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ABSTRACT Objective We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. Methods We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. Results We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. Conclusion This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency.
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RESUMO: Introdução: Um número crescente de estudos tem mostrado evidências consistentes dos efeitos nocivos da poluição do ar na saúde humana e afetando também o peso do recém-nascido. O objetivo deste estudo é avaliar o efeito da poluição do ar sobre o peso ao nascer, mais especificamente o peso insuficiente ao nascer (entre 2.500 e 2.999 g). Métodos: Trata-se de um estudo transversal com dados relativos a todos os nascidos de mães residentes no Município de São José dos Campos, São Paulo, nos anos de 2006 a 2010. Para examinar a associação entre exposição materna à poluição do ar e o peso ao nascer foi utilizada a regressão logística (univariada e múltipla), considerando-se a média da concentração de cada poluente do 1º e 3º trimestres e dos meses do 1º trimestre. Resultados: Do total de 39.453 nascidos vivos do período estudado, 10.542 (26,7%) recém-nascidos apresentaram peso insuficiente. Na análise logística múltipla, a exposição materna ao material particulado no 1º e 3º trimestre de gestação apresentou maior chance para o nascimento de uma criança com peso insuficiente. Há uma chance de 1,07 (IC95% 1,00 - 1,14) de ocorrência de peso insuficiente para exposição (ao 2o quartil) ao material particulado no 1º trimestre e de 1,10 (IC95% 1,04 - 1,18) para exposição (ao 3o quartil) no 3º trimestre. Conclusão: Os resultados da pesquisa indicam que a exposição materna no 1º e 3º trimestres de gestação à poluição do ar no município de São José dos Campos pode determinar o peso insuficiente de recém-nascidos.
ABSTRACT: Introduction: A growing number of studies have shown consistent evidence of the harmful effects of air pollution on human health, as well as its effects on newborn weight. The objective of this study is to evaluate the effect of air pollution on birth weight, more specifically the insufficient birth weight (identified between 2,500 and 2,999 grams). Methods: This was a cross-sectional study based on data gathered from all babies born to mothers living in São José dos Campos, São Paulo, Brazil, between the years of 2006 to 2010. The association between maternal exposure to air pollution and birth weight was examined using logistic regression (both univariate and multivariate) to consider the average concentration of each pollutant during the 1st and 3rd trimesters and the months of the 1st trimester. Results: Of the 39,453 total live births during the study period, 10,542 (26.7%) newborns had insufficient weight. In multiple logistic analysis, maternal exposure to particulate matter in the 1st and 3rd trimester of pregnancy had a greater chance for insufficient weight. There is a chance of 1.07 (95%CI 1.00 - 1.14) for an insufficient weight scenario for exposure (to the 2nd quartile) of particulate matter in the 1st trimester and 1.10 (95%CI 1.04 - 1.18) for exposure (the 3rd quartile) in the 3rd trimester. Conclusion: The survey results indicate that maternal exposure to air pollution in the 1st and 3rd trimesters of pregnancy for residents of São José dos Campos create considerable potential to cause insufficient weight.
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Humans , Male , Female , Pregnancy , Infant, Newborn , Adult , Air Pollutants/adverse effects , Air Pollution/adverse effects , Birth Weight/drug effects , Brazil , Cross-Sectional Studies , Infant, Low Birth Weight , Maternal Exposure , Time Factors , Urban HealthABSTRACT
OBJECTIVE: To investigate the effect of air pollution on birth weight in a medium-sized town in the State of São Paulo, Southeast Brazil. METHODS: Cross-sectional study using data from live births of mothers residing in São José dos Campos from 2005 to 2009. Data was obtained from the Department of Information and Computing of the Brazilian Unified Health System. Air pollutant data (PM10, SO2, and O3) and daily averages of their concentrations were obtained from the Environmental Sanitation & Technology Company. Statistical analysis was performed by linear and logistic regressions using the Excel and STATA v.7 software programs. RESULTS: Maternal exposure to air pollutants was not associated with low birth weight, with the exception of exposure to SO2 within the last month of pregnancy (OR=1.25; 95% CI=1.00-1.56). Maternal exposure to PM10 and SO2 during the last month of pregnancy led to lower weight at birth (0.28g and 3.15g, respectively) for each 1mg/m3 increase in the concentration of these pollutants, but without statistical significance. CONCLUSIONS: This study failed to identify a statistically significant association between the levels of air pollutants and birth weight, with the exception of exposure to SO2 within the last month of pregnancy...
OBJETIVO: Verificar o efeito da poluição do ar sobre o peso ao nascer numa cidade de médio porte paulista. MÉTODOS: Estudo transversal, com dados relativos a todos os nascidos vivos de mães residentes no Município de São José dos Campos nos anos de 2005 a 2009. Foram obtidos dados do Departamento de Informações e Informática do Sistema Único de Saúde. Os dados dos poluentes do ar (PM10, SO2 e O3), as médias diárias de suas concentrações, foram fornecidos pela Companhia de Tecnologia de Saneamento Ambiental. Aplicou-se a regressão linear e a logística para a análise dos dados, realizadas nos programas Excel e STATA v.7. RESULTADOS: A exposição materna aos poluentes do ar não se associou ao nascimento de crianças com baixo peso, com exceção do SO2, no último mês de gestação (OR=1,25; IC95% 1,00-1,56). Além disso, a exposição materna ao PM10 e SO2 no último mês levou à diminuição do peso ao nascer (0,28g e 3,15g, respectivamente) para cada 1mcg/m3 de aumento da concentração desses poluentes, porém sem significância estatística. CONCLUSÕES: Este estudo não permitiu identificar associação estatística entre os níveis de concentração dos poluentes atmosféricos e o peso ao nascer, com exceção da exposição SO2, no último mês de gestação...