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Introduction: The COVID-19 pandemic has affected nearly every facet of life, constituting a "new normal" and prompting an ongoing collective psychological crisis. People's ways of coping with the pandemic and corresponding well-being are of particular research interest; however, these constructs have largely been examined using deductive quantitative approaches, deficit-based lenses, and mononational samples. Methods: The current mixed-methods study used inductive-sequential (QUAL → QUAN) approaches to explore positive coping strategies (approach coping style and COVID-related connection appraisal) and well-being (loneliness, distress, and happiness) across individuals from the United States, Japan, and Mexico. Qualitative data were gathered from N = 141 U.S., Japanese, and Mexican adults to examine how people perceived connection during the pandemic. Results: Qualitative analyses illuminated common themes in which people appraised the pandemic as an opportunity for connection and strengthened interpersonal relationships. Quantitative measures, including a newly-developed questionnaire on COVID-related connection appraisal, were then administered to a separate sample of N = 302 adults in the U.S, Japan, and Mexico to assess associations among approach coping style, COVID-related connection appraisal, and well-being outcomes (loneliness, distress, happiness). Quantitative analyses found significant associations among approach coping style, COVID-related connection appraisal, and all well-being outcomes. Of note, these associations did not differ by country. COVID-related connection appraisal mediated the relationship between approach coping style and two well-being outcomes (loneliness and happiness). Discussion: Findings point to approach coping style and connection appraisal as pathways for resilience and growth in the face of global suffering.

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Background: Empathy is foundational in our intersubjective interactions, connecting with others across bodily, emotional, and cognitive dimensions. Previous evidence suggests that observing individuals in painful situations elicits whole bodily responses, unveiling the interdependence of the body and empathy. Although the role of the body has been extensively described, the temporal structure of bodily responses and its association with the comprehension of subjective experiences remain unclear. Objective: Building upon the enactive approach, our study introduces and examines "bodyssence," a neologism formed from "body" and "essence." Our primary goal is to analyze the temporal dynamics, physiological, and phenomenological elements in synchrony with the experiences of sportspersons suffering physical accidents. Methods: Using the empirical 5E approach, a refinement of Varela's neurophenomenological program, we integrated both objective third-person measurements (postural sway, electrodermal response, and heart rate) and first-person descriptions (phenomenological data). Thirty-five participants watched videos of sportspersons experiencing physical accidents during extreme sports practice, as well as neutral videos, while standing on a force platform and wearing electrodermal and heart electrodes. Subsequently, micro-phenomenological interviews were conducted. Results: Bodyssence is composed of three distinct temporal dynamics. Forefeel marks the commencement phase, encapsulating the body's pre-reflective consciousness as participants anticipate impending physical accidents involving extreme sportspersons, manifested through minimal postural movement and high heart rate. Fullfeel, capturing the zenith of empathetic engagement, is defined by profound negative emotions, and significant bodily and kinesthetic sensations, with this stage notably featuring an increase in postural movement alongside a reduction in heart rate. In the Reliefeel phase, participants report a decrease in emotional intensity, feeling a sense of relief, as their postural control starts to reach a state of equilibrium, and heart rate remaining low. Throughout these phases, the level of electrodermal activity consistently remains high. Conclusion: This study through an enactive approach elucidates the temporal attunement of bodily experience to the pain experienced by others. The integration of both first and third-person perspectives through an empirical 5E approach reveals the intricate nature of bodyssence, offering an innovative approach to understanding the dynamic nature of empathy.

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BACKGROUND: Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia. METHODS: We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability. RESULTS: Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews. CONCLUSIONS: The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia. TRIAL REGISTRATION: ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.

