Identifying strategies to improve PANSS based dimensional models in schizophrenia: Accounting for multilevel structure, Bayesian model and clinical staging.

BACKGROUND: Dimensional approaches can decompose a construct in a set of continuous variables, improving the characterization of complex phenotypes, such as schizophrenia. However, the five-factor model of the Positive and Negative Syndrome Scale (PANSS), the most used instrument in schizophrenia research, yielded poor fits in most confirmatory factor analysis (CFA) studies, raising concerns about its applications. Thus, we aimed to identify dimensional PANSS CFA models with good psychometric properties by comparing the traditional CFA with three methodological approaches: Bayesian CFA, multilevel modeling, and Multiple Indicators Multiple Causes (MIMIC) modeling. METHODS: Clinical data of 700 schizophrenia patients from four centers were analyzed. We first performed a traditional CFA. Next, we tested the three techniques: 1) a Bayesian CFA; 2) a multilevel analysis using the centers as level; and 3) a MIMIC modeling to evaluate the impact of clinical staging on PANSS factors and items. RESULTS: CFA and Bayesian CFA produced poor fit models. However, when adding a multilevel structure to the CFA model, a good fit model emerged. MIMIC modeling yielded significant differences in the factor structure between the clinical stages of schizophrenia. Sex, age, age of onset, and duration of illness did not significantly affect the model fit. CONCLUSION: Our comparison of different CFA methods highlights the need for multilevel structure to achieve a good fit model and the potential utility of staging models (rather than the duration of illness) to deal with clinical heterogeneity in schizophrenia. Large prospective samples with biological data should help to understand the interplay between psychometrics concerns and neurobiology research.

What is the Best Latent Structure of Negative Symptoms in Schizophrenia? A Systematic Review.

BACKGROUND: Determining the best latent structure of negative symptoms in schizophrenia could benefit assessment tools, neurobiological research, and targeted interventions. However, no review systematically evaluated studies that assessed and validated latent models of negative symptoms. OBJECTIVE: To identify and evaluate existing latent structure models in the literature of negative symptoms and to determine the best model. METHOD: Systematic search of MEDLINE, EMBASE, and Scopus on July 19, 2020, for confirmatory factor analysis models of negative symptoms in patients with schizophrenia. The available evidence was assessed through 2 sets of criteria: (1) study design quality-based on negative symptoms assessment and modeling strategy and (2) psychometric quality and model fit-based on fit indices and factor definition quality. RESULTS: In total, 22 studies (n = 17 086) from 9 countries were included. Studies differed greatly regarding symptom scales, setting, and sample size (range = 86-6889). Dimensional models included 2-6 factors (median = 4). Twelve studies evaluated competing models and adopted appropriate instruments to assess the latent structure of negative symptoms. The 5-factor and hierarchical models outperformed unitary, 2-factor, and 3-factor models on all direct comparisons, and most of the analyses derived from the Brief Negative Symptom Scale. Considering the quality criteria proposed, 5-factor and hierarchical models achieved excellent fit in just one study. CONCLUSIONS: Our review points out that the 5-factor and hierarchical models represent the best latent structure of negative symptoms, but the immaturity of the relevant current literature may affect the robustness of this conclusion. Future studies should address current limitations regarding psychometric properties and also address biological and clinical validity to refine available models.

Evaluation of dopamine transporter density in healthy Brazilians using Tc-99m TRODAT-1 SPECT.

ABSTRACT: The presynaptic dopamine transporter (DAT) modulates the uptake of dopamine by regulating its concentration in the central nervous system. We aimed to evaluate the DAT binding potential (DAT-BP) in a sample of healthy Brazilians through technetium-99 metastable TRODAT-1 single-photon emission computed tomography imaging.We selected 126 healthy individuals comprising 72 men and 54 women, aged 18 to 80 years. We conducted semi-quantitative evaluation in transaxial slices, following which we identified the regions of interest in the striatal region using the occipital lobe as a region of non-specific DAT-BP.We found a decrease in DAT-BP in healthy individuals aged over 30 years, culminating in a 42% mean reduction after 80 years. There was no difference in the decrease by age group between the right (linear regression test [R2] linear = 0.466) and left striatum (R2 linear = 0.510). Women presented a higher DAT-BP than men (women: R2 linear = 0.431; men: R2 linear = 0.457); nonetheless, their decrease by age group was equal to that in men.Our study sheds light on important DAT-BP findings in healthy Brazilian subjects. Our results will facilitate understanding of brain illnesses that involve the dopamine system, such as neuropsychiatric disorders.

