Investigação de surtos e epidemias: transformações na teoria, nos conceitos e nas práticas do século XVIII ao século XXI / Outbreaks and epidemics investigations: changes in theories, concepts, and practices from the 18th to the 21st century

Resumo Este ensaio objetiva discutir as investigações de surtos e epidemias, desde os primeiros relatos disponíveis na literatura científica do século XVIII até o momento atual, utilizando para sua construção artigos científicos e livros sobre a temática. O principal argumento desenvolvido é a passagem de abordagens qualitativas da epidemiologia, predominantes nos períodos iniciais, para a abordagem quantitativa, que inicialmente convive com a qualitativa, mas se torna dominante a partir da segunda metade do século XIX. Conclui-se com uma breve reflexão sobre o momento atual de enfrentamento da epidemia da covid-19.

Abstract This essay aims to discuss the investigation of outbreaks and epidemics, from the first reports available in scientific literature from the 18th century to the present time, using scientific articles and books on the subject for its construction. The main argument developed is the transition from qualitative approaches of epidemiology, which predominated in the early periods, to the quantitative approach, which initially coexists with the qualitative one but became dominant from the second half of the 19th century. It concludes with a brief reflection on the current moment of confronting the COVID-19 epidemic.

Evaluating perspective and quality of life of glaucoma patients during the COVID-19 pandemic in India: Results of a telephone survey

Purpose: The past few years have been difficult in the lives of most glaucoma patients in view of the COVID?19 pandemic. Our aim was to find out patients’ perspective and disruption of their quality of life during the COVID?19 pandemic by conducting a telephone survey among glaucoma patients. Methods: This was a cross?sectional study involving the glaucoma patients of a tertiary eye care hospital in India. Patients who had completed at least five years of follow?up before 2020 were randomized by a random number generator. A validated (forward–backward translation and completed pilot analysis) set of 14 questionnaires was administered to the patients, the latter of whom were telephonically interviewed by one of the investigators in February 2022. The entire data was audio?recorded. Statistical Package for the Social Sciences (SPSS) version 26 was used. Results: Out of 1141 patients with >5 years of follow?up, 103 were selected by randomization. A large group of 46 patients (44.6%) admitted to glaucoma affecting their daily activities. Only 12 (11.6%) admitted to being irregular with their drops. Thirty?four (33%) patients felt that their glaucoma was deteriorating and 31 (30.1%) had fear of blindness. Ninety?five patients (92.7%) felt that they were safe under the care of the treating doctor. There were 46 (44.6%) out of 103 patients who did not turn up for follow?up for six months or more. Lockdown (36.2%) and travel?expenses (27.6%) were the two most common reasons for the loss to follow?up visits. Conclusion: Nearly half of the long?term glaucoma patients were lost to follow?up during the COVID?19 pandemic. Glaucoma affecting daily lives and fear of losing vision turned out to be significant observations in the telephone survey. This fear seemed to be ameliorated by the majority still feeling safe by being in touch with their doctor for continued care even during the COVID?19 pandemic.

Building on the backbone of CD47-based therapy in cancer: Combination strategies, mechanisms, and future perspectives

Described as a "don't eat me" signal, CD47 becomes a vital immune checkpoint in cancer. Its interaction with signal regulatory protein alpha (SIRPα) prevents macrophage phagocytosis. In recent years, a growing body of evidences have unveiled that CD47-based combination therapy exhibits a superior anti-cancer effect. Latest clinical trials about CD47 have adopted the regimen of collaborating with other therapies or developing CD47-directed bispecific antibodies, indicating the combination strategy as a general trend of the future. In this review, clinical and preclinical cases about the current combination strategies targeting CD47 are collected, their underlying mechanisms of action are discussed, and ideas from future perspectives are shared.

Perspectives of Indian speech language pathologists towards assessing adolescents with language impairments

ABSTRACT Purpose Perspective-based studies have been carried out on health professionals to create clinical implications that will positively impact the healthcare system. There are no such studies exploring the perspectives of Indian speech language pathologists (SLPs) towards handling adolescents with language impairments. Therefore, the current study aims to explore the perspectives of Indian SLPs on the assessment of adolescent language. Methods The study followed a cross-sectional study design following a non-random convenient sampling procedure. A total number of 102 SLPs participated in the study. Phase 1 comprised developing a questionnaire to identify the perspectives of SLPs towards the assessment of adolescents with language impairments. A total of 9 questions were formulated for the same. Phase 2 included the data collection which was conducted through an online survey. Phase 3 focused on the data analysis. Descriptive statistics were to determine the mean and SD for continuous variables, and frequency and percentage for discrete variables. Results The current study results indicated significant disparities in the perspectives of SLPs towards adolescent language assessment. An overall level of poor awareness and a superficial understanding of the core area (about adolescence, and the areas and tools for assessment) was evident. Conclusion Understanding the perspectives of SLPs towards adolescent language assessment is critical in paving the way for future clinical development and research.

