Manual de orientaciones metodológicas para el desarrollo de actividades vocacionales en las ciencias médicas / Manual of methodological guidelines for the development of vocational activities in the medical sciences

Fundamento: una vía para fortalecer el trabajo extensionista es la labor de formación vocacional y orientación profesional; actividad esta factible de ser perfeccionada a través del trabajo metodológico. Objetivo: elaborar un manual de orientaciones metodológicas para el desarrollo de actividades vocacionales vinculadas a proyectos comunitarios de salud. Métodos: se realizó una investigación panorámica cualitativa en la Universidad de Ciencias Médicas de Villa Clara, durante septiembre 2018- septiembre 2022. Se utilizaron métodos teóricos: analítico- sintético, inductivo- deductivo; y empíricos: análisis documental y la entrevista a informantes clave. El producto fue valorado por criterio de especialistas. Resultados: se diagnosticaron necesidades de orientación sobre la ejecución de proyectos de investigación comunitaria desde la labor vocacional y profesional, por falta de experiencia en esta actividad y no existir un material de apoyo de consulta para desarrollar actividades vocacionales con fines investigativos en la solución de problemas de salud en la comunidad, para lo cual se elaboró el manual de orientaciones metodológicas. Conclusiones: se elaboró un manual de orientaciones metodológicas para el desarrollo de actividades vocacionales vinculadas a proyectos comunitarios de salud que constituye un material de apoyo para desarrollar actividades vocacionales en centros escolares que contribuyan a la solución de problemas de salud en la comunidad desde la investigación científica participativa.

Background: one way to strengthen extension work is the work of vocational training and professional guidance; activity is feasible to be perfected through methodological work. Objective: to prepare a manual of methodological guidelines for the development of vocational activities linked to community health projects. Methods: a qualitative panoramic investigation was carried out at the Villa Clara University of Medical Sciences, from September 2018-September 2022. Theoretical methods were used: analytical-synthetic, inductive-deductive; and empirical: documentary analysis and interviews with key informants. The product was evaluated by specialist criteria. Results: Guidance needs were diagnosed on the execution of community research projects from vocational and professional work, due to lack of experience in this activity and there being no support material for consultation to develop vocational activities for investigative purposes in solving problems of health in the community, for which the methodological guidelines manual was prepared. Conclusions: the manual constitutes support material to develop vocational activities in schools so that they contribute to the solution of community health problems through participatory scientific research.

Manual para evaluar la deglución y el rendimiento masticatorio en las clínicas de odontología / Manual to evaluate swallowing and chewing performance in dental clinics

Objetivo: desarrollar y aplicar un manual para evaluar los procesos de deglución y rendimiento masticatorio, dirigido a estudiantes y profesionales de odontología. Método: se realizó un estudio con enfoque cuali-cuantitativo, a partir de dos técnicas de recolección de información: documental para reunir información de los procedimientos y observacional para la aplicación del manual. Los métodos seleccionados fueron el rendimiento masticatorio (Albert T) y de deglución (Técnica Payne); el diseño se esbozó según la metodología para mejorar la calidad de los procesos y una guía técnica de elaboración de manuales de procedimientos en salud. Así, el manual cuenta con introducción, antecedentes históricos, alcance y objetivo, flujograma, descripción de procedimientos de evaluación de la deglución, del rendimiento masticatorio y bibliografía. Este fue aplicado en 27 pacientes de la clínica de ortodoncia, a quienes se les diagnosticó deglución atípica, y se midió el rendimiento masticatorio para conocer la mediana de tamaño de partícula (MTP) de cada individuo. Resultados: el manual se realizó basándose en dos procedimientos, uno con el diagnóstico de deglución y otro con rendimiento masticatorio. Este último fue aplicado por dos estudiantes investigadores a una muestra de 27 pacientes, cuyo resultado fue una mediana de tamaño total de partícula de MTP = 5.35 mm2. Hubo una diferencia estadísticamente significativa entre sexos (MTP en hombres: 6,0 mm2 y mujeres 5.1 mm2) siendo las mujeres quienes presentaron mejor desempeño masticatorio. Conclusión: al aplicar el manual, los estudiantes evaluaron el rendimiento masticatorio y la deglución, con lo cual lograron resultados medibles, aplicables y reproducibles.

Objective: To apply a manual to evaluate swallowing and chewing performance aimed at dental students and professionals. Method: A study was carried out with a qualitative-quantitative approach developing two information gathering techniques: documentary to gather information on procedures and observational in the application of the manual. The methods of chewing performance (Albert T) and swallowing (Payne Technique) were selected; the design was outlined according to the methodology to improve the quality of the processes and a technical guide for the elaboration of manuals of health procedures; in the development phase, the thematic units were created and the manual was prepared with: cover, back cover, authors, introduction, historical background, scope and objective, flow chart, description of swallowing evaluation procedures, chewing performance and bibliography; this was applied to 27 patients from the orthodontic clinic, who were diagnosed with atypical swallowing, and the masticatory performance was measured to determine the median particle size (MTP) of each individual evaluated. Results: The manual was made based on two procedures, one with swallowing diagnosis and the other with masticatory performance, which was applied by two student researchers to a sample of 27 patients, yielding a median total particle size of MTP = 5.35 mm2. There was a statistically significant difference between the sexes (MTP in men: 6.0 mm2 and women 5.1 mm2), with women presenting the best masticatory performance Conclusion: when applying the manual, the students evaluated the chewing performance and swallowing, achieving measurable, applicable and reproducible.

