Itinerário da família para obter o diagnóstico da criança com necessidades especiais de saúde / Itinerario de la familia para obtener el diagnóstico del niño con necesidades especiales de salud / The itinerary of families to obtain the diagnosis of the children with special healthcare needs

RESUMO Objetivo: conhecer o itinerário percorrido pela família para a obtenção do diagnóstico da criança com necessidades especiais de saúde. Método: realizou-se estudo qualitativo em uma unidade de internação pediátrica do sul do Brasil. Utilizou-se como referencial metodológico a Grounded Theory. Participaram 16 familiares cuidadores. Os dados foram coletados em 2019 por entrevistas e submetidos à codificação aberta e axial. Resultados: as famílias percorreram um longo itinerário até o recebimento do diagnóstico da criança: detectaram alterações no seu estado geral, realizaram diversos exames, desconfiaram o diagnóstico por já ter outros com o mesmo na família, receberam informações dos profissionais da saúde acerca dos cuidados necessários e dos serviços especializados para o seu tratamento, apresentaram medo, pânico, negação e valorizaram a fé em Deus na esperança da melhora da criança. Considerações finais: o enfermeiro necessita desenvolver um processo educativo junto à família para que ela se sinta preparada e capaz de cuidar dessas crianças.

RESUMEN Objetivo: conocer el itinerario recorrido por la familia para la obtención del diagnóstico del niño con necesidades especiales de salud. Método: se realizó estudio cualitativo en una unidad de hospitalización pediátrica del sur de Brasil. Se utilizó como referencial metodológico la GroundedTheory. Participaron 16 familiares cuidadores. Los datos fueron recolectados en 2019 por entrevistas y sometidos a la codificación abierta y axial. Resultados: las familias recorrieron un largo itinerario hasta la recepción del diagnóstico del niño: detectaron alteraciones en su estado general; realizaron diversos exámenes; desconfiaron del diagnóstico por tener ya otros con el mismo en la familia; recibieron informaciones de los profesionales de la salud acerca de los cuidados necesarios y de los servicios especializados para su tratamiento; presentaron miedo, pánico y negación; y valoraron la fe en Dios en la esperanza de la mejora del niño. Consideraciones finales: el enfermero necesita desarrollar un proceso educativo con la familia para que ella se sienta preparada y capaz de cuidar a esos niños.

ABSTRACT Objective: to know the itinerary taken by the family to obtain the diagnosis of the children with special health needs. Method: a qualitative study was carried out in a pediatric inpatient unit in southern Brazil. Grounded Theory was used as a methodological reference. Sixteen (16) family caregivers participated. Data were collected in 2019 through interviews and submitted to open and axial coding. Results: the families traveled a long route until receiving the children's diagnosis: they detected changes in their general condition; performed several exams; they were suspicious of the diagnosis because other members of the family had already been diagnosed with the same conditions; received information from health professionals about the necessary care and specialized services for the treatment; showed fear, panic and denial; and they valued faith in God in the hope of improving of the children. Final considerations: nurses need to develop an educational process with the family so that they feel prepared and capable of taking care of these children.

Influence of life habits and behaviors on the health of adolescents / Influencia de los hábitos y comportamientos de vida en la salud de los adolescentes / Influência de hábitos de vida e comportamentos na saúde de adolescentes

Objective: To identify the influence of life habits and behaviors on the health of adolescents. Materials and method: This is a quantitative research, with an exploratory and descriptive approach, developed with 124 adolescents, students from a pre-professional school in southernmost Brazil. Data was collected by means of a questionnaire. The analysis was performed using descriptive statistics by means of the SPSS software, version 20.0. Results: The high consumption of ultra-processed food in intermediate meals and insufficient sleep hours per night cause risks to the health of adolescents. Practicing physical activities has proved to be a health protection habit. Conclusions: The adolescents need to reframe the importance of healthy eating and sleep in their routine. It was observed that there are modifiable factors for sleep improvement in quality and quantity, as well as the value and inclusion of in natura food in intermediate meals. We believe that the role of nurses in school spaces, giving rise to joint reflections on the process of self-care, health concepts, risky and healthy behaviors, is capable of promoting and protecting the health of adolescents and preventing morbidities in the future.

Objetivo: identificar la influencia de los hábitos de vida y comportamientos de los adolescentes en su salud. Materiales y método: investigación cuantitativa, con un enfoque exploratorio y descriptivo, desarrollada con 124 adolescentes, estudiantes de una escuela preuniversitaria en el extremo sur de Brasil. Los datos se recolectaron mediante cuestionario. El análisis se realizó con la utilización de estadísticas descriptivas con el software SPSS, versión 20.0. Resultados: el alto consumo de alimentos ultraprocesados en las comidas intermedias y la cantidad insuficiente de sueño por noche representan riesgos para la salud de los adolescentes. La realización de actividades físicas resultó ser un hábito de protección de la salud. Conclusiones: los adolescentes deben resignificar la importancia de una alimentación saludable y del sueño en su rutina. Se observó que existen factores modificables para que el sueño mejore en calidad y cantidad, igualmente el valor y la inclusión de alimentos in natura en las comidas intermedias. Creemos que el papel del enfermero en los espacios escolares tiene que dar lugar a reflexiones conjuntas sobre el proceso de autocuidado, conceptos de salud, comportamientos de riesgo y saludables. Igualmente, promover y proteger la salud de los adolescentes y prevenir las morbilidades en el futuro.

