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Resumo: O objetivo deste estudo foi conhecer a opinião dos profissionais participantes da implantação-piloto de testes moleculares para detecção de Chlamydia trachomatis e Neisseria gonorrhoeae no Sistema Único de Saúde (SUS). Determinou-se a taxa de detecção de C. trachomatis e/ou N. gonorrhoeae e os fatores associados à infecção. A estratégia contou com laboratórios pertencentes à rede de carga viral de HIV e hepatites virais. A testagem teve como público-alvo pessoas mais vulnerabilizadas às infecções sexualmente transmissíveis, com coleta de amostras de urina e/ou swabs vaginal, endocervical e/ou uretral masculino. Questionários foram enviados aos gestores estaduais e profissionais de laboratório sobre a implantação-piloto. De maneira geral, as avaliações foram positivas. Entre as fraquezas, citou-se dificuldades na mudança do processo de trabalho, carência de recursos humanos, pouca sensibilidade de profissionais da assistência e ausência de tubo primário de urina, único insumo não fornecido. Como fortaleza, destaca-se aquisição centralizada de testes, compartilhamento de equipamentos e armazenamento de amostras à temperatura ambiente. Das 16.177 pessoas testadas, 1.004 (6,21%) foram positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae e 239 (1,48%) para C. trachomatis/N. gonorrhoeae. A detecção de infecção ocorreu mais em pessoas jovens (≤ 24 vs. > 24 anos) (aOR = 2,65; IC95%: 2,38-2,96), do sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), pardas/pretas (aOR = 1,06; IC95%: 1,05-1,11), na Região Sudeste (aOR = 1,08; IC95%: 1,02-1,13) e em amostras de secreção uretral (aOR = 1,46; IC95%: 1,41-1,52). Os resultados deste estudo demonstraram a importância da disponibilização da testagem em âmbito nacional, os quais subsidiaram a implantação da rede definitiva para detecção de C. trachomatis/N. gonorrhoeae no SUS.
Abstract: This study aimed to know the opinion of professionals participating in an experiment to implement a pilot for molecular tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae at the Brazilian Unified National Health System (SUS). The detection rate of C. trachomatis and/or N. gonorrhoeae and the factors associated with infection were determined. The strategy included laboratories belonging to the HIV and viral hepatitis viral load network. Testing targeted people who are more vulnerable to sexually transmitted infections and collected urine samples and/or vaginal, endocervical, and/or male urethral swabs. Questionnaires were sent to state managers and laboratory professionals about the implementation of the pilot. Reviews were overall positive. Weaknesses included difficulties changing work processes, lack of human resources, poorly sensitized care professionals, and absence of primary urine tubes, the only input not provided. Strengths included the centralized acquisition of tests, sharing of equipment, and storage of samples at room temperature. Of the 16,177 people who were tested, 1,004 (6.21%) were positive for C. trachomatis; 1,036 (6.4%), for N. gonorrhoeae; and 239 (1.48%), for C. trachomatis/N. gonorrhoeae . Detection of any infection occurred more frequently in young people (≤ 24 vs. > 24 years) (adjOR = 2.65; 95%CI: 2.38-2.96), men (adjOR = 1.95; 95%CI: 1.72-2.21), brown/black individuals (adjOR = 1.06; 95%CI: 1.05-1.11), those in Southeastern Brazil (adjOR = 1.08; 95%CI: 1.02-1.13), and in urethral secretion samples (adjOR = 1.46; 95%CI: 1.41-1.52). Results show the importance of making testing available nationwide, which supported the implementation of a definitive network to detection C. trachomatis/N. gonorrhoeae in SUS.
Resumen: El objetivo de este estudio fue conocer la opinión de los profesionales participantes de la implantación piloto de pruebas moleculares para la detección de Chlamydia trachomatis y Neisseria gonorrhoeae en el Sistema Único de Salud brasileño (SUS). Se determinó la tasa de detección de C. trachomatis y/o N. gonorrhoeae y los factores asociados con la infección. En la estrategia participaron laboratorios pertenecientes a la red de carga viral de VIH y hepatitis virales. La prueba tuvo como público objetivo a personas más vulnerables a las infecciones de transmisión sexual, con recolección de muestras de orina y/o swabs vaginal, endocervicales y/o uretral masculino. Se enviaron cuestionarios a los gestores estatales y a los profesionales de laboratorio sobre la implementación piloto. En general, las evaluaciones fueron positivas. Entre las debilidades, se citó las dificultades en el cambio del proceso de trabajo, la falta de recursos humanos, los profesionales de la asistencia poco sensibilizados y la ausencia del contenedor de orina primaria, el único insumo no suministrado. Como fortalezas, se destaca la adquisición centralizada de pruebas, el intercambio de equipos y el almacenamiento de muestras a temperatura ambiente. De las 16.177 personas evaluadas, 1.004 (6,21%) fueron positivas para C. trachomatis, 1.036 (6,4%) para N. gonorrhoeae y 239 (1,48%) para C. trachomatis/N. gonorrhoeae. La detección de alguna infección ocurrió más en personas jóvenes (≤ 24 vs. > 24 años) (aOR = 2,65; IC95%: 2,38-2,96), del sexo masculino (aOR = 1,95; IC95%: 1,72-2,21), parda/negra (aOR = 1,06; IC95%: 1,05-1,11), localizadas en la región Sudeste (aOR = 1,08; IC95%: 1,02-1,13) y en muestras de secreción uretral (aOR = 1,46; IC95%: 1,41-1,52). Los resultados de este estudio demostraron la importancia de la disponibilidad de la prueba a nivel nacional, los cuales subsidiaron la implantación de la red definitiva para detección de C. trachomatis/N. gonorrhoeae en el SUS.
