from 10.9% to 2%. Consumption of ceftriaxone (p = 0.04), piperacillin tazobactam (p = 0.01), cefepime (p = 0.04) and ciprofloxacin (p = 0.01) was reduced. There was a tendency to reduce the prevalence of E. coli ESBL. The intervention did not cause a delay in the start of antibiotics in the emergency department. Conclusions: A strategy of continuous feedback to general practitioners regarding the quality of antibiotic prescription reduces consumption of antibiotics without causing changes in diagnosis opportunity or the beginning of antibiotics in sepsis and can impact favorably the resistance profile of the institutional microbial flora.

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RESUMEN Fundamento: la formación del Médico General demanda la preparación de la habilidad tratar integralmente el dolor mediante la combinación de alternativas terapéuticas farmacológicas y no farmacológicas, para la atención a pacientes con dolor. Objetivo: validar un sistema de tareas docentes para la formación de la habilidad tratar integralmente el dolor en el Médico General. Métodos: se utilizó el criterio de expertos, método Delphi para validar el sistema y el W de Kendall para obtener la concordancia del consenso de los expertos sobre el sistema de tareas docentes. Se realizaron entrevistas y observación a los estudiantes, para obtener las tendencias que expresan sus criterios sobre el empleo de los diferentes tipos de tareas, para formar la habilidad tratar integralmente el dolor. Resultados: el sistema de tareas docente fue validado por los expertos de muy adecuado. Se aplicó en el sexto año de la carrera de medicina, durante la práctica docente, asistencial e investigativa. Los estudiantes demostraron desempeño en las acciones y operaciones de la habilidad para tratar integralmente el dolor. Conclusiones: el sistema de tareas aplicado resultó una alternativa formativa con integración de la actividad académica, laboral e investigativa en la formación de la habilidad de tratar integralmente el dolor.

ABSTRACT Background: the training of General Practitioners requires the ability preparation to comprehensively treat pain through the combination of pharmacological and non-pharmacological therapeutic alternatives, for the care of patients with pain. Objective: to validate a system of teaching tasks for the ability formation to comprehensively treat pain in the General Practitioner. Methods: the expert criterion, the Delphi method to validate the system and the Kendall W. was used to obtain the agreement of the experts consensus on the teaching task system. Interviews and observation of the students were carried out to obtain the trends that express their criteria on the use of different types of tasks, to form the ability to treat pain comprehensively. Results: the teaching task system was validated by highly adequate experts. It was applied in the sixth year of the medical career, during the teaching, healthcare and research practice. The students demonstrated performance in ability actions and operations to comprehensively treat pain Conclusions: the applied task system was a formative alternative with integration of academic, work and research activity in the ability formation to comprehensively treat pain.

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ABSTRACT Background: Alzheimer's disease (AD) is the leading cause of dementia worldwide. Despite alarming evidence on dementia prevalence, the condition is still underdiagnosed by general practitioners (GPs) in primary care. Early detection of the disease is beneficial for patients and relatives, who should be provided comprehensive guidance on dealing with dementia complications, covering medical, family and social aspects, thereby providing an opportunity to plan for the future. Objective: The objective of this study was to assess the knowledge of and attitudes toward dementia held by GPs from a city in the interior of São Paulo State, Brazil. Methods: A non-randomized intervention study was conducted involving six lectures about dementia. Before and after the intervention, the participating physicians completed two quizzes about knowledge of and attitudes towards dementia. The study was carried out in the primary care services of the town and a total of 34 GPs participated in the study. Results: The mean age of the sample was 33.9 (±10.2) years and the majority (76.5%) of the sample had not undertaken medical residency training. The mean number of correct answers on the Knowledge Quiz about dementia before and after the training intervention was 59.6 and 71.2% (p<0.001), respectively. The comparison of the mean responses on the Attitude Quiz revealed no statistically significant difference between the two applications of the instrument, before and after intervention (p=0.059). Conclusions: More training for GPs on dementia should be provided.

