Investigaciones biomédicas y psicosociales con enfoque comunitario en Ecuador

Introducción: Varios miembros del Departamento de Investigaciones en Adicciones de la Universidad de Ciencias Médicas de La Habana participaron en el 2020 y 2021 como docentes, asesores y directores de tesis en dos programas de formación académica de estudiantes ecuatorianos: especialización en Medicina Familiar y Comunitaria y maestría en Psicología Clínica (mención en Salud Mental Comunitaria). Objetivo: Describir los resultados del estudio y las investigaciones concluidas en ambos programas de formación académica. Método: Se realizó un estudio descriptivo de corte transversal basado en el análisis de los 69 proyectos de investigación desarrollados. Para la descripción de los resultados se realizó el análisis de contenido del 20 % de las investigaciones. Resultados: El 63,8 % de los estudios fueron investigaciones biomédicas, y el 36,1 % fueron estudios psicosociales. En ambos casos, el contexto social en las comunidades fue de (84,7 %). Entre las investigaciones médicas predominaron las dirigidas al paciente con hipertensión arterial (39,1 %) centradas en la adherencia terapéutica (32,6 %). En los estudios psicológicos predominaron los dirigidos a niños y adolescentes (23,0 %) y a profesionales sanitarios (23,0 %) centradas en las afecciones mentales (19,2 %). Conclusiones: Los proyectos desarrollados concluyeron resultados satisfactorios, se describió con mayor sistematicidad el enfoque comunitario en las investigaciones biomédicas. Se abordaron contenidos relativos a la adherencia terapéutica y las afectaciones a la salud mental. El impacto de la COVID-19 fue valorado como generador de dificultades en niños y adolescentes, profesionales sanitarios y en la población.

Introduction: In 2020 and 2021, the Department of Research on Addiction of Havana University of Medical Sciences participated as teachers, advisors and thesis directors in two academic training programs for Ecuadorian students: specialization in Family and Community Medicine and master's degree in Clinical Psychology with a mention in Community Mental Health. Objective: To describe the results of the study and the research concluded in both academic training programs. Methods: A descriptive cross-sectional study was carried out based on the analysis of the sixty nine research projects established. The content analysis of 20% of the investigations was carried out to describe the results. Results: 63.8% of the studies were biomedical research and 36.1% were psychosocial studies. In both cases, communities was the social context (84.7%). Among the medical investigations, those aimed at the patient with hypertension (39.1%) focused on therapeutic adherence (32.6%) predominated. In the psychological studies, those intended at children and adolescents (23.0%) and health professionals (23.0%) focused on mental disorders (19.2%) prevailed. Conclusions: These projects yielded satisfactory results. The community approach in biomedical research was more systematically described. Contents related to therapeutic adherence and the effects on mental health were addressed. The impact of COVID-19 was assessed as generator of difficulties in children and adolescents, health professionals, and in the population.

Teaching Competencies in Nursing Professors: Visions of Students and Academics / Competencias docentes en profesores de Enfermería: visión de alumnos y académicos

Objective. This work sought to know the view of Nursing professors and students about the competencies the faculty staff must have to deploy their educational function with maximum quality and efficiency. Methods. Descriptive qualitative study through focus groups conducted with professors, students and recent Nursing career graduates from universities in Spain. Results. The importance of the proposed teaching competencies was delved into, highlighting the importance of professors knowing the context in which they teach, having the ability to self-evaluate their activity, and having adequate interpersonal communication skills, and deploy the teaching-learning process by performing proper planning, using new technologies, and knowing how to engage in teamwork. Moreover, a small discrepancy was detected in relation to disciplinary competence, which students felt was of importance, but which academics indicated is taken for granted in nursing professors; competencies directly related to the act of teaching must be enhanced. Conclusion.Practical unanimity was found between academics and students in affirming that the competencies investigated are important for adequate development of the teaching activity in nursing professors. In all cases, the urgent need was highlighted for nursing professors to have adequate teaching training to provide their students with formation of the highest quality.

Objetivo. Conocer la visión de profesores y alumnos de Enfermería acerca de las competencias que deben presentar los docentes para desplegar su función educativa con la máxima calidad y eficacia. Métodos. Estudio descriptivo cualitativo a través de grupos focales realizados con profesores, alumnos y recién egresados del Grado en Enfermería de universidades de España. Resultados. Se profundizó en la importancia de las competencias docentes propuestas, destacando la relevancia de que los profesores conozcan el contexto en el que desarrollan la docencia, tengan la habilidad de autoevaluar su actividad, dispongan de unas adecuadas habilidades de comunicación interpersonal, y desplieguen el proceso de enseñanza-aprendizaje realizando una correcta planificación, empleando las nuevas tecnologías y sabiendo trabajar en equipo. Por otro lado, se detectó una pequeña discrepancia con relación a la competencia disciplinar, a la que los estudiantes brindaron una gran importancia, pero que los académicos indicaron que se da por supuesta en los profesores enfermeros, debiendo ser potenciadas las competencias directamente relacionadas con el acto docente. Conclusión. Se ha hallado una práctica unanimidad entre académicos y estudiantes en afirmar que las competencias investigadas son importantes para un adecuado desarrollo de la actividad docente en los profesores de Enfermería. En todos los casos, se destacó la imperiosa necesidad de que los profesores de Enfermería dispongan de una adecuada capacitación docente para poder brindar a sus estudiantes una formación de la máxima calidad.