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INTRODUCTION: Interpersonal negotiation skills (INS) comprise actions used to solve social situations between interacting individuals involving different needs or desires. These abilities are part of one's social competence and may be impaired in some psychiatric conditions. There are few validated psychometric tools for measuring INS in the literature. This pilot study aimed to investigate some basic psychometric properties of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in children and adolescents. METHODS: We developed a new version of the INSI adapted to the Brazilian culture using eight different dilemmas in dyadic situations (with peers and adults), presented visually as drawings on cards. A group of psychologists and psychiatrists chose and adapted the dilemmas formerly proposed by the original version. The same scoring criteria as for the original instrument were used. A total of 20 children and adolescents were included in this pilot study. We investigated test reliability using measures of interrater reliability, test-retest, and internal consistency. The content validity of the INSI was also evaluated by comparison with scores from the Child Behavior Checklist-Revised (CBCL). RESULTS: Internal consistency and test-retest evaluations were acceptable (rater 1: α = 0.77; rater 2: α = 0.72); the reliability of the instrument was excellent (K = 0.078; intraclass correlation coefficient = 0.98; 95% confidence interval 0.97-0.99); and content validity was strongly significant (p < 0.001). CONCLUSIONS: Preliminary results suggest that this version of the INSI has good interrater reliability and internal consistency and constitutes a promising tool to assess social competence.
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Negociação , Adolescente , Adulto , Brasil , Criança , Humanos , Projetos Piloto , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Abstract Introduction Interpersonal negotiation skills (INS) comprise actions used to solve social situations between interacting individuals involving different needs or desires. These abilities are part of one's social competence and may be impaired in some psychiatric conditions. There are few validated psychometric tools for measuring INS in the literature. This pilot study aimed to investigate some basic psychometric properties of the Brazilian version of the Interpersonal Negotiation Strategies Interview (INSI) in children and adolescents. Methods We developed a new version of the INSI adapted to the Brazilian culture using eight different dilemmas in dyadic situations (with peers and adults), presented visually as drawings on cards. A group of psychologists and psychiatrists chose and adapted the dilemmas formerly proposed by the original version. The same scoring criteria as for the original instrument were used. A total of 20 children and adolescents were included in this pilot study. We investigated test reliability using measures of interrater reliability, test-retest, and internal consistency. The content validity of the INSI was also evaluated by comparison with scores from the Child Behavior Checklist-Revised (CBCL). Results Internal consistency and test-retest evaluations were acceptable (rater 1: α = 0.77; rater 2: α = 0.72); the reliability of the instrument was excellent (K = 0.078; intraclass correlation coefficient = 0.98; 95% confidence interval 0.97-0.99); and content validity was strongly significant (p < 0.001). Conclusions Preliminary results suggest that this version of the INSI has good interrater reliability and internal consistency and constitutes a promising tool to assess social competence.
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Resumen: La enseñanza de la investigación debe abarcar todos los aspectos de su proceso, involucrando los estudios piloto. En la investigación biomédica, el primer paso en la ejecución de un proyecto es la realización de un estudio o prueba piloto, que busca probar en menor escala aspectos logísticos de la ejecución del estudio, lo que evitará cometer errores en los estudios posteriores y de mayor envergadura. La presente revisión pretende exponer aspectos fundamentales en la utilización y planeación de los estudios piloto, lo que servirá para optimizar los procesos de investigación en las áreas de la salud.
Abstract: The teaching of research covers all aspects of the research process, involving pilot studies. In biomedical research, the first step in the execution of a project is the realization of a pilot study, with the objective of testing on smaller scale logistic aspects of the execution of the study, which will avoid making mistakes in the larger studies. This review aims to expose fundamental aspects in the use and planning of pilot studies, which will serve to optimize research processes in the areas of health.
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Humanos , Projetos Piloto , Educação Médica , Projetos de Pesquisa , Bioestatística , Pesquisa Biomédica , Metodologia como AssuntoRESUMO
Distúrbios do equilíbrio consistem em um grande problema na doença de Parkinson (DP). A terapia por vibração do corpo inteiro mostra-se benéfica em pessoas saudáveis, mas apresenta eficácia incerta na DP. O objetivo desse estudo foi verificar os efeitos agudos da terapia por vibração do corpo inteiro sobre o equilíbrio de pacientes com DP e analisar o tamanho do efeito da intervenção para predizer o número ideal de participantes. Doze participantes com DP foram randomicamente divididos entre grupos intervenção e placebo. O grupo intervenção foi submetidos à terapia vibratória, tendo o equilíbrio avaliado em período anterior, imediatamente após e transcorrido cinco minutos da sessão. O grupo placebo fez uma intervenção simulada, tendo o equilíbrio avaliado nos mesmos períodos. Ambos os grupos tiveram seus olhos vendados para manter cegamento dos participantes sobre a intervenção. As variáveis analisadas foram deslocamento, área e velocidade de deslocamento. O tamanho do efeito foi verificado em análises univariadas e multivariadas, admitindo significância em 5%. Sobre os resultados, a terapia por vibração do corpo inteiro não apresentou eficácia sobre o equilíbrio na DP em momento imediato e transcorrido cinco minutos da aplicação da terapia. A análise que apresentou maior tamanho do efeito se deu quando o equilíbrio foi mensurado de forma multivariada, predizendo a necessidade de 46 pacientes. Em conclusão, os resultados desse estudo foram imprecisos quanto à eficácia da terapia por vibração do corpo inteiro no equilíbrio de pacientes com DP. Novas pesquisas com uma amostra superior a 46 participantes devem ser realizadas
Balance disorders are a major problem in Parkinson's disease (PD). The whole body vibration has benefits on the balance in healthy people, but it has imprecise effectiveness in PD. The aim of this study was to verify the effects of whole body vibration on balance in patients with PD and to predict the ideal number of participants from the effects size. Twelve participants with PD were randomly divided into intervention and placebo groups. Participants in the intervention group underwent whole body vibration and the subjects had their balance assessed prior therapy, immediately and five minutes after the session. The control group underwent a placebo intervention and the subjects had their balance assessed on the same periods. Both groups had their eyes closed during the intervention protocol. The variables assessed were body displacement, area and velocity of body displacement. The effect size of the intervention was analysed under univariate and multivariate analyses. Significance was set at 5%. With respect to the results, the whole body vibration was inefficient in improving balance immediately and five minutes after the session. The analysis that presented the strongest effect size occurred when balance was assessed under a multivariate basis, predicting the need of 46 participants. In conclusion, the results were imprecise as to the effects of whole body vibration on the balance in patients with PD. Studies with a sample size higher than 46 participants should be carried out to further address this topic
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Doença de Parkinson , Distribuição Aleatória , Projetos Piloto , Tamanho da Amostra , Equilíbrio PosturalRESUMO
ABSTRACT: Clinical motor skills are essential to train dental students. There is evidence that imagery serves to acquire and improve motor skills, since imagining an action, activates the same neural areas as when this is physically performed. The aim of this pilot randomized clinical trial was to examine the feasibility of tridimensional visualization associated with mental imagery on the development of fine motor skills of dental students compared to conventional training. Seventeen dental students without previous preclinical experiences, between 18-25 years old were recruited. After giving a theoretical lecture on the inlay preparation, participants were randomly allocated in two groups. The Experimental Group (N=9) performed daily 30 minutes of "mental practice" after visualizing a video showing the execution of an ideal inlay preparation alternating it with black screen periods to facilitate the imagery. The Control Group (N= 8) performed a 30 minutes "hands on practice" daily of the same preparation. On the fifth day, both groups carried out an inlay preparation physically, which was scanned and overlapped to the virtual preparation to assess accuracy. The execution time and accuracy of the preparation performed with regard to an ideal preparation were compared between groups. The learning style and fine motor skills at baseline were similar in all participants (P>0.001). No statistically significant differences were found between the groups in terms of accuracy. The time of execution in the experimental group was significantly lower than the control group. This pilot study showed that visualization associated to mental imagery could develop fine motor skills in dental students, requiring less execution time than physical practice.