RESUMO Introdução: A doença de Alzheimer é a principal causa de demência em todo o mundo. Apesar das evidências alarmantes sobre a prevalência de demência, a condição ainda é subdiagnosticada por clínicos gerais na atenção primária. A detecção precoce da doença é benéfica para pacientes e familiares, que devem receber orientações abrangentes sobre como lidar com as complicações relacionadas às demências, abrangendo aspectos médicos, familiares e sociais, proporcionando assim uma oportunidade de planejar o futuro. Objetivo: O objetivo deste estudo foi avaliar os conhecimentos e as atitudes em relação à demência por parte de clínicos gerais de uma cidade do interior de São Paulo, Brasil. Métodos: Foi realizado um estudo de intervenção não randomizado, envolvendo seis palestras sobre demência. Antes e depois da intervenção, os médicos participantes completaram dois questionários sobre conhecimentos e atitudes em relação à demência. O estudo foi realizado nos serviços de atenção primária da cidade e um total de 34 clínicos gerais participaram do estudo. Resultados: A idade média da amostra foi de 33,9 (±10,2) anos e a maioria (76,5%) da amostra não havia realizado treinamento em residência médica. O número médio de respostas corretas no Questionário do Conhecimento sobre demência antes e após a intervenção de treinamento foi de 59,6 e 71,2% (p<0,001), respectivamente. A comparação das respostas médias no questionário de atitudes não revelou diferença estatisticamente significativa entre as duas aplicações do instrumento, antes e após a intervenção (p=0,059). Conclusões: Deve ser fornecido mais treinamento sobre demência para os clínicos gerais.

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Background: The limited diffusion about hidradenitis suppurativa (HS) among general practitioners, leads to diagnosis delays. Objectives: To assess the impact of a short and long-term educational campaign on HS among the walk-in clinic physicians of the Hospital Italiano de Buenos Aires (HIBA) Materials and methods: Quasi-experimental study with an educational intervention by disseminating a piece of information about HS among 142 walk-in clinic physicians of the HIBA. The same anonymous survey on knowledge of the HS was carried out on 3 occasions: baseline, 1 and 9 months after the intervention. The correct answers were compared before, after 1 and 9 months. The survey and the piece of information were sent by WhatsAppⓇ. Results: Of the total, 64 (45%) answered in the first stage, 48 (34%) in the second stage and 56 (39%) in the third stage. In the baseline survey, only half knew the inflammatory nature of the disease, 3 out of 5 physicians chose an inadequate antibiotic scheme, the surgery mostly indicated was drainage, only a fifth considered ultrasound useful, and a third did not believe that the patient could benefit from referral to a dermatologist. After the educational campaign, we observed a learning in the HS management, which was held at 9 months. Discussion: We observed a lack of HS training among general practitioners. The WhatsAppⓇ platform could be useful as an educational tool.

Antecedentes: La escasa difusión de la hidradenitis supurativa (HS) entre los médicos generalistas, conduce a retrasos en el diagnóstico. Objetivos. Evaluar el impacto de una campaña educativa a corto y largo plazo sobre HS en los médicos que atienden la demanda espontánea (DE) del Hospital Italiano de Buenos Aires (HIBA) Materiales y Métodos: Estudio cuasi experimental con una intervención educativa mediante la difusión de un pieza de información sobre HS en 142 médicos de demanda espontánea del HIBA. Se realizó una misma encuesta anónima sobre conocimientos de la HS, en 3 oportunidades: basal, 1 y 9 meses luego de la intervención. Se compararon las respuestas correctas antes, al mes y a los 9 meses. La encuesta y la pieza de información fueron enviadas por WhatsAppⓇ. Resultados: Del total, 64 (45%) respondieron en la primera etapa, 48 (34%) en la segunda y 56 (39%) en la tercera. En la encuesta basal, sólo la mitad conocía la naturaleza inflamatoria de la enfermedad, 3 de cada 5 médicos elegían un esquema antibiótico inadecuado, la cirugía mayormente indicada era el drenaje, apenas la quinta parte consideraba de utilidad la ecografía, y un tercio de los médicos no creían que el paciente pudiera beneficiarse de la derivación a un dermatólogo. Luego de la campaña educativa, observamos un aprendizaje en el manejo de la HS, que se sostuvo a los 9 meses. Discusión: Observamos una falta de entrenamiento sobre HS entre los médicos generalistas. La plataforma WhatsAppⓇ podría ser útil como herramienta educativa.

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