Using active learning strategies during a quality improvement collaborative: exploring educational games to enhance learning among healthcare professionals.

BACKGROUND: The Breakthrough Series model uses learning sessions (LS) to promote education, professional development and quality improvement (QI) in healthcare. Staff divergences regarding prior knowledge, previous experience, preferences and motivations make selecting which pedagogic strategies to use in LS a challenge. AIM: We aimed to assess new active-learning strategies: two educational games, a card game and an escape room-type game, for training in healthcare-associated infection prevention. METHODS: This descriptive case study evaluated the performance of educational strategies during a Collaborative to reduce healthcare-associated infections in Brazilian intensive care units (ICUs). A post-intervention survey was voluntarily offered to all participants in LS activities. RESULTS: Seven regional 2-day LS were held between October and December 2022 (six for adult ICUs and one for paediatric/neonatal ICUs). Of 194 institutions participating in a nationwide QI initiative, 193 (99.4%) participated in these activities, totalling 850 healthcare professionals. From these, 641 participants responded to the survey (75.4%). The post-intervention survey showed that the participants responded positively to the educational activities. CONCLUSION: The participants perceived the various pedagogical strategies positively, which shows the value of a broad and diverse educational approach, customised to local settings and including game-based activities, to enhance learning among healthcare professionals.

Adapting lean management to prevent healthcare-associated infections: a low-cost strategy involving Kamishibai cards to sustain bundles' compliance.

Lean healthcare visual management has been successfully integrated into infection control programs, leading to lower healthcare-associated infection (HAI) rates and greater provider compliance with evidence-based prevention practices; however, its implementation during quality improvement (QI) initiatives in limited-resource settings has not yet been well exploited. We aimed to describe a low-cost strategy involving Kamishibai cards to sustain bundles' adherence to prevent HAIs in a middle-income country. This descriptive case study evaluated the implementation of a lean healthcare visual management tool-Kamishibai board (K-board)-during a nationwide QI collaborative preventing three critical HAIs in 189 adult and pediatric/neonatal intensive care units (ICUs) from September 2021 to January 2023. Considering a limited-resource setting, our team adapted a K-board using simple, cheap, and easy-to-handle materials for routine monitoring of QI procedures, including safety bundles' compliance. After test prototypes, the final K-board version was implemented. The chart materials and assembly cost BRL 80.00 (USD 15.48). Before launching, expert working group meetings were held to shape the contents, refine technical issues, and prepare the ICU teams for implementation. After starting, plan-do-study-act cycles were conducted according to the Breakthrough Series model. Participating ICU teams, including leaders and front-line health workers, performed bedside audits following a weekly chronogram. Two indicators were calculated: the percentage of ICUs in which K-boards were being implemented and whether bundles' compliance was addressed in the K-board. Audit data were recorded in 'SimpleQI'. After 17 months of this initiative, 177 (93.7%) participating ICUs had included this visual management tool in their daily care routines. When more than 94 (>50%) ICUs posted K-board data, the mean compliance for the bundles for each HAI was sustained above 85%. A lean healthcare visual management tool can be adapted to local settings, including healthcare facilities with limited resources. K-board seems to be a feasible method for auditing evidence-based practices in medical care, including safety bundles to simultaneously prevent three types of HAIs.

A proteção dos dados médicos e o acesso à informação de saúde em Portugal à luz do Regulamento (UE) 2016/679 / The protection of medical data access to health information in Portugal under (EU) Regulation 2016/679 / La protección de datos médicos y el acceso a la información sanitaria en Portugal según el Reglamento (UE) 2016/679

Objetivo: analisar a legislação e as principais questões pertinentes ao armazenamento das informações relativas à saúde do paciente em bancos de dados, bem como as exceções ao dever de sigilo, à luz do Regulamento (UE) 2016/679 (novo Regulamento Geral de Proteção de Dados) e da Lei n.º 58/2019. Metodologia: por meio de uma revisão legislativa e doutrinária, confrontamos os dispositivos que abordam o direito à privacidade do paciente, a proteção do sigilo médico e o acesso de dados, analisando as exceções ao dever de sigilo que decorrem da lei e dos estatutos das ordens profissionais que tutelam o exercício das profissões. Resultados: a dispersão das normas que tratam a proteção de dados pode criar obstáculos à efetivação do direito e dúvidas acerca da interpretação do novo Regulamento Geral de Proteção de Dados. Conclusão: o novo Regulamento e a Lei n.º 58/2019 têm o escopo de sistematizar a matéria concernente à proteção dos dados, mas deverão ser confrontadas com a legislação interna portuguesa que aborde outras questões transversais, a exemplo das tratadas na Lei de Bases da Saúde em Portugal, no Regime Geral dos Arquivos e do Património Arquivístico, dentre outros, o que implica uma dificuldade acrescida ao utilizador do direito.

