Communication in healthcare: experience of students and professionals from teaching- learning to practice in health.

Objectives: This study aimed to understand the teaching-learning experience in the Communication in Healthcare class among students, teaching assistants, and health professionals, as well as its applications to professional practice. Methods: This is a qualitative study with a theoretical approach based on Gadamer's Philosophical Hermeneutics and a methodological framework based on Minayo and Bardin's thematic content analysis. Communication in Healthcare is an elective multiprofessional class, which lasts one semester and is offered regularly. All former students (n = 368) were invited to participate by email, and 30 participated in these focus groups (13 students, 8 teaching assistants, and 9 health professionals). The online focus groups took place on an online platform, and they were video-recorded and subsequently transcribed. Through cross-sectional and vertical analysis, the main themes were identified. Results: The Communication in Healthcare class was an important step for personal, professional, and interprofessional formation and development of communication competence. The following dominant themes were identified: 1) motivation for signing up, 2) prior expectations, 3) meaning of the experience and shaping moments, 4) how the teaching-learning experience was retained and what was retained, 5) repercussions in relation to self, others, and professional life, and 6) reflections about the curriculum, interprofessional dialogue, and formation. Conclusions: The teaching-learning experience was important for the formation of communicational competence. This research contributes to medical education and opens teaching-learning paths for communication skills, empathy, dialogue, and interprofessionalism. Future studies with a philosophical hermeneutic framework and online focus groups are indicated for the comprehension of educational interventions in health.

Leptin and cardiometabolic risk factors in obese children and adolescents.

AIM: To verify the relationship between leptin and cardiometabolic risk factors in obese children and adolescents. METHODS: A cross-sectional study evaluated 200 children and adolescents treated in Campina Grande, Brazil, from April 2009 to March 2010. Leptin, fasting glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides were determined. The t-test was used to compare leptin means of two groups and analysis of variance to compare means of three groups. Multiple comparisons of pairs of group means were performed with Tukey's test. In all tests, a significance level of 0.05 was adopted. RESULTS: The leptin sample mean was 22.7 ± 10.0 µg/L (95% confidence interval: 21.3 µg/L to 24.1 µg/L). Leptin was significantly higher in the following groups: female, teenager, increased waist circumference, high systolic blood pressure, elevated triglycerides hyperinsulinemia, insulin resistance and metabolic syndrome. Most cardiometabolic risk factors had higher means in the last quartile of leptin, except total-cholesterol, LDL-C and triglycerides levels. HDL-C was reduced in the last quartile of leptin. Simple linear regression analysis showed a significant negative correlation between leptin and HDL-C and a positive correlation between leptin and triglycerides, insulin, HOMA-IR, body mass index, waist circumference, and systolic and diastolic blood pressure. Multiple linear regression models showed an independent association between leptin and HDL-C, triglycerides, insulin, HOMA-IR, body mass index, waist circumference, systolic and diastolic blood pressure, after age and gender control. CONCLUSION: Leptin may be a useful marker of metabolic syndrome and insulin resistance in obese adolescents.

Longitudinal variance of visceral fat thickness in pregnant adolescents.

This study aims to investigate the longitudinal change in visceral fat thickness (VFT) during normal pregnancy. A prospective cohort study with 75 primiparous adolescents was carried out in Petrolina, Brazil. VFT was evaluated by ultrasound between 12-20 weeks gestation and immediately after delivery. We noted a statistically significant increase in VFT; 1.3 cm ± 1.0. No correlation was found between VFT and maternal anthropometric variables. VFT increases about 30% from the first to the second half of pregnancy in primiparous adolescents.

[Asthma in schoolchildren from Recife, Brazil. Prevalence comparison: 1994-95 and 2002]. / Asma em escolares do Recife -- comparação de prevalências: 1994-95 e 2002.

OBJECTIVES: To describe the prevalence of asthma and asthma variants in schoolchildren from Recife in 2002, and to compare these data with data from 1994-95; to analyze the relationship between maternal schooling and the presence of asthma or worsening asthma; and to evaluate the diagnostic accuracy of the yearly prevalence of wheezing as an asthma indicator. METHODS: Cross-sectional study. A probabilistic sample of 3,086 and 2,774 13- and 14-year-old students answered a written questionnaire in 1994-95 and 2002, as part of the International Study of Asthma and Allergies in Childhood. RESULTS: The following prevalence rates were observed in 1994-95 and 2002, respectively: cumulative prevalence of referred asthma: 21 vs 18.2%; cumulative prevalence of wheezing: 39 vs 38%; yearly prevalence of wheezing: 19.7 vs 19.4%; yearly prevalence of night cough: 31 vs 38%; yearly prevalence of exercise-induced wheezing: 20.6 vs 23.8%. The yearly prevalence of asthma attacks was 16.3 vs 15.2% for 1 to 3 attacks; 2.7% vs 1.2% for 4 to 12 attacks; and 1% vs 0.4% for more than 12 attacks. The yearly prevalence of attacks that disturbed sleep was 13 and 10.3%. The yearly prevalence of attacks with compromised speech was 4.8 and 4.1%. Higher levels of maternal schooling were related to higher cumulative prevalence of referred asthma and to cumulative and yearly prevalence of wheezing. CONCLUSIONS: The prevalence of asthma and its severe forms is high in teenager students in Recife. It is also related to higher levels of maternal schooling.

