Simulação realística: tecnologia para consolidação de competências profissionais para segurança do paciente / Realistic simulation: technology for consolidating professional skills for patient safety

Resumo: Segurança do paciente é tema transversal na assistência e no ensino em saúde. Esta pesquisa metodológica enfoca a simulação como metodologia educacional, realizada entre abril e dezembro de 2022, com objetivo de estruturar, validar, aplicar e analisar tecnologia educativa, com vistas a consolidar competências em segurança do paciente para profissionais de enfermagem e medicina em formação nos programas de residência em saúde. O percurso metodológico ocorreu em duas fases. A primeira fase compilou competências para a formação em saúde e a segurança do paciente (etapa 1). Este material foi utilizado em reunião de grupo focal com líderes e chefias de serviços associados à qualidade e educação para subsidiar a identificação de fragilidades em segurança do paciente (etapa 2). A segunda fase correspondeu ao cenário de simulação, composta por oito etapas. A partir das fragilidades, definiram-se os objetivos de aprendizagem (etapa 1) que guiaram a elaboração de compilado teórico-prático nos subtemas educacionais (etapa 2), o qual foi discutido em workshop com os residentes (etapa 3). O cenário foi elaborado a partir de texto narrativo, concebido em ambiente assistencial hipotético, desenvolvido em ambiente simulado (etapa 4); esse foi avaliado pelos componentes do grupo focal (etapa 5). Após treinamento e orientações, ocorreram a simulação e observação crítica da cena pelos participantes (etapas 6 e 7). A oitava etapa correspondeu ao debriefing, com análise do desenvolvimento dos subtemas educacionais; e análise da simulação como recurso para o desenvolvimento e a consolidação de competências em segurança do paciente. Empregou-se a técnica de análise de conteúdo dos depoimentos transcritos; as fases foram registradas descritivamente; os resultados quantitativos foram analisados a partir de números absolutos e relativos. Para a validação do cenário foram utilizados os resultados do ranking médio e de confiabilidade. As fases e etapas sistematizadas foram compiladas em formato de Guia. As lacunas vinculadas às competências e que perfizeram os subtemas educacionais foram relativas à comunicação, adesão aos protocolos de segurança, continuidade do cuidado e trabalho em equipe. Foram objetivos educacionais: desenvolver a comunicação entre a equipe interprofissional; entender a importância dos protocolos e da inserção do paciente no processo de cuidar; desenvolver e consolidar competências profissionais relativas à segurança do paciente. Síntese da literatura subsidiou a contextualização das lacunas, guiando a compreensão e aproximação entre a teoria e a prática, a partir da discussão de casos, revisando e agregando conhecimentos. O cenário simulado foi elaborado e validado de acordo com os objetivos educacionais, observando-se os indicadores estabelecidos; a cena se desenvolveu concomitantemente à observação, propiciando análise crítica dos participantes da pesquisa. A tecnologia de modelagem educacional foi avaliada positivamente quanto às contribuições para o aprendizado e a consolidação de competências; concorreu para simular o cotidiano assistencial e fomentar a reflexão acerca de ações preventivas ao risco para o paciente. A estratégia educacional contribuiu para vigorizar competências em segurança do paciente entre profissionais em formação, cujo método para desenvolvimento e avaliação, compilado na forma de Guia, permite a replicação do percurso metodológico, com vistas à promoção da segurança do paciente.

Abstract: Patient safety is a cross-cutting theme in health care and education. This methodological research focuses on simulation as an educational methodology, carried out between April and December 2022, with the objective of structuring, validating, applying and analyzing educational technology, with a view to consolidating competences in patient safety for nursing and medical professionals in training in the programs residency in health. The methodological course took place in two phases. The first phase compiled competences for training in health and patient safety (step 1). This material was used in a focus group meeting with leaders and heads of services associated with quality and education to support the identification of weaknesses in patient safety (stage 2). The second phase corresponded to the simulation scenario, consisting of eight stages. Based on weaknesses, learning objectives were defined (stage 1) that guided the elaboration of a theoretical-practical compilation on educational subthemes (stage 2), which was discussed in a workshop with residents (stage 3). The scenario was elaborated from a narrative text, conceived in a hypothetical care environment, developed in a simulated environment (step 4); this was evaluated by the components of the focus group (step 5). After training and guidance, the participants simulated and critically observed the scene (steps 6 and 7). The eighth stage corresponded to the debriefing, with analysis of the development of educational subtopics; and simulation analysis as a resource for the development and consolidation of patient safety skills. The technique of content analysis of the transcribed testimonies was used; phases were descriptively recorded; the quantitative results were analyzed from absolute and relative numbers. For the validation of the scenario, the results of the average ranking and reliability were used. The systematized phases and steps were compiled in a Guide format. The gaps linked to competences and that made up the educational subtopics were related to communication, adherence to safety protocols, continuity of care and teamwork. The educational objectives were: to develop communication between the interprofessional team; understand the importance of protocols and the insertion of the patient in the care process; develop and consolidate professional skills related to patient safety. Literature synthesis subsidized the contextualization of the gaps, guiding the understanding and approximation between theory and practice, from the discussion of cases, revising and adding knowledge. The simulated scenario was elaborated and validated according to the educational objectives, observing the established indicators; the scene developed concurrently with the observation, providing a critical analysis of the research participants. Educational modeling technology was evaluated positively in terms of contributions to learning and skills consolidation; contributed to simulate daily care and encourage reflection on preventive actions to risk for the patient. The educational strategy contributed to strengthening patient safety skills among professionals in training, whose method for development and evaluation, compiled in the form of a Guide, allows the replication of the methodological path, with a view to promoting patient safety.