Objective: to analyze legislation and key issues related to the storage of patient data in databases and exceptions to confidentiality under Regulation (EU) 2016/679 (new General Data Protection Regulation) and Law No. 58/2019.Methods: through a review of legislation and doctrine, we contrast the provisions that address the patient's right to privacy, the protection of medical secrecy, and access to data, and analyze the exceptions to confidentiality arising from the law and the statutes of the professional codes that protect the practice of the professions. Results: the scattering of norms dealing with data protection may lead to obstacles in the realization of the right to data protection and to doubts in the interpretation of the new Regulation. Conclusion: the new Regulation and Law No. 58/2019 are suitable to systematize data protection. However, they must be confronted with Portuguese legislation that deals with other cross-cutting issues, such as the Portuguese Basic Health Law, the General Archives Law and others, which creates additional difficulties for the user of the law.

Objetivo: analizar la legislación y las principales cuestiones relevantes para el almacenamiento de información relacionada con la salud del paciente en bases de datos, así como las excepciones a la obligación de secreto, de acuerdo con el Reglamento (UE) 2016/679 (nuevo Reglamento General de Protección de Datos) y la Ley n.° 58/2019. Metodología: a través de una revisión legislativa y doctrinaria, confrontamos las disposiciones que atienden el derecho a la intimidad del paciente, la protección del secreto médico y el acceso a los datos, analizando las excepciones al deber de secreto, que se derivande la ley y los estatutos que protegen el ejercicio de las profesiones. Resultados: la dispersión de normas que tratan de la protección de datos puede generar obstáculos para la realización del derecho a la protección de datos y dudas sobre la interpretación del Reglamento. Conclusión: el Nuevo Reglamento y la Ley n.º 58/2019 tienen el alcance de sistematizar la materia relativa a la protección de datos, pero deben confrontarse con la legislación interna portuguesa que aborda otras cuestiones transversales, como las tratadas en el Ley de Salud en Portugal, en el Régimen General de Archivos, entre otros, lo que implica una dificultad añadida para el usuario del derecho.

Prevention and control of mosquito-borne arboviral diseases: lessons learned from a school-based intervention in Brazil (Zikamob).

BACKGROUND: Since the 1980s, when dengue was reintroduced in Brazil, outbreaks and epidemics caused by different arbovirus strains transmitted by vector mosquitoes such as Aedes aegypti have been an annual occurrence. The aim of this study was to evaluate the behavioural change of high school students and teachers who participated in an educational intervention for the prevention and vector control of arboviral diseases. METHODS: In this school-based intervention, a self-reported questionnaire was used in a pre-post intervention methodology to assess environmental risk factors, sociodemographic variables and to measure attitudes and behaviours. In all, 883 high school students and teachers from the city of Campina Grande, in the state of Paraíba, northeastern Brazil, participated. The e-health intervention consisted of a competition between schools to comply with preventive actions via content production for social networks, and the monitoring was performed over a period of three months through the ZikaMob software developed by the researchers. RESULTS: Out of the 883 survey participants, 690 were students ranging in age from 14 to 41 years, with an average of 17 ± 2 years; and 193 were teachers from 22 to 64 years old, averaging 38 ± 9 years. The analysis of the data shows that significant differences in most of the target behaviours were apparent after the intervention, with an increase of about 10% in the performance of inspection actions; a 7% greater separation of recyclables and a 40% increase in the screening of windows among students. Students showed lower fear of, and a lower self-perception of the risk of, acquiring arboviruses than teachers on average. CONCLUSIONS: ZikaMob is an innovative strategy with the potential to be replicated in any location that has an internet network and can involve an unlimited number of participants.

Molecular Detection of Trypanosoma kaiowa in Tabanus triangulum (Diptera: Tabanidae) from the Coastal Plain of Rio Grande do Sul, Southern Brazil.

