Childhood neurodevelopmental disorders account for 10% of the causes of childhood disability. The search for medical care leads to therapeutic itineraries routes taken by individuals to seek health care where diagnostic and treatment opportunities arise. Our objective was to explore these itineraries in order to understand the opportunities and barriers to the implementation of therapies and child rearing patterns promoting neurodevelopment.Qualitative study using in-depth interviews with children's parents (between June 2018 and November 2019). The analysis was based on the social model of disability and Vygotsky's approach to child development.A total of 16 interviews were conducted. Considering the time of diagnosis and the age when the therapeutic itinerary started, 2 groups were identified: those who started from birth to 2 years old (early initiation) and those who started from 3 years old (late childhood initiation). In the first group, the search for treatment starts at an early stage, while in the other group, decisions on the initiation and/or type of treatments are prolonged over time. Late initiation was accompanied by difficulties in school, periods of uncertainty, distress and/or family conflicts due to the complexities of parenting.Therapeutic itineraries started early in some cases and at a later stage in others. The initiation of treatments made it possible to use tools to bridge the gap of discrepancies between the biological and cultural lines of development.Introducción. Los trastornos en el neurodesarrollo infantil constituyen un 10 % de las causas de discapacidad en la niñez. La búsqueda de atención médica configura itinerarios terapéuticos, entendidos como los procesos de búsqueda y atención para el cuidado de la salud, donde surgen oportunidades de diagnóstico y tratamiento. El objetivo fue explorar dichos itinerarios para comprender las oportunidades y barreras que se presentan para instaurar terapias y pautas de crianza que promuevan el neurodesarrollo. Población y métodos. Estudio cualitativo mediante entrevistas en profundidad a madres y padres de niños (de junio de 2018 a noviembre de 2019). El análisis se realizó sobre la base del modelo social de la discapacidad y del de desarrollo infantil propuesto por Vygotsky. Resultados. Se realizaron 16 entrevistas. Considerando la edad de inicio de los itinerarios terapéuticos y el diagnóstico, se identificaron dos grupos: aquellos que los comenzaron desde el nacimiento hasta los 2 años (inicio precoz) y quienes lo hicieron a partir de los 3 años (inicio en la primera infancia e infancia tardía). En el primero se habilita tempranamente la búsqueda de tratamiento, mientras que en el segundo se prolongaron en el tiempo las decisiones sobre el inicio y/o el tipo de terapias. El inicio tardío se acompañó de dificultades en la escuela, períodos de incertidumbre, angustia y/o conflictos familiares por las complejidades de la crianza. Conclusiones. Los itinerarios terapéuticos se iniciaron en forma precoz en algunos casos y tardía en otros. El inicio de tratamientos permitió incorporar herramientas para acortar la brecha de incongruencia entre las líneas biológica y cultural de desarrollo.
En los últimos años surge el concepto de Una Sola Salud que reconoce la interdependencia sistémica al observar que los cambios en la salud humana se expresan de manera sincrónica e indivisible de la salud del ambiente. Nuevas enfermedades y daños crónicos inespecíficos ocurren a la par de la pérdida de biodiversidad y vitalidad. En las últimas décadas venimos observando el surgimiento de “adaptaciones sistémicas” que requieren un abordaje desde la clínica y la toxicología a nivel individual y desde la epidemiología de la complejidad a nivel poblacional. Luego de un largo recorrido de investigaciones, el Hospital Italiano formalizó el consultorio de Salud Ambiental con la intención de brindar respuesta a la demanda de pacientes que atribuyen síntomas y signos a la polución ambiental.