Improving the Quality of Residency Programs in Family and Community Medicine / Aprimorando a qualidade de Programas de Residência em Medicina de Família e Comunidade

ABSTRACT OBJECTIVE To develop and present an instrument to evaluate and monitor the quality of medical residency programs in residencies in family and community medicine (FCM) based on preceptors and residents, considering the insertion of the health network program. METHOD The instrument was developed in three stages: 1) interview with the preceptors of FCM; 2) literature review; and 3) production, adequacy, and approval of the evaluation instrument by renowned professionals of the Brazilian FCM. The third stage included 9 people and used the Delphi technique with 80% agreement. For the qualitative results, Bardin's Content Analysis was used. RESULTS In all, there were five evaluation cycles to adapt the proposed recommendations, with the elimination of one item and weighting, with a results analysis methodology of 10 resulting items, reaching an expected matrix for organizing residency programs in the health network, divided into 3 domains: Organization of the Unit, Human Resources, and Preceptor-resident relationship. CONCLUSION An instrument for evaluating and monitoring residency programs in family and community medicine can be a tool to facilitate program managers and allow evaluation and monitoring, continuously qualifying them.

RESUMO OBJETIVO Desenvolver e apresentar um instrumento para avaliar e monitorar a qualidade de programas de residência médica em medicina de família e comunidade (MFC) a partir dos preceptores e residentes, considerando a inserção do programa de rede de saúde. MÉTODO A elaboração do instrumento foi desenvolvida em três etapas: 1) entrevista com preceptores em MFC; 2) revisão da literatura; e 3) produção, adequação e aprovação do instrumento avaliativo por profissionais renomados na MFC brasileira. A terceira etapa contou com nove pessoas e utilizou a técnica Delphi com obtenção de 80% de concordância. Para os resultados qualitativos foi utilizada a análise de conteúdo de Bardin. RESULTADOS Ao todo ocorreram cinco ciclos de avaliação para adequação das recomendações propostas, com eliminação de um item e ponderação, e metodologia de análise de resultado de dez itens resultantes. Atingiu-se uma matriz esperada para a organização de programas de residência na rede de saúde, dividida em três domínios: organização da unidade, recursos humanos e relação preceptor-residente. CONCLUSÃO Um instrumento de avaliação e monitoramento de programas de residência em MFC pode ser uma ferramenta para auxiliar gestores de programas e permite a avaliação e monitoramento, qualificando-os continuamente.

Psicologia na defesa dos direitos humanos de crianças e adolescentes / Psychology in the defense of children and adolescents' human rights / La psicología en la defensa de los derechos humanos de la niñez y la adolescencia

A propósito da história mais recente da Psicologia no Brasil, considerando o período a partir da Constituição Federal de 1988, tomada aqui como acontecimento que favorece a emergência da Psicologia como uma área comprometida com a garantia dos Direitos Humanos, este artigo traz para conhecimento e análise fragmentos de memórias de egressos de instituições totais, como os antigos orfanatos, manicômios e preventórios, como parte de uma política de assistência ao chamado menor abandonado. É possível identificar nas lembranças em questão, com bastante clareza, o entendimento da criança como sendo objeto das ações dos adultos e das instituições, inclusive sendo submetida a práticas de abuso sexual e exploração no trabalho, e não como um sujeito de direitos cuja vida deve ser mantida, reconhecida e valorizada em todas as suas dimensões. Este texto também procura relembrar os vários movimentos de resistências que lutaram pela modificação desse tipo de situação, para que se possa enfrentar os problemas da atualidade, muitos decorrentes da pandemia vivida pela população.(AU)

Regarding the most recent history of Psychology in Brazil, since the 1988 Federal Constitution, considered here as a favorable event for the emergence of Psychology as an area committed to guaranteeing Human Rights, this article analyzes fragments of memories of individuals held at total institutions - such as the old orphanages, asylums and preventive care centers -, as part of an aid policy to the so-called neglected minor. These memories clearly show the understanding of the child as an object of the actions of adults and institutions, including being subjected to sexual abuse and exploitation, and not as a subject of rights whose life must be preserved, recognized and valued in all its dimensions. It also evokes the several resistance movements that fought to change this scenario, so that we can face today's challenges, many of them resulting from the pandemic experienced by the population.(AU)

Considerando la historia más reciente de la Psicología en Brasil a partir de la Constitución Federal de 1988 tomada aquí como un acontecimiento que favorece el surgimiento de una Psicología comprometida con la garantía de los Derechos Humanos, este artículo expone y analiza fragmentos de memorias de egresados de instituciones totales como los antiguos orfanatos, asilos y centros de atención preventiva como parte de una política de asistencia al llamado menor abandonado. Se puede identificar claramente en estas memorias la comprensión del niño como objeto de las acciones de adultos e instituciones, incluso víctimas de abuso sexual y explotación en el trabajo, y no como sujeto de derechos cuya vida debe ser mantenida, reconocida y valorada en todas sus dimensiones. Además, se busca destacar los momentos de resistencia en la lucha por cambios en estas situaciones, llevados a cabo en la pandemia que afectó a la población.(AU)