Telemedicine use and perspectives of municipal health officers in the Cordillera Administrative Region during the COVID-19 pandemic

Background@#Telemedicine has proven essential during COVID-19. However, concerns remain about the rural municipalities in the country such as those from the Cordillera Administrative Region (CAR), wherein perceived barriers by Municipal Health Officers (MHOs) include poor internet connectivity and inadequacy of the current telemedicine service.@*Objective@#This study aimed to assess the extent of Telemedicine use and perspectives in terms of perception, attitudes and perceived barriers among MHOs in CAR during COVID-19.@*Methods@#This is an analytical cross-sectional study that used a validated online questionnaire to 62 MHOs and DTTBs in CAR. Logistic regression analysis was employed to determine the effect of sociodemographic factors and physician perceptions and attitudes on the extent of Telemedicine use.@*Results@#Most MHOs use Telemedicine frequently in their practice for 0-1 year during COVID-19. There is no significant effect of sociodemographic factors to the extent of Telemedicine use except for IT expertise which had a negative influence on the extent of use [prevalence (p=0.011), frequency (p=0.013), length of use (p=0.044)]. Generally, MHOs agree that telemedicine is beneficial for them in performing consults with a positive effect on frequency (p=0.004) and length of use (p=0.009). There is positive attitude towards telemedicine, however, with no significant effect on extent of use (p=0.352, p=1.00, p=0.484). Compromised decision-making and network issues are the most prevalent perceived barriers that limit MHOs to practice Telemedicine. @*Conclusion and Recommendation@#This study showed that during COVID-19, there is good utilization of Telemedicine among MHOs in CAR. MHOs perceive Telemedicine as beneficial in their work and positive attitude remains. However, presence of barriers makes them apprehensive to fully incorporate it in their practice. Study results can contribute to policy-making on telemedicine as it is a key player in e- health to improve access to healthcare services in the attainment of the goal of Universal Healthcare.

Treatment options in hypoparathyroidism

ABSTRACT Hypoparathyroidism remains the single endocrine deficiency disease that is not habitually treated with the missing hormone. In this article, we aim to provide a review of the conventional approach and the novel therapies as well as an overview of the perspectives on the treatment of this rare condition. We conducted a literature review on the conventional therapy using vitamin D analogs and calcium salts, indications for thiazide diuretics and phosphorus binders, PTH analogs history and usage, and the drugs that are currently being tested in clinical trials. Conventional treatment involves calcium salts and vitamin D analogs. Thiazide diuretics can be used to reduce hypercalciuria in some cases. A low-phosphate diet is recommended, and phosphate binders are rarely needed. During pregnancy, a careful approach is necessary. The use of PTH analogs is a new approach despite the limitation of high cost. Studies have included modified PTH molecules, calcilytics, microencapsulation of human parathyroid cells, and allotransplantation.

Perspectivas con dianas para el tratamiento de la artritis reumatoide / Perspectives with targets for the treatment of rheumatoid arthritis

La artritis reumatoide se clasifica como una enfermedad articular autoinmune crónica poliarticular sistémica que afecta principalmente a manos y pies. El objetivo de este trabajo es mostrar información publicada que contribuye a direccionar el manejo de la artritis reumatoide con nuevos fármacos, a partir del conocimiento de aspectos novedosos relacionados con la fisiopatología y los avances recientes sobre un grupo importante de dianas para el tratamiento de esta enfermedad. Las modificaciones epigenéticas pueden regular la expresión génica sin alterar la secuencia del ADN. La regulación de los ARN no codificantes (ncRNA), la metilación del ADN, la metilación del ARN y las modificaciones de las histonas se consideran los principales mecanismos de las regulaciones epigenéticas. Numerosas investigaciones han establecido que varias anomalías en estos mecanismos terminan en el desarrollo de la AR. Este trabajo resume nuevas dianas, que incluyen proteínas, pequeños metabolitos moleculares y reguladores de la epigenética. Son dianas moleculares prometedoras para el descubrimiento de fármacos que alivien la aparición de enfermedades y resuelvan la falta de respuesta y las respuestas parciales, así como los efectos adversos de los FARME actuales. Es innegable que aún se necesitan mayores esfuerzos para definir con mayor precisión las vías de señalización subyacentes afectadas por estas moléculas recién descubiertas y para desarrollar métodos de terapia apropiados(AU)

Rheumatoid arthritis is classified as a systemic polyarticular chronic autoimmune joint disease that mainly affects the hands and feet. The objective of this work is to show published information that contributes to directing the management of RA with new drugs. Epigenetic modifications can regulate gene expression without altering the DNA sequence. Regulation of non-coding RNAs (ncRNAs), DNA methylation, RNA methylation, and histone modifications are considered the main mechanisms of epigenetic regulations. Numerous investigations have established that various abnormalities in these mechanisms lead to the development of RA. This work summarizes new targets, including proteins, small molecular metabolites and regulators of epigenetics. They are promising molecular targets for drug discovery to alleviate disease onset and resolve non-response and partial responses, as well as adverse effects of current DMARDs. It is undeniable that further efforts are still needed to further define the underlying signaling pathways affected by these newly discovered molecules and to develop appropriate therapy methods(AU)