Influencia del tiempo psicológico y el autocontrol en el malestar psicológico en adultos argentinos / Influence of psychological time and self-control on psychological distress in Argentinian adults

Resumen El objetivo de este estudio fue conocer si la temporalidad subjetiva -perspectiva y foco temporales- y la capacidad de autocontrol e impulsividad repercuten en el malestar psicológico, en particular durante la pandemia por COVID-19. La conjetura teórica es que el tiempo psicológico está estrechamente vinculado a la autorregulación, que influye en el desarrollo de la impulsividad y el autocontrol e impacta en el malestar psicológico. Se diseñó un modelo y se realizó un estudio empírico cuantitativo, no experimental y transversal (. = 279; 78 % mujeres; ME = 30.14 años; DE = 11.21). Los resultados del análisis de correlación mostraron relaciones significativas entre las variables de interés. Para determinar las variables predictoras del malestar psicológico se realizó un análisis de regresión lineal múltiple. El 48 % de la varianza del malestar psicológico fue explicado por el pasado negativo, autocontrol e impulsividad, y focos temporales futuro y presente. Finalmente, se probó el modelo teórico diseñado para analizar los efectos directos e indirectos del malestar psicológico a través de un análisis de senderos que presentó un buen ajuste a los datos, ya que explicó el 50 % de la varianza de aquel. La perspectiva y el foco temporal explicaron el 53 % de la variabilidad del autocontrol, y presentaron efectos indirectos sobre el malestar psicológico a través del autocontrol. El autocontrol influyó de manera inversa en el malestar. Los hallazgos indican que el tiempo subjetivo y el autocontrol sirven para explicar estados psicológicos, incluso en pandemia, lo cual confirma estudios previos que muestran la importancia de las variables de personalidad -además de las biológicas y contextuales- en la aparición de malestar psicológico.

Abstract Psychological time is an essential aspect of humans. Two of the most important notions of subjective temporality are time perspective and temporal focus. Time perspective is a process by which the flow of personal and social experiences are framed in five different temporal categories: past negative, past positive, present hedonistic, present fatalistic and future. Temporal focus refers to the attention people devote to thinking about the past, present, and future. Previous research shows there is a strong relation between psychological time and self-regulatory processes, specifically self-control and impulsivity. Self-control is the ability to inhibit impulsive behaviors or reactions that can keep the person from pursuing the proposed goals. On the other hand, impulsivity refers to a short attention span and a tendency to engage in risky behaviors, and to prefer immediate rewards. Both subjective temporality and self-regulatory processes influence behaviors and psychological states such as psychological distress. In particular, the objective of this study was to find out if subjective temporality -time perspective and temporal focus-- and self-control and impulsivity have repercussions on psychological distress, particularly during the COVID-19 pandemic, in an Argentinian sample. The theoretical conjecture is that subjective temporality is closely linked to self-regulation, which influences the development of impulsivity and self-control, and impacts psychological distress. A quantitative, non-experimental, and cross-sectional empirical study was carried out (. = 279; 78 % women; ME = 30.14 years old; SD = 11.21). Firstly, the results of the correlational analysis showed significant relations between the variables. Then, to facilitate further analyses, an index variable of self-control was created, which included the scores of self-control and three dimensions of impulsivity. An optimal parallel analysis was performed. It indicated the existence of a single dimension. Then a semi-confirmatory factor analysis was ran, which showed acceptable results (KMO = .68; X. (6) = 198.8, . < .001; GFI = .99; RMSR = 0.03). Thirdly, to determine the predictive variables of psychological distress, a multiple linear regression analysis was performed. It was found that 48 % of the variance of psychological distress was explained by negative past, self-control index, and future and present temporal focuses (. (4, 266) = 64.66, . < .001, R. = .49, R. adjusted = .48). The best predictor variable was past negative. Afterwards, a theoretical model was tested to explain the direct and indirect causes of psychological distress. It presented a good fit (X./gl = 1.63; GFI = .99; RMSEA = .04). Time perspective and temporal focus explained 53 % of the variability of self-control and presented indirect effects on psychological distress through self-control. Self-control inversely influenced psychological distress; more self-control generates less psychological distress. The model explained half of the variance of psychological distress (R. = .50). The findings indicate that subjective temporality and self-control explain psychological states, even during a pandemic, which confirms previous studies that show the importance of personality variables -in addition to biological and contextual variables- in the manifestation of psychological distress. The results support the theory that psychological time can be considered as a personality trait underlying self-control and psychological distress. A theoretical and practical discussion of the results is presented.

