EL ANÁLISIS POR COMPUTADORA DE DATOS CUALITATIVOS: REALIDAD O QUIMERA

El análisis por computadora de datos cualitativos representa uno de los pasos más importantes durante el desarrollo de una investigación de corte cualitativo y es una herramienta valiosa que permite que el enfoque del investigador se dirija a la parte creativa del proceso de análisis. Este artículo discute la fiabilidad que tienen los programas para el análisis cualitativo. El trabajo concluye que: se debe elaborar una estrategia antes de iniciar el análisis, decidir entre utilizar un programa de computadora o hacer el trabajo de forma manual es trabajo del investigador y que siempre será conveniente recibir capacitación sobre metodología y análisis cualitativo antes de utilizar cualquier programa de este tipo.  Abstract Computer assisted qualitative data analysis is one of the most important steps during a qualitative research, besides it is a valuable tool that allows the researcher to focus on the creative part of the analysis. This article discusses the confidence of the programs for qualitative analysis. The work concludes that one should make a strategy before the analysis begins deciding between using a computer program or making it by hand is a researcher’s job, and it always will be better to receive some training about methodology and qualitative analysis before using any computer program. Palabras clave: Análisis cualitativo, programas de computadora, metodología cualitativa, qualitative methodology

LA TOMA DE DECISIONES EN SALUD PÚBLICA: UNA REVISIÓN DEL PROCEDIMIENTO DESDE EL ENFOQUE RACIONAL

Se presenta una revisión que contextualiza y define el uso de las habilidades cognoscitivas para la toma de decisiones dentro del campo de la salud pública, y analiza cómo éstas se pueden desarrollar en el ámbito de la formación de recursos humanos en salud.  Se llevó a cabo una investigación documental de la literatura sobre el tema, teniendo como directriz el seguimiento a los principales autores y sus referencias hasta el año 2005. Los documentos encontrados fueron sujetos a un proceso de selección por pertinencia del tema y fueron sujetos a análisis de contenido. A partir de la propuesta de Herbert Simon en 1956 la teoría de la toma de decisiones es definida y posteriormente se encuentra a una serie de autores que analizan el proceso e identifican y operacionalizan las habilidades cognoscitivas que lo generan. El proceso de toma de decisiones coincide más con un proceso de orden racional que de orden heurístico o casual. Los autores coinciden en que la toma de decisiones es un proceso intelectual que debe ejercitarse y evaluarse en el personal que trabaja en el ámbito de la salud pública, debe formar parte de las competencias del personal de salud. Abstract A review that contextualizes and defines the use of cognitive skills for decision-making within the field of public health, and discusses how they can be developed in the field of training of human resources in health. Was conducted documentary research literature on the subject, taking as a guideline to follow the lead authors and references to 2005. The documents found were subject to a selection process by relevance of the topic and were subjected to content analysis. Since the proposal of Herbert Simon in 1956 the theory of decision making is defined and is subsequently a number of authors who analyze the process and identify and operationalize cognitive skills that generate it. The decision making process coincides with a rational order processing heuristic or random order. The authors agree that decision making is an intellectual process that must be exercised and evaluated in the staff working in the field of public health, should be part of the skills of health workers. Palabras Clave: Toma de decisiones, habilidades, competencias, salud públic

Diseño y validación de un instrumento para evaluar la adherencia médico-nutricional en personas con obesidad