Objetivo: identificar a influência de hábitos de vida e de comportamentos na saúde de adolescentes. Materiais e método: trata-se de uma pesquisa de natureza quantitativa, com abordagem exploratória e descritiva, desenvolvida com 124 adolescentes, estudantes de uma escola pré-profissionalizante no extremo sul do Brasil. Foram coletados dados mediante questionário. A análise foi feita com a utilização da estatística descritiva por meio do software SPSS, versão 20.0. Resultados: o alto consumo de alimentos ultraprocessados nas refeições intermediárias e a quantidade insuficiente de sono por noite causam riscos à saúde dos adolescentes. A realização de atividades físicas mostrou-se como hábito de proteção à saúde. Conclusões: os adolescentes precisam ressignificar a importância da alimentação saudável e do sono em sua rotina. Observou-se que existem fatores modificáveis para que o sono melhore em qualidade e quantidade, assim como o valor e inclusão dos alimentos in natura nas refeições intermediárias. Acreditamos que a atuação do enfermeiro nos espaços escolares, suscitando reflexões conjuntas sobre o processo de autocuidado, conceitos de saúde, comportamentos de risco e saudáveis, é capaz de promover e proteger a saúde dos adolescentes e prevenir morbidades no futuro.

Obstetric violence in the perception of multiparous women.

OBJECTIVE: To know the perception of multiparous women about their experiences with obstetric violence. METHODS: Qualitative descriptive study carried out from January to May 2019 in basic health units in the city of Rio Grande, Rio Grande do Sul. Twenty multiparous women from the community participated in the study. Data were collected through interviews and submitted to content analysis. RESULTS: Two subcategories were constructed: Obstetric Violence in primiparous women, where women suffered verbal violence to collaborate during fetal expulsion in labor; Obstetric violence in multiparous women, where there was verbal and physical violence related to the fact that the women had many children. FINAL CONSIDERATIONS: Obstetric violence in health institutions is experienced by many women. The trauma suffered will follow them through their lives. The naturalization of violent practices during labor and birth should be avoided, in order to ensure respectful and non-discriminatory care.

Expressions of Individualization on the Internet and Social Media: Multigenerational Focus Group Study.

BACKGROUND: Growing individualization within the past decades has been described as a fundamental shift in society. Studies have reported how the digital age promotes new forms of individualism with self-tracking technologies and self-presentation in social networks. Potential harmful effects on the mental health of young adults have already been at the forefront of research. However, 2 questions that remain unanswered are how emotional experiences and expressions of self-relatedness differ among generations in their usage of the internet and social media, and if an increasing individualism can be observed by this. OBJECTIVE: The aim of this study is to examine whether the use of the internet and social media has led people to be more concerned about themselves than former generations. The potential consequences of mental and emotional distress among different age groups are analyzed. METHODS: A focus-group approach was chosen to study the following age groups: Baby Boomers (those born in 1950-1965), Generation X (those born in 1966-1980), and Digital Natives (those born in 1981-2000). We organized 6 focus groups with 36 participants who discussed their private usage of the internet and social media, different devices, platforms and functions, communication behavior, and self-tracking. We applied inductive category formation and followed the Standards for Reporting Qualitative Research (SRQR) checklist. RESULTS: We found differences in the 3 studied generations regarding the reasons for their use of the internet and social media, the effects of this use, personal feelings and experiences, expressions of self-relatedness, and social relationships. The Baby Boomers voiced a wish to stay autonomous while being in contact with their personal network. Generation X included enthusiastic members who appreciate self-tracking for curiosity and fascination, as well as people who felt fears about data surveillance. The Digital Natives reported a wish to optimize their own body by self-tracking while being faced with norms and expectations that were communicated via the internet and social media. CONCLUSIONS: All generations expressed self-relatedness, yet by different means. The Baby Boomers expressed less individualism than Generation X and the Digital Natives, who felt the highest strain due to social comparisons. However, all generations reported specific, potentially problematic consequences for their mental health. Age-specific coping strategies are necessary to promote a mentally healthy way of using the internet and social media.

Obstetric violence in the perception of multiparous women / Violencia obstétrica en la percepción de multíparas / A violência obstétrica na percepção das multíparas

ABSTRACT Objective: To know the perception of multiparous women about their experiences with obstetric violence. Methods: Qualitative descriptive study carried out from January to May 2019 in basic health units in the city of Rio Grande, Rio Grande do Sul. Twenty multiparous women from the community participated in the study. Data were collected through interviews and submitted to content analysis. Results: Two subcategories were constructed: Obstetric Violence in primiparous women, where women suffered verbal violence to collaborate during fetal expulsion in labor; Obstetric violence in multiparous women, where there was verbal and physical violence related to the fact that the women had many children. Final considerations: Obstetric violence in health institutions is experienced by many women. The trauma suffered will follow them through their lives. The naturalization of violent practices during labor and birth should be avoided, in order to ensure respectful and non-discriminatory care.