Student's confidence in mental health practice before and after psychiatry rotation: a follow up study / Autoconfiança dos alunos para a prática em saúde mental antes e depois do internato em psiquiatria: um estudo de seguimento

ABSTRACT Objectives The primary objective was to measure the effect of psychiatry rotation in students self-confidence (SC) for managing mental health (MH) issues. Methods An eighteen questions version of "Preparation for Hospital Practice Questionnaire" (PHPQ) adapted for MH was applied before, after and six months later the psychiatry rotation. Sociodemographic and experience with mental illness was measured as confounding factors. Results Hundred and ten students were recruited and four factors were identified: "Diagnosis elaboration and basic care" (F1), "Crisis management and prevention" (F2), "External sickness determinants" (F3) and "Personal distress with clinics" (F4). Cronbach Alpha ranged from 0.71 to 0.90. Previous MH training were not frequent (9.09%), and associated with better SC in F2 (after p < 0.05, 6m p = 0.03). Previous mental disorder was frequent (42.16%), and associated with more SC on F2 (p < 0.01) and F3 (p = 0.03) before course, but only on F3 after (p < 0.01) and not 6 months later. Male gender had more SC in F4 (p < 0.01) before course, but after course and 6m later female gender became more SC in F1 (after p = 0.02, 6m p = 0.01) and equivalent in F4. All factors had higher scores after and 6 months later (p < 0.001). The class considered that an interview script is very important for their SC, and improves assistance (mean > 9.0/10.0). Conclusion Obligatory rotation in MH improved SC in students. Previous training and gender were related with long lasting effects in SC.

RESUMO Objetivos Avaliar os efeitos de empoderamento do internato em saúde mental (SM) na autoconfiança (AC) dos alunos de Medicina. Métodos Uma versão adaptada para a saúde mental do "Questionário de Preparação para Prática Hospitalar" foi aplicada antes, depois e seis meses após o internato. Resultados Cento e dez alunos participaram e quatro fatores foram extraídos: "Elaboração diagnóstica e cuidados básicos" (F1), "Gestão e prevenção de crise" (F2), "Determinantes externos de adoecimento" (F3) e "Sofrimento pessoal com a clínica" (F4). Treinamento prévio em SM é incomum (9,09%), mas foi associado com pontuações mais altas em F2 (p = 0,05 e 6m p = 0,03). Tratamento prévio em SM (42,16% dos alunos) foi associado a valores mais altos em F2 (p < 0,01) e F3 (p = 0,03) antes, mas apenas em F3 (p < 0,01) após o curso. O gênero masculino apresentou valores mais positivos que o feminino em F4 (p < 0,01) antes, mas não após o curso, quando apresentaram valores mais baixos em F1 (após p = 0,02, 6m p = 0,01). Todos os fatores apresentaram valores mais altos após o curso (p < 0,001). Os alunos consideraram o uso de uma entrevista estruturada muito importante para sua autoconfiança e qualidade da assistência (média > 9,0/10,0). Conclusão O internato em SM aumentou a AC nos alunos. Treinamento prévio e gênero estiveram associados com efeitos duradouros na AC.

Admission of alumni from Multiprofessional Residency Programs into the SUS / Inserção de egressos de Programas de Residência Multiprofissional no SUS

ABSTRACT INTRODUCTION: The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS). OBJECTIVE: To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors. METHODS: This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis. RESULTS: A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54-2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61-0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort. CONCLUSIONS: The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.

RESUMO INTRODUÇÃO: Os Programas de Residência Multiprofissional em Saúde (PRMS) configuram-se como estratégia para a formação de força de trabalho para o Sistema Único de Saúde (SUS). OBJETIVO: Investigar a proporção de egressos de PRMS voltados à Atenção Primária à Saúde (APS) inseridos no SUS e fatores associados. MÉTODOS: Trata-se de um estudo seccional desenvolvido com egressos de PRMS voltados à APS de todo o Brasil, referente ao período de 2015 a 2019. Os participantes responderam a um questionário on-line com informações pessoais gerais, inserção na pós-graduação stricto sensu, no mercado de trabalho e especificamente no SUS. Foram aplicados o teste qui-quadrado de Pearson, para análises bivariadas, e Regressão de Poisson, para a análise múltipla. RESULTADOS: Participaram do estudo 365 egressos de Programas de todas as regiões brasileiras. Destes, 80,2% relataram inserção no mercado de trabalho e 47,9% informaram estar trabalhando no SUS. A inserção no SUS esteve associada às profissões que compõem a Equipe de Referência para a APS (RP = 1,87; IC95% 1,54-2,28) e à não inserção em programas de pós-graduação stricto sensu (RP = 0,77; IC95% 0,61-0,97). Quanto às características de inserção, prevaleceram o cenário da APS (47,4%) e o trabalho voltado à atenção à saúde (84,9%). Quase 40% dos egressos inseridos no SUS estão trabalhando por intermédio de vínculos instáveis, além de frequente não valorização do título da residência no recrutamento (56,9%). Entre os inseridos no SUS, 8,7% relataram terem sido selecionados para o enfrentamento da pandemia de covid-19. CONCLUSÕES: Os resultados deste estudo reforçaram a necessidade de política de incentivo à manutenção, criação e valorização dos PRMS e alertaram para possível aumento da dificuldade de inserção das categorias profissionais, frente ao cenário de desfinanciamento da saúde.