Is treatment-resistant schizophrenia associated with distinct neurobiological callosal connectivity abnormalities?

BACKGROUND: Resistance to antipsychotic treatment affects up to 30% of patients with schizophrenia. Although the time course of development of treatment-resistant schizophrenia (TRS) varies from patient to patient, the reasons for these variations remain unknown. Growing evidence suggests brain dysconnectivity as a significant feature of schizophrenia. In this study, we compared fractional anisotropy (FA) of brain white matter between TRS and non-treatment-resistant schizophrenia (non-TRS) patients. Our central hypothesis was that TRS is associated with reduced FA values. METHODS: TRS was defined as the persistence of moderate to severe symptoms after adequate treatment with at least two antipsychotics from different classes. Diffusion-tensor brain MRI obtained images from 34 TRS participants and 51 non-TRS. Whole-brain analysis of FA and axial, radial, and mean diffusivity were performed using Tract-Based Spatial Statistics (TBSS) and FMRIB's Software Library (FSL), yielding a contrast between TRS and non-TRS patients, corrected for multiple comparisons using family-wise error (FWE) < 0.05. RESULTS: We found a significant reduction in FA in the splenium of corpus callosum (CC) in TRS when compared to non-TRS. The antipsychotic dose did not relate to the splenium CC. CONCLUSION: Our results suggest that the focal abnormality of CC may be a potential biomarker of TRS.

Schneider's first-rank symptoms as predictors of remission in antipsychotic-naive first-episode psychosis

Objective: German psychiatrist Kurt Schneider proposed the concept of first-rank symptoms (FRS) of schizophrenia in 1959. However, their relevance for diagnosis and prediction of treatment response are still unclear. Most studies have investigated FRS in chronic or medicated patients. The present study sought to evaluate whether FRS predict remission, response, or improvement in functionality in antipsychotic-naive first-episode psychosis. Methods: Follow-up study of 100 patients at first episode of psychosis (FEP), with no previous treatment, assessed at baseline and after 2 months of treatment. The participants were evaluated with the standardized Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) and for presence of FRS. Results: Logistic regression analysis showed that, in this sample, up to three individual FRS predicted remission: voices arguing, voices commenting on one's actions, and thought broadcasting. Conclusion: Specific FRS may predict remission after treatment in FEP patients. This finding could give new importance to Kurt Schneider's classic work by contributing to future updates of diagnostic protocols and improving estimation of prognosis.

A symptom combination predicting treatment-resistant schizophrenia - A strategy for real-world clinical practice.

Early identification of symptoms that can predict treatment-resistant schizophrenia (TRS) could help clinicians to avoid delays in clozapine therapy. This study aims to investigate symptom patterns that could predict TRS using a discovery/replication study design. First, we followed a cohort of inpatients with schizophrenia (n = 164) in which the most discriminative items at baseline of the Positive and Negative Syndrome Scale (PANSS) were determined using logistic regression with TRS status as an outcome. Using Receiver Operating Characteristic (ROC) curves, we tested the prediction performance of multiple combinations of the identified items. The same items' combination was tested in an independent replication sample of (n = 207) outpatients with schizophrenia. In the discovery sample, the best combination to predict TRS at the discharge was the sum of three baseline PANSS items - conceptual disorganization (P2), difficulty in abstract thinking (N5), and unusual thought content (G9). The P2 + N5 + G9 model yielded an area under the curve (AUC) of 0.881, a sensitivity of 77.8%, and a specificity of 83.3%. In the outpatient sample, the model P2 + N5 + G9 predictive accuracy for TRS was only in the range of "acceptable" with an AUC of 0.756 and sensitivity of 72.3% and a specificity of 74.4%. Overall, the P2 + N5 + G9 model corresponds to the construct of formal thought disorder composed of disorganized thinking, concrete thinking, and bizarre-idiosyncratic thinking. Pronounced levels of these symptoms are easily identifiable in clinical practice and may be a feasible strategy in TRS. Replicating in first-episode cohorts is desirable to understand the likely clinical utility.