RESUMEN: Las habilidades motoras clínicas son esenciales para entrenar a los estudiantes de odontología. Existe evidencia que la imaginería sirve para adquirir y mejorar las habilidades motoras, ya que al imaginar una acción, se activan las mismas áreas neuronales que cuando la acción se realiza físicamente. El objetivo de este ensayo clínico aleatorizado piloto fue examinar la factibilidad del uso de visualización tridimensional asociada con imaginería para el desarrollo de las habilidades motoras finas en estudiantes de odontología comparado con el entrenamiento convencional. Se reclutaron diecisiete estudiantes de odontología, entre 18-25 años de edad, sin experiencias preclínicas previas. Después de recibir una clase teórica sobre la preparación de una incrustación, los participantes fueron asignados aleatoriamente a dos grupos. El grupo experimental (N = 9) realizó diariamente 30 minutos de "práctica mental" después de visualizar un video que muestra la ejecución de una preparación de incrustación ideal alternando con períodos de pantalla negra para facilitar la imaginación. El grupo de control (N = 8) realizó una práctica diaria de 30 minutos de la misma preparación. El quinto día, ambos grupos llevaron a cabo físicamente una preparación de incrustación, que fue escaneada y esta imagen se superpuso a la preparación virtual ideal para evaluar la precisión. El tiempo de ejecución y la precisión de la preparación realizada con respecto a una preparación ideal se compararon entre ambos grupos. El estilo de aprendizaje y las habilidades motoras finas al inicio del estudio fueron similares en todos los participantes (P > 0,001). No se encontraron diferencias estadísticamente significativas entre los grupos en términos de precisión. El tiempo de ejecución en el grupo experimental fue significativamente menor que en el grupo control. Este estudio piloto mostró que la visualización asociada a imaginería podría desarrollar habilidades motoras finas en estudiantes de odontología, requiriendo menos tiempo de ejecución que la práctica física.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Estudantes de Odontologia/psicologia , Educação em Odontologia , Destreza Motora/fisiologia , Testes de Aptidão , Design de Software , Método Simples-Cego , Projetos Piloto , Estatísticas não Paramétricas , Imageamento Tridimensional , Treinamento por Simulação , AprendizagemRESUMO
El objetivo de este estudio fue la construcción y estudio piloto de un instrumento para evaluar factores asociados a la disposición hacia la donación de órganos. El Cuestionario sobre conocimientos, actitudes y creencias está conformado por 22 ítems tipo Likert de autoadministración. Fue respondido por 244 personas adultas apoderadas de 10 colegios de la provincia de Concepción, Chile, las cuales pertenecían a los grupos socioeconómicos bajo y medio. Se realizó un análisis factorial exploratorio (AFE) con el método de extracción de máxima verosimilitud y rotación varimax, el cual arrojó cinco factores: a) confianza en el proceso de donación y trasplante; b) comunicación familiar sobre donación de órganos; c) creencias ideológicas alrededor de la donación de órganos; d) conocimientos sobre donación y trasplante de órganos, y e) autonomía en la decisión de donar. La confiabilidad fue medida mediante el cálculo del coeficiente Alfa de Cronbach y la relación entre los factores mediante el coeficiente r de Pearson. Se establece que el instrumento es pertinente y confiable y se propone una nueva aplicación con una muestra más grande y que considere personas del grupo socioeconómico alto.
The object of this study was the construction and pilot study of an instrument for evaluating factors associated to individuals' willingness towards organ donation. The Questionnaire about Knowledge, Attitudes and Beliefs consists of 22 items Likert type of self administration. It was answered by 244 adults, guardians of 10 schools from Concepcion, Chile, who belonged to the middle and lower socioeconomic levels. An Exploratory Factor Analysis was done under the method of Maximum Likelihood Estimation and Varimax rotation, which derived in five factors: a) reliance on the process of donation and transplantation, b) communication about organ donation within the family, c) ideological beliefs on organ donation, d) knowledge about organ donation and transplantation, and e) autonomy on the choice of donation. The reliance was measured through the Cronbach's alpha and the relationship among the factors, through r of Pearson. It was established that the instrument is pertinent and reliable and a new application is proposed, to be administered on a bigger sample that includes individuals from the higher socioeconomic levels.
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Obtenção de Tecidos e ÓrgãosRESUMO
BACKGROUND: In Peru's urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies. OBJECTIVE: The objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru. METHODS: Recruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting. RESULTS: Of 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program's feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages. CONCLUSIONS: This study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima.