Boarding School: A Simple Approach To Reduce Soil Transmitted Helminth Infections In Orang Asli Children Of Sungai Siput, Perak, 2017

@#Soil transmitted helminth (STH) infection is a major public health concern among the indigenous children of Malaysia. Precarious living conditions at home including unavailability of water, drinking of contaminated water, poor sanitation and livestock presence, are known risk factors for the infection. In order to provide better living conditions, these children are enrolled in boarding schools. This study was conducted to determine whether boarding schools is a solution in reducing soil transmitted helminth infection among Orang Asli children in Sg Siput, Perak, Malaysia. An analytical cross-sectional study was conducted among 204 schoolchildren aged 7-17 years from three boarding schools in Sungai Siput, Perak from January to March 2017. Stool samples were collected and examined using direct smear and Kato-Katz technique. Information on sociodemographic and environmental conditions were collected using a modified Demographic Health Survey (DHS) questionnaire. Data analysis was done using IBM SPSS Statistics Processor 20.0.Out of a total of 204 children, only 48% (n= 97) were infected with at least one type of STH species which showed a reduced prevalence as compared to previous studies conducted among home dwelling schoolchildren with overall prevalence of 78-97%. Majority of the children had monoparasitism (31%; n=63) with moderate intensity by T trichuira (n=51, 25%). Univariate analysis shows that unavailability of water at home has a statistically significant association with STH infection among boarding school children (OR=0.73; 95% CI= 0.56-0.95 p=0.021). Multivariate analysis proves children who had unavailability of water at home has 2.1 times more likelihood of getting an STH infection (OR= 2.08; 95%CI= 1.07-4.07; p= 0.032).This study demonstrates a reduced STH prevalence among Orang Asli boarding school children as better living condition there limits the spread of STH infection among them.

Evaluation of the risk factors associated with emergency department boarding: A retrospective cross-sectional study / 中华创伤杂志(英文版)

PURPOSE@#Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center.@*METHODS@#All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test.@*RESULTS@#Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age.@*CONCLUSION@#The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

Variations In Blood Pressures Amongst Day School Children And Boarding School Children In Western Maharashtra

Introduction: School children majorly face stress due to the pressure and expectations from their parents besides aca-demics, athletics, etc. It is known that depression, stress increases blood pressure. Such wide variations in blood pres-sure at such a young age can increase the incidence of cerebrovascular accidents, ischemic heart diseases, renal failure and preterm death in the adulthood of such children. This survey will guide the parents and teachers to the various problems student face and how can they help the student cope with it. Method: The blood pressure of each student was taken three times to reduce them to minimise the possibility of errors and the blood pressures of all the students were compared according to their age (13-16 years) and the schooling type (boarders and day scholars). Results:On comparing the prehypertensive stage, the numbers of pre-hypertensives are found to be greater in the age group of 15 years in both day scholars and boarders i.e. 14% and 8% respectively. The on comparing the schooling type the day scholars have a greater number of prehypertensive i.e. 25% than boarders which is 17%. Though pre-hypertensives are higher in the age group of 15 years, but the numbers of hypertensives are more in 14 years of age which is 7% (6% in hypertension stage I and 1% in hypertension stage II) in day scholars and 4% (3% in hypertension stage I and 1% in hypertension stage II) in boarders. In schooling type, a similar trend as that of prehypertension is seen i.e. in day schol-ars 14% students are in hypertension stage I and 3% students are in hypertension stage II making a total of 17% of hypertensive in day scholars. Similarly, in boarders there are 6% in hypertension stage I and 1% in hypertension stage II making 7% hypertensive in boarders, thereby showing a higher percentage of hypertensive in day scholars. Conclu-sion: The study revealed Percentage of students in hypertension stage I and hypertension stage II were found more in day scholars (14% HT STAGE I and 3% HT STAGE II) than boarders (6%HT STAGE I and 1% HT STAGE II) re-spectively. Thus, it can be very well concluded that 17% of day school children and 7% boarders were found to be in hypertensive.

Analysis of the prevalence and influential factors for overweight and obesity of ninth grade students in China / 中华疾病控制杂志

Objective To investigate the prevalence of overweight and obesity in Chinese ninth grade students and to analyze the influential factors that contribute to this situation. Methods A total of 5 967 students were selected from the 2016 China Education Panel Survey. Chi-square test was used to examine the differences in the prevalence of overweight and obesity among different groups and Logistic regression models were used to analyze the factors affecting obesity in boys and girls. Results The prevalence of overweight and obesity was 15.23%, 18.55% and 11.84% in total, male and female ninth grade students respectively. The multiple Logistic regression analysis indicated that the risk factors between boys and girls were significantly different. The main factors affecting boys obesity rate were one-child, boarding, both parents obesity, taking health education courses, having indoor stadium and screen time. Meanwhile, for girls the factors were boarding, both parents obesity and sports time. Conclusions Schools should arrange the schedule of boarding students and offer health education courses based on the characteristics of boys and girls. Meanwhile schools should unite parents to control adolescents’ screen time and nutrition balance, which is benefit for preventing adolescents overweight and obesity.