Schneider's first-rank symptoms as predictors of remission in antipsychotic-naive first-episode psychosis.

OBJECTIVE: German psychiatrist Kurt Schneider proposed the concept of first-rank symptoms (FRS) of schizophrenia in 1959. However, their relevance for diagnosis and prediction of treatment response are still unclear. Most studies have investigated FRS in chronic or medicated patients. The present study sought to evaluate whether FRS predict remission, response, or improvement in functionality in antipsychotic-naive first-episode psychosis. METHODS: Follow-up study of 100 patients at first episode of psychosis (FEP), with no previous treatment, assessed at baseline and after 2 months of treatment. The participants were evaluated with the standardized Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) and for presence of FRS. RESULTS: Logistic regression analysis showed that, in this sample, up to three individual FRS predicted remission: voices arguing, voices commenting on one's actions, and thought broadcasting. CONCLUSION: Specific FRS may predict remission after treatment in FEP patients. This finding could give new importance to Kurt Schneider's classic work by contributing to future updates of diagnostic protocols and improving estimation of prognosis.

Cannabis acute use impacts symptoms and functionality in a cohort of antipsychotic naïve First Episode of Psychosis individuals.

INTRODUCTION: Cannabis use increases the risk of developing psychosis, and subjects with psychosis are more likely to use cannabis. However, studies on the influence of cannabis on psychotic dimensions, response to treatment, and functional outcomes showed conflicting results. Such heterogeneity may be due the inclusion of patients who were already under treatment, and lack of specificity in evaluations. We investigated whether cannabis use yields distinct symptom profiles and functionality in a cohort of antipsychotic-naïve patients at first episode of psychosis (FEP). METHODS: This research is part of a prospective cohort study performed in Sao Paulo, Brazil. The baseline assessment was completed by 175 individuals, and 99 of them were reassessed in a ten-week follow up. We investigated the relationship between cannabis exposure variables (acute use, lifetime use and age at first use) and outcomes: symptom dimensions and functioning. RESULTS: Individuals who reported acute use of cannabis had higher excitement symptoms at baseline, higher excitement and positive response rates, but no significant differences at follow-up. Additionally, more days of cannabis use in the last month predicted worse functionality and clinical impression at baseline but not at follow-up. DISCUSSION: The acute use of cannabis influenced the clinical presentation at our FEP baseline assessment, but did not to influence symptoms or functional outcomes at 10-week follow-up. Additionally, acute cannabis users had a better response for excitement and positive symptoms. Higher excitement symptoms at presentation of FEP should raise concerns of possible acute use of cannabis. Longer follow-up times may elucidate whether the effects on functionality would be more evident later in disease development.

Disorganized Symptoms Predicted Worse Functioning Outcome in Schizophrenia Patients with Established Illness.

Most patients with schizophrenia will have subsequent relapses of the disorder, with continuous impairments in functioning. However, evidence is lacking on how symptoms influence functioning at different phases of the disease. This study aims to investigate the relationship between symptom dimensions and functioning at different phases: acute exacerbation, nonremission and remission. METHODS: Patients with schizophrenia were grouped into acutely ill (n=89), not remitted (n=89), and remitted (n=69). Three exploratory stepwise linear regression analyses were performed for each phase of schizophrenia, in which the five PANSS factors and demographic variables were entered as the independent variables and the total Global Assessment of Functioning Scale (GAF) score was entered as the dependent variable. An additional exploratory stepwise logistic regression analysis was performed to predict subsequent remission at discharge in the inpatient population. RESULTS: The Disorganized factor was the most significant predictor for acutely ill patients (p<0.001), while the Hostility factor was the most significant for not-remitted patients and the Negative factor was the most significant for remitted patients (p=0.001 and p<0.001, respectively). In the logistic regression, the Disorganized factor score presented a significant negative association with remission (p=0.007). CONCLUSIONS: Higher disorganization symptoms showed the greatest impact in functioning at acute phase, and prevented patients from achieving remission, suggesting it may be a marker of symptom severity and worse outcome in schizophrenia.

