"It's a bit exasperating to be locked up"- an exploration of Mexican adolescents' perceived barriers and facilitators for physical activity and healthy eating / "É um pouco irritante estar preso" - uma exploração das barreiras e facilitadores percebidos pelos adolescentes mexicanos para a prática de atividade física e alimentação saudável

Mexican adolescents' diet and physical activity levels fall short of recommendations for health. The aim of this study was to explore Mexican adolescents' perceived barriers and facilitators of physical activity and healthy eating. Twelve single-sex focus groups were conducted in six secondary schools in Mexico City during three months from October 2016. Data were analysed via inductive thematic analysis. Three themes were identified, namely: understanding the health-behaviour link, the impact of a restricted life, and social support. Participants understood how physical activity contributes to multiple dimensions of health, and how diet contributes to physical health. They also identified so-cialising, having fun, and stress relief as facilitators of PA, and knowledge and the desire for healthy food as facilitators for healthy eating. Barriers included inadequate facilities, insufficient time within current school structures, and inadequate social support from teachers. Context-specific physical activity barriers of neighbourhood safety concerns, and limited family support were also reported. Participants had a basic knowledge of healthy eating but showed little motivation to improve their diet. In conclusion, the findings of this study suggest that improvement of opportunities for safe outdoor time, social support, and availability of healthy food would be useful to explore to promote the health behaviours of Mexican adolescents.

A dieta e os níveis de atividade física dos adolescentes mexicanos estão aquém das recomendações para a saú-de. O objetivo deste estudo foi explorar as barreiras percebidas por adolescentes mexicanos e facilitadores da atividade física e da alimentação saudável. Doze grupos focais unissexuais foram realizados em seis escolas secundárias na Cidade do México durante três meses a partir de outubro de 2016. Os dados foram analisados por meio da Análise Temática Indutiva. Foram identificados três temas: compreensão do nexo saúde-comportamento, impacto da restrição de vida e apoio social. Os participantes compreenderam como a atividade física contribui para múltiplas dimensões da saúde e como a dieta contribui para a saúde física. Identificaram a socialização, a diversão e o alívio do estresse como facilitadores da atividade física, e o conhecimento e o desejo por alimentos saudáveis como facilitadores para uma alimentação saudável. As barreiras incluíram instalações inadequadas, tempo insuficiente dentro das estruturas escolares atuais e apoio social inadequado dos professores. Barreiras de atividade física específicas do contexto de preocupações com a segurança da vizinhança e suporte familiar limitado também foram relatados. Os participantes tinham um conhecimento básico sobre alimentação saudável, mas mostraram pouca motivação para melhorar sua dieta. Em conclusão, os resultados deste estudo sugerem que a melhoria das oportunidades de tempo seguro ao ar livre, apoio social e disponibilidade de alimentos saudáveis seria útil para explorar para promover os comportamentos de saúde de adolescentes mexicanos.

Perception of Medical Students Regarding Implementing Telemedicine Practice Activities at a University Center in Brazil / Percepção de Estudantes de Medicina sobre a Implementação de Vivências em Telemedicina em um Centro Universitário do Brasil

Objective: evaluate medical students' perceptions regarding implementing Telemedicine teaching during their undergraduate studies. Methods: this is a cross-sectional qualitative study with 30 medical students. Three focus group sessions were conducted, and the data were analyzed using a content analysis approach. Results/Discussion: the students recognized the importance of digital health strategies and digital information and communication technologies (ICTs) for the healthcare ecosystem. However, some students pointed out that this area is still challenging for some doctors who oppose Telemedicine. They reported a need for training professionals and students, emphasizing the need to improve skills and competencies for teleconsultation and other Telemedicine modalities. They stated that these experiences helped them enhance their empathy skills for establishing a good doctor-patient relationship. When referring to the negative aspects of the experiences, they mentioned the dependence on reliable internet connection and digital tools. Another limitation mentioned was the difficulty in conducting specific physical examination components. Conclusions: the students experienced Telemedicine activities in a safe healthcare environment, learning about the bioethical principles for responsible teleconsultations, understanding the limiting factors of the method, and having the opportunity to improve skills and competencies for their future professional practice.