Folleto didáctico: modificaciones a las toracotomías axilares en el Hospital Clínico Quirúrgico "Arnaldo Milián Castro" / Didactic leaflet: modifications to axillary thoracotomy at the "Arnaldo Milián Castro" Clinical Surgical Hospital

RESUMEN Fundamento: la cirugía torácica es indispensable en la formación del cirujano general, específicamente las vías de abordajes al tórax. Del análisis de elementos contradictorios y teniendo como fundamentos la práctica y la revisión continua de la literatura, fue necesario realizar innovaciones sucesivas a las toracotomías axilares verticales, las cuales después de realizadas demandaron un instrumento para su socialización. Objetivo: diseñar un folleto didáctico para la socialización de los resultados de la investigación "Modificaciones a la toracotomía axilar vertical". Métodos: se realizó un estudio de innovación tecnológica, empleando el método general del conocimiento dialéctico-materialista en la confección de un folleto didáctico que contiene los resultados de una investigación cuasiexperimental en pacientes operados, en el período comprendido entre septiembre de 2012 a diciembre de 2016, por afecciones en la cavidad torácica (no cardiovasculares), en el Hospital Clínico Quirúrgico "Arnaldo Milián Castro" de Santa Clara, Villa Clara. Resultados: el folleto didáctico incluye la explicación metodológica de las modificaciones a la técnica quirúrgica e imágenes que las ilustran; tiene 35 páginas cuyo contenido está desglosado en ocho acápites que incluyen fundamentos teóricos, desarrollo de la técnica, novedad, ventajas, desventajas y resultados de su aplicación. Se encuentra disponible en la biblioteca del mencionado hospital para la preparación de los profesionales que se entrenan con este fin. Conclusiones: el folleto didáctico constituye un valioso material de apoyo a la docencia y una herramienta eficaz para elevar el desempeño profesional en la identificación y solución de problemas en la práctica médica relacionados con la toracotomía axilar vertical.

ABSTRACT Background: thoracic surgery is essential for the general surgeon training, specifically the approaches to reviewing the chest. Taking as reference the analysis of contradictory elements and having as basis practice and the continuous review of literature, it was necessary to make subsequent innovations to the vertical axillary thoracotomies, which after being performed required an instrument for their socialization. Objective: to design a didactic leaflet to socialize the research results "Modifications to vertical axillary thoracotomy". Methods: a technological innovation study was conducted, using the general method of dialectical-materialistic knowledge for designing a didactic leaflet containing the results of a quasi-experimental research in patients who underwent surgery, from September 2012 to December 2016, due to conditions in the thoracic cavity (non-cardiovascular conditions), at the "Arnaldo Milián Castro" Clinical Surgical Hospital in Santa Clara, Villa Clara. Results: the didactic leafklet includes the methodological details of the modifications to the surgical technique and images that illustrate them; the leaflet is 35 pages long with the content that is organized into eight chapters that include theoretical underpinnings, development of the technique, novelty, advantages, disadvantages and results of its application. It is available at the library of the above mentioned hospital, for the professional development of specialists in this field. Conclusions: the didactic leaflet is a valuable learner-teacher support material and an effective tool for the professional development of specialists in recognizing and solving problems in clinical practice related to vertical axillary thoracotomy.

Educational handbook for healthcare professionals: Preventing complications and treating peristomal skin / Manual educativo para profissional da área da saúde: prevenindo complicação e tratando a pele periestoma

Abstract Objective: To create and validate a handbook for the prevention of peristomal skin complications. Methods: For the elaboration of the handbook, a literature review was conducted in the following databases: Cochrane Library, SciELO, LILACS, and MEDLINE. The handbook "Preventing and treating the complications of intestinal peristomal skin" was elaborated in nine steps. The first step addressed the concepts of ostomy, stoma type, and ostomy classification. In the second step, the following were described: definition of the collection equipment, type of collection equipment, and technique of changing one- and two-piece equipment. In the third step, the peristomal skin cleansing technique was described. In the fourth step, the types of complications of the peristomal skin were listed. In the fifth step, preventive approaches to avoid complications with the peristomal skin were described. In the sixth step, the therapeutic approaches in the treatment of aforementioned peristomal skin complications were addressed. In the seventh step, the handbook layout was created by an Information Technology professional. In the eighth step, the handbook was validated by 25 nurses. In the ninth step, the final version of the instrument was laid out. Results: The final version of the "Preventing and treating the complications of intestinal peristomal skin" handbook has 37 pages. It was registered in the International Standard Book Number: 978-85-67647-46-3, standard format size (21 cm high by 15 cm wide), totaling 50 illustrations. In the first evaluation, the evaluators assessed the manual as partially adequate to completely adequate. In the first evaluation, the content validity index ranged between 0.88 to 1.0; no 100% agreement was observed among the evaluators' answers. In the second evaluation, as an agreement was observed in all items, the content validity index was 1.0. Conclusion: The handbook "Preventing and treating the complications of intestinal peristomal skin" was elaborated based on scientific principles and had its content, language, and design validated by specialists in the field.

