A PEDIATRIA NO MUNDO....(P/ Dr. Sergio Cabral)

Como está a pediatria no mundo?
Na África, apesar de haver uma necessidade absoluta de atenção médica, são poucos pediatras e muito mais dedicados à assistência em consultórios. O trabalho do Child of Africa – projeto da IPA – é exatamente formar lideranças que possam atuar na saúde pública. O padrão norte-americano é muito focado na clínica privada e na assistência a partir de convênios. Quem não tem seguro, não tem, não existe um sistema universal de saúde. Mas eu diria que, tanto nos EUA, quanto na Europa, há uma crise, nesse momento, em relação à remuneração do médico. O "managed care" reduziu muito a remuneração dos médicos americanos. Na Europa, uma consulta pediátrica, paga em torno de 60 ou 70 euros. Mas se pensarmos, não é muito diferente do que a classe média paga no Brasil. O que eles têm muito mais, por exemplo, é estrutura de ensino e pesquisa, suporte. Mas para o pediatra, no dia-a-dia do consultório ou no hospital, não é muito diferente, os problemas são parecidos. Outra coisa que existe em alguns países da Europa, como a Holanda, é um controle rígido, chegam a delimitar quantos profissionais podem se formar, de acordo com a necessidade. Na Índia, no Paquistão, também há uma situação de carência, de má remuneração. Não há um perfil único, mas as dificuldades estão ocorrendo em todo o mundo.

VALORIZAÇÃO DO PEDIATRA....(continuação)

Já as instituições públicas e privadas de saúde do país aliam-se na estratégia de desmerecer os cuidados pediátricos. Parecem convergir na meta de vulgarizá-los, negando-lhes o valor prioritário que as sociedades mais desenvolvidas passaram a dar-lhes. Insistem em desconhecer a evidência científica que identifica a qualidade do cuidado assegurado à infância como o único investimento capaz de prevenir as doenças do adulto. Aviltam salários dos pediatras, fecham leitos hospitalares para crianças, remuneram consultas pediátricas a preço de banana. Inviabilizam os padrões clínicos de qualidade que o pediatra sabe fazer como poucos médicos. Dão preferência a procedimentos de maior complexidade tecnológica e menor alcance social. Ignoram a medicina da criança e do adolescente no que realiza de ações educativas e preventivas, cujo alcance tem o poder revolucionário de transformar a realidade brasileira. Talvez seja essa a razão para políticas de saúde tão destoantes da verdade científica. Talvez a estratégia para perpetuar as desigualdades que interessam à plutocracia dominante. Os pediatras despertam. Percebem que já deram sua cota de sacrifícios e privações pessoais. Não aceitam mais a condição de míseros sobreviventes num sistema de saúde que se recusa a valorizá-los. Não querem integrar o exército de reserva à disposição de gestores inconsequentes, ávidos pelo poder, indiferentes às verdadeiras prioridades da saúde no país. Começam a expressar a força de sua identidade profissional. Não se submetem a contratos que lhes subestimem o mérito e lhes retirem a dignidade altaneira de uma vocação humanista, inteiramente comprometida em cuidar da maior riqueza da sociedade, a infância e a adolescência. As demonstrações da importante tomada de consciência multiplicam-se país afora. Ou os responsáveis pela saúde pública e privada corrigem as injustiças com que discriminam a pediatria, ou o impasse estará irreversivelmente instalado. No Distrito Federal, pediatras aprovados em concurso público não assumiram as vagas oferecidas. Em Tocantins, todos os pediatras que atendiam emergências pela Unimed deixaram de trabalhar na cooperativa porque os salários pagos foram reduzidos. No município de Canoas, na grande Porto Alegre, os pediatras não se inscreveram para concurso que os levaria a trabalhar sem remuneração à altura do que valem. Na Bahia, pediatras demitem-se das unidades de saúde pública, conscientes de que não devem acumpliciar-se do desrespeito com que são tratados. Fortes sinais da mobilização que leva à retomada da autoestima de médicos formados para cuidar de crianças e adolescentes no Brasil. Resultam de luta coordenada pela entidade pediátrica nacional para combater a injusta remuneração que ameaça a pediatria brasileira, especialidade médica que reúne compromisso social e qualidade científica postos a serviço do ser humano em crescimento e desenvolvimento. Como o prova a conquista da licença-maternidade de seis meses, iniciativa da Sociedade Brasileira de Pediatria em parceria com a senadora Patrícia Saboya. Os pediatras estão conscientes da integridade profissional com que trabalham. Sabem que a dedicação investida para cuidar da criança tem preço. Não abrem mão. Querem a vida a que fazem jus. Afinal, pediatra tem valor.

VALORIZAÇÃO DOS PEDIATRAS...