New evidence in support of staging approaches in schizophrenia: Differences in clinical profiles between first episode, early stage, and late stage.

Few studies have examined the progression of symptom dimensions in schizophrenia patients over the course of the illness. The objective of this study was to investigate whether clinical and psychopathological differences exist between first-episode schizophrenia (FES) and multiple-episode patients in an inpatient setting. Patients (N=203) were evaluated using the Positive and Negative Syndrome Scale (PANSS) over time. Five different generalized estimating equations were built for the PANSS factors using the following as covariates: sex, patient's age, assessment time point (i.e., moment of patient's evaluation, with a minimum of two and a maximum of four assessments throughout the study timeframe). The FES group was used as the reference to which the groups with up to five years of illness and more than five years of illness were compared. Remission rates and treatment resistance (TRS) rates were also compared. Generalized estimating equations were used to allow for different numbers of assessments over the study period. Patients with FES showed significantly milder severity in positive, disorganized, and hostility factors. Also, FES patients were more likely to achieve remission (P=0.002) and had lower rates of TRS (P=0.001). First-episode schizophrenia seems to be the critical period to improve outcome, as multiple-episode patients were similar in clinical characteristics regardless of illness duration.

Peripheral immuno-inflammatory abnormalities in ultra-high risk of developing psychosis.

BACKGROUND: Immuno-inflammatory imbalances have been documented in schizophrenia, but very little is known about the immunological changes prior to the onset of disease. OBJECTIVE: This work aimed to compare serum levels of pro- and anti-inflammatory cytokines in young subjects at ultra-high risk (UHR) of developing psychosis with age- and sex-matched healthy controls. METHODS: A total of 12 UHR and 16 age- and sex-matched healthy controls (HC) subjects were enrolled in this study. Clinical profile was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS), Semi-Structured Clinical Interview for DSM-IV Axis-I (SCID-I) or Kiddie-SADS-Present and Lifetime Version (K-SADS-PL), and Global Assessment of Functioning (GAF) scale. Serum interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α, IFN-γ, and IL-17 were measured by flow cytometry using the Th1/Th2/Th17 cytometric bead array. RESULTS: Compared with the healthy control group, patients in UHR showed increased IL-6 levels (Z=-2.370, p=0.018) and decreased IL-17 levels in serum (Z=-1.959, p=0.050). Levels of IL-17 positively correlated to the values in GAF symptoms (rho=0.632, p=0.028). CONCLUSION: Our results suggest that immunological imbalances could be present in the early stages of psychosis, including in at-risk stages. Future studies should replicate and expand these results.

Increased expression of NDEL1 and MBP genes in the peripheral blood of antipsychotic-naïve patients with first-episode psychosis.

Schizophrenia is a multifactorial neurodevelopmental disorder with high heritability. First-episode psychosis (FEP) is a critical period for determining the disease prognosis and is especially helpful for identifying potential biomarkers associated with the onset and progression of the disorder. We investigated the mRNA expression of 12 schizophrenia-related genes in the blood of antipsychotic-naïve FEP patients (N=73) and healthy controls (N=73). To evaluate the influences of antipsychotic treatment and progression of the disorder, we compared the gene expression within patients before and after two months of treatment with risperidone (N=64). We observed a significantly increased myelin basic protein (MBP) and nuclear distribution protein nudE-like 1 (NDEL1) mRNA levels in FEP patients compared with controls. Comparing FEP before and after risperidone treatment, no significant differences were identified; however; a trend of relatively low NDEL1 expression was observed after risperidone treatment. Animals chronically treated with saline or risperidone exhibited no significant change in Ndel1 expression levels in the blood or the prefrontal cortex (PFC), suggesting that the trend of low NDEL1 expression observed in FEP patients after treatment is likely due to factors other than risperidone treatment (i.e., disease progression). In addition to the recognized association with schizophrenia, MBP and NDEL1 gene products also play an essential role in the functions that are deregulated in schizophrenia, such as neurodevelopment. Our data strengthen the importance of these biological processes in psychotic disorders, indicating that these changes can be detected peripherally and potentially represent putative novel blood biomarkers of susceptibility and disorder progression.

Effects of depression on the cytokine profile in drug naïve first-episode psychosis.