Effect of Clinician-directed Technical Specifications on Entrance Skin Doses in Neonates

Objectives: To compare the entrance skin doses (ESD) before and after implementation of a radiation safety policy in neonates (RSN), which focused on clinician-directed technical specifications on the digital X-ray machine. Methods: Prospective observations included two sets of X-rays: Before (BRSN) and after (ARSN) implementation of RSN (documented indication for Xray/expected posttest findings, settings of 40 kVp, 0.5 mAs, film-focus distance 100 cm, gonadal-shield, optimal collimation, and post-shoot image-enhancement). Results: 33 and 32 X-rays were analyzed in respective groups. Mean (SD) of calculated and machine-quantified ESD (µGy/m2) was higher in BRSN group as compared to ARSN group (P <0.001). All ARSN X-rays were interpretable for expected post-test findings. Conclusion: Clinicians’ cognizance of ability to make consequential bedside technical specifications, can reduce ESD without affecting interpretability. These single observations could have a larger impact in sick neonates, where multiple X-rays are done.

Implementation of National Leprosy Eradication Programme during COVID-19 era: A qualitative research

Introduction: The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives: To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods: Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results: Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations: The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion: The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis

Development of an integrated telerehabilitation model in children with cerebral visual impairment in South India during the COVID-19 pandemic – A pilot study

Purpose: Coronavirus disease 2019 (COVID?19) pandemic affected the in?person rehabilitation/habilitation services in families with children with cerebral visual impairment (CVI) in India. This study aimed to develop a structured and family?centered telerehabilitation model alongside conventional in?person intervention in children with CVI to observe its feasibility in the Indian population. Methods: This pilot study included 22 participants with a median age of 2.5 years (range: 1–6) who underwent a detailed comprehensive eye examination followed by functional vision assessment. The visual function classification system (VFCS) was administered to the children and the structured clinical question inventory (SCQI) to the parents. Every participant underwent 3 months of telerehabilitation including planning, training, and monitoring by experts. At 1 month, the parental care and ability (PCA) rubric was administered to the parents. After 3 months, in an in?person follow?up, all the measures were reassessed for 15 children. Results: After 3 months of Tele?rehabilitation there were significant improvements noted in PCA rubric scores (P<0.05). Also, statistically significant improvements were noted in functional vision measured using SCQI and VFCS scores (P<0.05) compared to baseline. Conclusion: The outcomes of the study provide the first steps towards understanding the use of a novel tele?rehabilitation model in childhood CVI along?side conventional face?to?face intervention. The added role of parental involvement in such a model is highly essential.

Prevalence, Socio-cultural Restrictions and Determinants of School Absenteeism during Menstruation among Adolescent School Girls in Bangalore

Introduction: Menstrual-related problems are one of the most common problems among adolescent girls and might adversely affect their performance in academic and other activities of daily life. Aims & Objectives: 1. To determine the prevalence of school absenteeism among adolescent school girls during menstruation. 2. To assess the restrictions which are imposed on adolescent school girls during menstruation. 3. To evaluate the various factors associated with school absenteeism during menstruation. Methods: A study was conducted by carrying out a questionnaire and focus group discussion between October 2019-January 2020 in seven schools of Bangalore city after obtaining the assent and informed consent signed by their parents. Result: The mean age of the girls was 14.45 ± 1.71. The proportion of school absenteeism during menstruation was (30.25%). The majority (89.25%) of the students among the school absentees missed one day of school during menstruation. Among the school absentees, pain/discomfort was one of the main reasons for missing school, accounting for (69.42%). (46.25%) of the students were restricted from any kind of religious activities. Pain during menstruation, shame, fear of leakage, lack of toilet or water supply, lack of a place to dispose of sanitary pads and absence of a private place to manage periods were some factors that were associated with school absenteeism during menstruation. Conclusion: Considerably high school absenteeism among adolescent girls due to menstruation was noted in this study, highlighting the need for improved interventions that reach girls at a young age.