A process of feminization of the medical profession is observed, however, the massive access of women is associated with new gender inequalities named horizontal and vertical segregation. Horizontal segregation manifests itself in the unequal distribution of men and women in certain medical specialties and vertical segregation, in the limited representation of women in most high professional positions. The objective of this study was to determine how men and women are distributed in the different stages of the process that involves entering the medical residency system of an universitary hospital from Buenos Aires, Argentina, and to analyze the horizontal and vertical segregation of gender in the process of admission to medical residencies. Based on data from applicants to an universitary hospital, in the 2015-2017 period, a multiple logistic regression analysis was conducted to adjust the odds ratio of being male or female with potential confounders. There was no association between being man or woman and the performance of the exam, its approval and the admission to the interview. The adjusted odds ratio for the admission to the residency of men with respect to women was 2.03 (1.44-2.85). For the surgical residencies it was 2.75 (1.54-4.92) and for clinical it was 1.89 (1.17-3.00). In the inscription, women opted mainly for clinical residencies, and men for surgical purposes. Horizontal and vertical segregation was observed in the process of the residency. Making gender segregation visible will allow generating an equitable society.Se observa un proceso de feminización de la profesión médica, sin embargo, el acceso masivo de las mujeres se asocia a nuevas desigualdades de género, denominadas segregación horizontal y vertical. La segregación horizontal se manifiesta en la desigual distribución de hombres y mujeres en ciertas especialidades médicas y la segregación vertical, en la escasa representación de las mujeres en la mayoría de los altos cargos profesionales. El objetivo de este estudio fue determinar cómo se distribuyen hombres y mujeres en las distintas instancias del proceso que implica el ingreso al sistema de residencias médicas de un hospital universitario de Buenos Aires, Argentina y analizar la segregación horizontal y vertical de género en el proceso de ingreso a las residencias médicas. A partir de datos de postulantes a un hospital universitario, en el período 2015-2017, se realizó un análisis de regresión logística múltiple para ajustar el odds ratio de ser hombre o mujer con potenciales confundidores. No se observó asociación entre ser hombre o mujer y la realización del examen, su aprobación y el ingreso a entrevista. El odds ratio ajustado para el ingreso a la residencia de los hombres con respecto a las mujeres fue 2.03 (1.44-2.85). Para las residencias quirúrgicas fue 2.75 (1.54-4.92) y para las clínicas fue 1.89 (1.17-3.00). En la inscripción, las mujeres optaron mayormente por residencias clínicas, y los hombres por quirúrgicas. Se observó segregación horizontal y vertical en el proceso de ingreso a la residencia. Visibilizar la segregación de género permitirá generar una sociedad equitativa.
identify consultation reasons, experiences with seeking dermatological assistance and skin care strategies within neighbours from an urban deprived settlement in Buenos Aires province, Argentina. This setting lies onto a sanitary landfill with a high index of environmental contamination.a dermatological health care team from the main local hospital designed a dermatological assistance device (DAD), in cooperation with social leaders and institutions of the neighborhood. The DADs included walks around the neighborhood for attending those who could not get a consultation. The experiences were evaluated through a qualitative research strategy, developed from the theoretical framework of Sociocultural Epidemiology. Those who attended the DADs were interviewed. Ethnographic field notes were also recorded. Multiple accessibility barriers to the public health care system were identified and self care practices were also recognized.The most frequent consultations to the DADs were for "pimples", "stains'' and "lumps" on exposed areas of the skin. These lesions generated discomfort or pain, or even affected the interviewees aesthetically or emotionally. Most of them were associated to extremely dry skin and a high sun exposure, in connection with the lack of shade in the neighbourhood. An initiative to plant trees was promoted in order to prevent sun radiation-induced dermatoses.the reflective immersion of the dermatology team in the realm of the neighborhood daily life enabled the development of attention strategies grounded on the perceived needs of the population.analizar motivos de consulta, experiencias y formas de atención de las afecciones dermatológicas de la población de un asentamiento de la Provincia de Buenos Aires, ubicado sobre un relleno sanitario con altos índices de contaminación ambiental.investigación cualitativa, mediante entrevistas en profundidad a vecinos/as y elaboración de registros etnográficos de las recorridas. La investigación se realizó en el contexto de un dispositivo de atención dermatológica, planificado en conjunto con referentes barriales, bajo el marco teórico de la Epidemiología Sociocultural.se identificaron múltiples barreras de accesibilidad a la atención dermatológica en el sistema público de salud, y prácticas de autoatención como el uso de cremas, medidas de higiene y uso de elementos de protección personal para trabajos que significaban un riesgo para la salud. Las consultas al dispositivo más frecuentes fueron "granos", "manchas", "bultitos" en zonas visibles del cuerpo, que generaban molestia, dolor y/o afectaban estética y emocionalmente a lo/as entrevistado/as. Estas consultas se relacionaban principalmente con piel extremadamente seca y patologías por alta exposición solar, coincidiendo con la escasez de sombra en el barrio. Para prevenir patologías relacionadas a la exposición solar, se impulsó una iniciativa para plantar árboles.a partir de la inmersión reflexiva del equipo de atención, en las experiencias de atención de lo/as habitantes del barrio, se desplegaron estrategias según las necesidades percibidas por la población.
Several academic and government organizations have strongly recommended the inclusion of specific competences in clinical research. So far, the current state of research within this framework has not been modified in our country. The main goal of this study was to provide a thorough description of the research activities in medical residencies, which could be used as an indicator of the acquisition of such competences and to identify the supporters and detractors to achieve them. A cross section study was carried out and several levels were analyzed in order to consider residencies as a cluster; 382 residents from 24 different residencies were included. the study showed a preponderance of women. the average age was 29 years old. A 71% of the residents asserted doing research. Half of those residents have stated being authors of papers presented in congresses; only 9% have published their experience. Factors which predict the development of research assignments were: to belong to a large residency, oR 16.99 (IC 95%, 2.096-137.87), being in the 3rd year of the residency, oR 9.95 (IC 95%, 2.84-34.82), completion of a research course, oR 2.78 (IC 95%, 1.10-7.04). Variables which reduce the chance to do research: location in Buenos Aires, oR 0.25 (IC 95%, 0.0072-0.91), being a woman, oR 0.34 (IC 95%, 0.14-0.79) and patients assistance workload, OR 0.97 (IC 95%, 0.95-0.99). We believe that the identification of factors which influence the possibility of doing research will lead to a improvement in the training of medical residents.
