Lysosomal fusion and SNARE function are impaired by cholesterol accumulation in lysosomal storage disorders.

Partial Retraction of: The EMBO Journal (2010) 29: 3607-3620. DOI: 10.1038/emboj.2010.237 | Published online 24 September 2010 Journal statement The journal contacted the authors in February 2022 about potential image insertions and duplications in Fig 4A and 4E. In the absence of source data, the authors are retracting Fig 4A, the lower panel of Fig 4E (LAMP1 immunoblot), and the following statements in the text that rely on these data: "Quantitative analysis showed that the percentage of Flotillin-1 associated with DRMs was increased in LSD endolysosomal membranes (Figure 4A), indicating an increased amount of cholesterol-enriched regions in these membrane samples." "LAMP1 also displayed a similar distribution profile in WT and LSD cells (Figure 4E)". Author statement The authors could not verify the aberrations in panel A of Fig 4 and the lower immunoblot (LAMP1) of 4E because the original source data are no longer available (12 years after publication, which is beyond the institute's 10-year data retention policy). The authors wish to clarify that the main conclusions of the paper are not affected by the retraction of Figure panels 4A and 4E for the following reasons: Figure panel 4A supports the observation that there are increased cholesterol-enhanced regions in LSD samples. This finding is also supported by data provided in figs 4B, 4C and 4D. Figure panel 4E: The LAMP1 blot in Fig 4E shows that the distribution of protein normally excluded from DRMs is not altered between Wt and LSD samples. This result is also supported by the upper blot in this panel (Transferrin receptor). The authors apologize for these errors and agree with this corrigendum; no response could be obtained from AL.

A RANDOMIZED TRIAL - INTENSIVE TREATMENT BASED IN IVERMECTIN AND IOTA-CARRAGEENAN AS PRE-EXPOSURE PROPHYLAXIS FOR COVID- 19 IN HEALTHCARE AGENTS

Key PointO_ST_ABSIMPORTANCEC_ST_ABSThe emergency of COVID-19 requires the implementation of urgent strategies to prevent the spread of the disease, mainly in health personnel, who are the most exposed and has the highest risk of becoming infected with the SARS-COV-2. Drug repurposing is a pragmatic strategy, a faster and cheaper option, compared to the new drug development that has proven successful for many drugs and can be a key tool in emergency situations such as the current one that requires quick action. In addition, considering the limited access to vaccines for developing countries, preventive use of ivermectin can be a palliative that minimizes the risks of infection. OBJECTIVETo evaluate the protective effect of the combination Ivermectin / Iota-Carrageenan (IVER/IOTACRC), intensive treatment with repeated administration in oral- and nasal-spray, respectively, as a prophylaxis treatment prior to exposure to SARS-CoV-2, in health personnel at Public Healthcare Centers. PARTICIPANTS, DESIGN AND SETTINGRandomized controlled 1-1 clinical trial in Personal Health, n = 234. The subjects were divided into experimental (EG: n=117; 39.6 {+/-} 9.4 years old, 65F) and control groups (CG: n=117; 38.4 {+/-} 7.4 years old, 61F). The EG received Ivermectin orally 2 tablets of 6 mg = 12 mg every 7 days, and Iota-Carrageenan 6 sprays per day for 4 weeks. All participants were evaluated by physical examination COVID-19 diagnosed with negative RT-PCR at the beginning, final, and follow-up of the protocol. Differences between the variables were determined using the Chi-square test. The proportion test almost contagious subject and the contagion risk (Odds Ratio) were calculated using software STATA. The level of statistical significance was reached when p-Value < 0.05. RESULTThe number of subjects who were diagnosed with COVID-19 in EG was lower, only 4 of 117 (3.4%) than subjects in CG: 25 of 117 (21.4%) (P-Value = 1.10-5). Nineteen patients had mild symptoms, 4 were in EG whereas, 15 were in CG (p-Value = 0.001). Seven subjects were moderate, and 3 with severe diagnostics, all them in CG. The probability (Odds Ratio) of becoming ill with COVID-19 was significantly lower in EG with values of 0.13, 95% 0.03 to 0.40; p-Value = 1.10-4, this value (<1) indicates a protective effect of the IVER/IOTACRC in the EG. Logistic regression test demonstrated that treatment was effective to prevent COVID-19 (Odds Ratio 0.11, 95% 0.03 to 0.33; p-Value = 1.10-4). We also found that when increase the age, decrease contagious risk (Odds Ratio 0, 93, 95% 0.88 to 0.98, p-Value= 0, 02). On the other hand, the probability of contracting COVID-19 was dependent on the patients preexisting comorbidity (Odds Ratio 5.58, 95% 2.20 to 14.16, p-Value = 1.10-5). The other variables sex and designation were independent. CONCLUSIONThe intensive preventive treatment (short-term) with IVER/IOTACRC was able to reduce the number of health workers infected with COVID-19. This treatment had also effect in preventing the severity of the disease, since all patients treated were mild. We propose a new therapeutic alternative for prevention and short-term intervention scheme (intensive) that is of benefit of the health worker in this pandemic accelerated time. This intervention did not produce lack of adherence to treatment or adverse effects. Trial RegistrationClinicalTrials.gov Identifier: NCT04701710