Schizophrenia is accompanied by alterations in immuno-inflammatory pathways, including abnormalities in cytokine profile. The immune assessment of patients in a first episode of psychosis (FEP) and particularly in drug naïve patients is very important to further elucidate this association. The objectives of this study are to delineate the cytokine profile (IL-2, IL-10, IL-4, IL-6, IFNγ, TNFα and IL-17) in FEP patients (n=55) versus healthy controls (n=57) and to examine whether the presence of depressive symptoms in FEP is accompanied by a specific cytokine profile. We found increased levels of IL-6, IL-10 and TNFα in FEP patients when compared to healthy controls. FEP patients with depression showed higher IL-4 and TNFα levels versus those without depression. Cytokine levels were not correlated to the total PANSS and the positive or negative subscale scores. Our results suggest that FEP is accompanied by a cytokine profile indicative of monocytic and T regulatory cell (Treg) activation. Depression in FEP is accompanied by monocytic and Th-2 activation, whereas FEP without depression is characterized by Treg activation only. In conclusion, depression emerged as a key component explaining the cytokines imbalance in FEP that is responsible for a large part of the immune-inflammatory abnormalities described.

Factor structure of the Positive and Negative Syndrome Scale (PANSS) in Brazil: convergent validation of the Brazilian version

Objectives: The Positive and Negative Syndrome Scale (PANSS) was developed to assess the symptoms of schizophrenia dimensionally. Although it is widely used in clinical trials in Brazil, it is not fully validated. The aim of this study is to assess the factor structure of the Brazilian PANSS and generate validation data for its current version. Methods: A total of 292 patients diagnosed with schizophrenia were enrolled. Results: Principal component analysis suggested a forced five-factor final model that accounted for 58.44% of the total variance, composed of negative, disorganization/cognition, excitement, positive, and depression/anxiety. Conclusion: The Brazilian PANSS has a similar factor structure and internal consistency compared to its other country versions.

Factor structure of the Positive and Negative Syndrome Scale (PANSS) in Brazil: convergent validation of the Brazilian version.

OBJECTIVES: The Positive and Negative Syndrome Scale (PANSS) was developed to assess the symptoms of schizophrenia dimensionally. Although it is widely used in clinical trials in Brazil, it is not fully validated. The aim of this study is to assess the factor structure of the Brazilian PANSS and generate validation data for its current version. METHODS: A total of 292 patients diagnosed with schizophrenia were enrolled. RESULTS: Principal component analysis suggested a forced five-factor final model that accounted for 58.44% of the total variance, composed of negative, disorganization/cognition, excitement, positive, and depression/anxiety. CONCLUSION: The Brazilian PANSS has a similar factor structure and internal consistency compared to versions in several other languages.

Teaching of the Integrated Management of Childhood Illness strategy in undergraduate nursing programs.

OBJECTIVE: To describe and analyze the teaching of the Integrated Management of Childhood Illness (IMCI) strategy on Brazilian undergraduate nursing programs. METHOD: Integrating an international multicentric study, a cross-sectional online survey was conducted between May and October 2010 with 571 undergraduate nursing programs in Brazil RESULTS: Responses were received from 142 programs, 75% private and 25% public. 64% of them included the IMCI strategy in the theoretical content, and 50% of the programs included IMCI as part of the students' practical experience. The locations most used for practical teaching were primary health care units. The 'treatment' module was taught by the fewest number of programs, and few programs had access to the IMCI instructional manuals. All programs used exams for evaluation, and private institutions were more likely to include class participation as part of the evaluation. Teaching staff in public institutions were more likely to have received training in teaching IMCI. CONCLUSION: In spite of the relevance of the IMCI strategy in care of the child, its content is not addressed in all undergraduate programs in Brazil, and many programs do not have access to the IMCI teaching manuals and have not provide training in IMCI to their teaching staff.

[Integrated management of childhood illness (IMCI) in the practice of nurses graduated from USP]. / Atenção integrada as doenças prevalentes na infância (AIDPI) na prática de enfermeiros egressos da USP.