Introduction: Diagnostic techniques are living an euphoric cycle because of the genetic technologies applied to predictive diagnosis. Meanwhile anthropological and philosophical analysis understand these techniques as modern expressions of eugenic modelization of bodies and biologization of social relationships, and the medical institutions and physicians as intermediaries of this biopolitic. This could be rooted in the notion of gene that is assumed by this professional collective. Objective: to identify ideas and notions that can lead to construction of social relationships underpinned on the genetic of people. Methods: discourse analysis of medical interviews. 5 argentinean physicians from leading health institutions (3 oncologists (On), 1 endocrinologist (Endcr), and 1 genetic counsellor (GC) were interviewed during 2012 about their opinions and prescription practices on cancer genetic test. Results: The On and Endcr opinions are dominated by the preventive logic that is seen as a rule of higher order. They emphasize the biological heritage, the familial bonds and also the determination of sibling''s life, health and quality of life. On the contrary the GC discourse, because of the arouse of the disease can be expressed in probabilistic terms, are oriented to enforce patient''s autonomy regarding preventive measures. In spite the On and Endcr mention probabilities, their discourses are oriented to guarantee the patient''s adherence to these measures. As a result genes are being expressed as sufficient causes of the disease. Conclusion and discusion: The analysis suggests that the medical concept of gene rests on the idea of causality, concealing the notion of probability and multicausality of cancer.This fact can be interpreted in the light of the notions of Mario Bunge of Determination and Causal Determination, in combination with the Theory of Complementarity from Ingold. This theoretical crossing enable to hypothesize that, as genetics is a pre-intervention instance respecto to the culture and the environment, medical discourse interprets it as a Causal Determination (in the sense of efficient cause): the temporal precedence reinforces the Western tradition to dissociate form and substance, enabling the analogy of the genotype as a design specification that can be completed with the variable information provided by the environment. In this way genes are depicted as the main causal factor of human development, letting aside the multicausality of illness, that can better be viewed from the concept of Probabilistic Determination. Ingold''s thesis of self-assembly, which proposes that from the first moment of gestation, neurology and anatomy are the results of mutual modeling of biology, psychology and culture, opens the possibility to figure genes as a previous instance in the human development, but not its Sufficient Cause. As this theory is scientifically plausible opens the possibility to remove scientific basis to racist ideologies.
Background Medications delivered to primary care centers (PCC) all over the country through the Remediar program (RP) covers 80% of the most prevalent diseases. Among them, the prevalence of hypertension is 77% of 65 years or older . Objective To describe the pharmacological treatment and its appropriateness, and to understand needs and barriers among hypertensive beneficiaries of RP at Buenos Aires suburbs. Method Qualitative-quantitative triangulation: cross-sectional study with revision of medical records (MR) and in-depth interviews between December/2008 and February/2009 to hypertensive patients of 65 years or older and CAPS’s staff. Prevalence of correct treatment (CT); appropriate Indication (AI); Optimal control (OC) were analyzed Results The following PCCs were selected: Moreno, Tigre, Lomas de Zamora, Lanus and San Isidro. Prevalence of: CT: (10.2%; 95%CI 6,7-15,1); AI: (84.8%; 95% CI 80-89 ), and OC: 11,6% (95%CI 7-16) and OC among patients with good registry: 35.7% (95%CI 24,9-48,1). Eighty two % of patients received a prescription for enalapril. Deficient registry was detected in MR. Interviewees expressed difficulties in accessing treatment, lack of medication and use of alternative circuits to get them. Both, staff and patients were exposed to barriers generated by CAPSs and RP. Conclusions A low degree of blood pressure control was observed, even with adequate prescription. Multifactorial problems explain several barriers to access and maintain hypertension treatment.