Resumo Objetivo: Construir e validar um manual para a prevenção das complicações da pele periestoma. Método: Para a construção do manual, realizou-se uma revisão nas bases: Biblioteca Cochrane, SciELO, LILACS e MEDLINE. O manual "Prevenindo e tratando das complicações da pele periestoma intestinal" foi elaborado em nove etapas. A primeira etapa abordou os conceitos de estomia, tipo de estoma, classificação de estomia. Na segunda etapa, foram elaborados: definição de equipamento coletor, tipo de equipamentos coletores, técnica da troca do equipamento de uma e duas peças. Na terceira etapa, definiu-se a técnica de limpeza da pele periestoma. Na quarta etapa, foram descritos os tipos de complicações da pele periestoma. Na quinta etapa, enfocaram-se as condutas preventivas para evitar as complicações com a pele periestoma. Na sexta etapa, foram descritas as condutas terapêuticas no tratamento das complicações da pele periestoma citadas acima. Na sétima etapa, foi realizada a diagramação do manual por um profissional da área de Tecnologia da Informação. Na oitava etapa, validação do manual por 25 enfermeiros. A nona etapa correspondeu à diagramação da versão final do instrumento. Resultados A versão final do manual denominado "Prevenindo e tratando das complicações da pele periestoma intestinal" contém 37 páginas. Foi registrado no International Standard Book Number: 978-85-67647-46-3, tamanho padrão de formatação com 21 cm de altura por 15 cm de largura, totalizando 50 ilustrações. Na primeira avaliação, os juízes avaliaram o manual como parcialmente adequado a totalmente adequado. O Índice de validade de conteúdo na primeira avaliação foi entre 0,88 a 1,0; não tendo ocorrido 100% de concordância das respostas dos juízes; na segunda avaliação, tendo havido concordância dos juízes em todos os itens, o índice de validade de conteúdo foi 1,0. Conclusão O manual intitulado "Prevenindo e tratando das complicações da pele periestoma intestinal" foi construído com embasamento científico, validado quanto ao conteúdo, à linguagem e à aparência por especialistas na área.

Factores de riesgo y bases genéticas: el caso del trastorno por déficit de atención e hiperactividad / Risk factors and genetic bases: the case of attention deficit hyperactivity disorder

RESUMEN El trastorno por déficit de atención e hiperactividad (TDAH) es el trastorno mental considerado más frecuente en la infancia. Si bien su diagnóstico en el manual de psiquiatría hoy más utilizado en el mundo, el Diagnostic and statistical manual of mental disorders (DSM-5), se basa en los comportamientos de desatención, hiperactividad e impulsividad, se encuentran numerosos intentos de describir las bases biológicas del trastorno para usarlos con fines de diagnóstico y como marcadores de riesgo. En este trabajo analizamos críticamente la validez de los estudios asociados a la búsqueda de marcadores genéticos para el TDAH. En primer lugar, se presenta la caracterización del TDAH en el manual DSM-5; luego, se desarrolla el vínculo entre el TDAH y los factores de riesgo y los marcadores genéticos; y, finalmente, se presentan algunas conclusiones en las que se señalan simplificaciones y omisiones que pueden tener consecuencias significativas.

ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is considered to be the most frequent mental disorder in childhood. Although its diagnosis in the most utilized handbook of psychiatry in the world today - the Diagnostic and statistical handbook of mental disorders (DSM-5) - is based on behaviors of inattention, hyperactivity and impulsivity, numerous attempts to describe the biological bases of the disorder can be found, to be used for and also as risk markers. In this paper, we will critically analyze the validity of studies associated with the search for genetic markers of ADHD. First, a characterization of ADHD by the DSM-5 handbook is presented. Subsequently, the link between ADHD, risk factors and genetic markers is developed. Finally, some conclusions are presented which highlight simplifications and omissions that could have significant consequences.

Pesquisa participativa e as estratégias de promoção da saúde integral da criança no Sistema Único de Saúde (SUS) / Investigación participativa y las estrategias de promoción de la salud integral del niño en el Sistema Brasileño de Salud (SUS) / Participative research and comprehensive child healthcare promotion strategies in the Brazilian National Health System (SUS)

Neste artigo, discutem-se aspectos metodológicos de uma investigação que tomou a promoção da participação dos envolvidos como desafio. Interessou compreender os sentidos atribuídos por equipes de Saúde da Família à Caderneta de Saúde da Criança (CSC) e ao desenvolvimento infantil. A pesquisa-intervenção promoveu o compartilhamento de pontos de vista entre pesquisadores e trabalhadores em grupos focais com utilização de narrativas, construindo condições para que os participantes se tornassem protagonistas da investigação proposta. A realização dessa estratégia promoveu: 1) maior apropriação do instrumento; 2) aprofundamento e reposicionamento quanto a questões cristalizadas nos modos de funcionamento das equipes; 3) validação dos resultados da pesquisa. Tais resultados indicam que há uma contribuição das pesquisas participativas para a consolidação do SUS, pois, ao proporem o acesso a um plano comum como estratégia metodológica, promovem também maior engajamento das equipes em relação aos temas propostos.(AU)