Valorização do pediatra

Dioclécio Campos JúniorMédico, professor titular de pediatria da UnB e presidente da Sociedade Brasileira de Pediatria
No cenário atual da saúde, a tomada de posição firme pelos pediatras tarda, mas não falta. É só uma questão de tempo. Os arranjos animados por perspectivas ilusórias atrasam o processo, não o esgotam. A descrença que turva o olhar crítico é transitória, jamais irreversível. A depressão às vezes desencoraja atitudes, não as elimina. A humilhação rebaixa a autoestima, não a sepulta. A capacidade de reagir esmorece, não fenece. O cerne existencial do pediatra é íntegro, resiste. Revela o brio de alguém bem formado, a força da convicção forjada na tenacidade de quem crê no valor do que faz. A alma terna, porém indomável, do cidadão que milita no território da vida nascente, no reduto dos viços originais da criatura humana, nos recantos regados e alegrados pelas potencialidades infantis, cheias do ilimitado, plenas do imponderável. A maioria da sociedade brasileira, incluindo o ministro Temporão, respeita o pediatra, entende o caráter primaz da missão que exerce. Preza sua postura. Admira-lhe a compostura. Requer-lhe os préstimos especializados. Destina-lhe lugar diferenciado nas relações preferenciais do universo familiar. Situa-o no âmago das reverências que ainda cultiva como rito socialmente consagrado.

CONTINUAÇÃO-AVALIAÇÃO DE CONHECIMENTOS-APLS

CME Questions -modulo XXII

1: All of the following statements regarding impedance pneumography are correct except:
A: Display can be affected by patient movementB: Measures chest wall movementC: Measures respiratory effortD: Measures ventilationE: Uses the ECG monitor leads
2: Which of the following statements regarding basic airway management is correct?
A: Chin-lift maneuver is acceptable for most trauma victimsB: Chin-lift maneuver is acceptable for unconscious trauma victims as long as cervical spine films are normalC: Jaw-thrust maneuver is preferred for trauma victimsD: Nasal airways can only be used in conscious patientsE: Oral airways work best in conscious patients
3: Which of the following statements regarding RSI in pediatric patients is correct?
A: Involves administration of a sedative agent and a neuromuscular blocking agentB: Preoxygenation is of little benefitC: Should almost always be conducted as quickly as possible; equipment can be gathered while the procedure is being performedD: Tachycardia is a common side effect of succinylcholine E: There is almost no indication for the use of atropine
4: Cannulation of which of the following venous sites has the highest risk of complications?
A: Brachial veinB: Distal saphenous veinC: External jugular veinD: Femoral veinE: Subclavian vein

MAIS CASOS PARA DIAGNÓSTICO...

Case Challenges" From Pediatric Annals
A 16-year-old Boy with Hepatosplenomegaly
Published in Pediatric Annals October 2009
A 16-year-old boy, a new immigrant from Ethiopia, was referred for investigation of hepatosplenomegaly. Past medical history was unremarkable ex... more
A 3-day-old Boy with Acute Flaccid Paralysis
Published in Pediatric Annals September 2009
A 3-day-old male newborn presented to the emergency room with poor sucking, constipation, decreased urination, weak cry, decreased activity, and labor... more
A 5-year-old Girl with Scarring
Published in Pediatric Annals July 2009
A 5-year-old black girl was brought to our pediatric dermatology clinic by her foster mother after referral from the emergency room for the evaluat... more
A 6-week-old Boy with Apnea and Abdominal Distention
Published in Pediatric Annals May 2009
A 6-week-old boy in respiratory distress presented to the Emergency Department via ambulance. Earlier that day, he woke from his nap screaming and ... more
A 14-year-old Boy with Pain in Hands and Feet
Published in Pediatric Annals April 2009
A 14-year-old boy was referred for evaluation of pain in his hands and feet. The pain was intermittent, described as an intense “burning” sensat... more
An 11-year-old Boy with Ankle Trauma
Published in Pediatric Annals March 2009
An 11-year-old boy first presented to his physician following ankle trauma. At that time, radiographs of the ankle revealed no acute osseous inj... more
A 2-month-old Girl with an Enlarging Lesion of the Nasal Root
Published in Pediatric Annals February 2009
A 2-month-old, otherwise healthy white girl presented with an enlarging lesion of the nasal root, slightly to the right of midline. The lesion was fir... more
A 10-year-old Girl with Abdominal Pain
Published in Pediatric Annals January 2009
A 10-year-old girl presented to the emergency department with a 3-day history of intermittent abdominal pain. The pain was initially described as “dul... more
An Unusual Sore Throat
Published in Pediatric Annals December 2008
A previously healthy 15-year-old Hispanic boy presented to the emergency room with a history of fever and sore throat. Both symptoms began 4 days prio... more
A 7-year-old Girl with a Pruritic Facial Eruption
Published in Pediatric Annals November 2008
Editor’s note: Each month, this department features a discussion of an unusual diagnosis in genetics, radiology, or dermatology. A description and ima... more
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QUAL O SEU DIAGNÓSTICO?