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Introduction: Studying highly vulnerable areas is challenging, but it can support intersectoral actions to tackle the social inequalities prevalent therein.Objective: This research explores the relationship between the central constituents of intersectoral collaborations and the positive results of intersectoral actions in areas of high social vulnerability in São Paulo, Brazil. It also analyzes the perception of professionals in basic health units (BHU) regarding the results related to those actions.Methods: This study employed methodological triangulation and the mixed method sequential explanatory strategy. First, we applied an online form validated by face and content for BHU managers. Then, we used the SPSS Statistics software to perform nonparametric tests. Statistical significance was set at p < 0.05, and 95% confidence intervals and phi coefficients were calculated. After identifying the units that carried out intersectoral actions with different partners, we conducted focus groups in four of them with 26 health professionals until saturation. Finally, we integrated quantitative and qualitative data.Results: The bivariate analysis showed that the creation of healthy habits and environmental improvements were associated with the central components of intersectoral partnerships. The content analysis presented steps to elaborate the actions and arrive at the results from the central elements. Integration of the results explained how the results related to the actions were elaborated, considering the central elements of the collaborative processes.Conclusions: Partners negotiate with patients or communities to adhere to the care provided through the collaborative process. However, they recognized that they needed to evaluate the proposed actions regularly.

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Introdução: Estudar áreas de alta vulnerabilidade é desafiador, mas pode subsidiar ações intersetoriais para o enfrentamento das desigualdades sociais prevalentes nestas.Objetivo: Esta pesquisa explora a relação entre os constituintes centrais das colaborações intersetoriais e os resultados positivos das ações intersetoriais em áreas de alta vulnerabilidade social em São Paulo, Brasil. Também analisa a percepção dos profissionais das Unidades Básicas de Saúde sobre os resultados relacionados a essas ações.Método: Aplicamos uma triangulação de métodos. A estratégia explicativa sequencial de método misto foi utilizada seguindo os seguintes passos: Primeiramente, aplicamos um formulário online validado por face e conteúdo para gestores de UBS, e 60,7% dos gestores responderam. Utilizou-se o software SPSS Statistic para realizar o teste não paramétrico. Valores de p <= 0,05 foram considerados estatisticamente significantes. O intervalo de confiança de 95% e o coeficiente Phi também foram calculados. Após identificar as Unidades que realizavam ações intersetoriais com diferentes parceiros, realizamos grupos focais em quatro delas com a participação de 26 profissionais de saúde até a saturação. Por fim, integramos os dados quantitativos e qualitativos.Resultados: A análise bivariada mostrou que a criação de hábitos saudáveis e melhorias ambientais estiveram associadas aos elementos centrais que constituem as parcerias intersetoriais com significância estatística (p <= 5). A análise de conteúdo apresentou os passos para elaborar as ações e chegar aos resultados a partir dos elementos centrais. Ao integrar os resultados, respondemos como foram elaborados os resultados relacionados às ações, considerando os elementos centrais dos processos colaborativos.Conclusão: Os parceiros intersetoriais negociam com os pacientes ou comunidades a adesão aos cuidados sugeridos pelo processo colaborativo. No entanto, reconhecem que precisam avaliar regularmente as ações propostas.

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Abstract Metacognition is an important higher-order thinking process for successful learning. The present study investigated the relation between students' (N = 65) expectations about their grade (expressed as difference scores between expected grade and actual grade) and their metacognitive monitoring accuracy and bias and the extent to which these difference scores in expected grade versus actual grade predicted accuracy and bias, employing an explanatory sequential quantitative(QUALITATIVE mixed method research design. The study also explored how students develop and refine metacognitive judgments and the types of strategies they employ during this process. Results revealed that there were significant relations between difference scores in expected grade versus actual grade and accuracy and bias (r = .02 to r = .89 in absolute value), and that difference scores significantly predicted both accuracy (R 2 = .52) and bias (R 2 = .69). Further, qualitative findings revealed that there were differences in how students developed and refined metacognitive judgments as a function of four aspects of learning: effort/preparation, strategy selection/implementation, planning, and evaluation. Educators should explicitly teach metacognitive monitoring skills to improve students' self-regulated learning.

