Atención del parto y del puerperio inmediato con pertinencia intercultural / Care of childbirth and immediate puerperium

PROPÓSITO: Explorar los factores que influyen en la aplicación de la interculturalidad con respecto a la atención del parto y puerperio inmediato en personal médico y paramédico, comadronas y usuarias del Centro de Urgencias Médicas (CUM) de Tecpán, Chimaltenango, abril-mayo 2017. MATERIAL Y MÉTODOS: Estudio cualitativo con diseño etnográfico. Se realizaron entrevistas en profundidad al personal de salud y usuarias del CUM y grupos focales con comadronas. Se evaluó la infraestructura de las salas de parto y posparto. RESULTADOS: En el personal médico y paramédico se evidenciaron saberes limitados acerca de la pertinencia cultural, descrita en las Normas de Atención con Pertinencia Cultural. Se contó con el 65% de los elementos de infraestructura y equipo de la sala de partos culturalmente adecuada. Las comadronas percibieron una atención deficiente y refirieron poco interés y capacitación del personal del servicio de salud. Las usuarias opinaron que existe una buena relación con el personal de salud, sin embargo no se les brindó una atención con adecuación cultural. CONCLUSIONES: Los factores que influyen en la implementación de las prácticas interculturales son de índole económica principalmente, además de aspectos estructurales, organizaciones y socioculturales.

PURPOSE: To explore the factors that influence the implementation of interculturality in regards to care during childbirth and the immediate postpartum period, in medical and paramedical staff, traditional midwives and patients of the Center of Medical Urgencies (CUM), Tecpán, Chimaltenango, April-May 2017. MATERIALS AND METHODS: Qualitative study with an ethnographic design. In-depth interviews with medical staff and patients of the CUM were carried out in addition to focal groups with traditional midwives. The infrastructure of the birthing room and postpartum ward were evaluated. RESULTS: CONCLUSIONS: The medical and paramedical staff showed limited awareness of cultural pertinence, as described in the Norms of Attention with Cultural Pertinence. The birthing room satisfies 65% of the criteria of infrastructure and equipment of a culturally pertinent birthing room. The traditional midwives perceived deficient patient care and identified a lack of interest and training of the health staff. The patients experienced a good relationship with the health staff, but declared a lack of cultural adequacy in the attention. The factors that influence in the implementation of intercultural practices are principally of economic nature, in addition to structural, organizational and sociocultural aspects.

To Extract or to Restore the Tooth? Color/Race and Clinical Decision Making among Undergraduate Dental Students from Southern Brazil

Objective: To evaluate whether the color/race of a hypothetical patient is associated with the clinical decision to extract or restore a specific tooth, as well as with the recommendation for additional procedures for its adequate treatment. Material and Methods: Respondents assessed an anterior tooth with an extensive carious lesion and were asked: whether it should be extracted or restored; how much time should be spent in the first consultation; whether or not root canal retreatment was necessary; and whether complementary exams should be requested. While a Black hypothetical patient was assessed in the first stage of data collection, a White individual was subsequently shown to the study respondents. Results: The clinical decision on whether to extract or restore the decayed tooth was not associated with the patient's color/race (p=0.64). The mean time estimated for the first clinical consultation (p=0.28), the need for root canal retreatment (p=0.56), as well as the request for complementary exams were not associated with the patient's color/race (p=0.82). Analyses stratified by the participants' characteristics confirmed the lack of such an association. Conclusion: As opposed to previously published findings in Brazil, the patient's color/race was not associated with clinical decision making among undergraduate dental students.

Adaptação e validação discriminante do instrumento Mini Exame do Estado Mental (MEEM) para avaliação neuropsicológica em adultos angolanos com diagnóstico clínico de acidente vascular cerebral (AVC) e epilepsia / Adaptation and discriminant validation of the instrument Mini Mental State Examination (MMSE) for neuropsychological assessment in Angolan adults with a clinical diagnosis of stroke (CVA) and epilepsy