Objetivo: avaliar a percepção dos estudantes de Medicina quanto à implementação do ensino da Telemedicina durante a graduação. Métodos: trata-se de um estudo qualitativo transversal com 30 alunos do curso de Medicina. Foram realizadas três sessões de grupos focais e os dados foram analisados através de uma abordagem de análise de conteúdo. Resultados/Discussão: os estudantes reconheceram a importância das estratégias de Saúde Digital e das Tecnologias Digitais de Informação e Comunicação (TIC) para o ecossistema de saúde. Contudo, alguns estudantes apontaram que esta área ainda é um desafio para alguns médicos que se opõem à prática da Telemedicina. Relataram a necessidade de capacitação de profissionais e estudantes, enfatizando a necessidade de aprimoramento de habilidades e competências para teleconsultas e outras modalidades de Telemedicina. Afirmaram que as vivências os ajudaram a melhorar as suas capacidades de empatia para estabelecer uma boa relação médico-paciente. Ao se referirem aos aspectos negativos das atividades, mencionaram a dependência de conexão confiável à internet e de ferramentas digitais. Outra limitação citada foi a dificuldade na realização de etapas específicas do exame físico. Conclusões: os estudantes vivenciaram as atividades de Telemedicina em um ambiente de saúde seguro, conhecendo os princípios bioéticos para a prática de teleconsultas responsáveis, compreendendo os fatores limitantes do método e tendo a oportunidade de aprimorar habilidades e competências para a sua futura prática profissional.

Percepções de escolares e merendeiras sobre alimentação escolar: uma análise por grupos focais / Perceptions of schoolchildren and lunch ladies about school meals: a focus groups analysis

Resumo Introdução: O Programa Nacional de Alimentação Escolar (PNAE) destaca-se por ser um dos maiores programas do mundo de alimentação escolar, contemplando o Direito Humano à Alimentação Adequada a estudantes brasileiros. Entretanto, alguns estudos têm observado baixa aceitabilidade e adesão à alimentação escolar. Objetivo: Analisar a percepção de merendeiras e escolares acerca da aceitabilidade e adesão à alimentação escolar. Metodologia: Pesquisa qualitativa realizada através de grupos focais com merendeiras de três escolas e escolares do sexto ao nono ano de escola pública de Sumidouro, Rio de Janeiro, Brasil. Os grupos focais foram realizados utilizando-se roteiros semiestruturados e gravados em áudio e vídeo, posteriormente transcritos e analisados por Análise de Conteúdo. Resultados: Foram identificados seis temas: autoconhecimento, adesão, aceitabilidade, preparo e distribuição da alimentação escolar, cardápio e ambiente. Conclusão: O emprego de esforços na melhoria da infraestrutura e aspecto do ambiente alimentar, com a aquisição de utensílios adequados, alteração no modelo de serviço de distribuição e no modo de preparo das refeições, resultando em cardápios variados, são estratégias que podem contribuir para melhorar a adesão e aceitabilidade à alimentação escolar. Essas mudanças favorecem a promoção de saúde no espaço escolar, com foco em políticas públicas saudáveis.

Abstract Introduction: National School Feeding Program (PNAE) stands out for being one of the largest school feeding programs in the world, contemplating the Human Right to Adequate Food for Brazilian students. However, some research works have observed low acceptability and adherence to school meals. Objective: To analyze the perception of school lunch ladies and students about acceptability and adherence to school meals. Methodology: Qualitative research carried out through focus groups with lunch ladies from three schools and students from the sixth to the ninth grade of a public school in Sumidouro, Rio de Janeiro state, Brazil. The focus groups were carried out using semi-structured scripts and recorded in audio and video, later transcribed and analyzed by Content Analysis. Results: Six themes were identified: self-knowledge, adherence, acceptability, preparation and distribution of school meals, menu and environment. Conclusion: The use of efforts to improve the infrastructure and aspect of the food environment, with the acquisition of adequate utensils, change in the distribution service model and in the way of preparing meals, resulting in varied menus, are strategies that can contribute to improve adherence and acceptability to school meals. These changes favor the promotion of health in the school environment, focusing on healthy public policies.