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Resumen La metacognición es un proceso importante de pensamiento de orden superior para un aprendizaje exitoso. El presente estudio investigó la relación entre las expectativas de los estudiantes sobre su nota (expresadas como puntuaciones de diferencia entre la nota esperada y la nota real) (N = 65) y su precisión y sesgo de monitoreo metacognitivo y el grado en que estas diferencias en la nota esperada versus la nota real predijeron la precisión y el sesgo, empleando un diseño de investigación secuencial explicativo cuantitativo-CUALITATIVO de método mixto. El estudio también exploró cómo los estudiantes desarrollan y refinan juicios metacognitivos y los tipos de estrategias que emplean durante este proceso. Los resultados revelaron que había relaciones significativas entre las diferencia de puntajes en la nota esperada versus la nota real y la precisión y el sesgo (r = .02 to r = .89, en valor absoluto), y que estas diferencia de puntajes predijo significativamente tanto la precisión (R 2 = .52) como el sesgo (R 2 = .69). Además, los hallazgos cualitativos revelaron que había diferencias en la forma en que los estudiantes desarrollaban y refinaban juicios metacognitivos en función de cuatro aspectos del aprendizaje: esfuerzo / preparación, selección / implementación de estrategias, planificación y evaluación. Los docentes deben enseñar explícitamente habilidades de monitoreo metacognitivo para mejorar el aprendizaje autorregulado de los estudiantes.

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Metacognición , Aprendizaje , Motivación , Estudiantes , Pensamiento , Sesgo , Comprensión

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Stress can result in psychopathologies, such as anxiety or depression, when this risk factor continues in time. One major stressor was the COVID-19 pandemic, which triggered considerable emotional distress and mental health issues among different workers, including teachers, with another stressor: technology and online education. A mixed-method approach is presented in this research, combining a cross-sectional study of university teachers from Ecuador and Spain with a medium of twenty years of working experience (N = 55) and a bibliometric analysis carried out in three databases (161 documents). The levels of anxiety and depression, and therefore the risk of developing them as mental disorders, were high. The lack of training (p < 0.01), time (p < 0.05), or research regarding the use of technology in education (p < 0.01) and stress caused by COVID-19 (p < 0.001) were linked to frequency. The most relevant observational study obtained through the bibliometric analysis (138 citations and over 65% of methodological quality) indicated that previous training and behavioral factors are key in the stress related to technology. The combination of the results indicated that mental health in STEM teachers at university is related to diverse factors, from training to the family and working balance.

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COVID-19 , Salud Mental , Ansiedad/epidemiología , Estudios Transversales , Depresión/epidemiología , Humanos , Pandemias , SARS-CoV-2 , Tecnología , Universidades

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Following the 2020 confinement due to the COVID-19 pandemic, housing has become the only safe place and this has exposed inequity in habitability. This research on the reality of confined households and the perception of their homes in the Mexican republic is based on a mixed participatory study, combining quantitative and qualitative approaches. The online questionnaire consisted of 58 questions in the quantitative approximation. The qualitative part required the provision of an image of the workspace, with testimonies and personal reflections. During the lockdown, all participants saw an increase in overall energy consumption; more than half reported not being in thermal comfort; and a third declared deficiencies in noise insulation. Regarding the perception of the telework/tele-study space, we found the following categories: bedrooms, living/dining rooms, studies and others. In addition, respondents had often adapted the workspace for both individual and shared use. In general, the households were satisfied with the size of their houses but would like landscaped spaces or better views outside. Confinement made housing the protective element against the pandemic. The consequences will have an effect globally, so new architectural design paradigms need to be rethought.

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COVID-19 , Pandemias , Control de Enfermedades Transmisibles , Humanos , Satisfacción Personal , SARS-CoV-2

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An effective way to address risk factors for non-communicable chronic diseases (NCD) and reduce healthcare costs is by using sound health-related advice (HRA) to promote healthy lifestyle habits. In Argentina, however, few studies have examined the context in which HRA is communicated and undertaken by patients at the primary care level. In this study, we assessed the reception of HRA using a mixed-method approach in a central area of Argentina. A total of 1,044 participants from the community were contacted and sociodemographic characteristics, health-related lifestyle factors, and medical history were collected. A calendar with health messages was provided to participants and its usage was assessed after 1 year. Additionally, semi-structured interviews were conducted with 34 patients attending a local primary healthcare center. The results show that HRA was given more frequently to individuals with higher mean age, lower educational level, and to females. Participants with a chronic health condition are at a higher chance of receiving advice to reduce salt intake and maintain a healthy weight. Dietary advice is offered along with other lifestyle recommendations. The use of alcohol and tobacco is usually addressed together. HRA was primarily received in the context of an NCD diagnosis and advice was directed, especially, to risky behaviors. The HRA to increase the intake of fruits and vegetables was mentioned less frequently. Patients at the healthcare center greatly appreciated receiving an HRA, especially when given in a tailored, written, and detailed form, and acknowledged its importance to prevent or control a chronic health condition as part of the medical treatment but showed concern regarding the ability to fully incorporate the advice. Lifestyle recommendations are highly appreciated by patients but are still underutilized since they are offered mostly in the context of illness. The health calendar was shown to be useful to complement health intervention programs at the community level. The findings of our study underscore the acknowledged value of HRA by participants to tackle the risk factors of chronic diseases. If properly used HRA constitutes a simple and highly valued tool to help address patient's needs to prevent and control NCD in Argentina.

