Propuesta de procedimientos para elaborar tareas integradoras en asignaturas de la carrera Medicina / Proposal of procedures to develop integrative tasks in subjects from Medicine career

RESUMEN Fundamento: La educación médica en el siglo XXI exige de un estudiante capaz de captar las conexiones entre las diferentes asignaturas para dar solución a determinada problemática y puedan integrar aquello que se les enseñó aisladamente en las asignaturas. Objetivo: Describir procedimientos generales de las asignaturas de Anatomía Patológica, Microbiología y Genética para elaborar tareas integradoras que contribuyan al desarrollo de la independencia cognoscitiva de los estudiantes de la carrera Medicina. Desarrollo: Se exponen las características de las tareas docentes integradoras y los procedimientos para su elaboración a partir de la determinación de los nodos interdisciplinarios entre las asignaturas de Anatomía Patológica, Microbiología y Genética. Conclusiones: Los procedimientos que se presentan para la elaboración de las tareas docentes integradoras, orientan metodológicamente la actividad del profesor para desarrollar la independencia cognoscitiva de los estudiantes de la carrera Medicina.

ABSTRACT Background: In the 21st century, medical education requires a student capable of understanding the relations among the different subjects in order to solve a certain problem and integrate everything taught in isolation in all of them. Objective: To describe general procedures in the Pathological Anatomy, Microbiology and Genetics subjects to elaborate integrative tasks that contribute to the development of the cognitive independence in Medicine students. Development: The characteristics of the integrating teaching tasks and the procedures for their elaboration from the determination of the interdisciplinary nodes among the Pathological Anatomy, Microbiology and Genetics subjects are exposed. Conclusions: The procedures presented for the elaboration of the integrating teaching tasks, methodologically guide the teacher´s activity to develop the cognitive independence in Medicine students.

Impact of a provider training program on the treatment of children with autism spectrum disorder at psychosocial care units in Brazil

Objective: To develop, implement, and verify the impact of a training program for health care providers working with children with autism spectrum disorder (ASD) in psychosocial care centers for children and adolescents (Centro de Atenção Psicossocial à Infância e à Adolescência - CAPSi) in São Paulo, Brazil. Methods: This quasi-experimental study was conducted with 14 professionals from four CAPSi units. The training program consisted of six phases: 1) pre-intervention observation; 2) meeting with staff to assess the main needs of the training program; 3) developing materials for training and evaluation; 4) meetings to discuss program implementation; 5) a final meeting for case discussion and evaluation; and 6) distance supervision. Three measures were used to evaluate the training program: i) the Knowledge, Attitudes, and Practices (KAP) questionnaire; ii) videos containing questions designed to assess program comprehension; and iii) a satisfaction survey. Results: Thirteen videos were produced to as visual aids for use during the training program, and a further 26 videos were developed to evaluate it. The program was well evaluated by the participants. The video responses and KAP questionnaire scores suggest that staff knowledge and attitudes improved after training. Conclusion: The positive findings of this study suggest that the tested training program is feasible for use with multidisciplinary teams working in the CAPSi environment.

Brazilian Portuguese translation, cross-cultural adaptation, and apparent validation of the Trauma and Attachment Belief Scale / Tradução para o Português brasileiro, adaptação transcultural e validação aparente da Trauma and Attachment Belief Scale

Abstract Objective This article concerns the translation, cross-cultural adaptation, and apparent validation of the Trauma and Attachment Belief Scale (TABS), an instrument used to assess the psychological effects of traumatic life experiences and vicarious trauma. Methods This study involved literature review and evaluation of conceptual and item equivalences involving expert discussion groups focused on the existence and pertinence of the underlying theoretical concepts and corresponding items in a Brazilian context. Two translations and respective back-translations were performed during the evaluation of semantic equivalence, as well as an evaluation considering the referential and general equivalences between the original TABS and each version. Twenty-eight psychiatrists and psychologists completed a pretest. The final version was tested for reliability through the Cronbach's alpha and for verbal comprehension through the adapted verbal-numeric scale (ranging from 0 [I didn't understand anything] to 5 [I understood perfectly and I had no doubt]) in another 64 health professionals. Results The cross-cultural adaptation demonstrated high semantic equivalence for both the general (>95.0%) and the referential (>90.0%) meaning. The total Cronbach's alpha was 0.9173. All 84 items were maintained, and they favorably contributed to the internal consistency of the scale. The mean values of the adapted verbal-numeric scale for verbal comprehension obtained from health professionals varied from 4.2 to 4.9. Conclusion The Brazilian version of the TABS demonstrated high-quality conceptual, item, and semantic equivalence with the original instrument, as well as high acceptability, internal consistency, and verbal comprehension. The scale is now available for use.