RESUMEN Objetivo: Conocer la percepción de las mujeres multíparas sobre sus experiencias con la violencia obstétrica. Métodos: Estudio descriptivo cualitativo llevado a cabo de enero a mayo de 2019 en unidades básicas de salud en la ciudad de Rio Grande, Rio Grande do Sul. Participaron veinte mujeres multíparas de la comunidad. Los datos fueron recolectados a través de entrevistas y sometidos a análisis de contenido. Resultados: Se construyeron dos subcategorías: violencia obstétrica cuando era primípara, donde las mujeres sufrían violencia verbal para colaborar con el período expulsivo del parto; Violencia obstétrica cuando es multípara, donde se observó violencia verbal y física, guiada por la gran cantidad de niños que tuvieron. Consideraciones finales: La violencia obstétrica en las instituciones de salud es un hecho experimentado por muchas mujeres. El trauma sufrido los acompaña a lo largo de sus vidas. Es necesario evitar la naturalización de las prácticas violentas durante el proceso de nacimiento / parto, garantizando una atención respetuosa y no discriminatoria.

RESUMO Objetivo: Conhecer a percepção das multíparas acerca das suas experiências com a violência obstétrica. Métodos: Estudo qualitativo descritivo realizado de janeiro a maio de 2019 nas unidades básicas de saúde do município de Rio Grande, Rio Grande do Sul. Participaram 20 mulheres multíparas da comunidade. Os dados foram coletados por entrevistas e submetidos à análise de conteúdo. Resultados: Foram construídas duas subcategorias: Violência Obstétrica quando primíparas, onde as mulheres sofriam violência verbal para colaborarem com o período expulsivo do parto; Violência Obstétrica quando multíparas, onde foi observada violência verbal e física, pautadas pelo grande número de filhos que possuíam. Considerações finais: A violência obstétrica nas instituições de saúde é fato vivenciado por muitas mulheres. O trauma sofrido as acompanha ao longo da vida. É preciso evitar a naturalização de práticas violentas durante o processo de parto/nascimento garantindo um cuidado respeitoso e sem discriminação.

Dificuldades encontradas pela família no cuidado à criança/adolescente com HIV / Difficulties encountered by families in caring for children or adolescents with HIV / Dificultades encontradas por la familia en el cuidado al niño/adolescente con VIH

Objetivo: conhecer as dificuldades encontradas pela família para o cuidado à criança/adolescente com HIV. Metodologia: pesquisa qualitativa realizada em um Hospital Dia no sul do Brasil em 2018. Participaram 20 familiares cuidadores de crianças/adolescentes soropositivas. Os dados foram coletados por entrevistas e submetidos à Análise de Conteúdo. Respeitaram-se os princípios éticos. Resultados: as famílias afirmaram não ter facilidades no cuidado. Referiram dificuldades em manter o sigilo do diagnóstico para a criança/adolescente; na adesão desta à medicação e minimização dos seus efeitos colaterais, em seguir os horários de administração; na assiduidade às consultas; em sofrer preconceito e na aceitação da sociedade diante da doença, incluindo a preocupação com o futuro da criança/adolescente. Conclusão: verificou-se como importante a atuação dos profissionais da saúde/ enfermeiros investindo em uma assistência voltada para a promoção de saúde de crianças e adolescentes com HIV, promovendo educação em saúde e o manejo das dificuldades enfrentadas com o cuidado.

Objective: to learn the difficulties encountered by families in caring for children or adolescents with HIV. Methodology: this qualitative study was conducted at a day hospital in southern Brazil in 2018. The participants were 20 family caregivers of seropositive children or adolescents. Data were collected through interviews and subjected to Content Analysis. Ethical principles were respected. Results: the families claimed to have no care facilities. They reported difficulties in keeping the children's or adolescents' diagnosis confidential; securing adherence to medication and administration schedules; minimizing side effects; attending appointments; suffering prejudice and gaining social acceptance of the disease, which included concern for the children's or adolescents' futures. Conclusion: it was found to be important that health professionals' or nurses' invest in care focused on promoting the health of children and adolescents with HIV, furthering health education and managing the difficulties encountered in care.

Objetivo: conocer las dificultades encontradas por la familia para el cuidado al niño/adolescente con VIH. Método: investigación cualitativa realizada en un Hospital Día en el sur de Brasil en 2018. Participaron 20 familiares cuidadores de niños/adolescentes seropositivos. Los datos fueron recolectados por entrevistas y sometidos al Análisis de Contenido. Se respetaron los principios éticos. Resultados: las familias afirmaron no tener facilidades en el cuidado. Dijeron que tienen dificultades para mantener el secreto del diagnóstico junto al niño/adolescente, también para su adherencia a la medicación y minimización de sus efectos colaterales, para seguir los horarios correctos de administración; la asiduidad de las consultas; por sufrir con los prejuicios y la dificultad de aceptación social de la enfermedad y la preocupación por el futuro del niño/adolescente. Conclusión: se verificó que es muy importante la actuación de los profesionales de salud/enfermeros que invierten en una atención volcada a la promoción de salud de niños y adolescentes con VIH, promoviendo la educación sanitaria y la gestión de las dificultades enfrentadas con el cuidado.