En el artículo se discuten aspectos metodológicos de una investigación que consideró la promoción de la participación de los envueltos como un desafío. El interés se concentró en entender los sentidos atribuidos por equipos de Salud de la Familia a la Cartilla de Salud del Niño (CSC, por sus siglas en portugués) y al desarrollo infantil. La investigación-intervención promovió la compartición de puntos de vista entre investigadores y trabajadores en grupos focales con utilización de narrativas, construyendo condiciones para que los participantes pasaran a ser protagonistas del estudio propuesto. La realización de esta estrategia promovió: 1) mayor apropiación del instrumento; 2) profundización y reposicionamiento con relación a cuestiones cristalizadas en los modos de funcionamiento de los equipos; 3) validación de los resultados del estudio. Tales resultados indican que hay una contribución de los estudios participativos para la consolidación del SUS, puesto que al proponer el acceso a un plan común como estrategia metodológica también promueven un mayor compromiso de los equipos en relación a los temas propuestos.(AU)

The article discusses methodological aspects of an investigation aimed at promoting the involvement of participants as a challenge. We were interested in understanding how family health teams made sense of the child handbook - Caderneta de Saúde da Criança, and child development. The intervention-research promoted the sharing of viewpoints among researchers and providers in focal groups with the use of narratives making it possible for the participants to become key players of the proposed investigation. The implementation of the strategy promoted: 1) the greater ownership of the instrument, 2) the deepening and repositioning regarding crystalized issues in the functioning of teams, and 3 ) the validation of research results. These results indicate that there is a contribution of participatory research to the consolidation of SUS because they propose access to a common plan as methodological strategy and promote greater engagement of the teams in relation to the proposed themes.(AU)

Desenvolvimento de caderno sobre avaliação do eletrocardiograma: contribuição para a prática de enfermeiros da atenção primária de saúde / Development of a notebook on the evaluation of the electrocardiogram: contribution to the nursing practice of primary health care

Introdução: A realização do eletrocardiograma (ECG), através do Sistema de Tele- ECG, é ferramenta fundamental para aprimorar a assistência às Doenças Crônicas Não Transmissíveis (DCNT) na Atenção Primária de Saúde (APS). Aprimorar o conhecimento dos enfermeiros que atuam nesse âmbito da assistência na realização e avaliação do ECG adequadamente deve contribuir diretamente na prevenção das Doenças Cardíacas. Objetivo: Desenvolver um Caderno Didático para apoio do Enfermeiro na Realização e Avaliação do Eletrocardiograma na APS. Método: Tratase de uma pesquisa qualitativa do tipo estudo de caso. Os dados foram coletados em diferentes fontes, tais como o banco de dados do Sistema Tele-ECG do Instituto Dante Pazzanese de Cardiologia relativos à população atendida no Ambulatório da Várzea do Carmo de São Paulo, prontuários disponíveis nesse ambulatório e revisão de literatura. Resultados: Os dados apontaram que no período de 2010 a 2015, o perfil dos pacientes atendidos no Ambulatório Várzea do Carmo era 58% feminina e 42% masculina; a maior faixa etária era de 51 a 60 anos em ambos os sexos; uso de medicamentos ocorre em 41% dessa população. O diagnóstico de ECG normal foi em média 44% para ambos os sexos. Na faixa etária de 51 a 60 anos foi de 41%, e foram decrescentes em todas as faixas etárias acima desta e na faixa etária de 0 a 11 meses. A alteração eletrocardiográfica ocorreu em 30% dos diagnósticos totais e as principais arritmias foram: bradicardia sinusal, extrassístole, fibrilação atrial, ritmo ectópico, flutter atrial, bloqueios de ramo, sobrecarga e infartos cicatrizados. O defeito técnico na execução da técnica foi de 7,29% dos exames realizados no total de 62.850. A revisão de literatura sistematizada realizada nas bases de dados SibiUSP, IEEEXplore, Proquest, Pubmed, BVS, Cinahal, não localizou evidências de manuais de educação permanente para enfermeiros da APS sobre a temática, além de referências em plataformas correlacionadas ao Ministério da Saúde do Brasil, Diretrizes e Normas Técnicas sobre ECG e Arritmias. Face ao perfil da população usuária e as evidências encontrada na literatura construiu-se um caderno de recomendações práticas para os enfermeiros que atuam na Estratégia Saúde da Família (ESF). Esse caderno foi elaborado com os seguintes itens: conceito de ECG, técnicas para realização e avaliação do traçado eletrocardiográfico, avaliação de risco das arritmias e outros achados do ECG, breve apresentação das urgências cardiológicas. Conclusão: Pretende-se que o Caderno Didático produzido possa apoiar a educação permanente sobre o ECG, a assistência, controle e prevenção das DCNT no âmbito da APS e colaborar na expansão com qualidade do acesso a este procedimento nas unidades especializadas.