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OBJECTIVES: The aim of this study is to determine the adaptation process of international medical school students to university life in Turkey. METHODS: The mixed method design study, including all the international students (n=127) studying at Ege University School of Medicine, is employed. Qualitative data were collected from 23 students selected by purposive sampling technique. Two instruments were utilized for collecting data: Student Adaptation to College Questionnaire (SACQ) and Brief COPE. Focus group interviews were performed for qualitative data collection. RESULTS: The mean SACQ score of the medical students was found to be 407.44 (SD=68.29). The Academic Adjustment category included the themes of educational goals, different studying habits, accommodation, academic advisor, and scholarship. The Social Adjustment category included the themes of social interaction and support, differences, longing for family, discrimination and its effects on social life. The Personal/Emotional adjustment category included themes of psychological and physiological health problems. The Goal Commitment/Institutional Attachment category included themes of academic and social adaptation as well as the student' communication with education management. CONCLUSIONS: This study identifies to light critical issues in supporting international students with adaptation problems to university life in Turkey. It is clear that revising the content of education programs to enable international exchange is not sufficient enough by itself to meet the needs of international students.

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Adaptación Psicológica , Intercambio Educacional Internacional , Estudiantes de Medicina/psicología , Universidades , Aculturación , Adolescente , Adulto , África/etnología , Europa (Continente)/etnología , Familia , Femenino , Grupos Focales , Vivienda , Humanos , Masculino , Medio Oriente/etnología , Prejuicio , Investigación Cualitativa , Facultades de Medicina , Ajuste Social , América del Sur/etnología , Estudiantes de Medicina/estadística & datos numéricos , Turquía , Adulto Joven

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The health alert caused by the COVID-19 pandemic and the lockdown have caused significant changes in people's lives. Therefore, it has been essential to study the quality of life, especially in vulnerable populations, including children and adolescents. In this work, the psychological well-being, distribution of tasks and routines, as well as the physical activity done by children and adolescents from two samples: community and high abilities, have been analyzed. The methodology used was Mixed Method Research, through a survey conducted online through social networks. The informants were the parents of the children and adolescents, 209 in the community sample and 116 in the high ability sample. The instrument used was a questionnaire implemented through Google Forms, with open and closed questions, including the Kidscreen-27 scale to measure well-being. The assessment of the adequacy of the physical activity levels was analyzed through ALCESTE. The results showed the absence of differences between students from community samples and those with high capacities in well-being and physical activity. Parents residing in Spain observed less play time in the high ability sample, and more time spent on homework, whether or not they have a diagnosis of high ability. It is concluded that these results question the misconceptions held about high ability students in terms of poorer personal adjustment and better interest in physical activities.

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This study aims to investigate the associations between bullying and moral disengagement in a Brazilian sample, using a mixed method design. Two-thousand three hundred and thirty-four adolescents (11-19 years; 42.9% girls) answered self-report measures on bullying and moral disengagement in response to bullying situations. Fifty-five participants were randomly selected and interviewed on their experiences on bullying at school. Results allowed to identify specific mechanisms of moral disengagement associated with bullying behavior among Brazilian adolescents. Qualitative analysis highlighted how moral disengagement mechanisms were spontaneously used by the adolescents to explain both the bullying and the bystander behaviors. Findings support the relevance of moral disengagement mechanisms in explaining bullying behaviors. The value of addressing these mechanisms when designing anti-bullying interventions is discussed.

