Pediatric Liver Transplantation: Caregivers’ Quality of Life / 대한소아소화기영양학회지

Purpose@#The survival rate of pediatric patients undergoing liver transplantation has increased considerably. Despite this, the period after transplantation is still complex and poses several challenges to the recipient’s family, which is responsible for care management. Recently, more attention has been paid to the impact of this complex procedure on the quality of life of caregivers. Hence, this study is aimed at assessing the quality of life of caregivers of patients who have undergone liver transplantation and the aspects that influence it. @*Methods@#This was an observational and cross-sectional study. From November 2020 to January 2021, short-form-36 questionnaires and additional questions were given to the main caregivers of children and adolescents who underwent pediatric liver transplantation. @*Results@#Thirty-eight questionnaires were completed and the results revealed a lower quality of life in comparison to Brazilian standards, primarily in the mental domains (41.8±14.1 vs. 51.1±2.8; p<0.001). It did not show a significant association with socioeconomic or transplant-related factors, but it did show a negative impact on parents’ perception of the child’s health. Parents who reported worse health status for their children had a lower mental quality of life (44.1±13.8 vs. 33.3±12.6; p<0.05). @*Conclusion@#The caregivers of transplanted children have a lower quality of life than those of the local population. Psychological assistance should be routinely provided to parents for long-term follow-up to mitigate potential negative effects on the transplanted child’s care.

Quality of Life in Children and Adolescents with Inflammatory Bowel Disease: Impact and Predictive Factors / 대한소아소화기영양학회지

Purpose@#Inflammatory bowel disease (IBD) in children and adolescents is associated with high morbidity and possibly has a significant negative impact on their quality of life. This study aimed to evaluate the quality of life of children and adolescents with IBD and define the variables that impact these individuals. @*Methods@#We administered the Pediatric Quality of Life Questionnaire (PedsQL) to 35 children and adolescents diagnosed with IBD and with available quantitative data from clinical records on epidemiology, clinical evolution, complementary tests, medical interventions, and disease activity. Data were evaluated according to the IBD type and compared with a control group of healthy children. @*Results@#The study group showed a significantly lower PedsQL score than the control group (p<0.01). Significant factors contributing to poor overall quality of life included female sex, Crohn's disease, surgery, and food restrictions. Symptoms such as diarrhea and the fear of using public toilets were associated with low physical scores. Feeling sick had a negative impact on the emotional PedsQL scores. Patients with a fear of using public toilets, anthropometric scores below the 3rd percentile, and greater disease activity scored lower in the social domain. Regarding school and psychosocial evaluations, younger children with symptom onset after the age of 2 years had lower scores than younger children with symptom onset before the age of 2 years. @*Conclusion@#IBD negatively affects the quality of life of children and adolescents based on its impact on the physical, emotional, social, and psychosocial statuses of these patients.

Cystic Fibrosis: Clinical Phenotypes in Children and Adolescents / 대한소아소화기영양학회지

PURPOSE: The objective of this study was to describe the clinical phenotypes of children and adolescents with cystic fibrosis (CF); and to assess the role of pancreatic insufficiency and neonatal screening in diagnosis. METHODS: A cross-sectional study was conducted, which included 77 patients attending a reference center of CF between 2014 and 2016. Epidemiological data, anthropometric measurements, and the presence of pulmonary, pancreatic, gastrointestinal and hepatobiliary manifestations were evaluated based on clinical data and complementary examinations. RESULTS: Of the 77 patients, 51.9% were male, with a median age of 147 months (7.0-297.0 months), and the majority showed adequate nutritional status. The most common phenotype was pulmonary (92.2%), followed by pancreatic (87.0%), with pancreatic insufficiency in most cases. Gastrointestinal manifestation occurred in 46.8%, with constipation being the more common factor. Hepatobiliary disease occurred in 62.3% of patients. The group with pancreatic insufficiency was diagnosed earlier (5.0 months) when compared to the group with sufficiency (84.0 months) (p=0.01). The age of diagnosis was reduced following implementation of neonatal screening protocols for CF (6.0 months before vs. 3.0 months after, p=0.02). CONCLUSION: The pulmonary phenotype was the most common, although extrapulmonary manifestations were frequent and clinically relevant, and should mandate early detection and treatment. Neonatal screening for CF led to earlier diagnosis in patients with pancreatic failure, and therefore, should be adopted universally.