Introduction. Lack of therapeutic adherence is a major health problem that directly affects health systems. No validated instruments were found for the Mexican population with obesity that contemplated more than three factors or dimensions associated with lack of adherence. The objective of this work is to present the process of design and validation of an instrument that allows evaluating adherence to medical-nutritional treatment in people with obesity. Methods. Analytical cross-sectional study in which a filling card and a measurement instrument focused on health professionals were designed and validated to evaluate the medical-nutritional adherence of patients. It was carried out in 4 stages that include the design of the instrument (five dimensions: socioeconomic factors, those associated with the health team or systems, related to the patient, related to the disease and related to the treatment), its validation, test pilot (sample of 50 patients and 4 expert evaluators) and statistical analysis. Reproducibility (Pearson's correlation coefficient) and validity (Cronbach's alpha) were tested. Results. The experts rated all the items of the instrument as relevant, the global validity index was 0.86. The internal consistency of the instrument was good with a Cronbach's alpha of 0.85. Pearson's correlation coefficient for the complete instrument was 0.86 (p <0.001). Conclusion: The instruments that were designed allow health professionals to evaluate adherence to medical-nutritional treatment of patients with obesity comprehensively and at low cost.Introducción. La falta de adherencia terapéutica es un problema de salud importante que afecta a los sistemas de salud. No se encontraron instrumentos validados para la población mexicana con obesidad que contemplen más de tres factores o dimensiones asociadas a la falta de adherencia. El objetivo de este trabajo es presentar el proceso de diseño y validación de un instrumento que evalúe la adherencia al tratamiento médico-nutricional en personas con obesidad. Métodos. Estudio analítico transversal en el que se diseñó y validó una tarjeta de llenado y un instrumento de medida enfocado a los profesionales de la salud para evaluar la adherencia médico-nutricional de los pacientes. Se realizó en 4 etapas que incluyen el diseño del instrumento (con cinco dimensiones de indicadores: socioeconómicos, asociados al equipo o sistemas de salud, relacionados con el paciente, relacionados con la enfermedad y relacionados con el tratamiento), su validación, prueba piloto (muestra de 50 pacientes y 4 evaluadores expertos) y análisis estadístico. Se probaron la reproducibilidad (coeficiente de correlación de Pearson) y la validez (alfa de Cronbach). Resultados. Los expertos calificaron como relevantes todos los ítems del instrumento, el índice de validez global fue de 0,86. La consistencia interna del instrumento fue buena con un alfa de Cronbach de 0,85. El coeficiente de correlación de Pearson del instrumento completo fue de 0,86 (p< 0,001). Conclusión: El instrumento diseñado permite al profesional de la salud evaluar la adherencia al tratamiento médico-nutricional de los pacientes con obesidad de manera integral y a bajo costo

Prescripción inadecuada de medicamentos: aportaciones de los paradigmas científicos a su conocimiento

Se realizó una revisión narrativa con análisis temático sobre las aportaciones de los paradigmas científicos al conocimiento de la prescripción inadecuada de medicamentos. Se buscaron artículos de acceso abierto indexados en PubMed© entre 2010-2014, y se sistematizó información sobre el paradigma, tipo de publicación, perspectiva teórica, objetivo, método y resultados. De los 992 artículos encontrados, se seleccionaron 118, y se tomó una muestra propositiva de 15, según su diseño, representando los cuatro paradigmas. Los artículos positivistas reportaron prevalencia, factores asociados, efectividad de intervenciones y criterios de evaluación; los interpretativos explicaron las causas del problema según los involucrados; los críticos denunciaron la influencia de la industria farmacéutica; y el participativo abordó el problema secundariamente y lo solucionó en un escenario para una enfermedad y grupo farmacológico específicos. Se concluyó que la prescripción inadecuada de medicamentos como problema de investigación en salud pública recibe aportes de los cuatro paradigmas, con dominio del positivismo, lo que se atribuye al carácter paradigmático de la ciencia desde la que se le aborda habitualmente, y que una perspectiva multi-paradigmática es el mejor abordaje.This study conducted a narrative review with thematic analysis about contributions of scientific paradigms to knowledge of inadequate drugs prescription. We searched open access articles indexed in PubMed© between 2010 and 2014, and we systematized information about scientific paradigm, publication type, theoretical perspective, objective, method and results. From the 992 articles found, 118 were selected. From those, we chose a purposive sample of 15, according to the design of the studies, representing the four paradigms. The positivists articles reported prevalence, associated factors, effectiveness of interventions and evaluation criteria; the interpretive explained the causes of the problem according to those involved; the critics denounced the influence of pharmaceutical industry; and the participative addressed the problem secondarily and solved it in a scenario for a specific disease and pharmacological. We concluded that the inadequate drugs prescription as research problem in public health had contributions from the four paradigms, with dominance of positivism, which is attributed to the paradigmatic perspective of the science, from which it is usually studied, and that a multiparadigmatic perspective is the best approach to the public health issue

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Evaluación de la calidad de la información en Internet : estado del arte y consideraciones para su aplicación en la BVS Adolec México

OBJECTIVE: To present the state of the art concerning proposals and criteria for the assessment of the information disseminated in Internet, particularly the information related to health. METHODS: A qualitative design with a document research approach was used. More than 200 documents were collected from various search tools and on-line databases. An analysis of the thematic content was applied to the documents and the existing proposals were identified. OUTCOMES: The proposals for quality assessment of the resources available in the Web are classified as follows: a) proposals of criteria for the assessment of resources in the Web, b) references or author guides and sites which evaluate the resources, c) assessment of resources and creation of indexes for consultation and d) proposals of assessment of non-traditional material. CONCLUSIONS: There is a great deal of proposals for quality assessment of the resources available in Internet that lack classification and systematization. In this article the different types of proposals were identified and characterized. This will allow to establish the bases to guarantee the quality of the resources available in the virtual health library concerning teenagers in Mexico