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Abstract Background: Idiopathic dilated cardiomyopathy (IDCM), most common cardiac cause of pediatric deaths, mortality descriptor: a low left ventricular ejection fraction (LVEF) and low functional capacity (FC). FC is never self reported by children. Objective: The aims of this study were (i) To evaluate whether functional classifications according to the children, parents and medical staff were associated. (iv) To evaluate whether there was correlation between VO2 max and Weber's classification. Method: Prepubertal children with IDCM and HF (by previous IDCM and preserved LVEF) were selected, evaluated and compared. All children were assessed by testing, CPET and functional class classification. Results: Chi-square test showed association between a CFm and CFp (1, n = 31) = 20.6; p = 0.002. There was no significant association between CFp and CFc (1, n = 31) = 6.7; p = 0.4. CFm and CFc were not associated as well (1, n = 31) = 1.7; p = 0.8. Weber's classification was associated to CFm (1, n = 19) = 11.8; p = 0.003, to CFp (1, n = 19) = 20.4; p = 0.0001and CFc (1, n = 19) = 6.4; p = 0.04). Conclusion: Drawing were helpful for children's self NYHA classification, which were associated to Weber's stratification.
Resumo Fundamento: A cardiomiopatia dilatada idiopática (CMDid) possui poucos preditores de mortalidade descritos: a baixa fração de ejeção de ventrículo esquerdo (FEVE) e a baixa capacidade funcional, sendo esta subjetiva. Objetivo: Os objetivos desse estudo foram (i) Avaliar se as classes funcionais propostas pela NYHA, modificada para crianças, estiveram associadas entre a percepção médica (CFm), dos pais ou representantes (CFp) e das próprias crianças avaliadas (CFc). (ii) Avaliar se houve correlação entre VO2 max e a classificação proposta por Weber. Método: Crianças com CMDid e com IC por CMDid prévia com FEVE preservada, na fase pré-puberdade foram selecionadas submetidas a avaliações de ergoespirometria e classificação da classe funcional. As crianças utilizaram uma representação gráfica para se intitular quanto à classe funcional. Resultado: O teste Chi-quadrado mostrou que houve associação ente a CFm e CFp (1, n = 31) = 20,6; p = 0,002. Não houve associação significativa entre CFp e CFc (1, n = 31) = 6,7; p = 0,4. As CF segundo médico e CFc não foram, tampouco, associadas (1, n = 31) = 1,7; p = 0,8. A classificação de Weber foi significativamente associada às três classes funcionais (classificação de Weber e CFm (1, n = 19) = 11,8; p = 0,003; classificação de Weber e CFp (1, n = 19) = 20,4; p = 0,0001; classificação de Weber e CFc (1, n = 19) = 6.4; p = 0.04.). Conclusão: A representação gráfica serviu para que as crianças pudessem se classificar segundo a NYHA, que se demonstrou associada com a estratificação de Weber.
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Humanos , Masculino , Feminino , Pré-Escolar , Criança , Consumo de Oxigênio/fisiologia , Volume Sistólico/fisiologia , Cardiomiopatia Dilatada/fisiopatologia , Função Ventricular Esquerda/fisiologia , Cardiomiopatia Dilatada/classificação , Distribuição Aleatória , Projetos Piloto , Ventilação Voluntária Máxima/fisiologia , Estudos Transversais , Estudos Prospectivos , Teste de EsforçoRESUMO
PURPOSE: To determine the feasibility and applicability of a clinical backward masking test, focusing on the analysis of inter-stimuli interval, and not on the intensity thresholds as it has been traditionally done, thus proposing a new paradigm for temporal masking assessment. METHOD: The test consisted of the presentation of a target tone of 1.000 Hz followed by a broadband masking noise (950-1.050 Hz), with inter-stimuli interval of 0, 10, 20, 50 and 100 ms. The stimuli were presented monaurally to both ears, with intensity ratio between masker and target tone varying between -10, -20, -30 and -40 dB. Twenty undergraduate students, without hearing or auditory processing complaints, participated in this study. RESULTS: Regardless of the signal-to-noise ratio, we observed decrease of average performance according to the decrease of the interval between stimuli. We also observed the indication that little or no masking occurs at the 100 ms interval, suggesting this interval is unsuitable for temporal masking assessment. The average interval threshold was below 27 ms for all investigated intensities, and increased 9 ms with every increase of 10 dB at signal-to-noise ratio. The signal-to-noise ratios of -20 and -30 were the best ratios for the test application. CONCLUSION: The paradigm proposed in this pilot study proved to be feasible, easy to apply, and trustworthy, being compatible with other researches which are the foundation for the study of temporal masking. This theme deserves further studies, continuing the analysis initiated here. .
OBJETIVO: Determinar a viabilidade e aplicabilidade de um teste clínico do mascaramento temporal sucessor, com foco de análise nos intervalos interestímulos e não nos limiares de intensidade, como tradicionalmente realizado, propondo, assim, um novo paradigma para a avaliação do mascaramento temporal. MÉTODO: O teste contou com a apresentação de um tom alvo de 1.000 Hz seguido de um ruído mascarador de banda estreita (950-1.050 Hz), com intervalos entre os estímulos de 0, 10, 20, 50 e 100 ms. Os itens foram apresentados de forma monoaural em ambas as orelhas, com relação de intensidade entre o mascarador e o tom alvo variando entre -10, -20, -30 e -40 dB. Vinte universitários, sem queixas de audição ou de processamento auditivo, participaram deste estudo. RESULTADOS: Foi observada diminuição no desempenho médio de acordo com a diminuição do intervalo, independentemente da relação sinal-ruído. Observou-se também o indício de que pouco ou nenhum mascaramento ocorre para o intervalo de 100 ms, tornando-o inadequado para a avaliação do mascaramento temporal. O limiar de intervalo médio manteve-se abaixo de 27 ms para todas as intensidades avaliadas, e aumentou 9 ms a cada 10 dB de aumento na relação sinal-ruído. As melhores relações sinal-ruído para avaliação são -20 e -30 dB. CONCLUSÃO: O paradigma proposto neste estudo piloto provou-se factível, de fácil aplicação e confiável, mostrando-se compatível com resultados de pesquisas que fundamentam o estudo do mascaramento temporal. O tema merece outros estudos para aprofundar as análises aqui iniciadas. .