Acceptance and Expectations of Medical Experts, Students, and Patients Toward Electronic Mental Health Apps: Cross-Sectional Quantitative and Qualitative Survey Study.

BACKGROUND: The acceptability of electronic mental (e-mental) health apps has already been studied. However, the attitudes of medical experts, students, and patients taking into account their knowledge of and previous experiences with e-mental health apps have not been investigated. OBJECTIVE: The aim of this study was to explore the attitudes, expectations, and concerns of medical experts, including physicians, psychotherapists and nursing staff, students of medicine or psychology, and patients toward e-mental health apps when considering their knowledge of and former experiences with e-mental health apps. METHODS: This cross-sectional quantitative and qualitative survey was based on a self-developed questionnaire. A total of 269 participants were included (104 experts, 80 students, and 85 patients), and 124 eligible participants answered a paper version and 145 answered an identical online version of the questionnaire. The measures focused on existing knowledge of and experiences with e-mental health apps, followed by a question on whether electronic health development was generally accepted or disliked. Further, we asked about the expectations for an ideal e-mental health app and possible concerns felt by the participants. All items were either presented on a 5-point Likert scale or as multiple-choice questions. Additionally, 4 items were presented as open text fields. RESULTS: Although 33.7% (35/104) of the experts, 15.0% (12/80) of the students, and 41.2% (35/85) of the patients knew at least one e-mental health app, few had already tried one (9/104 experts [8.7%], 1/80 students [1.3%], 22/85 patients [25.9%]). There were more advocates than skeptics in each group (advocates: 71/104 experts [68.3%], 50/80 students [62.5%], 46/85 patients [54.1%]; skeptics: 31/104 experts [29.8%], 20/80 students [25.0%], 26/85 patients [30.6%]). The experts, in particular, believed, that e-mental health apps will gain importance in the future (mean 1.08, SD 0.68; 95% CI 0.94-1.21). When asked about potential risks, all groups reported slight concerns regarding data security (mean 0.85, SD 1.09; 95% CI 0.72-0.98). Patient age was associated with several attitudes toward e-mental health apps (future expectations: r=-0.31, P=.005; total risk score: r=0.22, P=.05). Attitudes toward e-mental health apps correlated negatively with the professional experience of the experts (rs(94)=-0.23, P=.03). CONCLUSIONS: As opposed to patients, medical experts and students lack knowledge of and experience with e-mental health apps. If present, the experiences were assessed positively. However, experts show a more open-minded attitude with less fear of risks. Although some risks were perceived regarding data security, the attitudes and expectations of all groups were rather positive. Older patients and medical experts with long professional experience tend to express more skepticism. TRIAL REGISTRATION: German Clinical Trials Register DRKS00013095; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00013095.

Stress and stressors of medical student near-peer tutors during courses: a psychophysiological mixed methods study.

BACKGROUND: Structured peer-led tutorial courses are widespread and indispensable teaching methods that relieve teaching staff and contribute to the development of students' competencies. Nevertheless, despite high general stress levels in medical students and associated increases in psychopathology, specific knowledge of peer tutors' additional burdens is very limited. METHODS: Sixty student near-peer tutors from two structured peer-teaching programmes volunteered to participate. On multiple occasions in three different course sessions, we assessed tutors' subjective stress, affective state, heart rate variability, and salivary cortisol. Additionally, tutors named everyday and course-specific stressors, which were evaluated by means of content analyses. RESULTS: The study participation rate was high (63% of all active tutors). The participating tutors are socially well adapted and resilient individuals. They report a variety of stressors such as time pressure, participant characteristics, teacher role demands, and study requirements, but nevertheless display only moderate psychological and physiological stress that decreases over sessions. Tutors' negative affect in sessions is low; their positive affect is consistently high for senior as well as novice tutors. Tutors rate their courses' quality as high and quickly recover after sessions. CONCLUSIONS: Tutors successfully cope with teaching-associated and everyday life demands. The results corroborate the viability and success of current peer-teaching programmes from the tutors' perspective. This study is the first to comprehensively quantify tutors' stress and describe frequent stressors, thus contributing to the development of better peer teaching programmes and tutor qualification training.

Professional and Personal Competency Development in Near-peer Tutors of Gross Anatomy: A Longitudinal Mixed-methods Study.

There are many benefits to peer and near-peer tutoring. The current literature suggests that near-peer teaching within the domain of gross anatomy may lead to the development of numerous competencies for burgeoning medical professionals. The aim of this study was a quantitative and qualitative approach to explore which professional and personal competencies anatomy tutors developed as a result of their teaching activities in a gross anatomy course at a medical school in Germany. For a period of 18 months, 24 peer tutors were followed and queried multiple times via questionnaire and semi-structured interviews. It was found that most of the skills tutors developed or strengthened over one semester matched most of the core competencies described in various official competency frameworks used for physician education. In particular, tutors thought that tutoring gross anatomy had improved their knowledge of professional behavior as well as their communication skills. They also felt that they had learned to take on more responsibility and to use available resources more effectively. Overall, tutoring gross anatomy was perceived as very challenging, but also very rewarding, mainly because it provided the opportunity to develop and strengthen important skills such as self-confidence, self-awareness, positive thinking, self-insight, and stress management. Ultimately, these are all factors that contribute to resilience, an important attribute for physicians.