Introduction: Electrocardiogram (ECG), through the Tele-ECG System, is a fundamental tool to improve the assistance to Chronic Non-communicable Diseases (CNCD) in Primary Health Care (PHC). Improving the knowledge of nurses working in this area of care in the performance and evaluation of ECG should contribute directly to the prevention of heart disease. Objective: Develop a Didactic Booklet for Nurse Support in the Performance and Evaluation of the Electrocardiogram in APS. Method: This is a qualitative case-study research. The data were collected in different sources, such as the database of the Tele-ECG System of the Dante Pazzanese Institute of Cardiology related to the population attended in the Várzea do Carmo Outpatient Clinic of São Paulo, charts available in this outpatient clinic and literature review. Results: The data showed that in the period from 2010 to 2015, the profile of the patients attended at the Várzea do Carmo Outpatient Clinic was 58% female and 42% male; the largest age group was 51 to 60 years old in both genders; drug use occurs in 41% of this population. The diagnosis of normal ECG was on average 44% for both genders. In the age group of 51 to 60 years was 41%, and were decreasing in all age groups above this and in the age group of 0 to 11 months. The electrocardiographic alteration occurred in 30% of the total diagnoses and the main arrhythmias were: sinus bradycardia, extrasystole, atrial fibrillation, ectopic rhythm, atrial flutter, branch block, overload and healed infarction. The technical defect in the execution of the technique was 7.29% of the examinations carried out in the total of 62,850. The systematized literature review carried out in the databases SibiUSP, IEEEXplore, Proquest, Pubmed, BVS, Cinahal, found no evidence of permanent education manuals for APS nurses on the subject, in addition to references on platforms correlated to the Brazilian Ministry of Health, Guidelines and Technical Norms on ECG and Arrhythmias. Considering the profile of the user population and the evidence found in the literature, a book of practical recommendations was developed for nurses working at the Family Health Strategy (FHS). This book was elaborated with the following items: ECG concept, techniques for conducting and evaluating the electrocardiographic tracing, risk assessment of arrhythmias and other ECG findings, brief presentation of cardiac urgencies. Conclusion: It is intended that the Didactic Book produced can support the permanent education on the ECG, the assistance, control and prevention of NCDs within the framework of the PHC and collaborate in the expansion with quality of access to this procedure in the specialized units.

The Effect of Home-Based Records on Maternal and Child Health Knowledge and Practices in Indonesia: Meta—analyses from the Indonesian Demographic and Health Surveys / 国際保健医療

<b>Objectives</b><BR>  The objective of the study was to analyze the effects of home-based records on pregnancy, delivery, and child health care in Indonesia.<BR><b>Methods </b><BR>  The data were obtained from women who had children under 5 years old at the time of the collection of the 2002, 2007, and 2012 Indonesia Demographic and Health Surveys. The study divided women into two groups: those who used the Maternal and Child Health Handbook (MCHHB) or antenatal card (AC) as a home-based records group, and those who did not use MCHHB or AC as the control group. We calculated the adjusted odds ratios and expressed the effects using meta-analysis methods. <BR><b>Results</b><BR>  The study revealed that, compared with the control group, the home-based records group had more knowledge and better practices during pregnancy, delivery, and child health care (e.g., immunization). The home-based records group knew how to solve the problems of complications during pregnancy and used skilled birth attendants for delivery. This study also found that husbands in the home-based records group were involved in discussing the delivery location, finding transportation, and identifying a blood donor. <BR><b>Conclusions</b><BR>  This study showed that home-based records had strong associations with the knowledge and practices of women regarding pregnancy, delivery, and child health care.

Almanaque do Agente Comunitário de Saúde: uma experiência de produção compartilhada de conhecimentos / Community Health Agent’s Handbook: an experience of shared knowledge production / Almanaque del Agente Comunitario de Salud: una experiencia de producción compartida de conocimientos

O Almanaque do Agente Comunitário de Saúde (ACS) foi produzido como um dispositivo de informação, comunicação e Educação Popular em Saúde, fundamentado na tradição utilitária e dialógica dos almanaques. Baseou-se na premissa de que as narrativas dos agentes constituem um campo cultural privilegiado para a compreensão da dinâmica cultural de produção de conhecimentos sobre saúde, devido ao seu papel mediador entre as equipes de profissionais e as comunidades nas quais vivem e atuam. Para compor a amostra qualitativa, foram selecionados Agentes Comunitários de Saúde em três regiões do país, além de profissionais, coordenadores e formadores. Para a coleta de dados, foram realizadas entrevistas narrativas e oficinas de leitura e apropriação de almanaques, além da extensa compilação de fontes textuais e iconográficas. Apresenta-se o modo de construção e a estrutura temática do Almanaque, ressaltando o seu caráter narrativo de “enciclopédia popular”...

The Community Health Agent’s Handbook was produced as an information, communication and popular education device, grounded on the handbooks’ utilitarian and dialogical tradition. It was based on the premise that the agents’ narratives are a privileged cultural field to understand the cultural dynamics of knowledge production on healthcare, due to their mediating role between health professional teams and the communities where they live and work. A qualitative sample was selected among Community Health Agents in three regions in Brazil, and also among healthcare professionals, coordinators and educators. Data collection was developed through narrative interviews, reading workshops and appropriation of handbooks. In addition, data were obtained from an extensive compilation of iconographic and textual sources. This paper presents the construction method and thematic structure of the Handbook, emphasizing its narrative character of a “popular encyclopedia”...

El Almanaque del Agente Comunitario de Salud (ACS) se produjo como dispositivo de información, comunicación y educación Popular en Salud, basado en la tradición utilitaria y dialógica de los almanaques. Su premisa es que las narraciones de los agentes constituyen un campo cultural privilegiado para la comprensión de la dinámica cultural de producción de conocimientos sobre salud, debido a su papel mediador entre los equipos de profesionales y las comunidades en que viven y actúan. Para componer la muestra cualitativa, se seleccionaron Agentes Comunitarios de Salud en tres regiones del país, además de profesionales, coordinadores y formadores. Para recolectar datos, se realizaron entrevistas narrativas y talleres de lectura y apropiación de almanaques, además de amplia compilación de fuentes textuales e iconográficas. Se presenta el modo de construcción y la estructura temática del Almanaque, subrayando su carácter narrativo de “enciclopedia popular”...