IVERMECTIN REPROPOSING FOR COVID-19 TREATMENT OUTPATIENTS IN MILD STAGE IN PRIMARY HEALTH CARE CENTERS

BackgroundThe emergence of COVID-19 requires alternative treatments based on the reuse of drugs as a strategy to prevent the progression of the disease in patients infected with SARS-COV-2. The goal was to evaluate the use of ivermectin in mild stage outpatients to heal and / or reverse the progression of COVID-19 disease towards the development of moderate or severe stages. MethodsCluster Assigned Clinical Trial (2:1) in outpatients, n = 234. The subjects were divided into experimental (EG: n = 110) and control groups (CG: n = 62). The EG received ivermectin orally 4 drops of 6 mg = 24 mg every 7 days for 4 weeks. All participants were diagnosed by positive RT-PCR for COVID-19 and were evaluated by clinical examination, at the beginning and the end of protocol. Data analyzed were applied the proportion, bivariate, and logical regression tests with level significance p < 0{middle dot}05. This study was registered at ClinicalTrials.gov Identifier NCT04784481. FindingsBoth groups were similar in age, sex, and comorbidities (EG: 56F, median age= 40{middle dot}0, range: 18{middle dot}0 - 75{middle dot}0; CG: 34F, median age = 37{middle dot}5, range: 18{middle dot}0 - 71{middle dot}0). A significant reduction in the symptom numbers was observed in the EG when the medical examination was performed from 5th to 9th days, after starting treatment (p = 0{middle dot}0026). Although, medical examination from 10th to 14th day, showed a progressive reduction of the percentage symptom numbers, these were not significative in both groups. A higher proportion of medical release was observed in EG (98{middle dot}2%) vs CG (87{middle dot}1%) (p = 0{middle dot}003). EG showed 8 times more chance of receiving medical release than CG (OR 7{middle dot}99, 95% CI: 1{middle dot}64 -38{middle dot}97, p = 0{middle dot}003). The treatment effect with ivermectin to obtain medical release was analyzed by the logistic regression model based in the following control variables: sex, age, and comorbidities. Then, the chance to obtain medical release was maintained in EG (OR 10{middle dot}37, 95% CI: 2{middle dot}05 - 52{middle dot}04, p = 0{middle dot}005). InterpretationTreatment with ivermectin in outpatients with mild stage COVID-19 disease managed to slightly reduce the symptom numbers. Also, this treatment improved the clinical state to obtain medical release, even in the presence of comorbidities. The treatment with ivermectin could significantly prevent the evolution to serious stages since the EG did not present any patient with referral to critical hospitalization. Clinical Trials registry number is NCT04784481 FundingMinistry of Public Health. Tucuman, Argentina. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSCurrently there are no specific therapies approved for COVID-19 treatment by the FDA, that is why different repositionable drugs are being studied in clinical trials and compassionate use protocols based on in vitro activity. ivermectin is a broad spectrum antiparasitic agent that has been shown to have antiviral activity against a wide range of viruses. A study by Caly et al. (2020) suggested thatnuclear transport inhibitory activity of ivermectin may be effective against SARS-CoV-2. Since the publication of that work, numerous clinical trials were started to study ivermectin potential for COVID-19 treatment. At the end of March 2021, there were about 60 studies registered in https://www.clinicaltrials.gov, and 43 studies listened https://www.who.int/clinical-trials-registry-platform about the safety and effectiveness of ivermectin in COVID-19 patients, for treatment and prophylaxis. Most of these studies are from developing countries, which shows the need of emerging economies to find alternative therapies to contain the spread of the disease and the collapse of health systems. Added value of this studyWe found that an early intervention with ivermectin has impacted on the score of symptoms related to COVID-19 in ambulatory patients, between the 5th and 9th day. The patients who received the treatment changed from score 2 to score 1 in the WHO ordinal scale. In any case, patients evolved to higher scores. Also the treatment increased the probability to obtain medical release, even in the presence of comorbidities. Implications of all available evidenceAccording to the COVID-19 Treatment Guidelines by the NIH, most trials have several limitations. It needs results from adequately powered and well-designed clinical trials to provide evidence-based guidance on the role of ivermectin in the treatment of COVID-19. However, our study shows overlaps in benefits with other authors, and taking together, these results are encouraging for further study about repurposing ivermectin for the treatment of COVID-19.

Awake prone positioning and oxygen therapy in patients with COVID-19: The APRONOX study

PurposeThe awake prone position (PP) strategy for patients with acute respiratory distress syndrome (ARDS) is a safe, simple, and cost-effective technique used to improve hypoxemia. We aimed to evaluate the relationship between awake PP (AP) and endotracheal intubation in patients with coronavirus disease (COVID-19). MethodsIn this retrospective, multicentre observational study conducted between 1 May and 12 June 2020 in 27 hospitals in Mexico and Ecuador, non-intubated patients with COVID-19 managed with AP or awake supine positioning (AS) were included to evaluate intubation and mortality risk in AP patients through logistic regression models; multivariable adjustment, propensity score analyses, and E-values were calculated to limit confounding. A CART model with cross-validation was also built. This study was registered at https://clinicaltrials.gov/ct2/show/NCT04407468 Results827 non-intubated patients with COVID-19 in the AP (n=505) and AS (n=322) groups were included for analysis. Less patients in the AP group required endotracheal intubation (23.6% vs 40.4%) or died (20% vs 37.9%). AP was a protective factor for intubation even after multivariable adjustment (OR=0.39, 95%CI:0.28-0.56, p<0.0001, E-value=2.01), which prevailed after propensity score analysis (OR=0.32, 95%CI:0.21-0.49, p<0.0001, E-value=2.21), and mortality (adjusted OR=0.38, 95%CI:0.25-0.57, p<0.0001, E-value=1.98). The main variables associated with PP failure in AP patients were age, lower SpO2/FiO2, and management with a non-rebreather mask. In the CART model, only two variables were used: SpO2/FiO2 (F 97.7, p<0.001) and PP (X2 50.5, p<0.001), with an overall percentage of 75.2%. ConclusionPP in awake hospitalised patients with COVID-19 is associated with a lower risk of intubation and mortality.

Tratamento precoce para COVID-19 baseado em evidência científica / Early treatment of COVID-19 based on scientific evidence / Tratamiento precoz para COVID-19 basado en evidencia científica

Objetivo: Apresentar uma proposta de tratamento precoce para pacientes com COVID-19 em Unidade Básica de Saúde (UBS). Métodos: Trata-se de uma proposta de protocolo de tratamento para COVID-19 com hidroxicloroquina ou cloroquina com base na literatura científica disponível no momento (13 de junho de 2020). O levantamento dos estudos ocorreu na base PubMed, por meio dos descritores COVID-19, hydroxychloroquine e chloroquine. Foram selecionados cinco artigos, dos 645 artigos encontrados, por abordarem o uso de hidroxicloroquina ou cloroquina no tratamento da fase precoce da COVID-19. Resultados: A proposta de protocolo para tratamento precoce para pacientes com suspeita de COVID-19 envolve orientações sobre os principais sintomas, orientações gerais à população, avaliação médica, considerações sobre exames, terapia recomendada, orientações pós prescrição e critérios para internação. Conclusão: Baseado em estudos, o tratamento precoce ambulatorial da COVID-19 com hidroxicloroquina ou cloroquina parece diminuir o risco de internação e, assim, a necessidade de leitos de terapia intensiva. A decisão de adoção do tratamento a ser proposto é do paciente, e o médico só deve adotar após o paciente assinar o consentimento livre e esclarecido, por tratar-se de prescrição off label. Estudos randomizados são necessários para confirmar essa hipótese.