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Adolescente , Adulto , Humanos , Adulto Jovem , Estimulação Acústica/métodos , Limiar Auditivo/fisiologia , Mascaramento Perceptivo/fisiologia , Projetos PilotoRESUMO
Introdução: Para o preparo pré-operatório endovascular dos aneurismas infrarrenais é necessária a mensuração acurada de suas características anatômicas e morfológicas, alcançada com o uso de softwares avançados em manipulação de imagens de tomografias multicanais. Este processo permite também o estudo acurado das relações anatômicas das demais artérias do eixo aorto-ilíaco. Uma visualização perpendicular à origem da artéria renal mais baixa possibilita o uso de toda a extensão do colo para fixação da endoprótese e selamento proximal, o que pode ser previsto durante o estudo da tomografia, impedindo um posicionamento subótimo e a sobreposição das estruturas vasculares no intraoperatório. Expõem-se aqui os resultados iniciais de um projeto piloto, envolvendo manipulação de imagens tomográficas, na correção ortogonal da artéria renal aplicada à orientação radioscópica no intraoperatório. Métodos: Por meio de reconstrução multiplanar de imagens tomográficas em software obtém-se um corte axial em ângulo reto. Conceitos geométricos de triangulação virtual promovem a correção ortogonal em três dimensões da visualização ostial da artéria renal, que pode ser reproduzida intraoperatoriamente, através do reposicionamento do arco cirúrgico. Resultados/Discussão: Embora alguns autores argumentem que a anatomia do vaso observada na tomografia possa mudar durante o intraoperatório, sabe-se que o posicionamento angular das artérias renais não se modifica, mesmo após a inserção dos fios guia rígidos, introdutores e da própria endoprótese. Assim, acreditamos ser possível, por meio de ...
Introduction: Endovascular aneurysm repair requires the precise deployment of the graft. In order to achieve accurate positioning, the anatomical and morphological characteristics of the aorta and its branches is mandatory. Software that perform three dimensional reformatting of multislice tomographic images, allow for the study of the whole aorto-iliac axis and the perpendicular visualization of the origin of the renal arteries. The correct length of the proximal neck can be evaluated and adequate graft fixation and sealing may be foreseen. A technique is presented, using an software, for the orthogonal correction of the position of the renal arteries in relation to the proximal neck, which may guide the radioscopic orientation intraoperatively. Methods: Within a multiplanar tomographic image reconstruction, virtual triangulation allows for the three dimensional orthogonal correction of the renal arteries' ostia position. The predetermined best angulations for visualization are annotated and used for the positioning of the surgical C-arm. Results/Discussion: Some authors discuss that the anatomic position of the renal vessels seen on the tomographic scan can change during the surgical procedure. It is known that the renal arterys' angular positioning does not alter, even after insertion of stiff guidewires, introducers, and the endograft itself. Therefore, it is possible, using concepts of spacial geometry and orthogonal correction, to predict the ideal bidimensional intraoperative positioning of the radioscopy device in order to reproduce the optimized renal artery ostial projection, ensuring the best accuracy during endograft deployment. Conclusion: As closer to the tomographic reproduction was the radioscopic correction, more careful is the visualization of the ostium of the renal artery, better is the exploitation of the lap for fixing and sealing and the endoprosthesis deployment is more accurate. .
Assuntos
Humanos , Aneurisma da Aorta Abdominal , Aneurisma da Aorta Abdominal/cirurgia , Artéria Renal , Artéria Renal/cirurgia , Software , Tomografia Computadorizada por Raios X/métodos , Aneurisma da Aorta Abdominal/patologia , Imageamento Tridimensional , Período Intraoperatório , Projetos Piloto , Valores de Referência , Reprodutibilidade dos Testes , Artéria Renal/patologiaRESUMO
As metas da educação ao paciente com artrite reumatoide (AR) visam estimular o sujeito a alcançar o máximo possível de independência funcional e qualidade de vida. O objetivo do trabalho foi verificar os efeitos do programa de extensão Educação ao Paciente Reumático, em um Serviço de Reumatologia, em Vitória/ES. A metodologia utilizada foi um ensaio clínico não controlado do tipo quantitativo. Pacientes foram avaliados ao iniciarem no programa e após quatro semanas, através do Health AssessmentQuestionnaire, do Patient Knowledge Questionnaire e da Escala de autoeficácia para dor crônica. Nos dados foram utilizados o teste t-pareado, para as variáveis paramétricas, e o teste de Wilcoxon, para as não paramétricas, sendo considerado um p<0,05. Os resultados foram os seguintes: cinquenta pacientes com AR participaram do programa, sendo que quinze pacientes compareceram a todos os encontros e dezenove completaram as 1ª e 2ª avaliações; 18,2%completaram o Ensino Médio e 63,6% recebiam até um salário mínimo. Concluiu-se que não houve diferença estatisticamente significativa entre as avaliações iniciais e finais. A amostra utilizada demonstrou que os pacientes não adquiriram mais conhecimentosobre a doença através do programa de educação a curto-prazo, provavelmente devido ao baixo nível de escolaridade, à renda mensal e à falta de adesão dos usuários e familiares...
The goal behind patients education about rheumatoid arthritis (RA) is to stimulate the person to achieve maximum functional independence e a healthy life-style. The point of thiswork was to verify the extension program Education to rheumaticpatient effects, on a Rheumatologic Service, in Vitória/ES. The applied methodology was a non-controlled clinical trial of the quantitative type. Patients were evaluated in the beginning of the program and after four weeks, through the Health AssessmentQuestionnaire, from Patient Knowledge Questionnaire and from the School of auto effi ciency for chronical pain. It was used the t-paired test on the data, for the parametrical variables, and the Wilcoxon test for the non-parametrical ones, been considered p<0.05. The results were: fi fty patients with RA started the program, being that fi fteenattended to all meetings and nineteen had the 1st and 2nd evaluationscompleted; 18.2% fi nished High School and 63.6% had a minimum wage income. We conclude that there was no signifi cant statistical difference between the initial and final evaluations. The used sample showed that the patients did not acquired more knowledge about the disease through the short-term education program, probably due their low level of education, the low income and lack of family support...