Patient's point of view on the diagnosis, treatment, and follow-up in acromegaly: single-center study from a tertiary center

SUMMARY OBJECTIVE: We aimed to evaluate the awareness and perspectives of acromegaly patients in the diagnosis and treatment processes and to evaluate basic clinical and demographic features. METHODS: This cross-sectional study was conducted at the Endocrinology Department of Yildirim Beyazit University between March 2019 and April 2020. A total of 58 acromegalic patients were enrolled. All patients were identified from our database and called for a clinical visit and filling the questionnaire forms. RESULTS: A total of 58 patients were included in this study (41.4% female). The mean age of the patients was 52±10.8 years. Median year from symptom to diagnosis (min-max) was 2 (1-12). Notably, 55.2% of the patients did not graduate from high school. Of the 58 patients, 30 (51.7%) patients had knowledge about the etiology of their disease. While 12 (20.7%) patients identified their initial symptoms themselves, 75% of the patients reported their symptoms during the clinical history taken by a health care professional. The majority of patients were diagnosed by an endocrinologist (69%). Acromegaly did not affect social life but affected work life and caused early retirement. Transsphenoidal surgery was performed as primary treatment in 96.6% of the patients (n=56). In all, 46 (79.3%) patients received medical treatment with somatostatin receptor ligands (e.g., octreotide or lanreotide long-acting release [LAR]) with or without cabergoline. Overall disease control was achieved in 38 (65.5%) patients. CONCLUSIONS: Acromegaly is usually detected incidentally by clinicians. The diagnosis of acromegaly is delayed in most patients and disease-related complications have already developed at the time of diagnosis. Therefore, increasing the awareness of the society and health care professionals will reduce both disease-related comorbidities and the economic burden on the health system.

Patogenia de la artritis reumatoide, manejo terapéutico actual y perspectivas futuras / Pathogenesis of rheumatoid arthritis, current therapeutic management and future prospects

La artritis reumatoide es una enfermedad autoinmune, sistémica, crónica, que afecta con más frecuencia a mujeres que a hombres, y se observa predominantemente en ancianos. El propósito de este trabajo es presentar el resultado de una revisión bibliográfica sobre aspectos generales relacionados con la patogenia de la artritis reumatoide y el manejo terapéutico actual, así como perspectivas futuras de nuevos enfoques terapéuticos. Existen dos subtipos principales de artritis reumatoide según la presencia o ausencia de anticuerpos antiproteína citrulinada. La citrulinación es catalizada por la enzima peptidilarginina-deiminasa dependiente de calcio, que cambia una arginina cargada positivamente a una citrulina polar, pero neutra como resultado de una modificación postraduccional. Este estudio se enfoca en el subconjunto de artritis reumatoide positivo para anticuerpos antiproteína citrulinada y se divide la progresión del proceso de artritis reumatoide en varias etapas. Cabe mencionar que estas etapas pueden ocurrir de forma secuencial o simultánea. Se requiere con urgencia una mejor comprensión de cómo los mecanismos patológicos impulsan el deterioro del progreso de la artritis reumatoide en los individuos con el fin de desarrollar terapias que tratarán eficazmente a los pacientes en cada etapa del progreso de la enfermedad(AU)

Rheumatoid arthritis is a chronic systemic autoimmune disease that arises more frequently in women than in men, and is predominantly observed in the elderly. To present the result of a bibliographic review on general aspects related to the pathogenesis of rheumatoid arthritis and current therapeutic management, as well as future perspectives of new therapeutic approaches. There are two main subtypes of rheumatoid arthritis according to the presence or absence of anti-citrullinated protein antibodies. Citrullination is catalyzed by the calcium-dependent enzyme peptidylarginine deiminase, which changes a positively charged arginine to a polar but neutral citrulline as a result of post-translational modification. This work focuses on the anti-citrullinated protein antibodies -positive rheumatoid arthritis subset and divides the progression of the rheumatoid arthritis process into several stages. It should be mentioned that these stages can occur sequentially or simultaneously. A better understanding of how pathological mechanisms drive the deterioration of rheumatoid arthritis progression in individuals is urgently required in order to develop therapies that will effectively treat patients at each stage of disease progression(AU)

Perspectivas da cooperação em saúde no espaço lusófono: análise da atuação do Brasil nas relações de cooperação com países de Língua Portuguesa / Perspectives of health cooperation in Lusophone area: analysis of Brazil's role in cooperation relations with Portuguese-speaking countries

O presente artigo objetivou examinar como se dá a cooperação em saúde entre o Brasil e os países de língua oficial portuguesa, de forma tanto bilateral quanto multilateral, com destaque para as ações adotadas pela Comunidade dos Países de Língua Portuguesa. Após análise dos desafios às iniciativas de cooperação, apontaram-se os avanços já obtidos e as perspectivas que se apresentam, com vistas a concretizar o cumprimento das metas da Agenda 2030 da Organização das Nações Unidas. Também se evidenciou a necessidade de minimizar os atrasos e paralisações que ocorrem quando há mudanças administrativas; de criar um marco legal que defina como se deve dar a cooperação brasileira nos planos bilateral e multilateral, fundada nos princípios que regem o Estado em suas relações internacionais, na busca de sustentabilidade financeira e em uma melhor análise prévia dos projetos a serem desenvolvidos, com uma avaliação posterior de seus resultados; bem como a necessidade de estabelecer mecanismos de resposta a crises humanitárias. Concluiu-se que a cooperação em saúde proporciona um aprendizado recíproco e pode ser vista como uma ferramenta de aperfeiçoamento nessa área. A pesquisa adotou metodologia analítica e quantitativa, de cunho bibliográfico e documental, e se pretendeu exploratória ao apontar possíveis respostas às questões levantadas.