Lifeworld: socio-environmental influence on crack cocaine use by teenagers.

OBJECTIVE: To understand the influence of the lifeworld on crack cocaine use by teenagers undergoing treatment at the Psychosocial Care Center for users of alcohol and other drugs. METHOD: Qualitative research carried out with thirteen teenagers attended at the Psychosocial Care Center for users of alcohol and other drugs, from a municipality in the South of Brazil. The data were collected through semi-structured interviews and the Comprehensive Analysis was carried out from the Phenomenology of the Social World of Alfred Schütz. RESULTS: In the lifeworld, there is influence of the community to which the teenager belongs; of the family, by the excess of permissibility and being in an environment of drug use and violence; and the school, where it is influenced by individuals to consume them. CONCLUSION: Elements from the lifeworld influence the teenager for the consumption of crack cocaine, being necessary actions contextualized with their world of life.

A communication-focused curriculum for dental students - an experiential training approach.

BACKGROUND: Successful interaction and communication with patients is as vital for dentists as it is for physicians. Therefore, the aim of this study was the development and evaluation of an interactive, experiential training curriculum with an emphasis on communication for dual degree seekers of medicine and dentistry. METHODS: A pre-clinical course with an emphasis in physician/dentist-patient communication and interaction was adapted by a team of subject experts based largely on the propositions of Experiential Learning Theory. After attending the course, dental students (N = 81) rated the course on a Likert- style scale and answered two open questions. RESULTS: Students found the interactive course curriculum to be very helpful and vital. Many students reported that their initial interest in the course was mainly because it is a dual degree requirement, but later on rated the course as highly important in terms of later physician/dentist-patient interaction. One aspect of the curriculum course participants regarded as very important, yet neglected during dental studies, was (self-) perception. CONCLUSION: In the view of dental students, the rigorous structure of the pre-clinical dental curriculum does not allow for time spent on topics such as (self-) perception and awareness, but training one's ability to self-reflect and think critically about one's own actions, conduct or position can aid with advanced medical and dental studies and practices later on. Experiential courses with an emphasis on patient-physician/dentist communication should be offered early on during pre-clinical medical and dental studies as a regular part of the curriculum.

Puérperas usuárias de crack: dificuldades e facilidades enfrentadas no cuidado ao recém-nascido / Puérperas dependientes de crack: dificultades y facilidades afrontadas en el cuidado al recién nacido / Crack-Dependent Postpartum Women: Newborn Care Difficulties and Facilities

RESUMO Introdução: os recém-nascidos de usuárias de crack sofrem os efeitos da dependência já nas primeiras horas de vida e podem apresentar quadro de irritabilidade, sudorese, hipertonia e dificuldade nos ciclos de sono e vigília. Essa realidade torna necessário o auxílio profissional à puérpera usuária de crack para sua instrumentalização ao cuidado do recém-nascido. Objetivo: conhecer dificuldades e facilidades de puérperas usuárias de crack no cuidado ao recém-nascido. Método: realizou-se pesquisa com abordagem qualitativa em uma maternidade do sul do Brasil, mediante entrevistas semiestruturadas com 18 puérperas. Resultados: a partir da análise de conteúdo, identificaram-se como dificuldades: abstinência da droga, não amamentação, falta de apoio familiar, vigilância dos profissionais do Conselho Tutelar, falta de habilidade para a realização de cuidados diretos ao recém-nascido, medo de machucá-lo e falta de condições financeiras. Como facilidades, revelaram o fato de o recém-nascido chorar pouco, ser tranquilo e quieto; apoio da família, vizinhos e amigos, e auxílio financeiro do companheiro e familiares. Conclusão: puérperas usuárias de crack necessitam de auxílio para desempenharem seu papel de cuidadoras do recém-nascido. Devem ser captadas durante a gestação e acompanhadas de forma a realizarem o pré-natal, orientadas acerca dos cuidados com a criança e acolhidas em serviços de apoio.