Parental perception of facilitators and barriers to activity and participation in an integrated tele-rehabilitation model for children with cerebral visual impairment in South India – A virtual focus group discussion study

Purpose: This study utilized virtual focus group discussions to document the facilitators and barriers reported by the parents as part of the tele?rehabilitation service delivery model in India. Methods: This study included 17 participants who were enrolled into the Tele?rehabilitation program (16 mothers, 1 father) and the virtual focus group discussion (V?FGD) were conducted through a WhatsApp video call. Three V?FGDs were conducted involving two moderators and a note taker. The V?FGD, focused at extracting the perceptions of parents pertaining to facilitators, barriers and coping mechanisms to barriers related to the tele?rehabilitation model. Results: Thematic analysis resulted in four themes for barriers that included: family and support, time, parent and care taker, child and place of living related; facilitators reported included: continuous monitoring, accessibility to professional services, provision of resource materials and parental empowerment. Themes “family and support” and “child” were most reported by parents with children >3 years and ?3 years respectively. Finally, the barriers and facilitators were aligned with the chapters and codes of International Classification of Functioning, children and youth version (ICF?CY) environment and personal factors. Conclusion: This V?FGD highlights the importance of parental?centred and structured Tele?rehabilitation among children with CVI in India. The outcome of this study opens avenues for creating effective intervention.

Impact of crossplay between ocular aberrations and depth of focus in topo-guided laser-assisted in situ keratomileusis outcomes

Purpose: To develop a nomogram in cases with mismatch between subjective and Topolyzer cylinder, and based on the magnitude of the mismatch, customize a treatment plan to attain good visual outcomes post?laser?assisted in situ keratomileusis (LASIK) surgery. Methods: The patients were evaluated preoperatively using corneal tomography with Pentacam. Five optimal corneal topography scans were obtained from the Topolyzer Vario were used for planning the LASIK treatment. For the nomogram purpose, the patients were divided into three categories based on the difference between the subjective cylinder and Topolyzer (corneal) cylinder. The first group (group 1) consisted of eyes of patients, where the difference was less than or equal to 0.4 D. The second group (group 2) consisted of eyes, where the difference was more than 0.4 D and the subjective cylinder was lesser than the Topolyzer cylinder. The third group (group 3) included eyes where the difference was more than 0.4 D but the subjective cylinder was greater than the Topolyzer cylinder. LASIK was performed with the WaveLight FS 200 femtosecond laser and WaveLight EX500 excimer laser. Assessment of astigmatism correction for the three groups was done using Aplins vector analysis. For comparison of proportions, Chi?square test was used. A P value less than 0.05 was considered statistically significant. Results: The UDVA was statistically significantly different when compared between groups 1 and 2 (P = 0.02). However, the corrected distance visual acuity (CDVA) was similar among all the three groups (P = 0.1). Group 3 showed an increase of residual cylinder by ?0.25 D, which was significant at intermediate and near reading distances (P < 0.05). Group 3 showed significantly higher target?induced astigmatism (TIA) compared to groups 1 and 2 (P = 0.01). The mean surgically induced astigmatism (SIA) was the least in group 2, which was statistically significant (P < 0.01). Conclusion: The outcomes for distance vision using our nomogram postoperatively were excellent, but further refinement for improving the near vision outcomes is required

Focus Groups in Brazilian Research: Current Scenario and Methodological Challenges / Grupos Focais na Pesquisa Brasileira: Cenário Atual e Desafios Metodológicos / Grupos Focales en la Investigación Brasileña: Escenario Actual y Desafíos Metodológicos

Abstract Based on an integrative review, this study aimed to critically discuss the use of focus groups in empirical research in Brazilian Psychology over the last two decades and to qualify the methodological decisions of those who opt for this approach. Scopus, Web of Science, and SciELO were consulted, finding 62 articles in national journals in the area. The primary contexts of use were work, education, health, and social, with wide theoretical diversity. There has been a significant growth of the technique in research in Psychology since 2002, despite the need for improvement in the description of selection procedures, group composition, number of participants, the script for conducting, analysis, and presentation of results. However, it is necessary to ensure alignment between objective, theory, and method to improve the use of focus groups in psychological interventions.

Resumo A partir de uma revisão integrativa, o objetivo do estudo foi discutir criticamente o uso de grupos focais nas pesquisas empíricas da Psicologia brasileira nas últimas duas décadas e qualificar as decisões metodológicas daqueles que optam por essa abordagem. Foram consultadas as bases Scopus, Web of Science e SciELO, encontrando-se 62 artigos em periódicos nacionais da área. Os principais contextos de utilização foram trabalho, educação, saúde e social, com ampla diversidade teórica. Conclui-se que houve um crescimento significativo da técnica nas pesquisas em Psicologia desde 2002, apesar da necessidade de aprimoramento na descrição dos procedimentos de seleção, composição dos grupos, número de participantes, roteiro de condução, análise e apresentação dos resultados. Contudo, é necessário garantir o alinhamento entre objetivo, teoria e método para melhorar o uso de grupos focais em intervenções psicológicas.