The acquisition of medical competence in the Internal Medicine Residencies (IMR) is a complex process. In Argentina there are not current data available on the number, organization and the way the residencies work. The objective of this study was to survey the IMR in Argentina and categorize their academic and general structure. From June 2007 to June 2008 we identified all the IMR using a combined searching strategy. We contacted them looking for structural and organizational data. Academic data were collected in a sample of 24 residencies using questionnaires. We also gathered data using qualitative measurements, in a subsample of 15 residencies, by means of direct observation and in-depth interviews. We identified 162 ongoing residencies and a total of 2012 residents. The majority of them (87%) were located in big cities, with a preponderance of public residencies (66%); 13% of these didn't have a residency instructor or coordinator. Most of these didn't have Institutional Internet available. The residents median age was 29 years old (Intercuartil range 2.7), with a 64.5% of women; 24% were under the regimen called "concurrente". From the sample, 230 residents were interviewed; 13% of them (CI95% 9-18.7) did not receive any remuneration. The rest received a monthly payment (in Arg $) ranging from US$ 140 to 552. A 58% (13/22) was involved in Specialist courses. Medians for weekly working hours and for "on duty" were respectively 50 and 8 per month, with no difference between public or private institutions. These findings evidence the need to certify the formative and academic process of IMR.
Conocer las creencias de los médicos sobre un registro médico electrónico para la atención ambulatoria en diferentes etapas del proceso de implementación del sistema. Investigación cualitativa longitudinal basada en entrevistas en profundidad (desde julio de 2001 hasta diciembre de 2003), desarrolladas en el Hospital Italiano de Buenos Aires (Argentina). Se entrevistó a 20 cardiólogos de atención ambulatoria con perfiles profesionales diversos (muestreo intencional) antes, durante y al finalizar la implementación del sistema (10 entrevistas por etapa). El análisis fue realizado por 2 investigadores independientes y las categorías refinadas conjuntamente. Antes y durante la primera etapa de la implementación los médicos esperaban que el sistema mejorara los procesos administrativos de la atención y la disponibilidad de los datos individuales que cada uno había registrado en consultas anteriores, pero no imaginaban que la información colectiva pudiera modificar los aspectos médicos de la atención. Al finalizarla implementación, en cambio, percibieron que el sistema les permitía acceder a una visión integral del paciente que modificaba el desempeño profesional. Durante la implementación, los médicos opusieron el contacto con el paciente a la interacción con el ordenador, oposición que les impide categorizar su uso como parte del acto médico y considerar los datos del sistema como signos directos del paciente. Con la implementación, los médicos modificaron su perspectiva sobre el registro médico electrónico, llegando a percibirlo como un auxiliar para la práctica médica. El valor que se asigna al sistema depende de su relevancia dentro del marco institucional. To explore physicians’ beliefs about a computerized ambulatory medical record system at different stages of its implementation. We performed a longitudinal qualitative in-depth interview study (July 2001 to December 2003) in the Hospital Italiano, Buenos Aires, Argentina. Semi-structured interviews were conducted in 20 primary care cardiologists purposively selected before, during and afterthe system's implementation process (10 interviews perstage). The interviews were independently analyzed by 2 researchers, who jointly designed an agreed category list. Both before and during the first stage of the implementation process, the physicians expected that that the system would improve healthcare-related administration and increase accessibility to individual data. However, they did not foresee that the system's shared information could modify the clinical aspects of patient care. By the end of the implementation process, the physicians realized that the system provided them with a broader perspective on their patients, which in turn improved their own professional performance. Throughout the implementation, the physicians were against using the computer while the patient was present. This opposition prevented them from regarding the system as part of the medical consultation and from considering data from the system as direct patient-related signs. The system's implementation modified the physicians’ views on computerized ambulatory medical records, as they eventually considered them as an ancillary tool to clinical activity. The value assigned to the system depends on its relevance within the institutional framework.
Medications delivered to primary care centers (PCC) all over the country through the Remediar program (RP) covers 80% of the most prevalent diseases. Among them, the prevalence of hypertension is 77% of 65 years or older.To describe the pharmacological treatment and its appropriateness, and to understand needs and barriers among hypertensive beneficiaries of RP at Buenos Aires suburbs. Method Qualitative-quantitative triangulation: cross-sectional study with revision of medical records (MR) and in-depth interviews between December/2008 and February/2009 to hypertensive patients of 65 years or older and CAPS's staff. Prevalence of correct treatment (CT); appropriate Indication (AI); Optimal control (OC) were analyzed.The following PCCs were selected: Moreno, Tigre, Lomas de Zamora, Lanus and San Isidro. Prevalence of: CT: (10.2%; 95%CI 6,7-15,1); AI: (84.8%; 95% CI 80-89 ), and OC: 11,6% (95%CI 7-16) and OC among patients with good registry: 35.7% (95%CI 24,9-48,1). Eighty two % of patients received a prescription for enalapril. Deficient registry was detected in MR. Interviewees expressed difficulties in accessing treatment, lack of medication and use of alternative circuits to get them. Both, staff and patients were exposed to barriers generated by CAPSs and RP.A low degree of blood pressure control was observed, even with adequate prescription. Multifactorial problems explain several barriers to access and maintain hypertension treatment.
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