RESUMEN Introducción: los recién nacidos de dependientes de crack sufren los efectos de la dependencia ya en las primeras horas de vida y pueden presentar cuadro de irritabilidad, sudoración, hipertonía y dificultad en los ciclos de sueño y vigilia. Esta realidad requiere el auxilio profesional a la puérpera usuaria de crack para su instrumentalización al cuidado del recién nacido. Objetivo: conocer dificultades y facilidades de puérperas dependientes de crack en el cuidado al recién nacido. Método: se realizó investigación con enfoque cualitativo en una maternidad del sur de Brasil, por medio de entrevistas semiestructuradas con 18 puérperas. Resultados: desde el análisis de contenido, se identificaron como dificultades: abstinencia de la droga, no lactancia, falta de respaldo familiar, vigilancia de los profesionales del Consejo Tutelar (Similar al Bienestar Familiar en Colombia), falta de habilidad para la realización de cuidados directos al recién nacido, miedo a lastimarlo y falta de condiciones financieras. Como facilidades, se encontró que el recién nacido llore poco, sea tranquilo y quieto; respaldo de la familia, vecinos y amigos, y auxilio financiero del compañero y familiares. Conclusión: puérperas dependientes de crack necesitan de auxilio para que cumplan su rol de cuidadoras del recién nacido. Deben ser identificadas durante el embarazo y acompañadas de forma a que realicen el prenatal, orientadas acerca de los cuidados con el niño y recibidas en servicios de apoyo.

ABSTRACT Introduction: Newborns of crack-dependent mothers suffer the effects of drug dependence in the first hours of life and can exhibit irritability, sweating, hypertonia and difficulty in their sleep and wake cycles. This reality means the crack-dependent mother requires professional help to be able to care for her newborn child. Objective: The purpose of the study is to identify the newborn care difficulties and facilities facing postpartum women who are dependent on crack. Method: A qualitative study was conducted at a maternity hospital in southern Brazil, through semi-structured interviews with 18 postpartum women. Results: The content analysis made it possible to identify a number of difficulties; namely, abstinence from crack cocaine, no breastfeeding, lack of family support, surveillance by professionals from the Guardianship Council, lack of ability to care for the newborn, fear of hurting the newborn and financial problems. As for facilities, it was found the newborns of crack-dependent mothers cry little and are quiet and tranquil. Support from family members, neighbors and friends and financial help from the partner and the family are possible resources as well. Conclusion: Crack-dependent postpartum women need help to fulfill their role as newborn caregivers. They should be identified during pregnancy so as to receive guidance during the prenatal period and orientation on newborn care and the support services to which they are entitled.

Lifeworld: socio-environmental influence on crack cocaine use by teenagers / Mundo de la vida: la influencia socioambiental para el consumo de crack por adolescentes / Mundo da vida: influência socioambiental para o consumo de crack por adolescentes

ABSTRACT Objective: To understand the influence of the lifeworld on crack cocaine use by teenagers undergoing treatment at the Psychosocial Care Center for users of alcohol and other drugs. Method: Qualitative research carried out with thirteen teenagers attended at the Psychosocial Care Center for users of alcohol and other drugs, from a municipality in the South of Brazil. The data were collected through semi-structured interviews and the Comprehensive Analysis was carried out from the Phenomenology of the Social World of Alfred Schütz. Results: In the lifeworld, there is influence of the community to which the teenager belongs; of the family, by the excess of permissibility and being in an environment of drug use and violence; and the school, where it is influenced by individuals to consume them. Conclusion: Elements from the lifeworld influence the teenager for the consumption of crack cocaine, being necessary actions contextualized with their world of life.

RESUMEN Objetivo: Comprender la influencia del mundo de la vida en el consumo de crack por adolescentes en tratamiento en un Centro de Atención Psicosocial para usuarios de alcohol y otras drogas. Método: Investigación cualitativa realizada con trece adolescentes atendidos en el Centro de Atención Psicosocial para usuarios de alcohol y otras drogas de un municipio del Sur de Brasil. Los datos fueron recolectados por medio de entrevistas semiestructuradas y el Análisis Comprensivo se realizó a partir de la Fenomenología Social de Alfred Schütz. Resultado: En el mundo de la vida, hay influencia de la comunidad a la que pertenece el adolescente; de la familia, por el exceso de permisibilidad y ser ambiente de uso de drogas y violencia; y de la escuela, donde es influenciado por los individuos a consumirlos. Conclusión: Los elementos del mundo de la vida influencian los adolescentes al consumo de crack, y son necesarias acciones contextualizadas con su mundo de la vida.

RESUMO Objetivo: Compreender a influência do mundo da vida no consumo de crack por adolescentes em tratamento em Centro de Atenção Psicossocial para usuários de álcool e outras drogas. Método: Pesquisa qualitativa realizada com treze adolescentes atendidos no Centro de Atenção Psicossocial para usuários de álcool e outras drogas, de um município do Sul do Brasil. Os dados foram coletados por meio de entrevistas semiestruturadas e a Análise Compreensiva realizou-se a partir da Fenomenologia Social de Alfred Schütz. Resultado: No mundo da vida, há influência da comunidade a qual o adolescente pertence; da família, pelo excesso de permissibilidade e estar em ambiente de uso de drogas e violência; e da escola, onde é influenciado por indivíduos a consumi-las. Conclusão: Elementos do mundo da vida influenciam o adolescente para o consumo de crack, sendo necessárias ações contextualizadas com seu mundo da vida.

Medical educators' perception of communication training with simulated patients: an explorative study approach.