This article aimed to examine how health cooperation between Brazil and Portuguese-speaking countries takes place, both bilaterally and multilaterally, with emphasis on the actions taken by the Community of Portuguese-speaking Countries. After analyzing the challenges to cooperation initiatives, the advances already achieved and the prospects presented were pointed out, with a view to achieving the goals of the 2030 Agenda of the United Nations. It also highlighted the need to minimize delays and stoppages that occur when there are administrative changes; to create a legal framework that defines how Brazilian cooperation should take place at bilateral and multilateral levels, based on the principles that govern the State, in its international relations, in the search for financial sustainability and a better prior analysis of the projects to be developed, with a further evaluation of its results; as well as the need to establish mechanisms to respond to humanitarian crises. It was conclude that health cooperation provides reciprocal learning and can be seen as a tool for improvement in this area. The research adopted an analytical and quantitative methodology, of bibliographic and documentary nature, and intended to be exploratory in pointing out possible answers to the questions raised.

Chinese Expert's Perspectives on Andrological Diseases Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

In recent years， the incidence rate of andrological diseases has shown a significant growth trend. Considering the unavailability of a perfect theoretical system for andrology in traditional Chinese medicine （TCM） and the complex pathogenesis despite of the limited types of andrological diseases， it is necessary to improve the clinical efficacy of andrological diseases so as to satisfy the needs of patients. Therefore， the China Association of Chinese Medicine （CACM） organized the andrologists of TCM and western medicine and the outstanding young clinicians to discuss the andrological diseases responding specifically to TCM or integrated TCM and western medicine， such as chronic prostatitis， male infertility， benign prostatic hyperplasia， erectile dysfunction， and premature ejaculation， determine their diagnostic criteria in western medicine， and standardize the specifications for TCM diagnosis and treatment based on syndrome differentiation， thus formulating recognized and integrated diagnosis and treatment protocols. Apart from proposing suggestions on the treatment of such andrological diseases with TCM and western medicine， the experts have also figured out the andrological diseases responding specifically to TCM， the optimal intervention time of TCM and western medicine， and the suitable measures including surgery. The resulting consensus helps to better guide the formulation of accurate， personalized， and optimized treatment plans in clinical practice and improve the diagnosis and treatment effects of andrological diseases by giving full play to the advantages of TCM， which will in turn contribute to further innovation and development of TCM.

Significados del amor e historias de infidelidad en parejas que inician un proceso de psicoterapia / Meanings of Love and Stories of Infidelity in Couples who Have Begun a Psychotherapeutic Process

Resumen Este artículo muestra los resultados del proyecto de investigación/intervención, denominado "Significados y Sentidos del amor en parejas con historias de infidelidad", realizado en la Universidad Santo Tomas de Bogotá (Colombia). Se realizó una apuesta por la comprensión de los significados del amor en parejas que han tenido engaños y desilusiones amorosas asociadas a infidelidades, y la intervención psicoterapéutica para la reorganización de versiones novedosas del amor, la infidelidad y el ser pareja desde una perspectiva sistémica constructivista, socio construccionista y compleja. En esta investigación, participaron dos parejas cuyo motivo de consulta se relaciona con la infidelidad, se desarrollaron 5 escenarios narrativos conversacionales con cada una de ellas, empleando dispositivos de intervención tales como: la construcción de historias, las esculturas y las metáforas. Los principales hallazgos reconocen relatos matizados de los conyugues, por imágenes idealizadas de la pareja generando sentimientos de culpabilidad, historias asociadas al silencio y sometimiento como forma de solucionar los conflictos, la deconstrucción de historias de infidelidad para reconstruir la trama narrativa de la pareja desde aspectos particulares que conectan a los enamorados, y el acontecimiento de infidelidad como posibilidad de cambio.

Abstract This article shows the results of the research/intervention project titled "Meanings and senses of love in couples with a history of infidelity", carried out in the Santo Tomas University of Bogotá (Colombia). An effort was made to understand the meanings of love in couples who have suffered from deceit and disappointment in love associated with infidelity, and who have received psychotherapeutic intervention for the configuration of new versions of love, infidelity, and being a couple from a systemic-constructivist, social-constructionist, and complex perspective. Two couples whose reason for consultation was related to infidelity participated in this research, and five conversational narrative scenarios were developed with both of them, using intervention devices such as the construction of stories, sculptures, and metaphors. The main findings show stories from the spouses that are nuanced through idealized images of the couple that generates feelings of guilt; stories associated with silence and submission as a means to resolve conflicts; the deconstruction of infidelity stories to reconstruct the couple's narrative plot based on particular aspects that connect the lovers; and the event of infidelity as a possibility for change.