Elaborando a capacitação de tutores: subsídios da prática / Developing tutorial expertise among medical faculty: contributions from experience

O curso de Medicina da Universidade Estadual de Londrina implementou em 1998 uma profunda mudança do currículo, adotando como estratégia e Aprendizagem Baseada em Problemas. Esta demanda o desempenho de novos e complexos papéis por parte dos docentes. Para isto, foram oferecidos cursos de capacitação ao longo dos anos de implementação. Este estudo analisa as perspectivas dos docentes que já atuaram como tutores acerca da capacitação recebida e das dificuldades e necessidades percebidas. Destacam-se como resultados a dificuldade em aplicar os instrumentos de avaliação dos alunos, na proposta formativa e participativa, bem como o desafio percebido de mobilizar alunos diferentes e lidar com conteúdos de várias disciplinas ao longo dos módulos tutorais. Conclui-se que é necessário ampliar a capacitação, num processo de educação permanente que garanta a plena implantação e a sustentabilidade do novo currículo.

Aprendizagem baseada em problemas (ABP): construindo a capacitação em Londrina / Problem-based learning (PBL): developing medical training in Londrina, Brazil

Objetivo: Registrar as ações desenvolvidas pela Comissão de Capacitação Docente (CC) do curso médico da Universidade Estadual de Londrina (UEL), no sentido de sensibilizar e treinar professores durante a implementação da ABP. Método: Consulta ao arquivo dos registros de ações da CC e análise das atividades desenvolvidas. Resultados: Entre 1997 e 2001, foram realizados cursos de sensibilização, de aprofundamento em ABP; de elaboração de problemas, de construção de módulo temático, fóruns de tutores e cursos de capacitação com dois desenhos. As atividades desenvolvidas nos cursos incluíram: observar e vivenciar grupos tutoriais; elaborar problemas surgidos no desempenho da função de tutor; treinamento de habilidades, ações de interação ensino-comunidade e sistema de avaliação. Conclusão: O programa de capacitação docente em Londrina foi construído a partir de demandas surgidas com a implementação da nova metodologia e de acordo com o grau de inserção e como pertinente um programa de capacitação mais abrangente, que envolva as instâncias gerenciais, profissionais e pedagógicas do processo.

Visäo docente do processo de implementaçäo da Aprendizagem Baseada em Problemas (ABP) no curso médico da Universidade Estadual de Londrina (UEL) / Faculty view of the implementation of a problem-based learning (PBL) curriculum in the medical course of University of Londrina

Objetivo: Conhecer a visäo dos docentes do curso de Medicina da UEL a respeito de implantaçäo e do momento atual do novo currículo em ABP. Método: Aplicaçäo de um questionário aos 268 docentes envolvidos com o curso e avaliaçäo das respostas pela escala Likert. REsultados: Responderam o questionário 220 docentes, 31, 4 por cento säo doutores e 40, 5 por cento säo mestres. Somente 31,6 por cento dos docentes avaliaram a qualidade do currículo anterior de primeira a quarta séries como boa, mas 83,3 por cento consideram o internato bom. Sentem-se bem informados sobre mudanças curriculares 55,5 por cento dos docentes, porém somente 28,9 por cento consideram que elas foram suficientemente discutidas. Apenas 32,7 por cento tiveram boa participaçäo na fase de planejamento e implantaçäo. A maioria dos docentes (63,6 por cento) já foi tutor. A ABP é considerada um avanço em relaçäo ao método anterior por 64, 8 por cento dos docentes; 69,8 por cento acham que ela facilita o aprendizado dos alunos e 70,9 por cento consideram que eles ficam mais motivados. Conclusäo: Embora näo tenha participado adequadamente da fase inicial de discussäo e execuçäo dos trabalhos, a maioria dos docentes considera a ABP vantajosa em relaçäo o método anterior e vem aumentando seu grau de inserçäo no processo, apontando para a consolidaçäo das mudanças propostas.