Percepción de estudiantes de medicina en Maceió, Alagoas, Brasil, sobre la atención a la mujer en el climaterio / Perception of medical students in Maceió, Alagoas and Brazil on care for women in climateric i: en

Introducción: el climaterio es un periodo especial en la vida de la mujer por lo que debe recibir un trato diferenciado en la Atención en Salud. Para tanto, el proceso de formación de médicos debe ofrecer prácticas que aborden, de manera específica esta situación. Objetivo: analizar prácticas en Unidades de Salud da Familia en relación con las competencias generales a cerca de las mujeres en climaterio. Métodos: fue un estudio cuantitativo, se tuvo como sujetos los alumnos de la escuela de medicina. La fuente de información utilizada en el estudio fue un instrumento de percepción de tipo Likert. Resultados: los resultados mostraron que las prácticas posibilitaron el desarrollo de competencias cognitivas y parte de las competencias técnicas necesarias para la atención a las mujeres en climaterio. Fueron encontradas limitaciones en la oportunidad de los avances para habilidades tales como: la realización del examen físico general, ginecológico y citopatológico; orientación sobre nutrición y factores de riesgo, tales como alcohol y tabaco, así como la discusión de la indicación de la terapia de reemplazo hormonal para esta fase de la mujer. La dimensión integrativa relacional apareció como el área más crítico de la etapa. En esta dimensión es muy visible la limitación de entorno multidisciplinar para el cuidado de las mujeres en el climaterio y la capacidad de integrar los datos epidemiológicos, tendencias y riesgos para la toma de decisiones. Conclusiones: estos resultados demuestran que aunque hay señales de ruptura con los paradigmas tradicionales de la formación médica, las grandes oportunidades de práctica médica en las Unidades de Salud da Familia, junto a la mujer en climaterio, son todavía centradas sobre la cognición(AU)

Introduction: The climacteric is a special period in the life of the woman being that this should receive differential treatment in health care. For both, the process of training doctors should offer practices to address, specifically this situation. Objective: This study has the objective to know any limits on the USF stage in the development of general skills necessary to care for women during the climacteric. Method: This is a quantitative study, with the subjects of the boarding students of medical school. The source of information used in the study was an instrument of perception Likert. Results: The results showed that the stage has enabled the development of cognitive skills and some of the technical skills required to care for women during the climacteric. There were limitations on the opportunity to progress to skills such as conducting general physical examinations, gynecological and pap smear; nutrition guidance and risk factors such as alcohol and tobacco, as well as the discussion of the indication of hormone replacement therapy for this phase of the woman. Finally, the integrative-relational dimension proved to be the most critical area of the stage. This dimension is very visible limiting environment for multidisciplinary care for women in climacteric, and the ability to integrate epidemiological data, trends and risks to decision-making. Conclusion: These results show that although there are signs of a break with the traditional paradigms of medical education, the greatest opportunities for medical practice at Family Health Unit, near the women in climacteric, are still focused on cognition(AU)

Violencia escolar en adolescentes: un análisis en función de la actividad física y lugar de residencia habitual / School violence in adolescents: A analysis based on physical activity and place of residence

Son variados y frecuentes los estudios que intentan establecer la relación directa entre variables de tipo psicosocial y deportivo en la conducta violenta y agresiva de los adolescentes, pero pocos incluyen la relación con residir fuera del contexto familiar. De esta manera en este estudio se evalúa la agresividad y componentes de la misma en jóvenes adolescentes, determinando los niveles de práctica de actividad físico-deportiva así como el lugar de residencia de alumnos de ESO de la ciudad de Granada (España) y dictaminando posibles relaciones entre la agresividad, lugar de residencia y realización de actividad física continua. La participación de un total de 2.273 adolescentes permitió el registro y evaluación de las variables de conducta violenta (medida con la escala de conducta violenta en la escuela), lugar de residencia y práctica de actividad física. Los resultados mostraron que los adolescentes no residentes en el hogar familiar tenían mayores índices de agresividad que los residentes y que los que practicaban deporte de manera regular presentaban índices de agresividad manifiesta mayores que los sedentarios. Como principal conclusión indicamos la necesidad de elaborar más estudios que intenten dilucidar más detalladamente aquellas variables que pueden inducir a comportamientos agresivos.

The studies attempting to establish the relationship directly between psychosocial variables and sporty type in violent behavior and aggressive adolescents are varied and frequent, but few include the relationship with reside outside the family context. The aim in this study is evaluated aggressiveness and components thereof in young adolescents, determining practice levels of physical and sporting activities as well as the residence of ESO students from the city of Granada (Spain) ruling and possible relationships between aggressiveness, place of residence and conducting continuous physical activity. The participation of a total 2,273 adolescents allowed the recording and evaluation of variables violent behavior (as measured by the scale of violent behavior at school) place of residence and physical activity. The results showed non-residents adolescents in the family home had higher aggressiveness indexes residents and practicing the sport regularly they had higher rates of aggression manifests that sedentary. The main conclusion indicated the need for develop more studies that attempt to elucidate in more detail those variables that can lead to aggressive behavior.