Duelo perinatal: perspectivas de los profesionales de la salud / Perinatal grief: perspectives of health professionals

INTRODUCCIÓN: Los profesionales tienen un rol significativo en el proceso del duelo perinatal, y la relación que construyan con los padres será decisiva para facilitar u obstaculizar su cuidado. OBJETIVO: Comprender la perspectiva de los profesionales de la salud con relación al duelo perinatal. MÉTODO: Se realizó una búsqueda bibliográfica en las bases de datos CINAHL, CUIDEN, PsycINFO, PubMed y Google Académico. Se realizó un análisis temático de estos, permitiendo delimitar categorías temáticas comunes. RESULTADOS: Se obtuvieron 46 artículos cientificos con menos de 10 años de antiguedad. Se identificaron tres categorias para abordar la experiencia vivida: 1) Sentimientos experimentados por los profesionales, como ansiedad, culpa, resignación, síntomas físicos, frustración y evitación; 2) Necesidades sentidas de apoyo, entre estas, soporte emocional, capacitación formal y experiencia laboral que permitan afrontar de mejor forma el duelo con las familias y el equipo; 3) Facilitadores del proceso, donde se destacan la capacitación, años de trayectoria profesional, confianza en si mismo, apoyo de los pares, equipo multidisciplinario, creencia religiososa y apoyo institucional. CONCLUSIÓN: El duelo perinatal es una situación dramática para los padres, los cuales demandan un cuidado sensible. Y los profesionales desempeñan un rol clave en el apoyo integral a los padres, siendo un proceso exigente tanto en lo personal como en lo profesional. Se sugiere formación de pregrado y postgrado, fomentando el diálogo y apoyo entre los equipos. De esta forma se beneficiarán los padres, su familia y los profesionales, los cuales podrán otorgar un cuidado efectivo y de calidad en situación de duelo perinatal.

INTRODUCCIÓN: Professionals play a significant role in the perinatal mourning. The relationship they established with parent in this process is critical in facilitating or hindering the quality of health care in this context. OBJETIVO: to understand the perspective of health care professionals in relation to perinatal grief. METHOD: A literature review was carried out in CINAHL, CUIDEN, PsycINFO, PubMed and the Google Scholar databases. A thematic analysis of the selected articles was carried out, allowing to define common thematic categories in these articles. RESULTS: 46 scientific articles, published in the last ten years, were obtained. Three topics were identified: 1) feelings experienced by professionals, including anxiety, guilt, anger, resignation, physical symptoms, frustration, avoidance and emotional pain; 2) needs related to support, such as emotional support, formal training and work experience that allows for a better approach with families and parents; and 3) facilitators of the process, where training, years of professional experience, self-confidence, peer support, multidisciplinary team, religious beliefs and institutional support stand out. CONCLUSION: Perinatal grief is a complex situation for parents who demand sensitive care. Professionals play a key role in comprehensive support for them, being a demanding process both personally and professionally. Undergraduate and postgraduate training is suggested, encouraging dialogue and support among teams. This would benefit family and professionals, providing effective and quality care in a situation of perinatal grief.

Modelo de aprendizaje organizacional: integración de las perspectivas de investigación / Organizational learning model: research perspectives integration / Modelo de aprendizagem organizacional: integração de perspectivas de pesquisa

Resumen Este trabajo presenta la construcción de un modelo de aprendizaje organizacional que integra tres perspectivas de investigación: conductual, cognitiva y social. Mediante la combinación de los procesos de adquisición, generación y distribución del conocimiento por parte de los miembros de la organización, los cambios en las rutinas debido a estos procesos y las condiciones socio-culturales que los facilitan. Para la conceptualización del modelo se utilizó una revisión sistemática de la literatura y para la formulación se plantearon las relaciones causales entre las principales variables explicativas del aprendizaje organización, bajo un enfoque sistémico, utilizando la metodología de modelamiento enriquecida de la dinámica de sistemas. Este nuevo constructo promete ser más integral que los constructos presentados hasta el momento en la literatura, logrando este alcance al incorporar las tres perspectivas teóricas sobre el aprendizaje organizacional. Para los profesionales, el modelo podría ser la base de una herramienta para el análisis de la capacidad de aprendizaje de las organizaciones.

Abstract This work presents the construction of an organizational learning model that integrates three research perspectives: behavioral, cognitive and social. By combining the processes of acquisition, generation and distribution of knowledge by members of the organization, the changes in the routines due to these processes and the sociocultural conditions that facilitate them. For the conceptualization of the model, a systematic literature review as used and for the formulation the causal relationships between the main explanatory variables of organizational learning were raised, under a systemic approach, using the enriched modeling methodology of the systems dynamics. This new construct promises to be more integral than the previous constructs, achieving this scope by incorporating the three theoretical perspectives on organizational learning. For professionals, the model could be the basis of a tool for analyzing the learning capacity of organizations.