Investigaciones biomédicas y psicosociales con enfoque comunitario en Ecuador / Biomedical and Psychosocial Research with Community Approach in Ecuador

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

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

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

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

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

Adecuación de mensajes de las guías alimentarias para personas con discapacidad visual en Lima, Perú: una experiencia de validación / Adaptation of food guideline messages for the visually impaired in Lima, Peru: a validation experience

RESUMEN El objetivo de este artículo es describir el proceso de diseño y validación de los mensajes de las guías alimentarias escritas bajo el sistema de lecto escritura braille dirigido a personas con discapacidad visual. El proceso involucró las siguientes etapas: i) diseño y elaboración del material con el contenido de mensajes de las guías alimentarias, así como, la adecuación del formato; ii) validación técnica con representantes del Consejo Nacional para la Integración de la Persona con Discapacidad (CONADIS); y iii) validación operativa mediante grupos focales con niños, adolescentes y adultos con discapacidad visual que saben leer braille. Los participantes confirmaron la legibilidad, claridad y comprensión de los mensajes y aprobaron el formato del material diseñado. Finalmente, se destaca que la participación de informantes claves y personas con discapacidad visual en todas las etapas resultó relevante para la elaboración de un material informativo con los mensajes de alimentación saludable en braille.

ABSTRACT This article aims to describe the design and validation process of food guideline messages written in the braille reading and writing system for people with visual impairment. The process involved the following stages: i) design and elaboration of the material containing the food guideline messages, as well as its adaptation to the format; ii) technical validation with representatives of the National Council for the Integration of Persons with Disabilities (CONADIS); and iii) operational validation through focus groups with children, adolescents and adults with visual disabilities who can read braille. The participants agreed on the legibility, clarity and comprehension of the messages and approved the format of the material. Finally, it should be noted that the participation of key informants and people with visual impairment in all stages was important for the development of an informative material with healthy eating messages in braille.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Validación de Actividades Profesionales Confiables (APROC) para la Certificación de Ginecología y Obstetricia / Validation of Entustable Professional Activities (EPAs) for Gynecology and Obstetrics Certification

Resumen Como parte del diseño de un instrumento para la evaluación de la certificación ante el Consejo Mexicano de Ginecología y Obstetricia en México se llevó a cabo el proceso de validación del constructo a evaluar. De acuerdo con la bibliografía consultada, la educación médica se basa en competencias, por lo que es coherente practicar una evaluación en el mismo tenor. Se decidió utilizar el concepto de Actividades Profesionales Confiables (APROC) porque son un puente entre la competencia y la actividad observable que puede llevar a cabo el sustentante. Se aplicó una metodología de cuatro fases que se inicia con una revisión bibliográfica con la que se definió una lista de APROC para validarla en el contexto mexicano. La fase dos consistió en aplicar la técnica de grupos focales que representarán las regiones médicas definidas por la FEMECOG, después de recabar y analizar la información de los grupos en la fase tres. La última fase consistió en una validación por parte de 10 expertos en Ginecología y Obstetricia para conseguir un nivel de acuerdo mayor al 80% en cada APROC. Como resultados de este proceso de validación de constructo a evaluar se obtuvo una lista de 15 APROC con alcances (definición de las delimitaciones de las APROC, dónde inician y dónde terminan) con un nivel de aceptación superior al 80%. Además, se corroboró la eficacia de la metodología cualitativa para realizar validaciones en donde las partes interesadas que podrían participar para definir áreas o temas no cuenten con disponibilidad debido a sus actividades laborales.

Abstract As part of the design of an instrument to evaluate the certification of the Mexican Council of Gynaecology and Obstetrics in Mexico, the validation process of the construct to be evaluated was carried out. According to the literature consulted, medical education is based on competencies, so it is coherent to carry out an evaluation in the same vein. It was decided to use Entrustable Professional Activities (EPA), as they provide a link between the competence and the observable activity that the supporter can perform. A four-phase methodology was carried out, starting with a bibliographic review that defined a list of EPAs in order to validate them for the Mexican context. The second phase consisted of using the technique of focus groups, representing the medical regions defined by FEMECOG in the country, once the information from the groups had been collected and analysed in the third phase, and the final phase consisted of validation by 10 experts in gynaecology and obstetrics, in order to achieve a level of agreement of more than 80% in each EPA. As a result of this validation process of the construct to be evaluated, a list of 15 EPAs with scopes (definition of the boundaries of the EPAs, where they start and how far they end) was obtained with a level of acceptance greater than 80%, in addition to confirming the effectiveness of the qualitative methodology to carry out validations when the interested parties who could participate in defining areas or topics are not available due to their work activities.

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

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

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

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

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

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