Objective: To present a proposal for early treatment of patients with COVID-19 in a Primary Health Care (PHC) center. Methods: This is a proposed treatment protocol for COVID-19 using hydroxychloroquine or chloroquine based on the currently (June 13, 2020) available scientific literature. PubMed database was searched for studies using the descriptors COVID-19, hydroxychloroquine, and chloroquine. Five studies were selected from the 645 studies found as they addressed the use of hydroxychloroquine or chloroquine in the treatment of COVID-19 in early stages. Results: The proposed early treatment protocol for patients with suspected COVID-19 includes guidance on the main symptoms, general guidelines for the population, medical evaluation, examination considerations, recommended therapy, post-prescription guidelines and criteria for hospitalization. Conclusion: According to the studies, early outpatient treatment of COVID-19 with hydroxychloroquine or chloroquine seems to decrease the risk of hospitalization and the need for intensive care beds. The decision to adopt the proposed treatment is made by the patient, and the physician should only conduct the treatment after obtaining written informed consent from the patient, as it is an off-label prescription. Randomized studies are needed to confirm this hypothesis.

Objetivo: Presentar una propuesta de tratamiento precoz para pacientes con la COVID-19 en Unidad Básica de Salud (UBS). Métodos: Se trata de una propuesta de protocolo de tratamiento para la COVID-19 con hidrocloroquina o cloroquina basado en la literatura científica disponible en el momento (13 de junio de 2020). La recogida de los estudios se dio en la base de datos PubMed a través de los descriptores COVID-19, hydroxychloroquine y chloroquine. De los 645 artículos encontrados se ha elegido cinco de ellos sobre el uso de la hidrocloroquina o cloroquina para el tratamiento de la fase precoz de la COVID-19. Resultados: En la propuesta del protocolo para el tratamiento precoz de pacientes con sospecha de la COVID-19 hay orientaciones de los síntomas principales, las orientaciones generales para la población, la evaluación médica, las consideraciones de las pruebas, la terapia recomendada, las orientaciones post prescripición y los criterios para el ingreso hospitalario. Conclusión: Basados en estudios, el tratamiento precoz de ambulatorio de la COVID-19 con hidrocloroquina o cloroquina parece disminuir el riesgo de ingreso hospitalario y la necesidad de camas de la unidad de cuidados intensivos. La decisión para la adhesión al tratamiento propuesto es del paciente y el medico solo debe iniciarlo tras la firma del consentimiento libre esclarecido de parte del paciente una vez que se trata de prescripción off label. Son necesarios estudios randomizados para confirmar esa hipótesis.

PLAN DE ACCIONES COMUNITARIAS PARA LA ATENCIÓN A MENORES CON NECESIDADES EDUCATIVAS ESPECIALES

El presente trabajo pretende socializar los principales resultados alcanzados en la aplicación de un plan de acciones comunitarias para contribuir a la atención de menores con Necesidades Educativas Especiales desde el trabajo intersectorial salud-educación en un Consejo Popular en el municipio Yaguajay, como parte de un proyecto institucional en función de la tesis de maestría en “Gestión del Desarrollo Local”. La metodología utilizada asume como método general el dialéctico materialista. Se emplearon métodos teóricos, empíricos y estadísticos matemáticos para el procesamiento de datos. Se revisaron los referentes teóricos que dieron sustento a esta investigación y permitieron la proyección de las acciones comunitarias intersectoriales, las mismas permiten el vínculo entre sectores como el MINED, MINSAP, INDER, FMC, CDR, Cultura, Órgano del Trabajo, Biblioteca pública, ANAP, Gobierno y PCC en la atención a menores con Necesidades Educativas Especiales en el Consejo Popular.[AU]

Skills for generalist and specialist nurses working in the prevention and control of infections in Brazil. / Competências para enfermeiros generalistas e especialistas atuarem na prevenção e controle de infecções no Brasil.

OBJECTIVE: to define the competencies for the prevention and control of healthcare-related infections that should be developed by the generalist nurse and the specialist nurse in infection control in Brazil. METHOD: the Delphi technique, developed in four rounds, was used. Thirty-one nurses and eight physicians participated in the study, with expertise in infection prevention and control. Data were collected using open-ended questionnaires, whose answers were treated using the content analysis technique. Structured instruments were used to evaluate the importance of each competency using a Likert scale. Data were analyzed and presented in a descriptive way, use of median and coefficient of variation. RESULTS: the competences were organized in 4 core, 14 generic and 17 specific, with name and description of each competency. CONCLUSION: the definition of competencies for the prevention and control of healthcare-related infections is the first step to begin the rethinking of the teaching and learning process in the initial training of nurses. The data found in the present study may help to restructure education and support permanent education programs in health.

Etnografía de la comunicación en la educación en enfermería: perspectiva metodológica / Ethnography of communication in nursing education: methodological perspective / Etnografiada comunicação na educação em enfermagem: perspectiva metodológica

Este artículo de revisión y análisis teórico se deriva de la investigación multicéntrica "Saberes disciplinares, saberes pedagógicos y aprendizaje situado: génesis e influencias mutuas en la enseñanza universitaria", desarrollada con facultades de Ciencias de la Salud y de la Educación en Universidades de España, Brasil, Colombia y Chile. Pretende profundizar la perspectiva epistemológica, teórica y metodológica del estudio como una ruta innovadora en la investigación cualitativa, por tanto, se presentan los fundamentos epistemológicos del Interaccionismo Simbólico, que se basa en la comprensión de la sociedad a través de la comunicación y permite dar significado a procesos humanos, como los procesos dialógicos entre profesores y estudiantes, analizando las repercusiones que tiene en su aprendizaje. La perspectiva teórica de la Etnografía de la Comunicación que se centra en el análisis de los patrones socio - lingüísticos con los que interactúan las personas, siendo prioritario conocer el significado que posee la comunicación verbal y no verbal en esta situación; y la perspectiva metodológica microetnográfica que logra una comprensión de las interacciones verbales y sociales entre profesores y estudiantes, por medio de observaciones no participantes y entrevistas Think aloud