Doenças como AVC e Epilepsia estão constantemente associadas à manifestação de comprometimentos cognitivos e demência, tendo como característica principal os déficits de memória. Atualmente,o instrumento Mini Exame do Estado Mental (MEEM) é o teste de rastreio de comprometimento cognitivo mais utilizado no mundo, individualmente ou como parte integrante em baterias de avaliação neuropsicológica. Devido afalta de instrumentos específicos pararastreiode comprometimento cognitivo de indivíduos com sintomas de demênciavítimas de AVC e/ou Epilepsia em Angola, África, fez se necessária aadaptação evalidação de instrumentos confiáveis.O presente estudoteve por objetivo a avaliação clínicada versão brasileira do instrumento MEEM adaptado por Brucki, para uso na população adulta de Angola.Trata-se de um estudo clínico comparado, envolvendo três populações. Foram incluídos neste estudo 85 indivíduos acometidos por AVC, 40 por Epilepsia e como grupo de comparação, 87 indivíduos de 20 a 65 anos de idade, supostamente saudáveis. A escolaridade mínima para inclusão do estudo foi definida em 4 anos de ensino formal. O presente estudo foi desenvolvido em parceria com o Serviço de Neurologia do Hospital Américo Boavida e com a Faculdade de Medicina da Universidade Agostinho Neto (FMUAN), ambos localizados ao norte da cidade de Luanda, capital de Angola, África.Toda a amostra foi submetida à coleta de dados sócio demográficos e avaliação neuropsicológica, através do instrumento MEEM. O instrumento consistiu no rastreio de comprometimento cognitivo, contemplando funções como orientação temporal e espacial, memória, cálculo, linguagem e capacidade construtivavisual.No presente estudo, encontramos dados que apontam um desempenho significativamente pior das funções cognitivas em pacientes acometidos por AVC quando comparados a pacientes com Epilepsia e grupo dossaudáveis. Esses achados confirmam a validade do instrumento MEEM, em função das características apresentadas pela doença, sendo possível discriminar com clareza os grupos AVC, Epilepsia e Controles Saudáveis. Os dados obtidos indicam uma boa qualidade da versão na língua portuguesa angolana, sendo a consistência interna da versão adaptada com ? de Cronbach = 0,736, semelhante aos dados de referência. Este estudo pioneiro preenche uma importante lacuna na produção de conhecimento em Angola, abrindo um leque de possibilidades para outros trabalhos científicos no país, facilitando a aplicação dos resultados tanto na área acadêmica-científica, quanto na clínica. É necessário aos profissionais de saúde que se apropriem de mais conhecimentos, para que possam propor intervenções adequadas, que auxiliam nos direitos de saúde e bem-estarda população angolana

Diseases such as stroke and epilepsy are constantly associated with the manifestation of cognitive impairment and dementia, having as main feature the memory deficits (Caramelli & Castro, 2005). Currently, the instrument Mini Mental State Examination (MMSE) is the screening test of cognitive impairment most used in the world, individually or as an integrated part in neuropsychological assessment battery (Melo & Barbosa, 2015). Due to the lack of specific instruments for screening cognitive impairment of individuals with dementia symptoms victims of stroke and / or epilepsy in Angola, Africa, it was necessary to adapt and validate reliable instruments. The presentestudy had as objective the clinical evaluationof the brazilian version of the MMSE instrument adapted by Brucki et al. (2003), for use in the adult population of Angola, Africa. It is a comparative clinical study involving three populations. This studyincluded 85 individuals affected by stroke, 40 by Epilepsy, and as a comparison group, 87 individuals, 20 to 65 years of age, who were supposed to be healthy. The minimum schooling for inclusion of the study was defined in 4 years of formal education. Thepresent study was developed in partnership with the Neurology Service of the Américo Boavida Hospital and the Faculty of Medicine of the Agostinho Neto University (FMUAN), both located north of the city of Luanda, the capital of Angola, Africa. All the sample was submitted to the collection of sociodemographic data and neuropsychological evaluation, through the MMSE instrument. The instrument consisted in the screening of cognitive impairment, including functions such as temporal and spatial orientation, memory, calculus, language and visual constructive capacity.In the presente study, we found data that indicate a significantly worse performance of cognitive functions in patients with stroke when compared to patients with epilepsy and healthy group. These findings confirm the validity of theinstrument MMSE in, due to the characteristics of the disease, being possible to discriminate with clarity the groups Stroke, Epilepsy and Healthy Controls. The data obtained indicate a good quality of the Angolan Portuguese language version, being the internal consistency of the adapted versionwhit the Cronbach's alpha = 0.736, similar to the reference data.This pioneering study fills animportant gap in knowledge production in Angola, opening up a range of possibilities for other scientific papers in the country, facilitating the application of the results both in the academic and scientific area, as at the clinic. It is necessary that health professional take ownership of more knowledge, so that they can propose appropriate interventions that assist in health and welfare rights of the Angolan population