A socio-demographic profile, growth, nutritional and hygiene status of children of primary and secondary boarding schools of Gandhinagar district: a cross sectional study.

Background: A school is a key location for educating children about health, hygiene and nutrition, and for putting in place interventions to promote the health of children. Objectives: of current study were 1) To study the socio demographic profile of children of boarding schools. 2) To study the growth, nutritional and hygiene status of children of boarding schools. Methods: The study was a cross sectional study. After taking the permission of principal of resident schools and consent of the parents of children, 867 children from 8 boarding schools were interviewed during February-March 2011. A self-administered questionnaire was used for data collection. Results: Age of the study children (total 867) ranged from 5-19 years. (Mean age = 13.80 ± 1.96 years). Out of 867, 434 (49.9%) were boys and 433 (50.1%) were girls. 32.6% belonged to socio economic class IV. There were only 122 (14.1%) children who had been in boarding school since 4 and more than 4 years. Good personal hygiene was observed in only 75 (8.7%) children followed by fair personal hygiene in 292 (33.7%) children and poor personal hygiene in 500 (57.7%) children. 220 (50.8%) female children had fair personal hygiene and 343 (79.0%) male children had poor personal hygiene and this difference was statistically significant. Prevalence of malnutrition in this study was 7.2% (Females = 4.2%; Males = 10.1%; P <0.001).The bulk of the malnutrition cases were constituted by the grade-I P.E.M. cases (66.1%) followed by grade-II P.E.M. cases (25.8%) and there were 5 (8.1%) cases of grade-III malnutrition only in female children. Conclusion: Poor personal hygiene, poor nutritional status among these children needs great attention and health education.

A survey of foodservice satisfaction and menu preference of high school boarding students in Jeju / 한국영양학회지

PURPOSE: This study analyzed the foodservice satisfaction and menu preference of 506 high school boarding students in Jeju surveyed from July 2-30, 2012 with the aim of providing basic data for improving the quality of boarding food-service management. METHODS: The data were analyzed using descriptive analysis, t-test, and Pearson's correlation coefficients, using the SPSS Win program (version 12.0). RESULTS: Regarding satisfaction with dormitory foodservice, the satisfaction scores for service and hygiene were 3.46 (out of 5 scales), whereas the score for menu quality was 3.26 points. In terms of satisfaction by meal, dinner showed the highest score, at 3.70 (out of 5 scales). The satisfaction scores for breakfast were significantly higher in girls (3.36) than boys (2.93). Regarding intake of meals provided, dinner showed the highest score, at 3.96 (out of 5 scales), whereas breakfast showed the lowest score, at 3.63 points. Intake of lunch and dinner was significantly higher in boys (4.12, 4.17, respectively) than girls (3.72, 3.76, respectively). Regarding the requirements of subjects for dormitory foodservice, 43.4% of subjects selected improvement of food taste and 36.6% of girls chose menu diversity. In terms of menu preferences for main dishes, the students preferred noodles (4.06) and one-dish cooked rice (3.92) to cooked rice (3.66). The subjects preferred beef rib soup (4.10) and Kimchi stew (3.99) in soups and stews. With regard to the menu preferences for side dishes, steamed foods showed the highest score, at 3.95 (out of 5 scales), whereas seasoned foods showed the lowest score, at 2.89 points. The students preferred beef, pork, and chicken to fish and vegetables. The students preferred dessert the most with fruit juices (4.52). Bread and rice cake were more favored by girls, showing significant differences between boys and girls (p < 0.05, p < 0.01, respectively). CONCLUSION: Development of a systematic nutrition education program that can encourage practice of proper eating habits is needed. In addition improvement of the quality of boarding school meals through the service of various menus is needed.

Food Habits and Dietary Behavior Related to Using Processed Food among Male College Students Residing in Dormitory and Self-boarding in Gangwon / 대한지역사회영양학회지

The purpose of this study was to examine food habits and dietary behavior related to using processed food among male college students residing in dormitory and self-boarding in Gangwon. A total of 344 students (dormitory group: 227, self-boarding group: 117) were surveyed from May to June of 2012. The results are summarized as follows: self-boarding group had a significantly higher frequency of skipping breakfast and lunch and frequency of out meal compared with the dormitory group (p < 0.05, p < 0.05, p < 0.05 respectively). The self-boarding group had a significantly lower the score of 'eat vegetables and Kimchi at every meal' (p < 0.001) and 'eat a variety of food everyday' (p < 0.001) compared with the dormitory group. The self-boarding group had a significantly higher the preference for meat products (p < 0.05) and canned food (p < 0.01) for selecting processed food compared with the dormitory group. The consideration for selecting processed food was ranked by 'taste', 'price', 'expiration', 'appearance' and 'nutrition' in both dormitory and the self-boarding group. In the dormitory group, nutrition labels were identified certainly 2.6%, sometimes 12.8%, and rarely 17.2%. In the self-boarding group, nutrition labels were identified certainly 1.7%, sometimes 18.0%, and rarely 24.8%. The necessity of nutrition education was high in both dormitory group (51.6%) and the self-boarding group (62.4%). Therefore, development of an educational program and application of the information from nutrition labels for male college students, especially self-boarding students will be effective in improving dietary life in order to maintain healthy dietary habits.