This review article and theoretical analysis is derived from multicentric research "Disciplinary knowledge, pedagogical knowledge and situated learning: genesis and mutual influences on university education", developed with Faculties of Health Sciences and Education in Universities of Spain, Brazil, Colombia and Chile. It aims to deepen the epistemological, theoretical and methodological perspective of the study as an innovative route in qualitative research, therefore, the epistemological foundations of Symbolic Interactionism are presented, which is based on the understanding of society through communication and allows to give meaning to human processes, such as the dialogical processes between teachers and students, analyzing the repercussions that it has on their learning. The theoretical perspective of the Ethnography of Communication that focuses on the analysis of the sociolinguistic patterns with which people interact, being a priority to know the meaning of verbal and non-verbal communication in this situation; and the microethnographic methodological perspective that achieves an understanding of the verbal and social interactions between teachers and students, through non-participant observations and "Think aloud" interviews

Este artigo de revisão e análise teórica é derivado da pesquisa multicêntrica "conhecimento disciplinar, conhecimento e aprendizagem pedagógica implantada: génese e influências mútuas das universidades", desenvolvidos com faculdades de Ciências da Saúde e Educação em universidades em Espanha, Brasil, Colômbia e o Chile. Visa aprofundar a perspectiva epistemológica, teórica e metodológica do estudo como um caminho inovador na pesquisa qualitativa, portanto, são apresentados os fundamentos epistemológicos do Interacionismo Simbólico, que se baseia na compreensão da sociedade através da comunicação e permite dar sentido aos processos humanos, como os processos dialógicos entre professores e alunos, analisando as repercussões que tem sobre sua aprendizagem. A perspectiva teórica da Etnografia da Comunicação que foca a análise dos padrões sóciolingüísticos com os quais as pessoas interagem, sendo uma prioridade conhecer o significado da comunicação verbal e não-verbal nessa situação; e a perspectiva metodológica microetnográfica que alcança uma compreensão das interações verbais e sociais entre professores e alunos, através de observações não-participantes e Pense em voz alta em entrevistas

O pet-saúde como norteador da formação em enfermagem para o sistema único de saúde / Pet-health as a guide for the training in nursing for the unified health system / El pet-salud como orientador de la formación en enfermería para el sistema único de salud

Resumo A saúde de qualidade e de acesso universal é um direito que deve ser garantido por políticas públicas, financiamento compatível e pela adequada formação dos profissionais de saúde. Uma das estratégias identificadas para alcançar esse desafio é o Programa de Educação para o Trabalho em Saúde, que visa promover a interação ativa de alunos e professores com os serviços de saúde. O objetivo deste estudo foi comparar, por meio dos resultados do Exame Nacional de Desempenho dos Estudantes dos cursos de Enfermagem de 2013, o desempenho dos que participaram com o daqueles que não fizeram parte do referido Programa. Trata-se de estudo observacional, de corte transversal analítico, que analisou o desempenho pelas médias ponderadas em formação geral, formação profissional e em Saúde Coletiva. A pesquisa analisou o desempenho pelas médias ponderadas em formação geral, formação profissional e saúde coletiva. A amostra do estudo consistiu de 30.289 estudantes, dos quais 876 vinculados ao Programa de Educação para o Trabalho em Saúde. Os alunos envolvidos com o Programa tiveram um desempenho superior em todos os segmentos, com diferença estatisticamente significativa (p <0,001) em comparação com aqueles que não participaram. Os resultados indicam que o Programa em questão tem potência para compreender a necessidade da formação no Sistema Único de Saúde, ao envolver conhecimentos de Saúde Coletiva e da área profissional, e deve ser elemento norteador da construção dos currículos dos cursos de Enfermagem.

Abstract Quality and universal health care is a right that should be guaranteed through public policies, proper funding, and through the adequate training of the health professionals. One of the strategies identified to overcome this challenge is the Education for the Work in Health Program (Programa de Educação para o Trabalho em Saúde, PET-Saúde, in the Portuguese acronym; PET-Health henceforth), which has the goal of promoting the interaction of students and professors with the health services. The goal of the present study was to compare, using the results of the 2013 National Nursing Student Performance Exam (Exame Nacional de Desempenho dos Estudantes dos cursos de Enfermagem, in Portuguese), the performance of the individuals who took part in the mentioned program with that of those who did not. It is an observational study, with a cross-sectional and analytical perspective, which was conducted between February and June 2017. The research analyzed the performance through the weighted arithmetic means regarding general training, professional training and Collective Health. The sample was composed of 30,289 students, 876 of which took part in the PET-Health. The students involved with the program performed better in every segment, with a statistically significant difference (p < 0.001) in comparison to those who did not take part in the program. The results indicate that the program in question has the power to understand the need for training within the Unified Health System (Sistema Único de Saúde, SUS, in the Portuguese acronym) regarding the knowledge on Collective Health and the professional area, which should be a guiding element in the development of the syllabuses of Nursing Courses.

Resumen La salud de calidad y de acceso universal es un derecho que debe ser garantizado a partir de políticas públicas, financiación compatible y la adecuada formación de los profesionales de salud. Una de las estrategias identificadas para alcanzar este desafío es el Programa de Educación para el Trabajo en Salud, que busca promover la interacción activa de alumnos y profesores con los servicios de salud. El objetivo de este estudio fue utilizar los resultados del Examen Nacional de Rendimiento de los Estudiantes de las carreras de Enfermería del 2013 para comparar el rendimiento de aquellos que participaron de dicho Programa con el de aquellos que no formaron parte del mismo. Se trata de estudio observacional, de corte transversal analítico, realizado en el período de febrero a junio del 2017. La investigación analizó el rendimiento a partir de las medias ponderadas en formación general, formación profesional y salud pública. La muestra del estudio consistió en 30.289 estudiantes, de los cuáles 876 estaban vinculados al Programa de Educación para el Trabajo en Salud. Los alumnos involucrados con el Programa tuvieron un rendimiento superior en todos los segmentos, con diferencia estadísticamente significativa (p <0,001) en comparación con aquellos que no participaron del mismo. Los resultados indican que el Programa en cuestión tiene potencial para comprender la necesidad de la formación en el Sistema Único de Salud, incluyendo conocimientos de Salud Pública y del área profesional, debiendo servir como elemento orientador de la construcción de los programas de las carreras de Enfermería.