Resumen A partir de una revisión integradora, el objetivo de este estudio fue discutir críticamente el uso de grupos focales en investigaciones empíricas de la Psicología brasileña durante las últimas dos décadas y calificar las decisiones metodológicas de quienes optan por este enfoque. Se consultaron Scopus, Web of Science y SciELO, y dio como resultado 62 artículos en revistas nacionales del área. Los principales contextos de uso fueron el laboral, educativo, sanitario y social, con amplia diversidad teórica. Se concluye que hubo un crecimiento significativo de la técnica en la investigación en Psicología desde 2002, a pesar de la necesidad de mejorar la descripción de los procedimientos de selección, composición del grupo, número de participantes, guion de realización, análisis y presentación de resultados. Sin embargo, es necesario asegurar la alineación entre objetivo, teoría y método para mejorar el uso de grupos focales en intervenciones psicológicas.

Exploration and practice of innovation mode of clinical pharmacists training / 中华医学教育探索杂志

In view of the current situation of the construction of clinical pharmacist system and the teaching and training of clinical pharmacist training base in China, this paper provides a reference for perfecting and improving the training mode of clinical pharmacists in China. By establishing a clinical pharmacist system that develops a "two-focus" model, it takes the "trinity" of "hierarchical teaching-innovative practice-stage assessment" as the operating mechanism of teaching management, and the innovative mode of training clinical pharmacist talents with diversified information service platform as the technical support system, thereby providing an effective model for training excellent clinical pharmaceutical care talents.

Genetic study of Yersinia pestis strains isolated from the Himalayan marmot natural focus area and domestic rat plague focus area in southern China / 中国热带医学

@#Abstract: Objective To understand the phenotypic and genetic characteristics of Yersinia pestis strains isolated from Himalayan marmot natural focus area and domestic rat plague focus area in southern China, and provide reference for mastering the pathogenic characteristics of Yersinia pestis of two plague foci. Methods A total of 412 of Yersinia pestis strains isolated from Himalayan marmot plague focus and domestic rat plague focus of southern China were subjected to to sorbitol fermentation assays, virulence factor, different region (DFR) typing, and clustered regularly interspaced palindromic repeats (CRISPR) typing. Results The biochemical types of Y. pestis from the two plague foci showed distinct regional distribution features. Five biochemical phenotypes were identified in Yersinia pestis isolated from Himalayan marmot natural focus area, while only one biochemical phenotype was identified in strains isolated from the domestic rat plague focus of Southern China. Most of the Yersinia pestis isolated from the two plague foci were capable of producing the virulence factors of Fl and PstI. Among the strains from Himalayan marmot focus, 70.53% (201/285) were VW-positive, 75.09% (214/285) were Pgm-positive, 20.00% (57/285) of the strains were Pgm-negative, and 5.26% (15/285) were Pgm mixed-type strains. Among strains from domestic rat plague focus of southern China, 37.80% (48/127) were VW-positive, 29.13% (37/127) were Pgm-positive, 58.27% (74/127) were Pgm-negative, and 12.60% (16/127) were Pgm mixed-type strains. DFR typing revealed 22 genotypes of Y. pestis from the Himalayan marmot plague focus, with the main genotypes being type 5, 7, 8, 10, 19, 32 and 49. All strains from domestic rat plague focus area in southern China belonged to type 9. CRISPR typing revealed that all strains from the Himalayan marmot natural focus were classified into 7 CRISPR gene clusters and 14 CRISPR genotypes, with the main genotypes being G7, G22, G26-a1'and G22-A1'. All strains from domestic rat plague focus area in southern China belonged to CRISPR genotype G30, with the gene cluster being Ca8. Conclusions The phenotypes and genotypes of the Yersinia pestis of Himalayan marmot plague focus are diverse, with an obvious characteristics of geographical distribution. The phenotype and genotype of the Yersinia pestis of domestic rat plague focus of Southern China are single. DFR and CRISPR genotyping methods with phenotypic characteristics can effectively identify the Yersinia pestis isolated from the two plague foci, thereby meeting the needs of identification and traceability research.

Capacitação para o controle da hanseníase: avaliação e contribuições para a gestão / Training process for leprosy control: evaluation and contributions to management

RESUMO Este estudo tem o objetivo de apresentar a avaliação de um projeto de capacitação em serviço para profissionais de saúde nas ações de prevenção e controle da hanseníase, problematizando o modelo de avaliação adotado, com foco na utilização para a gestão em saúde. Foi realizada uma avaliação ex-post em 18 municípios prioritários brasileiros participantes das capacitações. Empregou-se a estratégia Rapid Evaluation Methods (REM), priorizando: a) abordagem colaborativa; b) técnicas qualitativas; e c) enfoque conceitual da translação do conhecimento. Foram realizadas 24 entrevistas grupais, envolvendo 278 participantes. A abordagem de ensino em serviço foi importante para revalorização das ações de prevenção e controle da hanseníase e para conferir um lugar privilegiado de discussão técnica, de reflexão e de mudanças na atenção primária e em sua relação com a especializada. Conclui-se que o modelo de avaliação possibilitou que as controvérsias e convergências surgissem, assim como as recomendações para ajustes da intervenção junto à gestão em tempo oportuno.

