ABSTRACT
INTRODUCTION: Worldwide, half the population lives in rural or remote areas; however, less than 25% of doctors work in such regions. Despite the continental dimensions of Brazil and its enormous cultural diversity, only some medical schools in this country offer students the opportunity to acquire work experience focused on medicine in rural or remote areas. The objective of the present study was to develop a framework of competencies for a longitudinal medical training program in rural medicine as an integrated part of medical training in Brazil. METHODS: Two rounds of a modified version of the Delphi technique were conducted. Initially, a structured questionnaire was elaborated, based on a literature review. This questionnaire was submitted to the opinion of 20 panelists affiliated with the Rural Medicine Working Party of the Brazilian Society of Family and Community Medicine. The panelists were asked to evaluate the relevance of the competencies using a five-point Likert-type scale. In this study, the consensus criterion for a competency to be included in the framework was it being deemed 'very important' or 'indispensable' by a simple majority of the participants, while the criterion for excluding a competency was that a simple majority of the panel members considered that it 'should not be included' or was 'of little importance'. When a consensus was not reached regarding a given competency, it was submitted to a second round to enable the panelists to re-evaluate the now dichotomized questions. RESULTS: Compliance in responding to the questionnaire was better among the panelists predominantly involved in teaching activities (85%; n=12) compared to those working principally in patient care (45%; n=8). The questionnaire consisted of 26 core competencies and 165 secondary competencies. After evaluation by the specialists, all the 26 core competencies were classified as relevant, with none being excluded and only eight secondary competencies failing to achieve a consensus. No new competencies were suggested. Of the competencies that failed to reach a consensus in the first round, seven were excluded from the framework in the second round, with most of these being associated with hospital procedures. CONCLUSIONS: A framework of competencies for a program in rural medicine was developed and validated. It consists of 26 core competencies and 158 secondary competencies that should be useful when constructing competency-based curricula in rural medicine for medical education in Brazil.
Subject(s)
Clinical Competence , Education, Medical, Undergraduate/standards , Professional Practice Location , Rural Health Services , Rural Population , Brazil , Curriculum , Delphi Technique , Female , Humans , Male , Program Evaluation , Schools, Medical/standards , WorkforceABSTRACT
OBJECTIVE: The aim of the present study was to investigate the influence of enteral feeding management on occurrences of necrotizing enterocolitis (NEC) in very-low-birth-weight (VLBW) infants. METHODS: This was a case-control study conducted in a sample of 1028 VLBW infants (750 to 1499 g) admitted to a neonatal intensive care unit between January 2003 and May 2008. "Cases" were infants born with VLBW and diagnosed with NEC within the first 30 days of life, and "controls" were VLBW infants who did not develop NEC during this period. Occurrences of NEC were defined using the modified Bell criteria (stage ≥2). RESULTS: Among the 1028 VLBW infants, 55 (5.4%) developed NEC within the first month of life. Logistic regression analysis showed that breast milk given exclusively for <7 days (odds ratio [OR]â=â4.02), never achieving full enteral feeding during the first month (ORâ=â3.50), and parenteral nutrition (ORâ=â2.70) were factors that increased the chances of NEC occurrence. The use of vasoactive drugs was associated with a lower risk of NEC (ORâ=â0.15). CONCLUSIONS: Breast milk should be recommended as a priority for the enteral nutrition of VLBW infants for no <7 days. Enteral nutrition should start early and progress quickly to achieve full enteral feeding; these procedures may help reduce the occurrence of NEC.
Subject(s)
Energy Intake , Enteral Nutrition , Enterocolitis, Necrotizing/prevention & control , Fetal Growth Retardation/physiopathology , Infant Nutritional Physiological Phenomena , Milk, Human , Premature Birth/physiopathology , Brazil/epidemiology , Case-Control Studies , Enteral Nutrition/adverse effects , Enterocolitis, Necrotizing/epidemiology , Enterocolitis, Necrotizing/etiology , Female , Humans , Incidence , Infant, Newborn , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Logistic Models , Male , Parenteral Nutrition/adverse effects , Pregnancy , Risk , Vasoconstrictor Agents/adverse effects , Vasoconstrictor Agents/therapeutic use , Vasodilator Agents/adverse effects , Vasodilator Agents/therapeutic useABSTRACT
Objetivo: uma avaliação acurada do estado nutricional dacriança ao nascer tem importância na identificação precoce de eventos mórbidos relacionados com a aceleração ou desaceleração do crescimento intra-útero. Os índices antropométricos resultantes das razões entre o peso e o comprimento e aqueles que resultam da razão entre o perímetro braquial e o perímetro cefálico podem ser uma alternativa, dentro da antropometria, para esse fim. O objetivo principal deste estudo foi verificar o grau de correlação entre a prega cutânea triciptal e os índices antropométricos-índice ponderal de Rohrer, índice de massa corpórea, razão peso/comprimento, razão perímetro braquial/perímetro cefálico-utilizados como critério de avaliação do estado nutricional de recém-nascidos.Métodos: realizou-se um estudo de corte transversal em 390 recém-nascidos a termo na maternidade do Centro de Atenção à Saúde da Mulher do Instituto Materno-lnfantil de Pernambuco, no período de maio a julho de 1999. Os recém-nascidos foram avaliados quanto ao peso, comprimento, perímetros cefálico e braquial e pregacutânea triciptal.Resultados: os resultados mostraram que os índices antropométricos apresentaram correlação significante com a prega cutânea triciptal, tendo sido a razão simples entre o peso e o comprimento aquele que se correlacionou mais fortemente (r = 0,63; p <0,001),seguido da razão perímetro braquial/perímetro cefálico (r = 0,59; p(0,001). O índice ponderal de Rohrer foi o que se correlacionou mais fracamente com a prega cutânea triciptal (r = 0,43; p <0,001). A análise de regressão linear múltipla mostrou que a razão peso/comprimento teve uma melhor correlação com a prega cutânea.Conclusão: concluímos que, dentre os índices antropométricos estudados, a razão simples entre o peso e o comprimento mostrou-se como a melhor alternativa para a avaliação do estado nutricional ao nascimento
Subject(s)
Humans , Male , Female , Infant, Newborn , Mid-Upper Arm Circumference , Nutrition Assessment , Weight by HeightABSTRACT
OBJECTIVE: An accurate assessment of the nutritional status of an infant at birth is very important, since it provides information on early identification of pathological events related to intrauterine growth acceleration or retardation. Anthropometric ratios such as weight/length and mid-arm circumference/head circumference may be used as alternative tools for this purpose. The main objective of this study was to verify the correlation between triceps skinfold thickness with Rohrer Index, Body Mass Index, weight/length ratio, and mid-arm circumference/head circumference ratio. METHODS: A cross-sectional study was carried out with 390 full-term newborns delivered at the Maternity Ward of Instituto Materno Infantil of Pernambuco, from May to July 1999. The newborns had their birthweight, length, head and mid-arm circumferences and triceps skinfold thickness measured. RESULTS: The results showed that among the anthropometric indices studied the weight/length ratio showed the strongest correlation with triceps skinfold thickness (r=0.63, p<0.001) followed by mid-arm circumference/head circumference ratio (r=0.59, p<0.001). Rohrer index showed the weakest correlation (r=0.43, p<0.001). Multiple linear regression analyses revealed that weight/length ratio correlated best with skinfold thickness. CONCLUSIONS: We concluded that among the studied indices, weight/length ratio showed to be the best alternative to assess the nutritional status of infants at birth.