An attending physician float shift for the improvement of physician productivity in a crowded emergency department / 世界急诊医学杂志（英文）

BACKGROUND: Patients backlogged in the emergency department (ED) waiting for an inpatient bed (boarders) continue to require the attention of ED physicians, exacerbating crowding in the ED. To address this problem, we added a "fl oat shift" to our winter schedule solely to care for boarders. We sought to quantify the effect of this fl oat shift, hypothesizing greater physician productivity.METHODS: We performed a retrospective observational study in our community hospital ED, measuring the number of new patients seen in each 10-hour shift in the presence or absence of a fl oat shift physician. We calculated the number of new patients seen per shift for each of the 7 daily shifts, during February (fl oat shift scheduled) and May (fl oat shift unscheduled) of 2008. We then compared the mean number of patients seen per shift in February with May.RESULTS: Total monthly patient volume was 6656 for February and 6775 for May, with the mean daily census being 230 and 219 patients, respectively. The number of new patients seen during each shift was greater in February than in May, with a mean increase of 1.1 patients per shift (with the fl oat shift). Surveying participants about intervention effectiveness showed 92% of residents, but only 65% of attending physicians, in favor of maintaining the fl oat shift.CONCLUSION: The presence of a "fl oat shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED, despite the presence of longer throughput times and increased time on diversion.

The security characteristics of rural young boarding pupils and its influencing factors / 中华行为医学与脑科学杂志

Objective To investigate the security characteristics of rural young boarding pupils and its influencing factors.Methods 210 boarding and 265 non-boarding rural young pupils of Huojia in Henan were tested by questionnaires,including of a self-developed questionnaire,security questionnaire and adolescent mental resilience scale.Results ①The scores of the interpersonal security (25.99 ± 5.53),the determine control sense factor (24.63 ±6.17) and the total security(50.62 ± 10.37) in the boarding pupils were statistically lower than non-boarding pupils (27.36 ± 6.38,26.00 ± 6.55,53.36 ± 11.77,P ＜0.05).②There were statistically significant difference in the scores of the interpersonal security,the determine control sense factor and the total security among the different grades(P＜0.05),but there were no statistically sex difference in the scores(P ＞ 0.05).③Group regression analysis showed that,no family factors in the young boarding pupils had influence on the score of the security sense factors and the total (P＞0.05),and marital relationship of parents,only child,father' s and mother(')s education background of non-boarding pupils had certain influence on the score of the interpersonal security,the determine control sense factor and the total security (β =-0.43-0.27,P＜ 0.05).④The group regression analysis showed that,the problem solving and self-efficacy,parents'high expectations in mental toughness respectively had some effect on the interpersonal security of boarding and non-boarding pupils(β =-0.15,β =0.25,P＜0.05),and social ability and family care,schools resilience respectively had influence on the determine control sense in boarding and non-boarding pupils (β =-2.91-2.87,P＜0.05),and social ability,parents'high expectations respectively had influence on the total security in boarding and non-boarding pupils (β =-0.17,β=0.22,P＜0.05).Conclusion The security-sense in boarding young pupils are lower than the non-boarding young pupils,and family factors and mental toughness have different effects on security-sense of two kinds pupils.

A Survey on Present Situation of Intelligence among Boarding School-age Children of the Va Nationality / 昆明医科大学学报

Objective To analyze the present situation of intelligence of boarding school-age children of the Va nationality.Methods Multi-stage random sampling method was used to select 650 boarding school-age children from 10 primary schools in ShuangJiang county, and their level of intelligence was estimated by Raven's STANDARD progressive Matrices (SPM) .Results The level of intelligence of boarding school-age children of the Va nationality was significantly lower than the norm ( 0.05) .Conclusions The present situation of intelligence of boarding school-age children of the Va nationality is serious and should be improved as quickly as possible.

Tratamiento del hiperparatiroidismo primario mediante abordaje mínimamente invasivo / Treatment of the primary hiperparatiroidism by minimally invasive boarding

The unilateral boarding of the primary hiperparatiroidism constitutes a technical option increasingly secondhand and adapted for the characteristics of this surgery. This type of boarding has been possible for the appearance of the Tc sestamibi, of the subspecialization of the surgery and of the determination of the PTH intraoperatory. Later we expose an epidemiological, descriptive and retrospective study from january 2004 to December 2008. During this time there were controlled in the hospital Ramon and Cajal of Madrid a total of 195 patients for primary hiperparatiroidism. Of them, 140 were submitted to unilateral exploration by suspicion of the solitary adenoma. The correlation between the findings of Tc sestamibi and surgical was correct in all the cases (139) except one concerns to right or left side. It failed in 30 cases in which there was detected badly the top and low location. As for the results the adenoma was extirpated correctly in 135 of 140 patients. This way we can say that the combination of the gammagraphy, a surgeon with experience and the support of the PTH intraoperatory they meet a high rate of treatment in case of adenomas in the unilateral boarding on a rate of hipercalcemia appellant or persistently between 3 percent-5 percent, rate similar to the obtained one for expert surgeons on having fulfilled an exploratory cervicotomy (considered "gold standard") but with minor postoperatory morbidity, minor pain and minor surgical time.