Manual para la elaboración del Certificado Médico de Defunción / Handbook for the elaboration of the Medical Certificate of Death

Se desarrolló un Manual para la elaboración del Certificado Médico de Defunción en la ciudad de Cárdenas. El producto consta de prólogo, índice, dos capítulos, autoevaluaciones y anexos. El universo estuvo constituido por 98 estudiantes de Medicina y se utilizó una muestra de 64 pertenecientes a la Filial de Ciencias Médicas Gabriela Arias que consintieron en participar en el estudio. Se aplicó una encuesta inicial sobre el tema la cual arrojó un 6,25 por ciento del total de estudiantes evaluados de regular y un 93,75 por ciento evaluados de mal. Se demostró, después de la aplicación del manual, una mejoría significativa del nivel de conocimientos al predominar estudiantes evaluados de bien representando el 85,94 por ciento del total. El 100 porciento de los encuestados poseen un alto nivel de satisfacción con el uso del producto.

It was developed a handbook for the elaboration of the Medical Certificate of Death in Cardenas. The product consists of a prologue, an index, two chapters, self-evaluations and annexes. The universe was formed by 978 Medicine students and it was used a sample of 64 students from the Branch of the Medical Sciences University Gabriela Arias, who gave their consent to taking part in the study. An initial inquiry on the topic was applied and it resulted in 6,25 per cent of the total of students evaluated of regular and 93,75 per cent of bad. After applying the handbook, it was showed a significant improvement of the knowledge level predominating students evaluated of good; they represented 85,94 per cent of the total. 100 per cent of the inquired showed a high level of satisfaction with the use of the product.

Smartphones in ophthalmology.

The potential usefulness of smartphones in the medical field is evolving everyday. This article describes various tools available on smartphones, largely focusing on the iPhone, for the examination of an ophthalmic patient, for patient and physician education, as well as reference tools for both ophthalmologists and vision researchers. Furthermore, the present article discusses how smartphones can be used for ophthalmic photography and image management, and foremost, the usefulness of the applications such as the Eye Handbook for the ophthalmologist and interested students, patients, physicians, and researchers, currently available in the iPhone.

Humanistic spirit cultivation of the medical students during the clinical internship / 中华医学教育探索杂志

The clinical internship is an important transitional period for humanistic spirit cultivation of the medical students.But in this period there are some problems exposed.For example,there is the lack of transitional link in management; the clinical instruction doctors lack educational consciousness or guidance ability,the medical students pay little attention to enhancing the individual humanistic spirit level and there is a gap between theory and practice of humanistic spirit for them.Strengthening training for students,attaching importance to training,selection and incentive of clinical instruction doctors and revising handbook of clinical internship will help to solve the problems.

Is Maternal and Child Health Handbook effective? : Meta-Analysis of the Effects of MCH Handbook / 国際保健医療

<B>Background:</B><BR>Maternal and child health handbook (MCHH) consists of records of pregnancy, delivery, child development and immunization, as well as child growth charts. MCHH has been utilized in Japan since 1947 and it is now introduced in more than 20 countries in the world.<BR><B>Objectives:</B><BR>The objectives of this study were to collect research documents and reports in the past studies of MCHH and to analysis the effect of MCHH on maternal and child health through systematic review.<BR><B>Methods:</B><BR>The systematic searches were conducted for the studies published between 1980 and October 2011. After the initial screening of titles and abstracts of the studies, we reviewed 57 documents which were studied for MCHH in maternal and child health (MCH) programs or activities. After the final selection, we identified only 5 documents with 43 question items in Indonesia (1999 and 2001), Bangladesh (2003), the Philippines (2009) and Cambodia (2010).<BR><B>Results:</B><BR>The relationship between MCHH and pregnancy care revealed that mothers who used MCHH during pregnancy had higher level of knowledge (OR 1.44, 95% CI: 1.22-1.70) than whose did not use MCHH during pregnancy. The strong significant effects of MCHH were observed in knowledge of antenatal care visit (OR 1.86, 95% CI: 1.59-2.18), and mother should consume more food during pregnancy (OR 1.97, 95% CI: 1.37-2.83). Mothers who got MCHH during pregnancy had safer practice by skilled birth attendants (OR 1.12, 95% CI: 0.95-1.32) and delivered in health facilities (OR 1.31, 95% CI: 1.12-1.53). MCHH showed the effect of knowledge of child health care (OR 1.22, 95% CI; 1.05-1.41).<BR><B>Discussion:</B><BR>This study utilizing meta-analyses showed MCHH had higher association with knowledge of mothers than practice in pregnancy and child health care, although the study has its limitation. The illumination of the relationship between knowledge and practice by the effect of MCHH needs more quantitative analysis in both community and hospital settings in many countries.