ABSTRACT This study aims to present the evaluation of an in-service training project for health professionals in leprosy prevention and control actions, questioning the adopted evaluation model, focusing on its use for health management. An ex-post evaluation was carried out in 18 priority Brazilian municipalities participating in the training project. Rapid Evaluation Methods (REM) strategy was employed, prioritizing: a) a collaborative approach; b) qualitative techniques; and c) a conceptual approach to knowledge translation. Twenty-four group interviews were carried out, involving 278 participants. The in-service teaching approach was important for revaluing leprosy prevention and control actions and to provide a privileged place for technical discussion, reflection and changes in primary health care and in its relationship with specialized care. It can be concluded that the evaluation model enabled controversies and convergences to emerge, as well as recommendations for managers to adjust the intervention timely.

El rol predictivo de la red neuronal por defecto sobre la atención sostenida en edades escolares: una revisión sistemática

El rol de la Red Neuronal por Defecto en la aparición del trastorno de déficit atencional ha recibido evidencia científica creciente en los últimos 20 años. Este artículo tuvo por objetivo sistematizar la evidencia empírica y cuantitativa disponible en investigaciones sobre el rol de la Red Neuronal por Defecto en la atención sostenida y déficits atencionales en niños y adolescentes de etapa escolar; se usó la metodología de revisión sistemática de la literatura científica disponible entre 2010 y 2020. Se seleccionó una muestra de 13 estudios. Los resultados evidenciaron que la atención sostenida es rítmica y fluctúa junto a la memoria de trabajo. En cuanto a los niños con déficit atencional, se reportan anomalías en la disponibilidad de dopamina, adelgazamientos de las aéreas de la corteza cerebral interconectadas con la Red Neuronal por Defecto, así como hipo e híper conectividad de los tractos de materia blanca asociados a esta red. Estos hallazgos interpretados en su conjunto aportan evidencia valiosa acerca del rol emergente de la Red Neuronal por Defecto en los procesos subyacentes de la atención sostenida y la aparición de déficits atencionales. Estos hallazgos sistematizados pueden tener implicancias profundas en la didáctica y el diseño instruccional debido a que se cuenta con evidencia suficiente y validada como para adaptar las tareas de aprendizaje a los ritmos de atención y descanso puesto que estos obedecen a limitaciones biológicas y no a prescripciones administrativas.

The role of the Default Neural Network in the emergence of attention deficit disorder has received increasing scientific evidence in the last 20 years. This article aimed to systematize the empirical and quantitative evidence available in research on the role of the Default Neural Network in sustained attention and attention deficits in school children and adolescents; The methodology of systematic review of the scientific literature available between 2010 and 2020 was used. A sample of 13 studies was selected. The results showed that sustained attention is rhythmic and fluctuates along with working memory. Regarding children with attention deficit, anomalies in the availability of dopamine, thinning of the areas of the cerebral cortex interconnected with the Neural Network by Default, as well as hypo and hyper connectivity of the white matter tracts associated with this network are reported. These findings, interpreted as a whole, provide valuable evidence about the emerging role of the Default Neural Network in the underlying processes of sustained attention and the appearance of attentional deficits. These systematized findings can have profound implications in didactics and instructional design, due to the fact that there is sufficient and validated evidence to adapt the learning tasks to the rhythms of attention and rest since these processes obbey biological limitations and not to administrative requirements.

Saúde mental na atenção básica: percepção dos Agentes Comunitários de Saúde / Mental health in primary care: perception of Community Health Workers

Resumo Introdução Os fluxos de encaminhamento dos pacientes portadores de transtornos mentais e o seu devido acolhimento representam um grande desafio na área da saúde mental. Objetivo Conhecer a percepção dos Agentes Comunitários de Saúde em relação aos usuários da saúde mental e suas atividades nesse campo. Método Estudo de ordem qualitativa utilizando a técnica de grupo focal. Os dados coletados foram transcritos e submetidos à Técnica de Análise Qualitativa de Conteúdo. Participaram do estudo 15 agentes de saúde. Resultados Os dados foram organizados utilizando os temas que se destacaram nos depoimentos dos Agentes Comunitários de Saúde e agrupados em três categorias selecionadas previamente: Conhecimento sobre Transtornos Mentais, Ações em Saúde Mental, Entraves dos Serviços. Conclusão Os agentes demonstraram interesse pelo trabalho com os pacientes, mas apontaram dificuldades envolvendo os diversos pontos da rede de atenção à saúde. Melhor preparação técnica e teórica dos agentes resultaria em ganhos para a equipe de saúde e para os pacientes. Apesar de contemplar a realidade de um município de médio porte, este estudo pode fornecer subsídios para a discussão sobre a assistência em saúde mental na atenção básica de saúde.