This is a description of the Integrated Management of Childhood Illness (IMCI) strategy in the professional practice of nurses graduated from the School of Nursing of University of São Paulo (EE-USP). This is a case study of qualitative approach. The data were collected through focus groups and analyzed using thematic content analysis. IMCI strategy was considered an important tool in child health care, but only the assessment module was apart of professional practice. Difficulties in the use of the IMCI were: the strategy was not implanted at health services, it was unknown by co-workers and institutional obstacles. In spite of the limited and non-systematic use of IMCI, it has allowed nurses to provide integrated and comprehensive attention to the child, which justifies its teaching on undergraduate courses. Maintenance of the educational video, expansion of the practice, integration of courses and optimization of content and workload were suggested for improving the teaching of IMCI at the undergraduate level.

Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) na prática de enfermeiros egressos da USP / Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI) en la práctica de enfermeros graduados en USP / Integrated Management of Childhood Illness (IMCI) in the practice of nurses graduated from USP

Descreveu-se a incorporação da estratégia Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) na prática de enfermeiros egressos da Escola de Enfermagem da Universidade de São Paulo (EE-USP). Desenvolveu-se estudo de caso de abordagem qualitativa, com coleta de dados em grupo focal e análise de conteúdo do tipo temática. A estratégia AIDPI foi considerada ferramenta importante na atenção à saúde infantil, porém apenas o módulo de avaliação fazia parte da prática profissional. Destacam-se como dificuldades para sua utilização: não implantação nos serviços, desconhecimento por parte de colegas e barreiras institucionais. Ainda que com uso restrito e não sistematizado, a AIDPI possibilita ao enfermeiro prestar atenção integrada e integral à criança o que justifica sua abordagem na graduação. Manutenção do vídeo didático, ampliação da prática, integração das disciplinas e otimização dos conteúdos e da carga horária foram apontadas como relevantes para o aperfeiçoamento do ensino da AIDPI na graduação.

Se describió la incorporación de la estrategia Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI) en la práctica de enfermeros formados en la Escuela de Enfermería de la Universidad de São Paulo (EE-USP). Estudio de caso de carácter cualitativo, con recogida de datos en grupos focales y análisis de contenido temático. AIEPI fue considerada importante herramienta en el cuidado del niño, pero sólo el módulo de evaluación hacía parte de la práctica profesional. Dificultades en el uso de AIEPI fueron: no implantación en los servicios, desconocimiento de la estrategia por parte de colegas, barreras institucionales. Aunque con uso restringido y no sistematizado, cuando utilizado AIEPI permite a los enfermeros prestar atención integrada y integral al niño, lo que justifica su contenido en la graduación. Mantenimiento de vídeo educativo, expansión de práctica, integración de disciplinas y optimización del contenido y carga horaria fueron destacados como importantes para mejorar la enseñanza de AIEPI en el pregrado.

We described the use of the Integrated Management of Childhood Illness (IMCI) strategy in the professional practice of nurses graduated from the School of Nursing of University of São Paulo (EE-USP). A case study of qualitative approach was conducted. Data were collected from focus groups and we did thematic content analysis. IMCI strategy was considered an important tool in child health care, but only the assessment module was part of professional practice. Difficulties in the use of the IMCI were: the strategy was not implanted at health services, it was unknown to part of co-workers and institutional obstacles. Despite of the limited and non-systematic use of IMCI, it has allowed nurses to provide integrated and comprehensive attention to the child, which justifies its teaching on undergraduate courses. Maintenance of the tutorial video, expansion of the practice, integration of disciplines and optimization of content and workload were suggested for improving the teaching of IMCI in undergraduate courses.

Atenção Integrada às Doenças Prevalentes na Infância: conhecimento e prática de egressos da Escola de Enfermagem da Universidade de São Paulo – um estudo de caso / Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI): el conocimiento y la práctica de los enfermeros que se han graduado de la Escuela de Enfermería de la Universidad de São Paulo – un estudio de caso / Integrated Management of Childhood Illness (IMCI): knowledge and practice of nurses who have graduated from School of Nursing at University of São Paulo – a case study