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OBJECTIVE: To present a narrative review of the history of bioethics in Latin America and of scientific output in this interdisciplinary field. METHODS: This was a mixed-methods study. RESULTS: A total of 1458 records were retrieved, of which 1167 met the inclusion criteria. According to the Web of Science classification, the predominant topics of study were medical ethics (n= 488), social sciences and medicine (n= 354), and environmental and public health topics (n= 279). Four themes of bioethics output in the Latin American literature have emerged: (a) issues involving the beginning and end of life, (b) ethics in human research, (c) patient-provider relationships, and (d) ethics training for health professionals. CONCLUSION: Although bioethics is a growing interdisciplinary field in Latin America, its academic impact is still very low, and programmes are highly concentrated in large urban centres in a few countries. Challenges includes the regional and international impact of local scientific output.

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Discusiones Bioéticas , Bioética/educación , Bioética/historia , Ética Médica/educación , Personal de Salud/educación , Personal de Salud/ética , Modelos Teóricos , Comienzo de la Vida Humana/ética , Bioética/tendencias , Historia del Siglo XX , Experimentación Humana/ética , Humanos , Consentimiento Informado/ética , América Latina , Relaciones Profesional-Paciente/ética , Salud Pública/ética , Cuidado Terminal/ética , Salud Urbana

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BACKGROUND: This manuscript describes the design and rationale of a clinical trial that aims to investigate the multiple physiological, attitudinal, nutritional, and behavioral effects of a new interdisciplinary intervention based on the Health at Every Size® (HAES®) approach in obese women. METHODS: This will be a prospective, 7-month, randomized (2:1), mixed-method clinical trial. Obese women will be recruited and randomly allocated into two groups. The intervention group (I-HAES®; proposed n = 40) will undertake a novel HAES®-based intervention. Participants will take part in an exercise program, nutrition counseling sessions, and philosophical workshops, all aligned with the principles of the HAES® approach. The control group (CTRL; proposed n = 20) will participate in a program using a traditional HAES®-based group format, characterized by bimonthly lectures about the same topics offered to the experimental group, encouraging the adoption of a healthy lifestyle. The following multiple quantitative outcomes will be assessed pre and post intervention: health-related quality of life, cardiovascular risk factors, anthropometric assessments, physical activity level, physical capacity and function, and psychological and behavioral assessments. Qualitative analysis will be used to evaluate the experiences of the participants throughout the intervention, as assessed by focus groups and semi-structured interviews. CONCLUSIONS: The interdisciplinary research team leading this study has varied and complementary expertise. The knowledge arising from this study will help to guide new interdisciplinary interventions with the potential to holistically improve the health of obese individuals. This trial is registered at Clinicaltrials.gov (NCT02102061).

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Dieta Saludable , Estilo de Vida Saludable , Salud Holística , Obesidad Metabólica Benigna/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Estrés Psicológico/prevención & control , Adulto , Terapia Combinada , Ejercicio Físico , Femenino , Grupos Focales , Conocimientos, Actitudes y Práctica en Salud , Humanos , Ciencias de la Nutrición/educación , Obesidad Metabólica Benigna/psicología , Grupo de Atención al Paciente , Educación del Paciente como Asunto , Psicoterapia de Grupo , Investigación Cualitativa , Calidad de Vida , Estrés Psicológico/psicología , Estrés Psicológico/terapia

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BACKGROUND: Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize. METHODS: The study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview. RESULTS: The prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies. CONCLUSIONS: This study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

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Diabetes Mellitus Tipo 2/terapia , Hipertensión/terapia , Evaluación de Necesidades , Adulto , Anciano , Belice/epidemiología , Diabetes Mellitus Tipo 2/etnología , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Hipertensión/etnología , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural , Autocuidado , Encuestas y Cuestionarios