Assuntos
Humanos , Masculino , Feminino , Artrite Reumatoide , Educação de Pacientes como Assunto , Ensaios Clínicos como Assunto , Hospitais de Ensino , Projetos Piloto , Acolhimento , Educação , Inquéritos e QuestionáriosRESUMO
Objective: To detect the effects of Tai Chi Chuan practice on the cognition of elderly subjects with Mild Cognitive Impairment. Methods: This is a pilot study with 26 elderly patients (mean age of 74 years) with Mild Cognitive Impairment. The evaluation instruments were Subjective Memory Complaint Scale (SMC), Rivermead Behavioral Memory Test (RBMT) and Digit Span Forward and Backward (DSF and DSB) from the Wechsler Adult Intelligence Scale (WAIS). One group of 13 patients received two weekly 60-minute classes of Tai Chi Chuan (Yang style) for 6 consecutive months, and the rest formed the Control Group. The Tai Chi Chuan Group was also evaluated as to learning of the Tai Chi Chuan practical exercises by means of a Specific Learning Test applied after three months of intervention. Results: After six months of intervention, the TCC Group showed significant improvement on the RBMT and the SMC (p = 0.007 and p = 0.023, respectively). The Control Group showed no significant differences in the cognitive tests during the study. There was a significant correlation between the Tai Chi Chuan Learning Test and RBMT (p = 0.008), showing that patients with a better performance in exercising TCC also showed a better performance in memory. Conclusions: In this study, a six-month program of Tai Chi Chuan afforded a significant improvement of the performance of memory complaints in the elderly with Mild Cognitive Impairment. Additional randomized studies with larger samples and more prolonged follow-up are needed to confirm these benefits.
Objetivo: Detectar os efeitos da prática de Tai Chi Chuan na cognição de idosas com comprometimento cognitivo leve. Métodos: Estudo piloto com 26 idosas (média de idade de 74 anos) com comprometimento cognitivo leve. Os instrumentos de avaliação foram: Escala Subjetiva de Queixas de Memória (EQM), Teste Comportamental de Memória de Rivermead (RBMT) e Amplitude de Dígitos Verbal Direta e Indireta (DD e DI, respectivamente) derivadas do Weschler Adult Intelligence Scale (WAIS). Um grupo de 13 pacientes recebeu duas aulas semanais de 60 minutos de Tai Chi Chuan (estilo Yang) por 6 meses consecutivos, e o restante formou o Grupo Controle. O grupo Tai Chi Chuan também foi avaliado quanto ao aprendizado da prática dos exercícios de Tai Chi Chuan através de um Teste de Aprendizado Específico aplicado após três meses de intervenção. Resultados: Após seis meses de intervenção, o grupo Tai Chi Chuan apresentou melhora significativa no RBMT e na EQM (p = 0,007 e p = 0,023, respectivamente). O Grupo Controle não apresentou diferenças significativas nos testes cognitivos no decorrer do estudo. Houve correlação significativa entre o Teste de Aprendizado de Tai Chi Chuan e o RBMT (p = 0,008), apontando que os pacientes com melhor performance na prática de Tai Chi Chuan apresentaram melhor desempenho da memória. Conclusões: Neste estudo, um programa de seis meses de Tai Chi Chuan propiciou uma melhora significativa do desempenho e das queixas de memória de idosas com comprometimento cognitivo leve. Estudos adicionais randomizados com casuística maior e seguimento mais prolongado são necessários para confirmar estes benefícios.
RESUMO
OBJETIVO: Descrever a relação entre os resultados visuais e a morfologia macular através da tomografia de coerência óptica (OCT) em pacientes submetidos à remoção da membrana epirretiniana idiopática. MÉTODOS: Dez olhos de 10 pacientes com diagnóstico de membrana epirretiniana idiopática foram incluídos neste estudo. Todos os olhos foram submetidos à vitrectomia posterior via pars plana pelo mesmo cirurgião, durante o período de fevereiro de 2002 a março de 2004. A acuidade visual corrigida usando a tabela de Snellen, bem como a retinografia, a angiofluoresceinografia, a biomicroscopia de fundo e a tomografia de coerência óptica pré e pós-operatórios foram obtidos de todos os pacientes em todas as visitas. No estudo da tomografia de coerência óptica foram avaliadas três características em cada imagem: presença de depressão foveal, presença de edema macular cistóide e média da espessura central macular. RESULTADOS: A idade média dos pacientes foi de 63,3 anos (57 a 78). Cinco pacientes eram do sexo masculino e 5, do sexo feminino. A acuidade visual pré-operatória variou de 20/80 a conta dedos a 1 metro. A acuidade visual melhorou pelo menos duas linhas de visão em 8 olhos (80 por cento) e a metamorfopsia melhorou também na mesma proporção (80 por cento). Quatro pacientes não apresentavam metamorfopsia com a tabela de Amsler, e os demais apresentavam melhora parcial. À tomografia de coerência óptica todos os olhos mantiveram o aumento da espessura central, variando de 232 a 605 µ (média= 351,9 µ). Três olhos mantiveram o edema macular cistóide. Quatro olhos apresentaram acuidade visual final melhor ou igual a 20/30. Neste grupo a média de espessura central foi de 277 µ (265 a 285 µ). A recuperação do contorno foveal foi observada em dois destes olhos. Nos quatro pacientes não havia edema macular cistóide residual. CONCLUSÃO: A tomografia de coerência óptica é uma ferramenta capaz de avaliar as alterações estruturais antes e depois da cirurgia...