Abstract Background The referral flows of patients with mental disorders and their proper reception represent a major challenge in the mental health area. Objective To know the perception of Community Health Agents concerning mental health patients and their activities in this field. Method This is a qualitative study using the focus group technique. The collected data were transcribed and submitted to the Qualitative Content Analysis Technique. Fifteen health agents participated in the study. Results The data were organized using the themes that stood out in the testimonies of the Community Health Agents and grouped into three previously selected categories: Knowledge about Mental Disorders, Mental Health Actions, and Service Barriers. Conclusion The agents showed interest in working with patients but pointed out difficulties involving the different points of the healthcare network. Better technical and theoretical preparation of agents would result in gains for the health team and for patients. Despite considering the reality of a medium-sized municipality, this study can provide support for the discussion on mental health care in primary health care.

"Desculpe a demora!": métodos online como estratégia para desenvolvimento de pesquisas sobre maternidades / "Sorry for the delay!": online methods as a strategy for developing research on maternity

Resumo A partir da experiência de pesquisa com mulheres mães lésbicas e bissexuais e das dificuldades encontradas para realização de encontros síncronos para a coleta de dados, observou-se que métodos de pesquisa online assíncronos se apresentam como estratégias em potencial para esse grupo em específico, considerado de difícil acesso. Este trabalho visa retratar o percurso metodológico para desenvolvimento de pesquisa exploratória, com abordagem qualitativa, desenvolvida por meio de métodos online, utilizando-se de estratégias como entrevistas abertas e grupo focal online, por meio da mídia social WhatsApp.

Abstract From a research experience with lesbian and bisexual mothers and the difficulties found in the management of synchronous meetings for data collection among these women, it was found that asynchronous methods of online research are potential strategies for this group in specific, considered of difficult access. This work aims to demonstrate the methodological path to develop exploratory research, with a qualitative approach, by online methods, applying strategies such as open-ended interviews and online focus groups, by using WhatsApp as social media.

Validación de dominios y competencias por grupos focales y juicio de expertos / Validation of domains and competencies by focus groups and expert judgment

Resumen El Consejo Mexicano de Ginecología y Obstetricia certifica a los especialistas para ejercer su especialidad y brindar una atención de alta calidad a las pacientes. En la actualidad, el Consejo está rediseñando el examen de Certificación en Ginecología y Obstetricia orientado a la evaluación de competencias profesionales a partir de las actividades profesionales confiables que permitan identificar los dominios de la competencia médica en un especialista. La competencia es una variedad de habilidades ejercidas a través de múltiples dominios o aspectos del desempeño profesional; sus descriptores requieren que contengan habilidades relevantes, contexto y la etapa o nivel de evaluación. Por su parte, los dominios son un conjunto de competencias clave. Este informe incluye los resultados de la primera validación en México de dominios y competencias para la evaluación de los ginecoobstetras a partir de una metodología cualitativa que comprende una revisión de la bibliografía, grupos focales, análisis de trabajos colegiados y validación por juicio de expertos. Los resultados se presentan divididos por los ocho dominios en los que se trabajó, se mencionan los comentarios más relevantes a discutir por los cuatro grupos focales. Éstos y la validación por expertos permitió reunir comentarios valiosos, coherentes y funcionales para el sistema de evaluación que quiere llevar a cabo el Consejo. Este ejercicio permitirá el posterior desarrollo de la tabla de especificaciones, reactivos o nuevos instrumentos de evaluación coherentes con un sistema de dominios, competencias y actividades profesionales confiables.

Abstract The Mexican Council of Gynecology and Obstetrics certifies specialists to practice their specialty and provide high-quality healthcare to patients. Currently, the Council is redesigning the Gynecology and Obstetrics Certification exam, oriented to the evaluation of professional competencies based on reliable professional activities that allow the identification of domains of a specialist's medical competencies. Competency can be defined as a variety of skills across multiple domains or aspects of professional performance. Its descriptors require to contain relevant skills, context, and the stage or level of assessment. Domains can be described as a set of competencies that are considered essential. This report includes the results of the first validation done in Mexico. The validation of domains and competencies for the evaluation of physicians in the area of Obstetrics and Gynecology is based on a qualitative methodology that includes a literature review, focus groups, analysis of collegiate works, and validation through expert judgment. The obtained results are divided into eight domains that mention the most relevant observations that were discussed by the four focus groups. The focus groups and the validation through expert judgment made it possible to gather valuable, coherent, and functional feedback for the evaluation system that the Council wants to carry out. This method will allow the subsequent development of the table of specifications, items, or new evaluation instruments congruent with a system of domains, competencies, and reliable professional activities.