Condições sociais, escolarização e hábitos de estudo no desempenho acadêmico de concluintes da área da saúde / Social conditions, schooling and study habits in the academic performance of finalists in the field of health / Condiciones sociales, escolarización y hábitos de estudio en el desempeño académico de graduados del área de la salud

Resumo Vários fatores contribuem para a dificuldade no acesso e permanência na Educação Superior no Brasil. O objetivo deste estudo foi identificar a diferença de desempenho dos estudantes por condições socioeconômicas, escolarização e hábitos de estudo. Foi realizado estudo transversal analítico com base nos dados do Exame Nacional de Desempenho dos Estudantes, em amostra de 196.856 alunos dos cursos de saúde em 2013. A nítida barreira que estudantes de classes sociais menos favorecidas apresentam para ingresso e permanência na Educação Superior requer uma permanente busca de maior justiça social. Enquanto se mantiver a atual situação, é papel do governo proporcionar estratégias que viabilizem o acesso à Educação Superior por meio de políticas afirmativas e recursos para viabilizar que pessoas com piores condições socioeconômicas possam investir em sua formação. A bolsa-permanência apresentou-se como essencial na busca da equidade, assim como a bolsa acadêmica permitiu melhor desempenho, em especial, pelo maior vínculo com a Instituição de Educação Superior.

Abstract Many factors contribute to the difficulty in accessing and remaining in Higher Education in Brazil. The objective of the present study was to identify the difference in the performance of the students due to socioeconomic conditions, schooling and study habits. We conducted an analytical cross-sectional study based on the data of the National Student Performance Exam (Exame Nacional de Desempenho dos Estudantes, in Portuguese), with a sample of 196,856 students from health courses in 2013. The clear obstacle faced by the students from underprivileged social classes to their admission and permanence in Higher Education requires a constant struggle for greater social justice. While the current situation remains unchanged, it is the role of the government to provide strategies to make viable the access to Higher Education through affirmative policies and resources to make it possible for the underprivileged to invest in their education. The permanence scholarship presented itself as crucial in the struggle for equity, and it enabled a better performance on the part of the students, especially due to their stronger ties with the Higher Education Institution.

Resumen Varios factores contribuyen a la dificultad en el acceso y permanencia en la Educación Superior en Brasil. El objetivo de este estudio fue identificar la diferencia de desempeño de los estudiantes por condiciones socioeconómicas, escolarización y hábitos de estudio. Fue realizado un estudio transversal analítico con base en los datos del Examen Nacional de Desempeño de los Estudiantes, en alrededor de 196.856 alumnos de los cursos de salud en 2013. La nítida barrera que estudiantes de clases sociales menos favorecidas presentan para ingreso y permanencia en la Educación Superior requiere una permanente búsqueda de mayor justicia social. Mientras se mantenga la actual situación, es papel del gobierno proporcionar estrategias que viabilicen el acceso a Educación Superior por medio de políticas afirmativas y recursos para viabilizar que personas con peores condiciones socioeconómicas puedan invertir en su formación. La beca-permanencia se presentó como esencial en la búsqueda de equidad, así como la beca académica permitió mejor desempeño, en especial, por mayor vínculo con la Institución de Educación Superior.

Autoscopia no processo de formação de docentes reflexivos / Autoscopy in the process of training reflective professors

Objetivo compreender como a autoscopia, apoiada no Modelo de Ação e Raciocínio Pedagógico, contribui para formação de docentes reflexivos. Métodos estudo qualitativo e descritivo, realizado com uma docente de Enfermagem, do Curso Técnico em Enfermagem. Para os dados coletados, por meio de entrevistas, observação não participante e autoscopia, foi utilizada análise de conteúdo, com os resultados interpretados à luz do referencial teórico de Shulman. Resultados as percepções relatadas pela docente antes da autoscopia diferem das conclusões pós-autoscopia, demonstrando avanços na nova compreensão. A estrutura da autoscopia, seguindo o Modelo de Ação e Raciocínio Pedagógico de Shulman, possibilitou o exercício reflexivo docente. Conclusão a inclusão da autoscopia nos processos de formação docente pode estimular postura reflexiva, permitindo avanços nas práticas de ensino.

Objective to understand how autoscopy, supported by the Model of Action and Pedagogical Reasoning, contributes to the formation of reflective professors. Methods a qualitative and descriptive study, carried out with a Nursing professor, of the Nursing Technical Course. For the collected data, through interviews, non-participant observation and autoscopy, content analysis was used, with the results interpreted in the light of the referential theorist of Shulman. Results the perceptions reported by the professor before autoscopy differ from the post-autoscopy findings, demonstrating advances in the new comprehension. The structure of autoscopy, following Shulman's Model of Action and Pedagogical Reasoning, made possible reflective professor exercise. Conclusion the inclusion of autoscopy in teacher training processes can stimulate reflective posture, allowing for advances in teaching practices.

Competências para enfermeiros generalistas e especialistas atuarem na prevenção e controle de infecções no Brasil / Skills for generalist and specialist nurses working in the prevention and control of infections in Brazil / Competencias para enfermeros generalistas y especialistas actúan en la prevención y control de infecciones en Brasil

Objetivo definir as competências para a prevenção e o controle de infecções relacionadas à assistência à saúde que devem ser desenvolvidas pelo enfermeiro generalista e pelo enfermeiro especialista em controle de infecções no Brasil. Método empregou-se a técnica Delphi, desenvolvida em quatro rodadas. Participaram do estudo 31 enfermeiros e oito médicos com expertise em prevenção e controle de infecções. Para a coleta de dados, utilizaram-se instrumentos com perguntas abertas cujas respostas foram tratadas por meio da técnica de análise de conteúdo e instrumentos estruturados para avaliar a importância de cada competência por meio de escala Likert, sendo os dados analisados e apresentados de forma descritiva, uso de mediana e de coeficiente de variação. Resultados as competências foram organizadas em 04 centrais, 14 genéricas e 17 específicas, com nome e a descrição de cada competência. Conclusão a definição das competências para a prevenção e o controle de Infecções Relacionadas à Assistência à Saúde é o primeiro passo para se iniciar o repensar acerca do processo de ensino e aprendizagem na formação inicial dos enfermeiros. Os dados encontrados auxiliam na reestruturação do ensino, além de fundamentar programas de educação permanente em saúde.

Objective to define the competencies for the prevention and control of healthcare-related infections that should be developed by the generalist nurse and the specialist nurse in infection control in Brazil. Method the Delphi technique, developed in four rounds, was used. Thirty-one nurses and eight physicians participated in the study, with expertise in infection prevention and control. Data were collected using open-ended questionnaires, whose answers were treated using the content analysis technique. Structured instruments were used to evaluate the importance of each competency using a Likert scale. Data were analyzed and presented in a descriptive way, use of median and coefficient of variation. Results the competences were organized in 4 core, 14 generic and 17 specific, with name and description of each competency. Conclusion the definition of competencies for the prevention and control of healthcare-related infections is the first step to begin the rethinking of the teaching and learning process in the initial training of nurses. The data found in the present study may help to restructure education and support permanent education programs in health.