OBJECTIVE: Medical students' perceptions of the use of simulated patients (SP) in communication training in medicine have been studied intensively, but insights about faculty perception of this type of simulation training remain rare. This study aimed to assess medical educators' perception of the relevancy of SP communication training, as well as its closeness to reality. Medical educators were surveyed by standardized questionnaire and open-ended questions. The questionnaire allowed educators to rate several aspects of the training such as its closeness to reality and relevancy to real-life physician-patient interaction. RESULTS: Educators' perception of relevance and realism of SP training increases with teaching experience. This appears to be influenced by factors such as internal or external status of the educator, personal experience with communication training during medical studies, as well as medical field taught. Communication training with SP is valued highly by medical educators mainly because of its versatility and broad spectrum of applicability. The wide range of application of SP in medical education seems most evident to senior educators because of their increased amount of experience with physician-patient interaction, whereas junior educators appear often hindered by the aspect of simulation caused by the thought that the patients are "merely" actors.

Practice Report / Bericht aus der Praxis: An exploration of peer tutor roles and recruitment at German medical schools.

BACKGROUND: Almost all medical faculties in Germany actively employ peer tutors. However, little is known about the roles these tutors play from a faculty point of view. Also, there are only few descriptions of the tutor recruitment and selection processes. METHODS: 32 of the medical faculties in Germany, where tutors are used in the training of medical students, were asked to provide information on the role and recruitment of tutors by means of a partially standardized questionnaire. RESULTS: At the surveyed faculties (return rate 28%), tutors are mostly employed for the purpose of teaching staff support. Even though desired in individual cases, tutors rarely play an active role in curriculum- or faculty development. The way tutor recruitment is handled strongly depends on the capabilities of the individual faculties and the way tutors are utilized. In many cases this process is structured, consisting of written and oral application phases, in other cases recruitment takes place without formal application procedures. The selection criteria, however, were found to be very similar at most faculties. CONCLUSION: The role of tutors from the faculties' point of view depends strongly on the respective nature of the tutorials, which are just as diverse as the approaches to tutor recruitment.

An overview of peer tutor training strategies at German medical schools.

BACKGROUND: An increased popularity of peer-assisted learning in medical schools all over the globe has caused a growing interest in taking a closer look into how student tutors are trained to handle the task. This article provides an overview of the tutor training strategies at five medical faculties in Germany. METHODS: Nine German medical faculties with an evident tutor training strategy were contacted by phone or e-mail. Ultimately, five of the nine contacted faculties responded and provided a detailed overview of their individual tutor training. RESULTS: In many cases, tutors receive a mandatory didactic training in preparation of the tutorials and also an additional technical or specialized training. Frequently, tutor training is provided within the framework of an organized, faculty-based tutor training program. There is a trend towards a needs-adapted training strategy. CONCLUSION: There is a broad variety of peer teaching and tutor training strategies at the various faculties surveyed. Their individual characteristics are determined by factors such as the nature of tutorials and the number of students.

Uso del crack durante el embarazo: repercusiones para el recién nacido / Uso de crack na gestação: repercussões para o recém-nascido / Use of crack in pregnancy: repercussions for the newborn

Objective. To know the effects for the newborn of the use of crack in pregnancy. Methods. This is a qualitative study conducted in a university hospital in southern Brazil, in the first half of 2014. Fifteen mothers crack users and five grandparents participated. The data were produced through semi-structured interviews and later submitted to content analysis. Results. It was found that the use of crack in pregnancy leads to repercussions related to the health of the newborn and repercussions related to family restructuring. In relation to the newborn, prematurity, congenital malformation, hospitalization in an intensive care unit, use of care and feeding technologies through artificial milk formulas were mentioned. In the family context, it was evidenced the occurrence of abandonment of the child by the mother, causing the adoption of the newborn by relatives of the family nucleus or their institutionalization due to lack of family structure. Conclusion. It was found that the use of crack in pregnancy leads to repercussions related to the health of the newborn and repercussions related to family restructuring. In this sense, the recruitment of pregnant users of crack by health/nursing professionals and referral for high-risk prenatal care, as well as early identification of the peculiarities of the newborns of these women, and the development of actions that minimize the repercussions of crack are imperative. (AU)

Objetivo. Conocer las repercusiones para el recién nacido por el consumo de crack durante el embarazo. Método. Estudio cualitativo realizado en un hospital universitario en el sur de Brasil, en el primer semestre de 2014. Participaron quince puérperas usuarias de crack durante la gestación y cinco abuelos. Los datos se recolectaron en entrevistas semiestructuradas y posteriormente se sometieron a análisis de contenido. Resultados. Para los participantes del estudio el uso de crack en la gestación llevó a repercusiones relacionadas con la salud del recién nacido, como prematuridad, malformación congénita, internación en unidad de cuidado intensivo, uso de tecnologías de cuidado y alimentación mediante fórmulas lácteas artificiales. Por otra parte, en el ámbito familiar produjo abandono del niño por por parte de la madre lo que derivo en la adopción del recién nacido por parientes del núcleo familiar o su institucionalización por falta de estructura familiar adecuada. Conclusión. Se constató que el uso de crack en la gestación conlleva a repercusiones relacionadas con la salud del recién nacido y con la desestructuración familiar. En este sentido, se hace indispensable la captación de las gestantes usuarias de crack por los profesionales de la salud y por enfermería para la realización del control prenatal de alto riesgo, así como la identificación precoz de las necesidades de los recién nacidos y el desarrollo de acciones que minimicen las repercusiones del crack. (AU)