Resumo Objetivo Este artigo se refere à tradução, adaptação transcultural e validação aparente da Trauma and Attachment Belief Scale (TABS), instrumento utilizado para avaliar os efeitos psicológicos das experiências de vida traumáticas e do trauma vicário. Métodos Este estudo envolveu uma revisão de literatura e avaliação da equivalência conceitual e dos itens, empregando grupos de discussão de especialistas, focando na existência e pertinência dos conceitos teóricos subjacentes e na correspondência dos itens dentro de um contexto brasileiro. Duas traduções e respectivas retrotraduções foram realizadas durante a avaliação da equivalência semântica, bem como foi feita uma avaliação considerando a equivalência referencial e geral entre a TABS original e cada versão. Vinte e oito psiquiatras e psicólogos completaram um pré-teste. A versão final foi testada para confiabilidade através do alfa de Cronbach e para compreensão verbal através de uma escala verbal-numérica adaptada [variando de 0 (Eu não entendi nada) a 5 (Eu entendi perfeitamente e não tive qualquer dúvida)] em outros 64 profissionais de saúde. Resultados A adaptação transcultural demonstrou alta equivalência semântica, tanto para o significado geral (>95,0%) quanto referencial (>90,0%). O alfa de Cronbach total foi de 0,9173. Todos os 84 itens foram mantidos e contribuíram favoravelmente para a consistência interna da escala. Os valores médios da escala verbal-numérica adaptada para a compreensão verbal obtidos dos profissionais de saúde variaram de 4,2 a 4,9. Conclusão A versão brasileira da TABS demonstrou equivalência conceitual, de itens e semântica de alta qualidade com o instrumento original, bem como elevada aceitabilidade, consistência interna e compreensão verbal. A escala está atualmente disponível para uso.

Residência integrada em Saúde: percepção dos atores da ênfase em Saúde da Família e Comunidade / Integrated residency in Health: perception of the players with emphasis on Family and Community Health / Residencia Integrada en Salud: percepción de los actores da énfasis en Salud de la Familia y Comunidad

O estudo analisa a percepção dos atores envolvidos sobre a contribuição da Residência Integrada com ênfase em Saúde da Família e Comunidade (RISSFC-ESP) para o fortalecimento da Estratégia Saúde da Família (ESF). A metodologia utilizada foi estudo de caso analítico, sendo realizadas 42 entrevistas com gestores, trabalhadores, preceptores e residentes de sete municípios do Ceará, Brasil, de julho de 2015 a agosto de 2016. Na percepção dos entrevistados, a RISSFC-ESP, por meio da dinâmica da educação pelo trabalho, implementou equipes multiprofissionais de residentes na ESF e no Núcleo de Apoio à Saúde da Família (Nasf), promoveu o diagnóstico situacional de saúde das comunidades; e o planejamento e operacionalização de ações de promoção e de atenção à saúde, tendo contribuído para a melhoria do acesso, da integralidade e da coordenação do cuidado dos usuários nos territórios contemplados. Conseguiu-se superar deficiências infraestruturais com ressignificação de práticas e articulação das redes sociais nas comunidades.(AU)

The study analyses the perception of the players involved in the Integrated Residency with an emphasis on Family and Community Health (RISSFC-ESP) for strengthening the Family Health Strategy (FHS). The method applied was the analytical case study, whereas 42 interviews with managers, workers, tutors, and residents from seven cities of Ceará state, Brazil, from July 2015 to August 2016, were carried out. In the perception of the respondents, the RISSFC-ESP, through the education in work dynamics, implemented multidisciplinary teams of residents in FHS and in Family Health Support Centers (NASF), promoted the health situational diagnosis of the communities; and the planning and operationalization for promoting activities and health care; thus contributing to improve health care access, integration, and coordination for users in the covered regions. Infrastructure deficits were overcome with the redefinition of the practices and the coordination of social networks in the communities.(AU)

El estudio analiza la percepción de los actores envueltos sobre la contribución de la Residencia Integrada con énfasis en Salud de la Familia y Comunidad (RISSFC-ESP) para el fortalecimiento de la Estrategia Salud de la Familia (ESF). La metodología utilizada fue un estudio de caso analítico, realizándose 42 entrevistas con gestores, trabajadores, preceptores y residentes de siete municipios de Ceará, Brasil, de julio/2015 a agosto/2016. En la percepción de los entrevistados, la RISSFC-ESP, por medio de la dinámica de la educación por el trabajo, implementó equipos multi-profesionales de residentes en la ESF y en el NASF, promovió el diagnóstico situacional de salud de las comunidades; y la planificación y puesta en operación de acciones de promoción y de atención a la salud, habiendo contribuido en la mejora del acceso, de la integralidad y de la coordinación del cuidado de los usuarios en los territorios incluidos. Fue posible superar deficiencias infraestructurales con resignificación de prácticas y articulación de las redes sociales en las comunidades.(AU)