El abordaje unilateral del hiperparatiroidismo primario constituye una opción técnica cada vez más usada y apropiada debido a las características de esta cirugía. Este tipo de abordaje ha sido posible por la aparición del Tc sestamibi, de la subespecialización de la cirugía y de la determinación de la PTH intraoperatoria. A continuación exponemos un estudio epidemiológico, descriptivo y retrospectivo desde enero de 2004 a diciembre de 2008. Durante este tiempo fueron intervenidos en el hospital Ramón y Cajal de Madrid un total de 195 enfermos por hiperparatiroidismo primario. De ellos, 140 fueron sometidos a exploración unilateral por sospecha de adenoma único. La correlación entre los hallazgos gammagráficos y quirúrgicos fue correcta en todos los casos (139) menos uno en cuanto a lo que a lateralidad se refiere. Falló en 30 casos en los que se detectó mal la localización superior e inferior. En cuanto a los resultados, se extirpó el adenoma correctamente en 135 de los 140 pacientes. Así podemos decir que la combinación de la gammagrafía, de un cirujano con experiencia y el apoyo de la PTH intraoperatoria proporciona una elevada tasa de curación en el caso de adenomas paratiroideos en el abordaje unilateral con una tasa de hipercalcemia recurrente o persistente entre el 3 por ciento-5 por ciento, tasa similar a la obtenida por cirujanos expertos al realizar una cervicotomía exploradora (considerada gold standard) pero con menor morbilidad postoperatoria, menor dolor y menor tiempo quirúrgico.

Vivenciando a internação do filho prematuro na UTIN: (re)conhecendo as perspectivas maternas diante das demandas neonatais / Living through the hospitalization of the premature child in the neonatal-ICU: recognizing the maternal perspectives facing

As experiências vivenciadas como profissional, no cotidiano da UTIN, com mães de bebês prematuros suscitou o desejo de compreender a ação intencional destas mulheres em permanecer no alojamento de mães durante a internação do filho. O estudo teve como objeto o Vivido da permanência das mães na unidade hospitalar durante a internação do filho prematuro na Unidade de Tratamento Intensivo Neonatal de um Hospital Maternidade Municipal do Rio de Janeiro e o objetivo de apreender o motivo para da mãe permanecer na unidade hospitalar durante a internação do filho prematuro. Adotou-se como suporte metodológico a fenomenologia Sociológica de Alfred Schütz, buscando a apreensão na relação face a face e através da intersubjetividade, a intencionalidade da mãe acompanhante em permanecer no alojamento durante a internação do filho, como uma ação social. Esta corresponde a uma ação projetada, dotada de significados subjetivos que podem ser dirigidas para o passado, presente ou futuro. O ‘motivo para’ instiga a realização da ação direcionada para o futuro e o ‘motivo porque’ está presente nas realizações passadas, podendo influenciar nas ações presentes, pois não são esquecidos. Foram sujeitos da pesquisa, 12 (doze) mães de recém-nascidos prematuros que permaneceram no Alojamento de Mães durante a internação do filho. A Entrevista Fenomenológica foi a técnica utilizada para captar a ação intencional, que consistiu de três questões orientadoras: O que você tem em vista quando aceita ficar no alojamento de mães? Como é sua vivência no alojamento de mães? e Como tem sido a sua vida após a decisão de estar no alojamento de mães?...

The lived experiences as a professional, in the daily life of Neonatal-ICU, with mothers of premature babies brought about the desire to understand the intentional action of these women in staying in the mother’s hospital boarding during the hospitalization of the child. The study aimed as object the Lived of the staying mothers in the hospital unit during the hospitalization of the premature child in the Neo-natal Intensive Care Unit of a maternity District Hospital in Rio de Janeiro and the goal to learn about the mother’s motives to stay in the hospital unit during the hospitalization of her premature child. It was adopted as methodological support the Alfred Schutz’s sociological phenomenology, seeking the understanding in the face to face relation and through the inter-subjectivity, the intentionality of the supporting mother in remaining in the mother’s hospital boarding during the child’s hospitalization, as a social action. This action corresponds to a projected one, filled with subjective meanings which may be driven to the past, present or future. The ‘motive for’ instigates the undertaking of the action directed to the future and the ‘motive why’ is present in the past undertakings and may influence in the present actions because they are not forgotten. !2 (twelve) premature-new born’ mothers, were the research subjects, which stayed in the mother’s boarding during the child’s hospitalization. The phenomenological interview was the technique used to capture the intentional action, which consisted of 3 guiding questions, which are: What do you have in view when you accept to stay in the mother’s hospital boarding for mothers? How are the living experiences in the mother’s hospital boarding? And, how has you life been after your decision to stay in the mother’s hospital boarding?...

Skiing and Snowboarding Injuries

The population enjoying ski had increased since 1970's in Korea. Recently, that of snowboarders has increased rapidly among young population. Patterns of injuries are somewhat different between two sport activities. The most commonly injured region is knee among skiers and wrist among snowboarders. Head injury, spinal injury, and abdominal injury are not so common but a few serious injuries had been reported in Korea. To prevent or minimize injuries, proper pre-seasonal training including muscle strengthening, proper selection of equipments, and instruction for both sport technique and protection for safety are important. Also primary care for the injured as well as delivery system for seriously injured population should be established.