RESUMEN

A Estratégia Saúde da Família (ESF) constitui o principal modelo de organização da Atenção Primária (APS) no Brasil. A Saúde Bucal foi inserida na ESF em 2001 com a criação das equipes de saúde bucal (ESB) como área prioritária diante da necessidade de melhorar as condições de saúde bucal da população. Na última década, observou-se uma expressiva expansão da ESF com o alcance de serviços chegando a cerca de 63% da população brasileira em 2016. Com o objetivo de avaliar a qualidade dos serviços da ESF, o Ministério da Saúde lançou em 2011 o Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). O principal desafio do PMAQ é instituir uma cultura de avaliação entre os profissionais e gestores da ESF que monitore e avalie processos e resultados das equipes. O objetivo desse estudo foi descrever as ações de APS realizadas pelas ESB no Brasil e compreender aspectos que levam ao diferente desempenho das ESB. Para isso, foi desenvolvido um estudo misto explanatório sequencial. Na fase quantitativa, análise descritiva e de cluster foram aplicadas em dados do PMAQ-AB para descrever a produção de 12.403 ESB. Também foi utilizada a Teoria de Resposta ao Item (TRI) para avaliar as qualidades psicométricas de 20 questões de saúde bucal do PMAQ-AB. Resultados da TRI foram usados para selecionar ESB com desempenhos extremos para a próxima fase. Na fase qualitativa foi realizado um estudo descritivo em dez ESB da região metropolitana de Belo Horizonte com desempenhos extremos classificados pela TRI na fase anterior. Os resultados quantitativos demonstraram que as ESB realizam procedimentos clínicos da odontologia básica, mas fazem menos reabilitação com próteses e coordenação do cuidado de câncer bucal. A análise da TRI demonstrou que os itens do questionário foram insuficientes para discriminar ESB de alto e baixo desempenho. No entanto, foi observado que ESB de alto desempenho tendem a realizar ações de prevenção e acompanhamento de câncer e confecção de prótese na APS. Os resultados da fase qualitativa confirmaram que ESB de alto desempenho tendem a trabalhar mais ações de promoção e prevenção de câncer de boca, inclusive utilizando contatos pessoais para encaminhar pacientes para serviço especializado. Já em relação à questão da prótese na APS, os dados qualitativos confirmaram os achados quantitativos e demonstraram que ESB de alto desempenho fazem prótese na APS, garantindo a reabilitação do usuário

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The Family Health Strategy is the main organizational model of primary health care in Brazil. Dental care was included in the FHS in 2001 as a priority area due to the need to improve the oral health status of the population, and the oral health teams were created. In the last decade, there was a significant expansion of the ESF with the range of services reaching about 63% of the population in 2016. In 2011, the Brazilian Ministry of Health launched a program to assess the quality of FHS Programa Nacional de Melhoria do Acesso e Qualidade da Atenção Básica ­ PMAQ-AB. The main challenge of PMAQ-AB was to stimulate a culture of evaluation among FHS professionals and managers who evaluate processes and outcomes of the teams. This study aimed to describe the actions performed at primary health care by oral health teams in Brazil and to understand factors that contribute to different performance of each team. For this, a mixed sequential explanatory study was developed. In the quantitative phase, we undertook descriptive statistics and cluster analysis to describe the production of 12,403 OHTs, and applied Item Response Theory (IRT) to assess survey's 20 dental care questions psychometric properties. IRT results were used to sample OHTs with extreme scores performance to the next phase. In the qualitative phase, we used descriptive approach applying thematic analysis in 10 dentists from extreme performance OHTs. Quantitative results showed OHTs provided basic dentistry clinical care, but underprovided rehabilitation with dentures and oral cancer care coordination. IRT analysis showed survey limitation to discriminate OHTs performance, except for rehabilitation with dentures and oral cancer-related items that tend to discriminate high-performance OHTs. Qualitative data showed barriers to access oral health services and failures for integrating oral cancer delivery services. Dentists' empathy and altruism determine the quality of oral cancer care coordination by means of their own network to refer patients suspect of oral cancer. OHTs that deliver dentures know better the population rehabilitation needs. Mixed method results showed the improvements in oral health services in Brazil, but pointed that in low performance OHT, patients face multiples barriers to access services. Also, low performance OHT failed to following oral câncer patients, and provided dentures

Asunto(s)

Servicios de Salud Dental/organización & administración , Encuestas de Salud Bucal/métodos , Estrategias de Salud Nacionales , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Atención a la Salud/organización & administración , Evaluación del Rendimiento de Empleados/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Colaboración Intersectorial