PURPOSE: The species of the genus Trypanosoma are carried and transmitted by horseflies parasitizing a high diversity of vertebrates. In the Coastal Plain of Rio Grande do Sul, southern Brazil, Tabanus triangulum is the most abundant species and, similarly to the other species of horseflies, there is little knowledge about its vector competence. Therefore, this study aimed to screen the field-collected T. triangulum for the presence of Trypanosoma, to estimate infectivity. METHODS: Horseflies were sampled by the Malaise trap in the forest fragments at the coastal plain and DNA was extracted from whole body flies. The Polymerase Chain Reaction was performed. RESULTS: Horseflies presented amplification of 18S ribosomal gene-specific of Trypanosoma species. DNA sequencing and phylogenetic analysis positioned the strains in the Kaiowa clade with Trypanosoma kaiowa, associated with the crocodilian clade of Trypanosoma. CONCLUSION: This study represents the first report of the presence of the Tr. kaiowa in T. triangulum and the expansion of the parasite's range further south in South America.

Effects of Climatic Change on the Potential Distribution of Lycoriella Species (Diptera: Sciaridae) of Economic Importance.

Lycoriella species (Sciaridae) are responsible for significant economic losses in greenhouse production (e.g., mushrooms, strawberries, and nurseries). The current distributions of species in the genus are restricted to cold-climate countries. Three species of Lycoriella are of particular economic concern in view of their ability to invade areas in countries across the Northern Hemisphere. We used ecological niche models to determine the potential for range expansion under future climate change scenarios (RCP 4.5 and RCP 8.5) in the distribution of these three species of Lycoriella. Stable environmental suitability under climate change was a dominant theme in these species; however, potential range increases were noted in key countries (e.g., USA, Brazil, and China). Our results illustrate the potential for range expansion in these species in the Southern Hemisphere, including some of the highest greenhouse production areas in the world.

Climate change impacts on Anopheles (K.) cruzii in urban areas of Atlantic Forest of Brazil: Challenges for malaria diseases.

Around 27% of South Americans live in central and southern Brazil. Of 19,400 human malaria cases in Brazil in 2018, some were from the southern and southeastern states. High abundance of malaria vectors is generally positively associated with malaria incidence. Expanding geographic distributions of Anopheles vector mosquito species (e.g. A. cruzii) in the face of climate change processes would increase risk of such malaria transmission; such risk is of particular concern in regions that hold human population concentrations near present limits of vector species' geographic distributions. We modeled effects of likely climate changes on the distribution of A. cruzii, evaluating two scenarios of future greenhouse gas emissions for 2050, as simulated in 21 general circulation models and two greenhouse gas scenarios (RCP 4.5 and RCP 8.5) for 2050. We tested 1305 candidate models, and chose among them based on statistical significance, predictive performance, and complexity. The models closely approximated the known geographic distribution of the species under current conditions. Under scenarios of future climate change, we noted increases in suitable area for the mosquito vector species in São Paulo and Rio de Janeiro states, including areas close to 30 densely populated cities. Under RCP 8.5, our models anticipate areal increases of >75% for this important malaria vector in the vicinity of 20 large Brazilian cities. We developed models that anticipate increased suitability for the mosquito species; around 50% of Brazilians reside in these areas, and ∼89% of foreign tourists visit coastal areas in this region. Under climate change thereefore, the risk and vulnerability of human populations to malaria transmission appears bound to increase.

Patentes, genéricos eacesso ao medicamento: o caso daspandemias / Patent rights, generic medicines andaccess to medicines: the case of pandemics / Patentes, genéricos y acceso a la medicina: el caso de las pandemias

Este artigo tem por objetivo a realização de uma breve análise dos requisitos da patenteabilidade (novidade, atividade inventiva e aplicação industrial) e do procedimento de autorização de introdução do medicamento no mercado(AIM) no âmbito europeu e português, tendo em conta a atual crise pandêmica daCOVID-19, bem como a possibilidade (ou não) de utilização da licença obrigatória em situações pandêmicas.

This article aims to conducta brief analysis of the requirements for patentability (novelty, inventive step and industrial application) and the authorization procedure for placing the medicine on the market in the European and Portuguese scope, taking into account the current crisispandemic of COVID-19, as well as the possibility (or not) of using the mandatory license in pandemic situations.

Este artículo tiene como objetivo realizar un breve análisis de los requisitos de patentabilidad (novedad, actividad inventiva y aplicación industrial) y el procedimiento de autorización para la comercialización del medicamento en el ámbito europeo y portugués, teniendo en cuenta la crisis actual. pandemia de COVID-19, así como la posibilidad (o no) de utilizar la licencia obligatoria en situaciones de pandemia.