Implicaciones clínicas del uso de los manuales diagnósticos / Clinical implications of the use of diagnostic manuals

Los seres humanos gran parte del tiempo hacemos juicios y clasificamos nuestro mundo, como una manera de entenderlo, ordenarlo, relacionarnos con él, muestra de ello son las extensas clasificaciones de animales, plantas, objetos que el hombre ha construido a lo largo de su historia; de estas clasificaciones no escapa la imperiosa necesidad de clasificar, nombrar, caracterizar las enfermedades mentales; de este modo, los manuales diagnósticos aparecen y se consolidan como una respuesta frente la incertidumbre que produce el sufrimiento propio y el del otro. Es bien sabido, pero olvidado, que la enfermedad sea física o mental es una construcción y no una entidad. Es una ficción, que no obstante sirve para poder estudiarla, la cual se construye a partir de la agrupación de signos y síntomas, para conformar las categorías nosológicas, que se compilan en los manuales diagnósticos.

Humans much of the time make judgments and classify our world, as a way of understanding it, ordering it, relating to it, proof of this are the extensive classifications of animals, plants, objects that man has built throughout its history ; These classifications do not escape the urgent need to classify, name, characterize mental illnesses; In this way, diagnostic manuals appear and are consolidated as a response to the uncertainty produced by their own suffering and that of another. It is well known, but forgotten, that illness, whether physical or mental, is a construction and not an entity. It is a fiction, which nonetheless serves to study it, which is constructed from the grouping of signs and symptoms, to form the nosological categories, which are compiled in diagnostic manuals.

The Introduction of Compendium of Materia Medica and Praxis in the Late Joseon Dynasty / 의사학

Sakae Miki said Classified Emergency Materia Medica had been the dominant standard of herbology throughout Joseon Dynasty, and that Compendium of Materia Medica had only been accepted so lately that a few books used herbological result of it in the late Joseon Dynasty. But according to Visiting Old Beijing Diary written by Munjoong Seo in 1690, Compendium of Materia Medica was in fact introduced before the year 1712, the year Miki Sakae argued to be the year Compendium of Materia Medica was accepted to Joseon officially. Now, we can assume that the introducing year of Compendium of Materia Medica was faster than Miki Sakae's opinion by the following reasons; the effort of Joseon government and intellectuals to buy new books of Ming & Ching; the publishing year of the book for living in countryside regarded as the first citing literature of Compendium of Materia Medica. And the True Records of the Joseon Dynasty and many collections written by intellectuals in the 18th century show that the herbological knowledge from Compendium of Materia Medica had already spread to the corners of Joseon Dynasty. Thus we can make the following assumption: Classified Emergency Materia Medica and Compendium of Materia Medica had coexisted in the late Joseon Dynasty. Sakae Miki suggested 6 examples which used Compendium of Materia Medica in the late Joseon Dynasty. I reviewed two of them in this paper, Essentials of Materia Medica & Handbook of Prescriptions from Materia Medica. Essentials of Materia Medica quoted Compendium of Materia Medica briefly focusing clinical use, and Handbook of Prescriptions from Materia Medica also re-compiled Compendium of Materia Medica to practical use according to the form of Treasured Mirror of Eastern Medicine. It means that the results of Compendium of Materia Medica have been used positively, based on the herbology of materia medica from countryside. From this point of view, the hyphothesis there weren't any herbological progress after accepting Compendium of Materia Medica in the late Joseon Dynasty by Sakae Miki can be denied.

A needs survey of medical service for foreign residents in Japan from the viewpoint of medical practitioners-Report of a survey for doctors in Gunma medical association and Gunma pediatric association- / 国際保健医療

<B>Introduction</B><BR>Recently, an increasing number of registered foreigners get married and bear children in Japan. At the same time, a variety of needs for maternal and child health (MCH) impose burden for medical practitioners. A questionnaire survey was conducted to clarify the situation of MCH service for foreign residents.<BR><B>Method</B><BR>Self-report questionnaires developed by “The study group for MCH in a multiethnic and multicultural society” were sent by mail to the pediatricians registered in the Gunma medical association or Gunma pediatric association. In total, target number was 299. The survey period was between 2003/10/6-11/3.<BR><B>Result</B><BR>The number of valid response was 167. Out of 167, 155 doctors replied to have experience of caring foreigners. 75% of them had the experience of trouble in communication. For the question of the need of translator, 76.8% of doctors answered “absolutely necessary” or “necessary if the quality of translation is high enough”. Desired competencies for translators were “Accurate translation of diagnosis, hands on of treatment strategy” or “To help taking detailed patient's history”.<BR>For the experience of using MCH handbook in foreign languages, 52.9% of doctors answered “Never used it”.<BR><B>Discussion</B><BR>We found that the majority of doctors had difficulty in communicating with foreigners.<BR>To meet the doctors' requirement for the competency of translator, two strategies should be considered. One is to develop professional medical translator through education of basic medical knowledge or Japan's health care system. The other is to train foreigners already engaging in translation.<BR>For communication tools development, user friendly concept should be reflected including 1) adscript of foreign and Japanese languages, 2) illustration usage and 3) eye-friendly materials for elderly. Contents should have explanations including 1) diagnosis and treatment policy for common disease, 2) ways of coping with common symptoms, and 3) the information of a variety of Japan's welfare services.