Objetivo. Conhecer as repercussões do uso de crack na gestação para o recém-nascido. Método. Trata-se de uma pesquisa do tipo exploratória e descritiva, com abordagem qualitativa, realizada em um hospital universitário no sul do Brasil. Participaram quinze puérperas usuárias de crack e cinco avós. Os dados foram produzidos por meio de entrevistas semiestruturadas e, posteriormente, submetidos à análise de conteúdo. Resultados. Para os participantes de este estudo constatou-se que o uso de crack na gestação acarreta repercussões relacionadas à saúde do recém-nascido e repercussões relacionadas à desestruturação familiar. Em relação ao recém-nascido foram apontadas a prematuridade, malformação congênita, internação em unidade de tratamento intensivo, uso de tecnologias de cuidado e alimentação por meio de fórmulas lácteas artificiais. No âmbito familiar evidenciou-se a ocorrência de abandono da criança pela mãe, ocasionando a adoção do recém-nascido por parentes do núcleo familiar ou a institucionalização do mesmo por falta de estrutura familiar. Conclusão. Constatou-se que o uso de crack na gestação acarreta repercussões relacionadas à saúde do recém-nascido e repercussões relacionadas à desestruturação familiar. Nesse sentido, faz-se imperativa a captação de gestantes usuárias de crack pelos profissionais da saúde/enfermagem e encaminhamento para a realização do pré-natal de alto risco, bem como identificar precocemente as peculiaridades dos recém-nascidos dessas mulheres, tendo em vista o desenvolvimento de ações que minimizem as repercussões do crack. (AU)

Practice Report / Bericht aus der Praxis: Tutor training for a peer-assisted interprofessional communication seminar: A work in progress.

A novel peer-led communication seminar for medical students and for students of the Interprofessional Health Care B.Sc. degree programme at the Medical Faculty of Heidelberg is currently being developed to address the increasing need for interprofessional collaborative competencies in health care professionals. The core elements of this course include role plays in interprofessional communication situations, patient-centred professional practice, and reflections on underlying attitudes. Each seminar will be conducted by a team of two senior students from both undergraduate programmes, practising their new roles as interprofessional tutors and, at the same time, serving as competent role models for interprofessional collaboration. To provide tutors with the necessary didactic preparation, an interprofessional tutor training was developed and implemented. It was positively evaluated and well accepted by participants. The seminar and tutor training concept presented in this paper aims to foster (inter-)professional ethics and communication competency development in medical students.

Development of a didactical training concept for peer tutors in gross anatomy.

Even though peer tutors are often used in gross anatomy courses, research in the field is rather a subject of the last two decades. This is especially true about the didactical challenges these types of peer tutors experience during their tutorials and about how they are prepared for the task. The aim of the presented study was to learn about the training needs of the tutors, and to subsequently design, implement, and evaluate a didactical training concept. A qualitative design was chosen to examine how tutors can best be prepared for tutorials of gross anatomy. To do so, focus group interviews were conducted. The data were analyzed and grouped into various concepts, using semi-structured interview questions as guidance. It was found that peer tutors are in need of training in the following aspects: Dealing with students who are experiencing difficulties during or as a result of dissection, dealing with group dynamics, that is, at the dissection table, keeping students motivated, time management, and staying confident as a tutor. In order to be regarded as useful and relevant in the eyes of tutors, a preparatory training course should include all these aspects in addition to general didactical training elements. Training needs of peer tutors of gross anatomy go beyond the content of standardized didactical curricula; therefore, tutors should be prepared with a curriculum that is specifically geared toward the many challenges associated with teaching gross anatomy to first year medical students which are already so well documented in the research literature. Anat Sci Educ 10: 495-502. © 2017 American Association of Anatomists.

Use of crack in pregnancy: repercussions for the newborn.

OBJECTIVES: To know the effects for the newborn of the use of crack in pregnancy. METHODS: This is a qualitative study conducted in a university hospital in southern Brazil, in the first half of 2014. Fifteen mothers crack users and five grandparents participated. The data were produced through semi-structured interviews and later submitted to content analysis. RESULTS: It was found that the use of crack in pregnancy leads to repercussions related to the health of the newborn and repercussions related to family restructuring. In relation to the newborn, prematurity, congenital malformation, hospitalization in an intensive care unit, use of care and feeding technologies through artificial milk formulas were mentioned. In the family context, it was evidenced the occurrence of abandonment of the child by the mother, causing the adoption of the newborn by relatives of the family nucleus or their institutionalization due to lack of family structure. CONCLUSIONS: It was found that the use of crack in pregnancy leads to repercussions related to the health of the newborn and repercussions related to family restructuring. In this sense, the recruitment of pregnant users of crack by health/nursing professionals and referral for high-risk prenatal care, as well as early identification of the peculiarities of the newborns of these women, and the development of actions that minimize the repercussions of crack are imperative.