Climate change implications for the distribution of the babesiosis and anaplasmosis tick vector, Rhipicephalus (Boophilus) microplus.

Climate change ranks among the most important issues globally, affecting geographic distributions of vectors and pathogens, and inducing losses in livestock production among many other damaging effects. We characterized the potential geographic distribution of the ticks Rhipicephalus (Boophilus) microplus, an important vector of babesiosis and anaplasmosis globally. We evaluated potential geographic shifts in suitability patterns for this species in two periods (2050 and 2070) and under two emissions scenarios (RCPs 4.5 and 8.5). Our results anticipate increases in suitability worldwide, particularly in the highest production areas for cattle. The Indo-Malayan region resulted in the highest cattle exposure under both climate change projections (2050), with increases in suitability of > 30%. This study illustrates how ecological niche modeling can be used to explore probable effects of climate change on disease vectors, and the possible consequences on economic dimensions.

The prevention of arboviral diseases using mobile devices: a preliminary study of the attitudes and behaviour change produced by educational interventions.

OBJECTIVES: In Brazil, the National Policy for Dengue Control seeks to incorporate the lessons of national and international experience in dengue control, emphasising the need for health education activities. The objective of this study was to evaluate and compare knowledge, attitudes and behaviours related to the prevention of arboviruses before and after a two-month educational intervention using a learning platform on mobile devices. METHODS: This quasi-experimental study corresponds to the first phase of the project 'Impact of mobile learning in the prevention and management of complications caused by arboviruses (Zika, Dengue, Chikungunya) - ZIKAMOB', sponsored as part of the British Council Newton Fund. RESULTS: Thirty of the 93 participants were first-year undergraduate university students (36.7% male), and 63 were police officers (84.1% male). The pattern of attitudes and behaviour was very similar in both groups before the intervention. The students changed their attitudes and behaviour (P = 0.032) in relation to their engagements in actions for the prevention of arboviral diseases and several other activities related to house inspections and precautions with water tanks (P < 0.01). However, recycling and surveillance activities were not as effective in changing behaviour. Female participants showed more motivation to participate in preventive activities, but living alone and working were barriers to participation. Individuals who already perform selective waste collection and are cultivating gardens demonstrated both a positive attitude and a positive behaviour towards actions for the prevention of arboviral diseases. CONCLUSION: Mobile learning and behaviour change theories might be successful as the basis for school-based and community-based interventions to avoid arboviruses. These outcomes need to be confirmed in broader future studies.

OBJECTIFS: Au Brésil, la politique nationale de lutte contre la dengue cherche à intégrer les leçons tirées des expériences nationales et internationales en matière de lutte contre la dengue, en insistant sur la nécessité d'activités d'éducation sur la santé. L'objectif de cette étude était d'évaluer et de comparer les connaissances, les attitudes et les comportements liés à la prévention des arbovirus avant et après une intervention éducative de deux mois à l'aide d'une plate-forme d'éducation basée sur des appareils mobiles. MÉTHODES: Cette étude quasi expérimentale correspond à la première phase du projet "Impact de l'éducation mobile dans la prévention et la prise en charge des complications causées par les arbovirus (Zika, Dengue, Chikungunya) - ZIKAMOB", parrainé dans le cadre du British Council Newton Fund. RÉSULTATS: Trente des 93 participants étaient des étudiants de première année d'université (36,7% d'hommes) et 63 étaient des agents de police (84,1% d'hommes). Le modèle des attitudes et de comportement était très similaire dans les deux groupes avant l'intervention. Les étudiants ont changé leurs attitudes et comportements (P = 0,032) en ce qui concerne leur participation à des actions de prévention des maladies à arbovirus et à plusieurs autres activités liées aux inspections des maisons et aux précautions d'utilisation des réservoirs d'eau (P < 0,01). Cependant, les activités de recyclage et de surveillance n'étaient pas aussi efficaces pour le changement de comportement. Les participantes étaient plus motivées à participer aux activités de prévention, mais le fait de vivre seul et de travailler constituait un obstacle à la participation. Les personnes qui effectuent déjà une collecte sélective des déchets et cultivent des jardins ont démontré à la fois une attitude positive et un comportement positif à l'égard des actions de prévention des maladies à arbovirus. CONCLUSION: Les théories sur l'éducation mobile et le changement de comportement pourraient être couronnées de succès en tant que base d'interventions en milieu scolaire et communautaire visant à éviter les arbovirus. Ces résultats doivent être confirmés dans des études supplémentaires plus larges.

Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.

Adaptation of a cognitive-behavioral protocol for generalized anxiety disorder patientswith low educational attainment / Adaptação de um protocolo cognitivo comportamental para pacientes com transtorno de ansiedade generalizada com baixo nível educacional / Adaptación de un protocolo cognitivo-conductual de trastornos de ansiedad generalizada para pacientes con bajo nivel educativo

This article reports the experience of treating low-income patients with a primary diagnosis of generalized anxiety disorder (GAD) in a public hospital in Rio de Janeiro, Brazil. At the start of the project for outpatient treatment, which included the application of a cognitive model for GAD treatment, we observed that the majority of patients presented low educational level, which made it hard for them to understand key aspects of the cognitive-behavioral based treatment offered. Therefore, important adaptations to the treatment protocol were made necessary, including the way techniques were presented and applied, the therapeutic approach used, and even the duration of sessions. Since variations of cognitive therapy are increasingly being applied in hospital outpatient clinics in countries worldwide, the objective of this article is to present the adaptations performed and promote a discussion on the possible solutions for the difficulties faced in applying clinical psychology practice among patients with low educational and socioeconomic levels. This is a clinical study presenting an illustrative case, where adaptations to the treatment protocol were essential for the positive outcome of the case. It is concluded that, with the scope of treatment in mind, the therapist must be attentive to the client's demands and particularities in order to achieve therapeutic success.(AU)

Este artigo relata a experiência de tratamento de pacientes de baixa renda com diagnóstico primário de transtorno de ansiedade generalizada (TAG) em hospital público no Rio de Janeiro, Brasil. A ideia inicial do projeto era tratamento ambulatorial, com aplicação de um modelo cognitivo para o tratamento de TAG; porém, observamos que a maioria dos pacientes apresentou baixo nível educacional, o que tornava difícil sua compreensão dos principais aspectos do tratamento cognitivo-comportamental oferecido. Assim, foram feitas adaptações no protocolo de tratamento, incluindo a forma como as técnicas foram apresentadas e aplicadas, a abordagem terapêutica utilizada e a duração das sessões. Considerando que variações de terapias cognitivas são cada vez mais aplicadas em ambulatórios hospitalares em todo o mundo, o objetivo deste artigo é apresentar as adaptações realizadas e discutir possíveis soluções para as dificuldades enfrentadas na prática clínica com pacientes com baixo nível educacional e socioeconômico. Trata-se de um estudo clínico, com apresentação de um caso ilustrativo. Os resultados obtidos foram positivos e mostraram que as adaptações no protocolo foram essenciais para o sucesso terapêutico. Conclui-se que, tendo em mente o escopo do tratamento, o terapeuta deve estar atento às demandas e particularidades do cliente a fim de obter sucesso terapêutico.(AU)

Este artículo reporta la experiencia del tratamiento de pacientes de bajos recursos con diagnóstico primario de Trastorno de Ansiedad Generalizada (TAG) en hospitales públicos de Rio de Janeiro, Brasil. La idea original era el tratamiento ambulatorio con aplicación de un modelo cognitivo para el TAG. No obstante, el bajo nivel educativo presentado por la mayoría de los pacientes hace que les resulte difícil la comprensión de los principales aspectos del tratamiento cognitivo-conductual ofrecido. Adaptaciones fueron entonces realizadas en el protocolo de tratamiento, incluyendo cómo las técnicas fueron introducidas y aplicadas, el enfoque terapéutico utilizado y la duración de las sesiones. Dado que variantes de la terapia cognitiva son cada vez más aplicadas en la atención ambulatoria hospitalaria de todo el mundo, el objetivo de este artículo es presentar las adaptaciones realizadas y analizar posibles soluciones a las dificultades encontradas en la práctica de la psicología clínica con pacientes con bajo nivel educativo y socioeconómico, a partir de un caso ilustrativo. Los resultados obtenidos, positivos, indican que las adaptaciones realizadas fueron fundamentales para el éxito de la terapia. Podemos concluir que el terapeuta debe estar atento a las demandas y particularidad del cliente a fin de que la terapia sea exitosa.(AU)

Requisição de prontuário ou ficha clínica no Brasil (Justiça, Ministério Público e Polícia) x Sigilo Médico / Request for medical records or medical records in Brazil (Justice, Public Prosecution and Police) x Medical Confidentiality / Solicitar registros médicos o registros médicos en Brasil (Justicia, fiscales y policías) x secreto médico

A requisição de prontuários médicos para a instrução de inquéritos policiais, procedimentos administrativos e processos judiciais é uma realidade no Brasil e desperta inúmeras dúvidas. Este artigo visa, à luz da legislação e da jurisprudência brasileira, trazer alguns esclarecimentos sobre o tema, sem a pretensão de exauri-lo.