http://www.pediatricsupersite.com/section.aspx?sid=190


"Spot the Rash" From Infectious Diseases in Children
13-year-old girl with lesion on scalp
Published in Infectious Diseases in Children September 2009
A 13-year-old girl presents to your clinic stating that the mole behind her ear extending into her scalp is changing. She states the lesion has b... more
12-year-old boy admitted for febrile illness
Published in Infectious Diseases in Children August 2009
A previously healthy 12-year-old boy is admitted to the inpatient ward in mid-July for evaluation of a febrile illness. He had a rapid onset of fev... more
6-week-old girl with a facial rash
Published in Infectious Diseases in Children July 2009
A 6-week-old girl presents to your clinic with a facial rash. Her mother reports that the lesions developed about three weeks ago and appear to be ... more
A 6-year-old boy with black spots
Published in Infectious Diseases in Children June 2009
A 6-year-old boy was referred to rule out melanoma when he developed an asymptomatic “black dot” on the left tragus present for two days.... more
A 5-year-old with rash on extremities and trunk
Published in Infectious Diseases in Children April 2009
A 5-year-old boy presents to your clinic with an asymptomatic rash involving his extremities and trunk for three days (Figure 1). Further history ... more
A 4-year-old with foot laceration
Published in Infectious Diseases in Children March 2009
A previously healthy 4-year-old girl presented to our clinic to be evaluated for a possible infection after injuring herself at the beach. ... more
An 18-month-old boy with erythematous eruption
Published in Infectious Diseases in Children February 2009
An 18-month-old healthy black boy presented to your office with a three-week history of an erythematous, edematous eruption, which began around his el... more
A 2.5-year-old girl with an annular plaque
Published in Infectious Diseases in Children December 2008
A 2.5-year-old girl presented to the clinic complaining of a skin colored annular plaque on her right arm. Her mother reported it had been present f... more
A 34-week-old boy with skin lesions
Published in Infectious Diseases in Children November 2008
A boy, gestational aged 34 weeks and 4 days, was born at an outlying hospital and transferred to the neonatal intensive care unit for evaluation of ex... more
A 9-year-old boy with pruritic lesions
Published in Infectious Diseases in Children October 2008
A 9-year-old healthy boy presented to the clinic complaining of a three-day history of several moderately pruritic lesions on his lower legs. This was... more
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CME Activities
Managing Special Healthcare Needs Pediatric Annals, September 2009Screening and Testing: Genetics Pediatric Annals, August 2009Pediatric Immunization: Meeting the Challenges of the 21ST Century Infectious Diseases in Children, August 2009 Pediatric Annals, October 2008
Allergy
Pediatric Annals, September 2008
School Emergency
Pediatric Annals, August 2008
Lorem ipsum dolor
Infectious Diseases in Children, July 2008 -->View more CME


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Rotavirus and Red Book 2009: An interview with Larry K. Pickering, MD, editor
Physician supports the processes of the CDC and the AAP that lead to the recommendations in the Red Book for immunization practices in general and for rotavirus in particular.Click here

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IMAGENS PARA DIAGNOSTICO...

"Spot the Rash" From Infectious Diseases in Children
13-year-old girl with lesion on scalp
Published in Infectious Diseases in Children September 2009
A 13-year-old girl presents to your clinic stating that the mole behind her ear extending into her scalp is changing. She states the lesion has b... more
12-year-old boy admitted for febrile illness
Published in Infectious Diseases in Children August 2009
A previously healthy 12-year-old boy is admitted to the inpatient ward in mid-July for evaluation of a febrile illness. He had a rapid onset of fev... more
6-week-old girl with a facial rash
Published in Infectious Diseases in Children July 2009
A 6-week-old girl presents to your clinic with a facial rash. Her mother reports that the lesions developed about three weeks ago and appear to be ... more
A 6-year-old boy with black spots
Published in Infectious Diseases in Children June 2009
A 6-year-old boy was referred to rule out melanoma when he developed an asymptomatic “black dot” on the left tragus present for two days.... more
A 5-year-old with rash on extremities and trunk
Published in Infectious Diseases in Children April 2009
A 5-year-old boy presents to your clinic with an asymptomatic rash involving his extremities and trunk for three days (Figure 1). Further history ... more
A 4-year-old with foot laceration
Published in Infectious Diseases in Children March 2009
A previously healthy 4-year-old girl presented to our clinic to be evaluated for a possible infection after injuring herself at the beach. ... more
An 18-month-old boy with erythematous eruption
Published in Infectious Diseases in Children February 2009
An 18-month-old healthy black boy presented to your office with a three-week history of an erythematous, edematous eruption, which began around his el... more
A 2.5-year-old girl with an annular plaque
Published in Infectious Diseases in Children December 2008
A 2.5-year-old girl presented to the clinic complaining of a skin colored annular plaque on her right arm. Her mother reported it had been present f... more
A 34-week-old boy with skin lesions
Published in Infectious Diseases in Children November 2008
A boy, gestational aged 34 weeks and 4 days, was born at an outlying hospital and transferred to the neonatal intensive care unit for evaluation of ex... more
A 9-year-old boy with pruritic lesions
Published in Infectious Diseases in Children October 2008
A 9-year-old healthy boy presented to the clinic complaining of a three-day history of several moderately pruritic lesions on his lower legs. This was... more
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