The Handbook of Nosocomial Infections Management:Evaluation of the Use and Effect / 中华医院感染学杂志

OBJECTIVE To promote the management of nosocomial infections continuous improvement in the clinical and medical technology department.METHODS According to the regulation of nosocomial infections management,a handbook of nosocomial infections management for clinical and medical technology department was designed,and the monitors of nosocomial infection could perform real time inspection and record according require of the handbook.The department of nosocomial infections management examined the monitoring work of clinical and medical technology department every month and summarized every year,and the results were internalized to the valuation of medical quality management.RESULTS After 3 years of the usage of the handbook,the capability of the monitor groups of nosocomial infection and the quality of the all monitoring items were significantly improved;the qualified rates were all above 96.30%.CONCLUSIONS The handbook of nosocomial infections management is useful to improve the quality of nosocomial infections management in the clinical and medical technology department.

Maternal and Child Health Handbook in Thailand / 国際保健医療

 The maternal and child health service in Thailand was originally established in 1918, and the first official maternal and child heath handbook was published in 1985. Since then, the handbook has been a major feature of the Thai MCH service and an important instrument for improving the health of pregnant women and children in Thailand. It has been periodically reviewed, revised and updated to maintain currency and to meet the ever changing and evolving health care needs of Thai women and children. This paper outlines the origins and history of this handbook. It comments briefly on its utilization which is still less widespread than expected, especially among clients of private health services. Future challenges are to promote use of the handbook through all types of health facilities throughout Thailand, so as to increase its utilization and further improve the quality of maternal and child health services.

Prontuário médico e suas implicações médico-legais na rotina do colo-proctologista / Medical record and his medical-legal involvement in daily procedures of colon and rectal surgeon

As normas do Conselho Federal de Medicina preceituam que o médico não poderá deixar de preencher corretamente o prontuário médico. Essa observância é fundamental, pois sendo o atendimento prestado ao paciente uma ação multidisciplinar, todos os envolvidos ficarão informados sobre as condições clínicas, evolução, resultados de exames e procedimentos realizados nos pacientes. Sob o ponto de vista legal é um precioso instrumento, talvez o mais importante, em demandas judiciais, pois é a partir de sua análise que os peritos e julgadores colhem subsídios para a decisão judicial. Sob o ponto de vista de saúde pública, são nos prontuários médicos que residem os dados, permitindo os dados de prevalências e de incidências de determinadas doenças, permitindo assim, ações de prevenção e medidas de tratamento mais eficazes. Este trabalho tem como objetivo enfatizar a importância do cumprimento das normas e do correto preenchimento do prontuário médico, ressaltando suas implicações médico-legais, principalmente na prática da cirurgia colo-retal. Tais práticas não só representam a qualidade do trabalho profissional, mas permitem aos médicos dispor de um importante instrumento de defesa nas ações judiciais.

The norms of Federal Council of Medicine set down that the doctor cannot stop filling out the medical handbook correctly. That observance is fundamental, because being the service rendered the patient an action to multi-discipline, all involved they will be them informed about the clinical conditions, evolution, results of exams and procedures accomplished in the patients. Under the legal point of view it is a precious instrument, maybe the most important, in judicial demands, because it is starting from his/her analysis that the experts and judges pick subsidies for the judicial decision. Under the point of view of public health they are in the medical handbooks that the data live, al1owing the data of prevalences and of incidences certain diseases, allowing like this, prevention actions and more effective treatment measures. This work has as objective emphasizes the importance of the execution of the norms and of the correct completion of the medical handbook, emphasizing their forensic implications, main in the colon rectal surgery practice. Such practices not only they represent the quality of the professional work, but they allow to the doctors disposal of an important defense instrument in the lawsuits.

Introducing a Maternal Child Health Handbook in the Province of Dajabon, Dominican Republic: Prospects and Issues from the Perspectives of Sustainability and Replicability / 国際保健医療

<b>Introduction</b><br>In the Caribbean country of the Dominican Republic, specifically in the northwestern Province of Dajabón bordering Haiti, a Maternal and Child Health (MCH) handbook, “History of My Health” was introduced through the technical cooperation of the Inter-American Development Bank's Japan Program with the leadership of the Provincial Office of the Secretary of Health. This report describes the implementation process and results, examines the project's sustainability and replicablility, and shares good practices and lessons learned.<br><b>Activities</b><br>The implementation of the project can be divided into three phases: first, development of a Dominican version of MCH handbook, local awareness raising, capacity building of health personnel, and the establishment of monitoring system were areas of high priority; the second phase centered around the improvement of MCH handbook with participatory approach and the continuation of the capacity building of health personnel; and the last phase focused on the sustainability through local management-precisely securing recurrent costs of the project.<br><b>Results</b><br>The evaluation and regular monitoring visits revealed positive results: as for pregnant women, the handbooks were well accepted for their friendliness, simplicity, durability and mobility, and the rate of their receiving antenatal and postpartum cares at designated clinics or hospitals increased; as for newborns and children, the immunization coverage improved while common problems such as diarrhea decreased; and as for health personnel, the handbook helped clarify the division of work and enhanced their sense of responsibility, communication, and continuity and integration of service. Currently, 359 trained health personnel use MCH handbook in all of the 22 health establishments in the Province, covering around 98% of the target population.<br><b>Conclusions</b><br>To achieve self-sustainability, this pilot project suggests that the use of MCH handbook needs to be institutionalized through the bottom-up approach and to integrate into the existing rural and national health care system through the top-down approach.