The request medical records for the instruction of criminal investigations, administrative and judicial proceedings is a reality in Brazil and arouses many questions. This article aims, in the light of the legislation and case law, bring some clarification on the subject, with no claim to exhaust it.

La solicitud de registros médicos para la instrucción de las investigaciones policiales, los procedimientos administrativos y judiciales es una realidad en Brasil y suscita muchas preguntas. Este artículo tiene como objetivo, a la luz de la legislación y la jurisprudencia brasileña, trae algunas aclaraciones sobre el tema, sin pretensión de agotarlo.

[Assessment of competencies of community health workers for epidemiological data collection]. / Avaliação de competências de Agentes Comunitários de Saúde para coleta de dados epidemiológicos.

The scope of this study was to assess competencies in terms of reading, comprehension and problem-solving using educational material created for epidemiological research on people with disabilities. A form with twenty multiple-choice questions was prepared and distributed to a sample of 348 community health workers (CHWs) in the State of Paraíba. The socioeconomic profile revealed that, within the sample, most of these CHWs are female, between 30-49 years of age, married or in a stable relationship, with two children and have graduated from high school. Over 98% of CHWs are government employees and more than half have been working for more than eight years in the same community, predominantly in the urban area. The score for overall performance evaluation ranged from 33 to 60 points, with the mean score of 53.44 ± 4.88 points. This means that the CHWs were able to resolve over 65% of the questions properly. The overall performance was positively correlated with education and negatively with age, having children and the time taken to complete high school education. The overall results indicate the increasing professionalization and education of the CHWs and their potential role as collaborators in basic scientific research to make generalizations about public health.

Avaliação de competências de Agentes Comunitários de Saúde para coleta de dados epidemiológicos / Assessment of competencies of community health workers for epidemiological data collection

Este trabalho objetivou avaliar as competências de leitura, interpretação de texto e resolução de problemas de um material didático criado para pesquisa epidemiológica sobre pessoas com deficiências. Uma avaliação contendo vinte questões de múltipla escolha foi desenvolvida e aplicada em uma amostra de 348 agentes comunitários de saúde no estado da Paraíba. A caracterização socioeconômica da amostra mostrou que a maior parte desses profissionais é constituída por mulheres, de 30 a 49 anos, casadas ou que mantêm união estável, com dois filhos e ensino médio completo. Mais de 98% dos ACS são concursados e atuam há mais de oito anos nesta profissão e predominantemente na zona urbana. A pontuação referente ao desempenho global na avaliação variou de 33 até 60 pontos, sendo obtida a média de 53,44 ± 4,88 pontos. Isto significa que os agentes foram capazes de resolver adequadamente mais de 65% das questões. O desempenho global mostrou correlação positiva com a escolaridade e negativa com a idade, ter filhos e o tempo de conclusão do ensino formal. O conjunto dos resultados aponta a crescente profissionalização e escolarização dos ACS, e seu potencial papel como colaborador em pesquisas científicas fundamentais para estabelecimento de generalizações sobre a saúde das populações.

The scope of this study was to assess competencies in terms of reading, comprehension and problem-solving using educational material created for epidemiological research on people with disabilities. A form with twenty multiple-choice questions was prepared and distributed to a sample of 348 community health workers (CHWs) in the State of Paraíba. The socioeconomic profile revealed that, within the sample, most of these CHWs are female, between 30-49 years of age, married or in a stable relationship, with two children and have graduated from high school. Over 98% of CHWs are government employees and more than half have been working for more than eight years in the same community, predominantly in the urban area. The score for overall performance evaluation ranged from 33 to 60 points, with the mean score of 53.44 ± 4.88 points. This means that the CHWs were able to resolve over 65% of the questions properly. The overall performance was positively correlated with education and negatively with age, having children and the time taken to complete high school education. The overall results indicate the increasing professionalization and education of the CHWs and their potential role as collaborators in basic scientific research to make generalizations about public health.