Objetivo definir las competencias para la prevención y el control de infecciones relacionadas a la asistencia a la salud que deben ser desarrolladas por el enfermero generalista y por el enfermero especialista en controle de infecciones en Brasil. Método se empleó la técnica Delphi, desarrollada en cuatro rodadas. Participaron del estudio 31 enfermeros y ocho médicos, con experiencia en prevención y control de infecciones. Para la recolección de datos se utilizaron instrumentos con preguntas abiertas, cuyas respuestas fueron tratadas por medio de la técnica de análisis de contenido, e instrumentos estructurados para evaluar la importancia de cada competencia por medio de escala Likert, siendo los dados analizados y presentados de forma descriptiva, uso de mediana y de coeficiente de variación. Resultados las competencias fueron organizadas en 04 centrales, 14 genéricas y 17 específicas, con nombre y la descripción de cada competencia. Conclusión la definición de las competencias para la prevención y el control de Infecciones Relacionadas a la Asistencia a la Salud es el primer paso para iniciarse el repensar acerca del proceso de enseñanza y aprendizaje en la formación inicial de los enfermeros. Los datos encontrados auxilian en la reestructuración de la enseñanza además de fundamentar programas de educación permanente en salud.

Teaching of infection control in undergraduate courses in health sciences: opinion of experts.

OBJECTIVE: To know the perception of expert professionals in infection control and prevention on the teaching of skills for the prevention and control of infections related to health care in undergraduate courses in Health Sciences. METHOD: We used the Delphi technique, developed in four sequential rounds. Thirty-one nurses and eight physicians participated in the study. Qualitative data were analyzed through content analysis; the quantitative ones, from the descriptive statistics. RESULTS: The importance of the courses has had teachers with expertise in infection control and prevention added to arguments about the development of the subject in the curricula by means of a specific subject or as a transversal theme. CONCLUSIONS: In order to cover the complexity of the elements that are interconnected for professional training, teaching must be based on pedagogical strategies that provoke reflection in students, encouraging them to develop critical thinking about their experiences.

Improved reactive nanoparticles to treat dentin hypersensitivity.

The aim of this study was to evaluate the effectiveness of different nanoparticles-based solutions for dentin permeability reduction and to determine the viscoelastic performance of cervical dentin after their application. Four experimental nanoparticle solutions based on zinc, calcium or doxycycline-loaded polymeric nanoparticles (NPs) were applied on citric acid etched dentin, to facilitate the occlusion and the reduction of the fluid flow at the dentinal tubules. After 24 h and 7 d of storage, cervical dentin was evaluated for fluid filtration. Field emission scanning electron microscopy, energy dispersive analysis, AFM and Nano-DMA analysis were also performed. Complex, storage, loss modulus and tan delta (δ) were assessed. Doxycycline-loaded NPs impaired tubule occlusion and fluid flow reduction trough dentin. Tubules were 100% occluded in dentin treated with calcium-loaded NPs or zinc-loaded NPs, analyzed at 7 d. Dentin treated with both zinc-NPs and calcium-NPs attained the highest reduction of dentinal fluid flow. Moreover, when treating dentin with zinc-NPs, complex modulus values attained at intertubular and peritubular dentin were higher than those obtained after applying calcium-NPs. Zinc-NPs are then supposed to fasten active dentin remodeling, with increased maturity and high mechanical properties. Zinc-based nanoparticles are then proposed for effective dentin remineralization and tubular occlusion. Further research to finally prove for clinical benefits in patients with dentin hypersensitivity using Zn-doped nanoparticles is encouraged. STATEMENT OF SIGNIFICANCE: Erosion from acids provokes dentin hypersensitivity (DH) which presents with intense pain of short duration. Open dentinal tubules and demineralization favor DH. Nanogels based on Ca-nanoparticles and Zn-nanoparticles produced an efficient reduction of fluid flow. Dentinal tubules were filled by precipitation of induced calcium-phosphate deposits. When treating dentin with Zn-nanoparticles, complex modulus values attained at intertubular and peritubular dentin were higher than those obtained after applying Ca-nanoparticles. Zn-nanoparticles are then supposed to fasten active dentin remodeling, with increased maturity and high mechanical properties. Zinc-based nanogels are, therefore, proposed for effective dentin remineralization and tubular occlusion. Further research to finally prove for clinical benefits in patients with dentin hypersensitivity using Zn-doped nanogels is encouraged.

Ação e raciocínio pedagógico de professoras de Enfermagem: expressões em diferentes contextos educacionais / Acción y raciocinio pedagógico de profesoras de Enfermería: expresiones en diferentes contextos educacionales / Pedagogical reasoning and action of professors of Nursing: expressions in different educational contexts

RESUMO Objetivo: relacionar fontes de conhecimento base para o ensino, categorias de conhecimento base para o ensino e fases da ação e raciocínio pedagógico de professoras de ensino superior em enfermagem em universidades pública e privada da região Sul do Brasil. Método: estudo coletivo de casos instrumentais com abordagem qualitativa. São casos a ação e raciocínio pedagógico de duas professoras de enfermagem. A coleta de dados incorporou documentos, entrevistas e observação analisados pelo método das comparações constantes. A análise originou duas metacategorias, denominadas caso pública e caso privada, e seus eixos transversais: relações entre fontes e conhecimento base para o ensino, relações entre categorias de conhecimento base para o ensino, e relações entre conhecimento-base e Modelo de Ação e Raciocínio Pedagógico. Resultados: há relações distintas entre fontes, conhecimento-base e fases do Modelo na ação e raciocínio pedagógico dos casos. Conclusão: destacam-se a hierarquização e encadeamento nas relações entre os construtos de Shulman e sugere-se o estímulo à reflexão e a ampliação das fontes de conhecimento-base como meio de formação docente.