PURPOSE: To describe the relation between visual results and macular morphology through optical coherence tomography (OCT) in patients submitted to removal of the idiopathic epiretinal membranes. METHODS: Ten eyes of ten patients with diagnosis of idiopathic epiretinal membranes underwent standard 20-G pars plana vitrectomy. Posterior hyaloid attachments were identified and dealt with. Idiopathic epiretinal membranes were removed in all cases. Corrected visual acuity, retinography, fluorescein angiography, fundus biomicroscopy and the optical coherence tomography in the pre- and postoperative periods were performed in all patients. In OCT, three characteristics were considered in each image: presence of foveal depression, presence of cystoid macular edema and mean central macular thickness. RESULTS: Pre-operative visual acuity varied from 20/80 to counting fingers. The mean age was 63 years, ranging from 57 to 78 years. Five patients were male and five female. Preoperative visual acuity (VA) varied from 20/80 to CD to 1 meter. An improvement in VA of at least two lines was noted in all cases and metamorphopsia in eight eyes (80 percent). Four patients did not present metamorphopsia according to Amsler grid test, and the remaining presented partial improvement. On optical coherence tomography all eyes maintained increased central thickness, ranging from 232 to 605 µ (mean of 351.9 µ). Three eyes maintained cystoid macular edema. Four eyes presented final VA better or equal to 20/30. In this group the mean central thickness was of 277 µ. Foveal contour was recovered in two of these eyes. Four patients had no residual cystoid macular edema. CONCLUSIONS: Optical coherence tomography is a tool that evaluates the structural changes before and after surgery to remove idiopathic epiretinal membranes. Although the foveal area architecture stays irregular six months after surgery, the visual outcomes are very promising. Other prognostics factors...
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Membrana Epirretiniana/cirurgia , Macula Lutea/patologia , Fóvea Central/patologia , Edema Macular/patologia , Projetos Piloto , Tomografia de Coerência Óptica , Resultado do Tratamento , Vitrectomia , Acuidade Visual/fisiologiaRESUMO
An alternative vector control method, using lambda-cyhalothrin impregnated wide-mesh gauze covering openings in the walls of the houses was developed in an area in the Eastern part of the interior of Suriname. Experimental hut observations showed that Anopheles darlingi greatly reduced their biting activity (99-100%) during the first 5 months after impregnation. A model assay showed high mortality both of mosquitoes repelled by the gauze as well as of those that succeeded in getting through it. A field application test in 270 huts showed good acceptance by the population and good durability of the applied gauze. After introducing the method in the entire working area, replacing DDT residual housespraying, the malaria prevalence, of 25-37% before application dropped and stabilized at between 5 and 10% within one year. The operational costs were less than those of the previously used DDT housespraying program, due to a 50% reduction in the cost of materials used. The method using wide-mesh gauze impregnated with lambda-cyhalothrin strongly affects the behavior of An. darlingi. It is important to examine the effect of the method on malaria transmission further, since data indirectly obtained suggest substantial positive results.
PIP: Field application testing in Suriname confirmed that use of wide-mesh gauze impregnated with lambda-cyhalothrin to cover openings in the walls of Bush Negro homes represents an effective, acceptable, and low-cost vector control method. In experimental hut observations in the Eastern part of the interior of Suriname, this method reduced the biting activity of Anopheles darlingi by 99-100% in the first 5 months after impregnation. A model assay showed high mortality among mosquitoes repelled by the gauze and 100% mortality in insects that were able to cross through the mesh. A field application test in 270 huts showed good acceptance by the population, with no conflicts with local cultural customs, and excellent durability. After replacement of DDT residual house-spraying (associated with a malaria prevalence of 25-37%) with the impregnated gauze method, malaria prevalence dropped to 5-10% and material costs were halved. When the Suriname Government resumed responsibility for health care in the interior in 1992 when political strife stopped, use of this vector control method was not continued despite its demonstrated benefits.
Assuntos
Anopheles , Insetos Vetores , Inseticidas , Controle de Mosquitos/métodos , Animais , Malária/prevenção & controle , SurinameRESUMO
PIP: This article briefly describes an INSTRAW study of an income generation program in the Dominican Republic. The women in development program is operated by the Association for the Development of Micro-Enterprises in the Dominican Republic. The evaluation aims to quantify the results for men and women borrowers in terms of income, family health and nutrition, business reinvestment, job creation, and other measures. The aim is to compare findings between female household heads and non-heads. Findings support other empirical results showing increased sales and income after development. Women invested some of their additional income in their families' health, nutrition, and education. Women also hired other women and tended to employ more unpaid family members. 12% of employees were aged 7-14 years. The use of local community members, who were recent college graduates, as field officers was found to be an effective management tool. The young loan officers were successful in identifying potential clients and in creating accessible opportunities for advice and service. Loan officers increased the number of borrowers, and the program had low rates of nonpayment of loans. Comparisons between female heads and non-heads indicated different reasons for involvement in the program. Non-heads with other income providers reported personal reasons such as self realization and more money. Heads desired financial stability for the family and sometimes satisfaction of survival needs. Female heads tended to reinvest and expand their income-generating capacities. Women tended to increase their working space. This usually meant home space, since many women conducted their business at home. One obstacle was identified which limited income enhancement. For 30% of interviewed women a limit was set on available credit. Credit could only yield income equal to the minimum wage. This pilot study was limited to 400 persons from Santo Domingo. A further impact study is planned which would identify program strengths and weaknesses. Future plans for financial institutions and lending practices would be based on research findings.^ieng
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Renda , Projetos Piloto , Pobreza , Avaliação de Programas e Projetos de Saúde , Mudança Social , Mulheres , América , Região do Caribe , Países em Desenvolvimento , República Dominicana , Economia , América Latina , América do Norte , Organização e Administração , Pesquisa , Fatores SocioeconômicosRESUMO
Family planning clinics for university students play a valuable role in promoting health. This research project, a pilot study among women students who sought family planning services through a Costa Rican university clinic, introduced student evaluation of the family planning clinic, documented services provided in family planning visits, and identified issues for further study. Aged 18-33 years, the 53 respondents (a convenient sample) who completed a self-administered questionnaire were mostly (64%) single; all were sexually active; and 78% wished to have children (or more children) some day. Though all were sexually active at the time of their visit, only 62% were currently using contraception, and fewer than half of these were using effective methods. Nearly all students (96%) reported they learned new information during their appointment, and many received screening tests and examinations. Respondents rated their satisfaction with aspects of clinic service as high, citing the clinic's low visibility on campus as the most important area for improvement. All of the students said they would definitely return (85%) or would consider returning (15%). The results support the continuance of such a clinic on the campus, as well as of the practice of student evaluation. This collaborative study demonstrated areas for future research and stimulated interest in the university clinic as a research setting.