Resumo Este artigo apresenta a construção de um modelo de aprendizagem organizacional que integra três perspectivas de pesquisa: comportamental, cognitiva e social. Combinando os processos de aquisição, geração e distribuição de conhecimento por membros da organização, as mudanças nas rotinas devidas a esses processos e as condições socioculturais que os facilitam. Para a conceptualização do modelo, foi utilizada uma revisão sistemática da literatura e, para a formulação, as relações causais entre as principai s variáveis explicativas da aprendizagem organizacional foram levantadas, sob uma abordagem sistêmica, utilizando a metodologia de modelagem enriquecida da dinâmica dos sistemas. Esta nova construção promete ser mais abrangente do que as construções apresentadas atê agora na literatura, alcançando esse escopo incorporando as três perspectivas teóricas sobre aprendizagem organizacional. Para os profissionais, o modelo poderia ser a base de uma ferramenta para analisar a capacidade de aprendizagem das organizações.

Perspectives & practices of doctors-in-training at the University of Santo Tomas Hospital when assessing, managing & referring patients with behavioral manifestations to psychiatry: A 2015 cross-sectional study

OBJECTIVE@#The study objective was to determine current perspectives and practices of residents- and fellows-in-training in non-psychiatric specialties when dealing with patients with behavioral and psychological problems at the University of Santo Tomas Hospital. It aimed to identify the trainees’ perceived role, and approach to diagnosis and treatment of psychiatry. Lastly, the study goals included gathering insights and suggestions on the improving psychiatric services in the hospital. @*METHODOLOGY@#This was a cross-sectional descriptive study surveying non-psychiatric residents- and fellows-in-training with clinical or patient encounters at the University of Santo Tomas Hospital in 2015. This was followed by the delivery of a lecture on psychological response to illness, an open forum, and an option for focus group discussion thereafter. Data and results underwent further statistical analysis and grouping into themes.@*RESULTS@#Among the 256 qualified subjects, a total of 178 respondents participated in the survey (69.53%). Perceptual disturbance was perceived as a behavioral problem that was most difficult to handle, followed by suicidality/self-harming behavior as well as addiction. Sleep disturbance (n=63) was cited as the behavioral manifestation that was directly managed by trainees while suicidal behavior / self-harm (n = 173), and thought disturbances (n = 164-166) were mainly cited as presentations that were referred to psychiatry. Services like Clinical Psychology and Neurology were among the specialties to whom behavioral problems were referred to. In terms of perception of psychiatric diagnosis, a pure psychological approach was deemed by 40.31% of the respondents, while only 18.85% viewed psychiatric diagnosis taking a bio-psycho-socio-spiritual approach. Psychiatric treatment approach however was deemed as a combination of biomedical, psychological, and social by 63.93%. The trainees’ view of psychiatry’s role in their practice encompassed management of psychiatric presentations of medical conditions, its complications, or treatments, psychological reactions to medical conditions or treatments, medical presentations of psychiatric conditions or treatments, and co-morbid medical and psychiatric conditions, pre & post-procedural consultation & screening, and other consultations including promotion of general mental wellness. Suggestions for improvement covered (1) the referral system/process, including a general agreement on the need for a standardized referral form (2) an intensification of education & information dissemination among colleagues, (3) psychoeducation for patients and the lay, (4) expansion and improvement access through infrastructure, (5) open collaboration, as well as (6) added services including patient support groups.@*CONCLUSION@#This study allowed for a better understanding of non-psychiatry trainees’ perspectives and approach towards patients manifesting with behavioral problems approach from non-psychiatric specialties and their understanding of psychiatry. Trainees had a good understanding of the role of psychiatry in their practice, while identifying barriers towards optimizing referral. This study was an example on how opening communication lines with the different subspecialties can bring to light, ways on how the hospital’s psychiatric services could be improved towards better patient service and care.

Perspectivas profissionais e motivações de estudantes de Medicina para atuação na Estratégia Saúde da Família / Professional perspectives and motivations of Medicine students to work with Family Health Strategy / Perspectivas profesionales y motivaciones de estudiantes de Medicina para actuación en la Estrategia Salud de la Familia

Este estudo objetiva caracterizar aspectos motivacionais de futuros médicos relativos às perspectivas profissionais e atuação na Estratégia Saúde da Família (ESF) e as estratégias indutoras do projeto político-pedagógico (PPP) dos cursos. Trata-se de um estudo descritivo-exploratório, de abordagem qualitativa, com 31 estudantes de Medicina de duas instituições de ensino. Os dados foram coletados a partir da análise dos PPPs e de entrevista. O material empírico foi analisado pela técnica de análise de conteúdo, à luz do referencial da Teoria da Autodeterminação. Emergiram três categorias analíticas: motivação intrínseca, motivação extrínseca e desmotivação. Os resultados demonstraram a ESF como oportunidade de trabalho temporário, com ideologia que cativa os acadêmicos, mas a ação das forças motivadoras extrínsecas resulta na não escolha da área para carreira. É fundamental explorar, nos estudantes, o potencial motivacional intrínseco, desenvolvendo estratégias para romper barreiras que limitam a escolha pela ESF.(AU)