RESUMEN

This study explored the effects of Health at Every Size(®)-based intervention on obese women by qualitatively evaluating participants' perception toward the program and quantitatively evaluating changes related to psychological, behavioral, and body composition assessments. A prospective 1-year quasi-experimental mixed-method trial was conducted. The mixed-method design was characterized by a spiral method, and quantitative and qualitative findings were combined during the interpretation phase. The qualitative data involved three focus groups; and quantitative data comprised physiological, psychological, and behavioral assessments. Initially, 30 participants were recruited; 14 concluded the intervention. From the focus groups, the following interpretative axes were constructed: the intervention as a period of discoveries; shifting parameters: psychological, physical, and behavioral changes; eating changes, and; redefining success. Body weight, body mass index, total body fat mass, and body fat percentage were significantly decreased after the intervention (-3.6, -3.2, -13.0, and -11.1%, respectively; p ≤ 0.05, within-time effect). Participants reported to be more physically active and perceiving better their bodies. Eating-wise, participants reported that the hunger and satiety cues and the consumption of more frequent meals facilitated their eating changes. Finally, participants reported that they could identify feelings with eating choices and refrain from the restrained behavior. These qualitative improvements were accompanied by modest but significant improvements in quantitative assessments. Clinicaltrials.gov registration: NCT02102061.

RESUMEN

STUDY OBJECTIVES: To evaluate the effect of a housing transition on sleep quality and quality of life in slum dwellers, participating in a slum housing upgrading program. DESIGN: Observational before-and-after study with a convergent-parallel mixed method design. SETTING: Five slums located in the metropolitan area of Buenos Aires, Argentina. PARTICIPANTS: A total of 150 slum dwellers benefited by a housing program of the nonprofit organization TECHO (spanish word for "roof"). INTERVENTIONS: Participants moved from their very low-quality house to a basic prefabricated 18 m(2) modular house provided by TECHO. MEASUREMENTS AND RESULTS: The Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life brief scale (WHOQOL-BREF) were administered before and after housing upgrading. Data about housing conditions, income, education, sleeping conditions, and cardiovascular risk were also collected. Semistructured interviews were used to expand and nuance quantitative data obtained from a poorly educated sample. Results showed that sleep quality significantly increased after the housing program (z = -6.57, P < 0.001). Overall quality of life (z = -6.85, P < 0.001), physical health domain (z = -4.35, P < 0.001), psychological well-being domain (z = -3.72, P < 0.001) and environmental domain (z = -7.10, P < 0.001) of WHOQOL-BREF were also improved. Interviews demonstrated the importance of serenity for improving quality of life. CONCLUSIONS: A minimal improvement in the quality of basic housing can significantly increase sleep quality and quality of life among slum dwellers. Understanding sleep and daily life conditions in informal urban settlements could help to define what kind of low-cost intervention may improve sleep quality, quality of life, and reduce existent sleep disparity.

Asunto(s)

Áreas de Pobreza , Vivienda Popular , Calidad de Vida , Sueño , Adulto , Argentina/epidemiología , Índice de Masa Corporal , Vivienda/estadística & datos numéricos , Humanos , Masculino , Vivienda Popular/estadística & datos numéricos , Calidad de Vida/psicología , Privación de Sueño/epidemiología , Privación de Sueño/etiología , Factores Socioeconómicos , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos

RESUMEN

O presente artigo tem a finalidade de problematizar a relação necessária entre o método marxiano de investigação e o enfoque misto ou quanti-qualitativo na pesquisa social. Abordamos inicialmente as principais características do método de pesquisa utilizado por Marx e explicitado no conjunto de sua obra, bem como sistematizações de autores marxistas que o analisam e dão visibilidade ao movimento de desvendamento do real por ele realizado, destacando a articulação entre qualidade e quantidade. Posteriormente, apresentamos as características do enfoque misto, buscando dar visibilidade a suas aproximações, com ênfase nos diferentes desenhos possibilitados por este modo de investigação e na técnica de triangulação, que o caracteriza.

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This article has the purpose of analyze the relationship required between the Marxist of research and the joint approach. We discuss initially the main features of the search method used by Marx and expressed in his work, as well as Marxist authors that analyze and give visibility to the movement of real ownership held by him, highlighted the linkage between quality and quantity. Subsequently, we present the characteristics of the mixed approach, seeking to give visibility to their approximations, with emphasis on different designs made possible by this mode of research and the technique of triangulation, that characterizes him.

Asunto(s)

Humanos , Masculino , Femenino , Ciencias Sociales/métodos , Investigación Cualitativa , Investigación/métodos