The aim of this study was to identify knowledge and practice about the strategy of Integrated Management of Childhood Illness (IMCI) in the professional practice of graduates of the School of Nursing at University of São Paulo (EEUSP). It was developed a descriptive study from a quantitative approach. Online questionnaire, created and managed by the editor Dream Weaver, was sent to 396 graduate students from 2003-2007. From this total, 62 (16.6%) were labeled as non-existent addresses and 61 (15.4%) questionnaires were filled. The descriptive analysis was performed using SPSS version 16.0. Most respondents were women (91.8%) and the participant ages concentrated between 25 and 29 years old (65.6%). Two-thirds had made at least one graduate course, mostly in hospitals. Only one-third worked or works in primary care. Two ex-students correctly answered all the questions about knowledge, one of them with training in IMCI. The strategy was remembered as part of the undergraduate curriculum for almost all graduates (95.1%) and useful for 86.9%. For 45.9%, the workload was insufficient for their learning and practice and 37.7% did not feel confident to apply the strategy in professional practice. The results showed that almost all participants remembered the strategy in the undergraduate curriculum and most consider it useful. On the other hand, more than one third did not feel confident to apply it, and little of the theoretical content has been consolidated. This data suggests the need for a revision of the teaching methodology adopted.

Com o objetivo de identificar conhecimentos adquiridos sobre a estratégia de Atenção Integrada às Doenças Prevalentes na Infância (AIDPI) e consolidados na prática profissional de egressos da Escola de Enfermagem da Universidade de São Paulo (EEUSP), desenvolveu-se um estudo descritivo de abordagem quantitativa. Constituiu-se no envio de questionário online, criado e gerenciado pelo editor Dream Weaver, a 396 egressos de 2003-2007. Desse total, 62 (15,6%) retornaram por endereços inexistentes e obteve-se retorno de 61 (15,4%) questionários preenchidos. As análises foram realizadas com uso do programa SPSS versão 16.0. A maioria dos respondentes foram mulheres (91,8%) com idade entre 25-29 anos (65,6%). Dois terços haviam feito pelo menos um curso de aperfeiçoamento, em sua maioria na área hospitalar. Apenas um terço atua ou atuou na atenção básica. Dois egressos responderam corretamente todas as questões sobre conhecimento, sendo um deles o único que referiu capacitação em AIDPI. A estratégia foi lembrada como parte do currículo da graduação por quase todos os egressos (95,1%) e útil para 86,9% Para 45,9%, a carga horária foi insuficiente para seu aprendizado e 37,7% não se sentiram seguros para aplicar a estratégia na vida profissional. Os resultados evidenciaram que quase a totalidade se lembra da estratégia no currículo da graduação e a grande maioria a considera útil, porém mais de um terço não se sentia seguro e pouco do conteúdo teórico foi consolidado. Esses dados sugerem a necessidade de revisão da metodologia de ensino empregada.

Con el objetivo de identificar conocimiento acerca de la estrategia de Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI), consolidadas en la práctica profesional de egresados de la Escuela de Enfermería de la Universidad de São Paulo (EEUSP), se desarrolló un estudio descriptivo de enfoque cuantitativo. Consistió en el envío de cuestionario en línea, creado y administrado por el editor Dream Weaver, a 396 estudiantes graduados en el período 2003-2007. De este total, 62 (15,6%) regresó por e-mail no existentes y se obtuvo retorno de 61 (15,4%) cuestionarios completados. El análisis se realizó mediante SPSS versión 16.0. La mayoría de los encuestados fueron mujeres (91,8%) de edades entre 25-29 años (65,6%). Dos tercios habían hecho al menos un curso de postgrado, principalmente en área hospitalario. Sólo un tercio trabajaba o tenía trabajado en la atención primaria. Dos ex-alumnos respondieran correctamente a todas las preguntas de conocimiento, uno de ellos el único con capacitación postgrado en AIEPI. La estrategia fue recordada como parte del currículo de pregrado por casi todos los graduados (95,1%) y referida como útil por 86,9%. Para 45,9%, el volumen de contenido fuera insuficiente para su aprendizaje y 37,7% no se sentirán seguros para aplicar la estrategia en la práctica profesional. Los resultados mostraron que casi todos recordaban de la estrategia en el currículo de pregrado y la gran mayoría considera que es útil, pero más de un tercio no se sentía seguro y poco contenido teórico se ha consolidado. Estos datos sugieren la necesidad de revisión de la metodología de enseñanza utilizada.