This study aims at describing the motivational aspects of future doctors as to their professional perspectives of working in Family Health Strategy (ESF) and the inducing strategies of the course's Political and Pedagogical Project (PPP). This descriptive and exploratory study of qualitative approach was conducted with 31 Medicine students of two education institutions. Data were collected based on the PPP analysis and through interview. The empirical material was reviewed using the content analysis technique based on the Self-determination Theory. Three analytical categories emerged: intrinsic motivation, extrinsic motivation, and demotivation. The results showed ESF is a temporary job opportunity with an ideology that captivates academics. However, extrinsic motivations end up forcing students not to choose the area as a career. It is essential to explore the intrinsic motivational potential of students developing strategies to overcome barriers that limit choosing ESF as a career path.(AU)

El objetivo de este estudio es caracterizar aspectos motivacionales de futuros médicos relativos a las perspectivas profesionales y actuación en la Estrategia Salud de la Familia (ESF) y las estrategias inductores del Proyecto Político Pedagógico (PPP) de los cursos. Estudio descriptivo-exploratorio, de abordaje cualitativo, con 31 estudiantes de Medicina de dos instituciones de enseñanza. Los datos se colectaron a partir del análisis de los PPP y por entrevista. El material empírico se analizó por la técnica de análisis de contenido, a la luz del referencial de la Teoría de la Autodeterminación. Surgieron tres categorías analíticas: motivación intrínseca, motivación extrínseca y desmotivación. Los resultados demostraron la ESF como oportunidad de trabajo temporal con ideología que cautiva a los académicos, pero la acción de las fuerzas motivadoras extrínsecas resulta en la no elección del área para carrera. Es fundamental explorar, en los estudiantes, el potencial motivacional intrínseco, desarrollando estrategias para romper barreras que limitan la elección por la ESF.(AU)

La investigación alimentaria en Venezuela. Perspectivas y desafíos / Food research in Venezuela. Perspectives and challenges

La evaluación dietética es una de las herramientas más importantes de la epidemiología nutricional, su práctica continúa siendo un reto para los profesionales de la Nutrición, que actualmente se enfrentan a cambios en el perfil epidemiológico de la población, avances científicos y tecnológicos, escasez de recursos y desigualdades sociales. Los estudios dietéticos, como cualquier otro tipo de investigación evaluativa, ven comprometidas su validez y confiabilidad ante debilidades técnicas y metodológicas que deben ser atendidas, durante el diseño y la ejecución. Venezuela, al igual que el resto de los países latinoamericanos, tiene una larga historia de investigación alimentaria, encontrando estudios que difieren en objetivos, tamaño de la muestra, tipo de muestreo, técnicas aplicadas, tratamiento estadístico, análisis y uso de la información. Actualmente, es indiscutible la necesidad de acercarse al consumo real de alimentos y nutrientes por parte de la población venezolana, contar con una línea base es indispensable para la formulación, implementación y evaluación de estrategias de intervención eficaces para el alcance de mayores niveles de salud nutricional y la prevención de enfermedades, que garanticen una vida activa y productiva para la población. Las nuevas exigencias y retos exhortan a la revisión permanente de conceptos, enfoques y protocolos de evaluación dietética. La invitación es a transitar por el fascinante campo de la investigación alimentaria y tomar lo mejor de los dos mundos: la rigurosidad científica que siempre se debió mantener y las oportunidades y desafíos que caracterizan a los nuevos tiempos(AU)

Dietary assessment is one of the most important tools in nutritional epidemiology; its practice continues to be a challenge for nutrition professionals, who are currently facing changes in the epidemiological profile of the population, scientific and technological advances, scarcity of resources and social inequalities. Dietary studies, like any other type of evaluative research, have their validity and reliability compromised in the face of technical and methodological weaknesses that must be addressed during design and execution. Venezuela, like the rest of the Latin American countries, has a long history of food research, finding studies that differ in objectives, sample size, type of sampling, applied techniques, statistical treatment, analysis and use of information. Currently, the need to approach the real consumption of food and nutrients by the Venezuelan population is indisputable; having a baseline is essential for the formulation, implementation and evaluation of effective intervention strategies to achieve higher levels of nutritional health and the prevention of diseases that guarantee an active and productive life for the population. The new demands and challenges call for the permanent revision of concepts, approaches and protocols for dietary assessment. The invitation is to travel through the fascinating field of food research and take the best of both worlds: the scientific rigor that always had to be maintained and the opportunities and challenges that characterize the new times(AU)

Perspectivas médicas sobre las fuentes de información: protocolo de una revisión panorámica de revisiones sistemáticas / Physicians' perspectives about medical sources of information: protocol for an overview of systematic reviews