RESUMEN Objetivo relacionar fuentes de conocimiento básico para la enseñanza, categorías de conocimiento básico para la enseñanza y fases de la Acción y Razonamiento Pedagógico de profesoras de enseñanza superior en enfermería en universidades públicas y privadas de la región Sur de Brasil. Método estudio colectivo de casos instrumentales con abordaje cualitativo. Son casos la acción y raciocinio pedagógico de dos profesoras de enfermería. La recolección de datos incorporó documentos, entrevistas y observación analizados por el método de las comparaciones constantes. El análisis originó dos metacategorías, denominadas caso público y privado, y sus ejes transversales: relaciones entre fuentes y conocimiento básico para la enseñanza, relaciones entre categorías de conocimiento básico para la enseñanza, y relaciones entre conocimiento base y Modelo de Acción y Razonamiento Pedagógico. Resultados existen relaciones distintas entre fuentes, conocimiento base y fases del Modelo en la acción y raciocinio pedagógico de los casos. Conclusión se destacan la jerarquización y encadenamiento en las relaciones entre los constructos de Shulman y se sugiere el estímulo a la reflexión y la ampliación de las fuentes de conocimiento básico como medio de formación docente.

ABSTRACT Objective: to report sources of knowledge base for teaching, categories of knowledge base for teaching and phases of pedagogical reasoning and action of professors of higher education in Nursing in public and private universities in the South region of Brazil. Method: a collective study of instrumental cases with a qualitative approach. The cases involve the pedagogical reasoning and action of two professors of Nursing. Data collection incorporated documents, interviews and observation analyzed using the constant comparative method. The analysis gave rise to two metacategories, termed public case and private case, and their transversal axes: relationships between sources and knowledge base for teaching, relationships between categories of knowledge base for teaching, and relationships between knowledge base for teaching and the Model of Pedagogical Reasoning and Action. Results: there are distinct relationships between sources, knowledge base for teaching and phases of the Model in the cases' pedagogical reasoning and action. Conclusion: emphasis is placed on hierarchization and linking in the relationships between Shulman's constructs and encouragement to reflection, and broadening of the sources of knowledge base for teaching as a source of lecturer training is suggested.

Teaching of infection control in undergraduate courses in health sciences: opinion of experts / Enseñanza del control de infecciones en la graduación en salud: la opinión de expertos / Ensino do controle de infecções na graduação em saúde: opinião de experts

ABSTRACT Objective: To know the perception of expert professionals in infection control and prevention on the teaching of skills for the prevention and control of infections related to health care in undergraduate courses in Health Sciences. Method: We used the Delphi technique, developed in four sequential rounds. Thirty-one nurses and eight physicians participated in the study. Qualitative data were analyzed through content analysis; the quantitative ones, from the descriptive statistics. Results: The importance of the courses has had teachers with expertise in infection control and prevention added to arguments about the development of the subject in the curricula by means of a specific subject or as a transversal theme. Conclusions: In order to cover the complexity of the elements that are interconnected for professional training, teaching must be based on pedagogical strategies that provoke reflection in students, encouraging them to develop critical thinking about their experiences.

RESUMEN Objetivo: Conocer la percepción de los profesionales con experiencia en prevención y control de infección sobre la enseñanza de las competencias para la prevención y control de infecciones relacionadas a la asistencia a la salud en los cursos de graduación del área de la salud. Método: Se utilizó la técnica Delphi, desarrollada en cuatro rondas secuenciales. Participaron del estudio 31 enfermeros y 8 médicos. Los datos cualitativos fueron analizados por medio del análisis de contenido y los cuantitativos, a partir de la estadística descriptiva. Resultados: Ha surgido la importancia de que los cursos tengan docentes con experiencia en prevención y control de infecciones. Sumada a las argumentaciones sobre el desarrollo del tema en los currículos por medio de una disciplina específica o como tema transversal. Conclusiones: Para abarcar la complejidad de los elementos que se interconectan para la formación profesional, la enseñanza debe guiarse en estrategias pedagógicas que instiguen la reflexión en el estudiante, estimulándolo a desarrollar el pensamiento crítico sobre sus vivencias.

RESUMO Objetivo: Conhecer a percepção dos profissionais com expertise em prevenção e controle de infecção sobre o ensino das competências para a prevenção e o controle de infecções relacionadas à assistência à saúde nos cursos de graduação da área da saúde. Método: Utilizou-se a técnica Delphi, desenvolvida em quatro rodadas sequenciais. Participaram do estudo 31 enfermeiros e oito médicos. Os dados qualitativos foram analisados por meio da análise de conteúdo; os quantitativos, a partir da estatística descritiva. Resultados: Emergiu a importância de os cursos contarem com docentes com expertise em prevenção e controle de infecções. Somada a argumentações sobre o desenvolvimento do tema nos currículos por meio de uma disciplina específica ou como tema transversal. Conclusões: Para abranger a complexidade dos elementos que se interligam para a formação profissional, o ensino deve pautar-se em estratégias pedagógicas que instiguem a reflexão no estudante, estimulando-o a desenvolver o pensamento crítico sobre suas vivências.

The student-nurse pedagogical relationship: a hermeneutic-phenomenological study / Relação pedagógica estudante-enfermeiro: um estudo hermenêutico-fenomenológico / La relación pedagógica estudiante-enfermera: un estudio hermenéutico-fenomenológico

ABSTRACT Objective: to research studied the meaning of the pedagogical relationship in the training of nursing student and characterizes the role that such a relationship in the practice of reflexive, relational and ethical care student. Method: qualitative research with a Phenomenological-Hermeneutical approach Gadamer, ethnographic. Developed during the clinical practices of 11 students, with their respective teacher and clinical instructors in a School of Nursing of Barcelona, from February 2011 to February 2012. Strategies for data collection were: participant observation, informal conversation, in-depth interviews, and written materials. The data analysis used the method of constant comparisons of Glaser and Strauss. Results: the pedagogical relationship "oriented towards the student" emerged as the thematic core, includes categories such as "being there for the student", "trust", and "autonomy". Conclusions: the pedagogical relationship 'oriented towards the student' is a relationship of care that provides support, trust, presence, empowerment, and autonomy.

RESUMO Objetivo: esta pesquisa estudou o significado da relação pedagógica na formação do estudante de enfermagem e caracteriza o papel que essa relação na prática do cuidado reflexiva, relacional e ética do estudante. Método: pesquisa qualitativa com abordagem hermenêutica-fenomenológico de Gadamer, etnográfico. Desenvolvido durante o estágio clínico de 11 alunos, com seu respectivo professor e instrutores clínicos de uma Escola de Enfermagem em Barcelona, entre fevereiro de 2011 e fevereiro de 2012. As estratégias de coleta de dados foram: observação participante, conversas informais, entrevistas em profundidade e materiais escritos. Para análise dos dados foi utilizado o método de comparativo constante de Glaser e Strauss. Resultados: a relação pedagógica 'orientada para o aluno' emergiu como o núcleo temático, inclui categorias tais como 'estar para o aluno', 'confiança' e 'autonomia'. Conclusão: a relação pedagógica 'orientada para o aluno' é uma relação de cuidado que oferece acompanhamento, confiança, presença, empoderamento e autonomia.