Asma em escolares do Recife - comparação de prevalências: 1994-95 e 2002 / Asthma in schoolchildren from Recife, Brazil. Prevalence comparison: 1994-95 and 2002

OBJETIVOS: Descrever a prevalência atual (2002) de asma e suas variantes em escolares da cidade do Recife, comparando os dados com o período de 1994-95; analisar a relação entre instrução materna e o surgimento ou o agravamento da asma; e avaliar a acurácia diagnóstica da prevalência anual de sibilância como indicador de asma. MÉTODO: Em um corte transversal, estudou-se, por questionário escrito, uma amostra probabilística de escolares de 13 e 14 anos em Recife, em 1994-95 (n = 3.086) e 2002 (n = 2.774), como parte do projeto ISAAC (International Study of Asthma and Allergies in Childhood). RESULTADOS: Em 1994-95 e 2002, as prevalências foram, respectivamente: cumulativa de asma referida, 21 e 18,2 por cento; cumulativa de sibilância, 39 e 38 por cento; anual de sibilância, 19,7 e 19,4 por cento; anual de tosse equivalente de asma, 31 e 38 por cento; anual de sibilância desencadeada por exercício, 20,6 e 23,8 por cento. A prevalência anual de crises, estratificada em 1 a 3, 4 a 12 e mais de 12 foi: 16,3, 2,7 e 1 por cento em 1994-95 e 15,2, 1,2 e 0,4 por cento em 2002. A prevalência anual de crises que comprometeram o sono foi, respectivamente, de 13 e 10,3 por cento; a prevalência de crises com prejuízo da fala foi de 4,8 e 4,1 por cento. Nível mais elevado de instrução materna associou-se a maior prevalência cumulativa de asma referida, prevalência cumulativa e anual de sibilância. CONCLUSÕES: A prevalência de asma e suas formas graves é elevada em escolares adolescentes do Recife e está associada a maior instrução materna.

[Visceral leishmaniasis: clinical and epidemiological features of children in an endemic area]. / Leishmaniose visceral: características clínico-epidemiológicas em crianças de área endêmica.

OBJECTIVE: To describe the clinical and epidemiological features of children with visceral leishmaniasis admitted to a pediatric referral hospital, and to describe treatment measures and the case fatality rate. METHODS: Retrospective analysis of biological, demographic, clinical and laboratory data from children with visceral leishmaniasis admitted to Instituto Materno Infantil de Pernambuco (Recife, state of Pernambuco, northeastern Brazil) between 1996 and 2001. RESULTS: 431 children were included in the study. Age ranged from 4 months to 13.7 years. 50.3% were female and 82.5% came from the interior of the state of Pernambuco. 70% of the patients lived in brick homes, and 70% were not served with piped water and sewage services. Average maternal schooling was 3 years. Clinical presentation included splenomegaly (97%), fever (95.6%) and malnourishment (44.5%). Associated infections were diagnosed in 10.9% of cases. The mean values for laboratory variables were: hemoglobin 6 g/dl, leukocyte count 3,516/mm(3), and platelet count 118,641/mm(3). The first line treatment used in 98% of the cases was glucantime. Amphotericin B was used in seven cases. The case fatality rate was 10.2%. The main immediate causes of death were associated infections, bleeding and liver failure. CONCLUSIONS: Health care workers should be trained for the early recognition and appropriate management of visceral leishmaniasis and its complications.

Leishmaniose visceral: características clínico-epidemiológicas em crianças de área endêmica / Visceral leishmaniasis: clinical and epidemiological features of children in an endemic area

OBJETIVO: Descrever as características clínico-epidemiológicas, o tratamento e a letalidade das crianças internadas com leishmaniose visceral em um hospital pediátrico de referência. MÉTODOS: Análise retrospectiva dos dados biológicos, demográficos, clínicos e laboratoriais das crianças internadas no Instituto Materno-Infantil de Pernambuco, em Recife, no período compreendido entre 1996 e 2001. RESULTADOS: Foram incluídas 431 crianças, de 4 meses a 13,7 anos de idade, sendo que 50,3 por cento eram do sexo feminino, e 82,5 por cento eram do interior do estado de Pernambuco. Cerca de 70 por cento dos domicílios eram de alvenaria, 70 por cento não dispunham de água encanada ou sistema de esgoto sanitário, e o tempo médio de permanência das mães na escola foi de 3 anos. Esplenomegalia e febre estavam presentes em 97 por cento e 95,6 por cento dos casos, respectivamente, e 44,5 por cento dos pacientes eram subnutridos. Em 47 (10,9 por cento) dos pacientes foi detectada infecção na admissão. O nível médio de hemoglobina foi de 6 g/dl, de leucócitos 3.516/mm e de plaquetas 118.641/mm . O tratamento de escolha foi o glucantime (98 por cento dos casos), e em sete pacientes, a anfotericina B foi utilizada. A letalidade foi de 10,2 por cento, sendo que as principais causas imediatas de óbito foram atribuídas a infecções associadas, hemorragias e insuficiência hepática. CONCLUSÕES: Os autores destacam as características clínicas, epidemiológicas e laboratoriais da leishmaniose visceral em área endêmica, além do diagnóstico tardio e alta letalidade, sugerindo a capacitação de profissionais de saúde para o reconhecimento precoce e tratamento adequado da doença e suas complicações.