Spatial-temporal trends and risk of suicide in Central Brazil: an ecological study contrasting indigenous and non-indigenous populations

Objective: To examine spatial-temporal distribution and risk of suicide, as well as trends in suicide mortality rates, in the indigenous and non-indigenous population of the state of Mato Grosso do Sul, Brazil. Methods: Data were obtained from the Information Department of the Brazilian Unified Health System. Deaths recorded as voluntary self-inflicted injuries (ICD-10 codes X60.0 to X84.9) were considered suicide. Suicide rates were estimated and adjusted by age in the population > 9 years of age. Kernel analysis was used to assess the spatial distribution of suicide cases, while trend analysis was carried out using a non-parametric test (Mann-Kendall). Results: The suicide risk among the indigenous population was 8.1 (95%CI 7.2-9.0) times higher than in the non-indigenous population. For indigenous residents in the 15-24 age group, the risk was 18.5 (95%CI 17.5-19.6) times higher than in the non-indigenous population. The majority of indigenous cases were concentrated in a few villages in reservation areas, mainly occupied by Guarani-Kaiowá and Guarani-Ñandeva groups. Rate patterns remained stable over time in both groups. Conclusion: Suicide is a serious public health problem in Mato Grosso do Sul, and has had an alarming and disproportionate impact on the indigenous population for more than a decade.

Motor development of children with attention deficit hyperactivity disorder

Objective:To compare both global and specific domains of motor development of children with attention deficit hyperactivity disorder (ADHD) with that of typically developing children.Methods:Two hundred children (50 children with clinical diagnoses of ADHD, according to the DSM-IV-TR and 150 typically developing controls), aged 5 to 10 years, participated in this cross-sectional study. The Motor Development Scale was used to assess fine and global motricity, balance, body schema, and spatial and temporal organization.Results:Between-group testing revealed statistically significant differences between the ADHD and control groups for all domains. The results also revealed a deficit of nearly two years in the motor development of children with ADHD compared with the normative sample.Conclusion:The current study shows that ADHD is associated with a delay in motor development when compared to typically developing children. The results also suggested difficulties in certain motor areas for those with ADHD. These results may point to plausible mechanisms underlying the relationship between ADHD and motor difficulties.

Telemental health in Brazil: past, present and integration into primary care

Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization. Objective To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care. Methods Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication. Results The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care. Discussion Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research...

Recovery: revisão sistemática de um conceito / Recovery: systematic review of a concept

O conceito de recovery tem sido descrito em artigos como um estado de recuperação ou restabelecimento de funções psíquicas, físicas e sociais no funcionamento cotidiano. O objetivo do artigo é analisar concepções terminológicas em diferentes metodologias investigativas e a evolução paradigmática da noção de recovery. Pesquisa bibliográfica sistemática na base Pubmed com as palavras "recovery + schizophrenia", limitada a dois anos retrospectivos e a artigos completos gratuitos. Dezenove artigos foram analisados. A maioria destes busca associações entre dada característica e recovery, poucos são aqueles que discutem a sua concepção de forma que se distinga de termos comuns como "cura" e "reabilitação". Recovery como um estado em que o portador de transtorno mental grave possa sentir-se criador de seus caminhos tende a estar presente em estudos com metodologia qualitativa e em revisões bibliográficas, em que a medida de recovery deixa de relacionar-se à ausência de sintomas e passa a priorizar o quão participativa pode ser a vida de um indivíduo apesar da doença. Alguns estudos quantitativos vislumbram essa diferença conceitual. Em pesquisas qualitativas ocorre expansão na concepção de recovery e nas formas de promovê-lo.

The concept of recovery has been described in papers as a state of psychic, physical and social recuperation of day-to-day functions. The scope of this article is to analyze the concepts of the term in different research methodologies and the paradigmatic evolution of the recovery concept. Systematic bibliographical research was conducted in the Pubmed database using the words "recovery + schizophrenia" limited to freely available full papers published in the previous two years. Nineteen papers were analyzed. The majority of the papers sought associations between characteristic data and recovery; few papers discussed the concept in a way to distinguish it from other words like cure or rehabilitation. Recovery as a state in which people with severe mental illness can feel like the creators of their own itinerary tend to be found in qualitative studies and in bibliographic reviews in which the meaning of recovery is not related to the lack of symptoms and tends to prioritize how participative the life of an individual can be despite the disease. Some quantitative studies detect this conceptual difference. In qualitative research there is an increase in the concept of recovery and in ways of promoting it.