INTRODUCCIÓN: Pese a la creciente cantidad y disponibilidad de evidencia, así como de fuentes de información, no existe claridad respecto a las fuentes de información de preferencia utilizadas por los médicos para dar respuesta a sus preguntas clínicas. OBJETIVO: Resumir la evidencia disponible acerca de las fuentes de información que prefieren los médicos para dar respuesta a las interrogantes surgidas de la práctica médica, además de las barreras y facilitadores percibidos sobre su uso. MÉTODOS: Realizaremos una revisión panorámica de revisiones sistemáticas, de acuerdo con las guías PRISMA. Buscaremos en Epistemonikos desde el inicio hasta marzo de 2019. También utilizaremos PROSPERO y efectuaremos una búsqueda de citas en Scopus. Los criterios de inclusión considerarán revisiones sistemáticas (métodos cualitativos, cuantitativos o mixtos) centrados en las preferencias de los médicos sobre las fuentes de información, así como las barreras y facilitadores percibidos. Dos autores examinarán y seleccionarán de forma independiente los estudios para su inclusión. Evaluaremos la calidad de las revisiones sistemáticas incluidas utilizando la lista de verificación del Instituto Joanna Briggs y la superposición de los estudios primarios, de acuerdo con la fórmula del área cubierta corregida. Realizaremos una síntesis narrativa de datos cuantitativos y un análisis temático de hallazgos cualitativos. DISCUSIÓN: Esperamos que nuestros hallazgos contribuyan a mejorar la práctica médica basada en la evidencia, mediante la identificación de las perspectivas médicas sobre las diversas fuentes de información médicas disponibles.

INTRODUCTION: Despite the growing availability of evidence and sources of information, it is not clear what are the physicians' preferences for filling gaps in their medical knowledge. OBJECTIVE: To summarize the available evidence about physicians' preferences and perceived barriers and facilitators about sources of information. METHODS: We will undertake an overview of systematic reviews according to PRISMA guidelines. We will search Epistemonikos from inception until March 2019. We will also search PROSPERO, and we will perform a forward citation search in Scopus. Inclusion criteria will consider systematic reviews (qualitative, quantitative, or mixed methods) focusing on physicians' preferences about sources of information, as well as perceived barriers and facilitators. Two authors will independently screen and select records for inclusion. We will appraise the quality of included systematic reviews using the Joanna Briggs Institute checklist, and the overlap of primary studies according to the corrected covered area formula. We will conduct a narrative synthesis of quantitative data and a thematic analysis of qualitative findings. DISCUSSION: We expect that our findings will contribute to improving the evidence-based general practice by identifying physicians' perspectives about different sources of medical information.

Experts' perspectives on the application of public-private partnership policy in prevention of road traffic injuries / 中华创伤杂志(英文版)

PURPOSE@#Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts' perspectives.@*METHODS@#This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method.@*RESULTS@#The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustainability, government's financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention.@*CONCLUSION@#This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy.

Apontamentos sobre a História da Psicologia Social no Brasil / Notes on the history of Social Psychology in Brazil / Apuntes sobre la historia de la Psicología Social en Brasil

Neste artigo, buscamos apresentar algumas das abordagens teóricas, grupos de pesquisa e instituições que fizeram e fazem parte do vasto (e diverso) campo da psicologia social brasileira. Para isso, em um primeiro momento, retomamos o modo como a história dessa ciência costuma ser contada - colocando a "crise de referência" da década de 1970 como um importante momento de inflexão, no qual ganham força a oposição ao modelo positivista de ciência e a necessidade de desenvolver abordagens críticas e comprometidas com a transformação social. Em um segundo momento, apresentamos algumas das abordagens teórico-metodológicas desenvolvidas após esse momento de "crise". Mais especificamente, abordamos o desenvolvimento da análise institucional, da psicologia sócio-histórica, da teoria das representações sociais e das abordagens construcionistas.(AU)

In this article, we aim to present some of the theoretical approaches, research groups and institutions that that have been part of the vast (and diverse) field of Brazilian social psychology. With this in mind, we begin with the history of the subject as it is usually told, placing the "crisis of reference" of the 1970's as an important turning point and two important ideas which gain ground then: opposing forces to the positivistic model of science and the recognition of the need to develop critical approaches committed to social transformation. After that, we present some of the theoretical-methodological approaches developed after this moment of "crisis". More specifically, we will tackle the development of institutional analysis, social-historical psychology, social representation theory and constructionist perspectives.(AU)

En este artículo, buscamos presentar algunos de los abordajes teóricos, grupos de investigación e instituciones que formaron y forman parte del vasto (y diverso) campo de la psicología social brasileña. Para ello, en un primer momento, retomamos el modo en que la historia de esta ciencia suele ser relatada - colocando la "crisis de referencia" de la década de 1970 como un importante momento de inflexión, en el que ganan fuerza la oposición al modelo positivista de ciencia y la necesidad de desarrollar enfoques críticos y comprometidos con la transformación social. En un segundo momento, presentamos algunos de los enfoques teórico-metodológicos desarrollados después de ese momento de "crisis". Más específicamente, abordamos el desarrollo del análisis institucional, de la psicología socio-histórica, de la teoría de las representaciones sociales y de los abordajes construccionistas.(AU)