RESUMEN Objetivo: esta investigación estudió el significado de la relación pedagógico en la formación del estudio de enfermería y caracteriza el papel que esta relación posee en la práctica del cuidado, reflexiva, relacional y ética del estudiante. Método: investigación cualitativa con abordaje hermenéutico fenomenológico de Gadamer, etnográfico. Desarrollado durante la pasantía clínica de 11 alumnos con su respectivo profesor e instructor clínico de una Escuela de Enfermería en Barcelona, entre febrero de 2011 y febrero de 2012. Las estrategias de recolección de datos fueron: observación participante, conversas informales, entrevistas a profundidad y materiales escritos. Para su análisis fue utilizado el método comparativo constante de Glasser y Strauss. Resultados: la relación pedagógica orientada para el alumno emergió como el núcleo temático que incluyó categorías tales como "estar para el alumno", "confianza" y "autonomía". Conclusión: la relación pedagógica orientada para el alumno es una relación de cuidado que ofrece acompañamiento, confianza, presencia, empoderamiento y autonomía.

The legacy of care as reflexive learning.

OBJECTIVE: to analyze whether the tutor's use of reflexive strategies encourages the students to reflect. The goal is to discover what type of strategies can help to achieve this and how tutors and students behave in the practical context. METHOD: a qualitative and ethnographic focus was adopted. Twenty-seven students and 15 tutors from three health centers participated. The latter had received specific training on reflexive clinical tutoring. The analysis was developed through constant comparisons of the categories. RESULTS: the results demonstrate that the tutors' use of reflexive strategies such as didactic questioning, didactic empathy and pedagogical silence contributes to encourage the students' reflection and significant learning. CONCLUSIONS: reflexive practice is key to tutors' training and students' learning. OBJETIVO: analisar se o uso de estratégias reflexivas por parte da tutora de estágio clínico estimula a reflexão nos estudantes. A intenção é descobrir qual tipo de estratégias podem ajudar a fazê-lo e como as tutoras e os estudantes se comportam no contexto prático. MÉTODO: foi adotado um enfoque qualitativo de cunho etnográfico em que participaram 27 estudantes e 15 tutores de três centros de saúde que haviam recebido formação específica sobre tutoria clínica reflexiva. A análise foi realizada por meio de comparações constantes das categorias. RESULTADOS: os resultados demonstram que o uso de estratégias reflexivas como a interrogação didática, a empatia didática e o silêncio pedagógico por parte das tutoras, contribui para fomentar a reflexão do estudante e sua aprendizagem significativa. CONCLUSÕES: a prática reflexiva é a chave para a formação dos tutores e para a aprendizagem dos estudantes. OBJETIVO: analizar si el uso de estrategias reflexivas por parte de la tutora de prácticas clínicas fomenta la reflexión en los estudiantes. Se trata de conocer qué tipo de estrategias pueden ayudar a hacerlo y cómo se comportan tutoras y estudiantes en el contexto práctico. MÉTODO: se ha utilizado un enfoque cualitativo de corte etnográfico en el que participaron 27 estudiantes y 15 tutores de tres centros sanitarios que habían recibido formación específica sobre tutoría clínica reflexiva. El análisis se ha realizado mediante las comparaciones constantes de las categorías. RESULTADOS: los resultados demuestran que el uso de estrategias reflexivas como la interrogación didáctica, la empatía didáctica y el silencio pedagógico por parte de las tutoras contribuye a fomentar la reflexión del estudiante y su aprendizaje significativo. CONCLUSIONES: la práctica reflexiva es la clave para la formación de los tutores y para el aprendizaje de los estudiantes.

The legacy of care as reflexive learning / O legado do cuidado como aprendizagem reflexiva / El legado del cuidado como aprendizaje reflexivo

Abstract Objective: to analyze whether the tutor's use of reflexive strategies encourages the students to reflect. The goal is to discover what type of strategies can help to achieve this and how tutors and students behave in the practical context. Method: a qualitative and ethnographic focus was adopted. Twenty-seven students and 15 tutors from three health centers participated. The latter had received specific training on reflexive clinical tutoring. The analysis was developed through constant comparisons of the categories. Results: the results demonstrate that the tutors' use of reflexive strategies such as didactic questioning, didactic empathy and pedagogical silence contributes to encourage the students' reflection and significant learning. Conclusions: reflexive practice is key to tutors' training and students' learning.

Resumo Objetivo: analisar se o uso de estratégias reflexivas por parte da tutora de estágio clínico estimula a reflexão nos estudantes. A intenção é descobrir qual tipo de estratégias podem ajudar a fazê-lo e como as tutoras e os estudantes se comportam no contexto prático. Método: foi adotado um enfoque qualitativo de cunho etnográfico em que participaram 27 estudantes e 15 tutores de três centros de saúde que haviam recebido formação específica sobre tutoria clínica reflexiva. A análise foi realizada por meio de comparações constantes das categorias. Resultados: os resultados demonstram que o uso de estratégias reflexivas como a interrogação didática, a empatia didática e o silêncio pedagógico por parte das tutoras, contribui para fomentar a reflexão do estudante e sua aprendizagem significativa. Conclusões: a prática reflexiva é a chave para a formação dos tutores e para a aprendizagem dos estudantes.

Resumen Objetivo: analizar si el uso de estrategias reflexivas por parte de la tutora de prácticas clínicas fomenta la reflexión en los estudiantes. Se trata de conocer qué tipo de estrategias pueden ayudar a hacerlo y cómo se comportan tutoras y estudiantes en el contexto práctico. Método: se ha utilizado un enfoque cualitativo de corte etnográfico en el que participaron 27 estudiantes y 15 tutores de tres centros sanitarios que habían recibido formación específica sobre tutoría clínica reflexiva. El análisis se ha realizado mediante las comparaciones constantes de las categorías. Resultados: los resultados demuestran que el uso de estrategias reflexivas como la interrogación didáctica, la empatía didáctica y el silencio pedagógico por parte de las tutoras contribuye a fomentar la reflexión del estudiante y su aprendizaje significativo. Conclusiones: la práctica reflexiva es la clave para la formación de los tutores y para el aprendizaje de los estudiantes.