The unspoken plight of married adolescent girls in rural Tamil Nadu: Narrative summary on unmet sexual and reproductive health needs and barriers

Background: Young women who marry as adolescents face a number of sexual and reproductive health (SRH) issues. This study aimed to identify unmet SRH needs of adolescent girls and barriers they face in achieving them in rural Tamilnadu, India. Methodology: This qualitative study used narratives to understand participants and their immediate family’s SRH needs and barriers based on World Health Organization (WHO) guidelines. Totally, 14 in-depth interviews with young women and 14 focus group discussions with family members were conducted. The collected data were recorded digitally and transcribed verbatim and analysed by content analysis method. Results: Unmet SRH needs, primarily constituted of family planning methods, menstrual hygiene, sexual health, and Sexually Transmitted Diseases STD awareness. Barriers to healthcare access are societal stigma, taboos, intimate partner violence, and early marriage. Conclusions: The topic of family planning was taboo, menstruation as a negative influence on their daily activities, engaging in sexual activities was to provide sexual pleasure to their partners, to comply with their partners' wishes when under the influence of alcohol, and to produce children and lack of education regarding obtaining consent for sexual activity. We can conclude that it is important to understand how the SRH needs of adolescent girls can be met and need better-suited policies and services.

Acercamiento psicosocial con enfoque de género a la atención del paciente con cáncer de pulmón / Approach psicosocial with gender focus to the patient's attention with lung cancer

RESUMEN El cáncer de pulmón constituye un flagelo a la salud mundial; Cuba y dentro de ella la provincia de Camagüey, no escapan a este fenómeno. En tal sentido, se desarrolla un estudio de carácter investigación + desarrollo que debe derivar en el establecimiento de estrategias de intervención psicosocial con enfoque de género dirigidas a los pacientes diagnosticados en los hospitales Manuel Ascunce Domenech y María Curie que involucran a los afectados con esta situación de salud del municipio Camagüey en el período de enero del 2021 a junio del 2022, lo cual determina que se asuma como población a 192 individuos, de ellos 75 mujeres y 11 hombres. Por tanto, el objetivo del presente trabajo está dirigido a exponer los resultados iniciales del acercamiento teórico al tema, a partir de una revisión documental.

ABSTRACT Lung cancer is a global health scourge; Cuba and within it the province of Camagüey, do not escape this phenomenon. In this sense, a research +development study is developed that should lead to the establishment of psychosocial intervention strategies with a gender approach aimed at patients diagnosed in the Manuel Ascunce Domenech and María Curie hospitals that involve those affected by this situation of health of the Camagüey municipality in the period from January 2021 to June 2022, which determines that 192 individuals are assumed as a population, of them 75 women and 11 men. Therefore, the objective of this work is aimed at exposing the initial results of the theoretical approach to the subject, based on a documentary review.

Perceptions on COVID-19 Vaccination among People Aged more than 50 years in Urban Field Practice Area of Department of Community Medicine in a Tertiary Care Teaching Hospital, Hyderabad: A Reflection from Focus Group Discussions

Background: Despite several efforts to limit the viral transmission, the COVID-19 vaccine has been the only “the ray of hope” to end the pandemic. However, vaccine hesitancy could reduce coverage and hinder herd immunity. People’s intention to get vaccinated can be shaped by several factors, including risk perception which, in turn, is influenced by effect. The need to acquaint oneself to the beliefs, concerns, and circumstances of one’s own population in the community becomes important for successful implementation of the program. Therefore, the present study was conducted to gain insights into perceptions of vaccination. Objectives: The objective is to understand the felicitating factors and hindering factors for acceptance of vaccines by the population among people aged 50 years in urban field practice area of the Department of Community Medicine in a Tertiary care teaching hospital, Hyderabad. Subjects and Methods: Data were extracted from audio recording of five focus group discussions that were conducted in the urban field practice care of a tertiary care teaching hospital in Hyderabad through open-ended questions. Categories, subcategories, and themes were created by deductive approach. Results: The motivating factors for vaccine acceptance were found to be fear of getting disease, wanting to return normalcy, and trust in treating doctors, whereas, barriers were fear of death due to vaccine, opacity in vaccine details, anxiety, and misinterpretation of adverse events. Conclusion: Having a clear understanding about the belief system of the target population could help in designing the guidelines for vaccination program to escalate the immunization and increase the acceptance.