PIP: In Costa Rica, a nurse researcher or a nurse clinician interviewed 53 female students aged 18-33 at the family planning clinic at the Universidad Nacional Heredia. This 6-month, descriptive pilot study aimed to learn what services are covered during family planning visits, the students' evaluation of the clinic, and their demographic characteristics. 36% of the students were either married or in a consensual union. Just 25% of the women had children. 78% of the students wanted to be mothers (mean ideal family size = 1.8). All the women were sexually active, yet only 26% had previously sought family planning advice. 62% currently used birth control. 62% of family planning users used natural family planning methods or barrier methods. Referral by a health provider was more common than referral by a friend (17% vs. 7.3%). 34% of all students had used other services in the student health department. The most common services covered during family planning visits were pelvic exam (59%) and contraceptive information (51%). Other relatively common services were sexuality counseling (26%), breast exam (24%), and blood pressure check (23%). 96% of the students received new information mainly on contraceptive methods (65%), breast self-examination (39%), and sexuality education (35%). The students were satisfied with all clinic services (3.9-4.9, with 5 equaling very satisfied), especially, with the opportunity to ask questions, counseling provided, and advice given by clinicians. 22% of the students wanted greater clinic outreach, especially about family planning. 85% said that they would definitely return to the university clinic. 91% would recommend it to a friend wanting family planning advice. The field of family planning needs of and services to university students is an open field for nurse researchers.
Assuntos
Comportamento do Consumidor , Serviços de Planejamento Familiar , Serviços de Saúde para Estudantes , Estudantes , Adolescente , Adulto , Comportamento do Consumidor/estatística & dados numéricos , Costa Rica , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Humanos , Projetos Piloto , Fatores Socioeconômicos , Serviços de Saúde para Estudantes/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
Observations made in Antigua indicate that children consume significant amounts of food between main meals. Some of the constituents of snacks are nutritionally valuable but much of this intake is undesirable and could be laying the foundations of ill-health. Continuing efforts in the field of education on nutrition are clearly necessary for both the children and their parents.
PIP: Protein malnutrition remains a problem throughout much of the Caribbean region. In Antigua 5-7% of children are malnourished, and 15% of children aged 17-19% are obese and at risk for diabetes, hypertension, and stroke later in life. Problems of malnutrition are exacerbated by the high cost of fruits and vegetables and nonnutritious imports from the US of fatty fast foods that are high in sugar, fat, and additives. Nutrition education is introduced in home economic courses in schools and in parental education efforts. The Caribbean Food and Nutrition Institute has a pilot education project operating in elementary and secondary schools. The aim is to study the nature, extent, and quality of snacking among children aged 9-11 years of age. The study involves 20 children who keep a log of foods consumed in the course of a day. Snacks are considered to be all food consumed between meals or after the evening meal. Nonbasic foods are identified as those not fitting the basic six food groups. Findings show that every child eats between meals. 60% of the children eat between breakfast and lunch. 41% of all energy is obtained from foods consumed as snacks between lunch and dinner, and 8% of all energy is obtained from morning snacks. Principal snack foods include soft drinks, fresh fruit and unsweetened fruit juices, sweets and chocolates, sugar, and based products (listed in highest to lowest frequency of consumption). Over 33% of daily energy intake, almost 50% of carbohydrate intake, and almost 66% of added sugar are obtained from snacks. Daily consumption averages 61 g of sugar and ranges from 8 to 101 g. 33% of average energy intake is obtained from meals.
Assuntos
Países em Desenvolvimento , Obesidade/prevenção & controle , Desnutrição Proteico-Calórica/prevenção & controle , Adolescente , Antígua e Barbuda , Criança , Feminino , Humanos , Masculino , Valor NutritivoRESUMO
PIP: In 1982, a breast feeding support program (PROALMA) first operated in 3 large public hospitals and a large health center in Tegucigalpa and San Pedro Sula, Honduras. It trained health workers about the benefits of breast feeding and lactation management and developed hospital breast feeding policies and practices, e.g., creation of a milk bank for premature newborns. It even convinced hospitals to stop free distribution of infant formula and bottles. In fact, annual expenditures for infant formula at the Social Security Hospital in San Pedro Sula fell from US$ 40,000 to 6000 in 1 year and to 0 by 1990. Hospital practices which were not conducive to breast feeding included separation of newborns from mothers and giving newborns sugar water as their first food. In fact, 69% of mothers at Tegucigalpa hospitals said hospital staff gave their newborns breast milk substitutes within 24 hours of birth. The program began a rooming-in system which made it easier for mothers to initiate early, frequent, and on-demand breast feeding. PROALMA staff were in the maternity wards daily to provide breast feeding counseling. At the end of 3 years, 98% of women delivering at Tegucigalpa hospitals breast fed their infants. The project eventually expanded to hospitals nationwide. Between 1981 and 1988, breast feeding rose from 80% to 93% in cities and from 95% to 98% in rural areas. Further, the median duration of breast feeding increased from 4 months to 10 months (1982-1987) in cities. Yet, just 6% of mothers exclusively breast fed their 3-4 month old infants in 1987. In addition, only 28% exclusively breast fed before introducing the bottle. Staff attitude improved as evidenced by an increase in the percentage of workers promoting breast feeding at birth (37-86% during 1982-1986). PROALMA concluded that increased efforts to promote exclusive breast feeding are needed.^ieng
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Publicidade , Atitude do Pessoal de Saúde , Aleitamento Materno , Educação em Saúde , Hospitais , Fenômenos Fisiológicos da Nutrição do Lactente , Mães , Projetos Piloto , Pesquisa , Ensino , América , Atitude , Comportamento , América Central , Atenção à Saúde , Países em Desenvolvimento , Economia , Educação , Características da Família , Relações Familiares , Saúde , Instalações de Saúde , Honduras , América Latina , Marketing de Serviços de Saúde , América do Norte , Fenômenos Fisiológicos da Nutrição , Pais , PsicologiaRESUMO
PIP: The UN Population Fund contends that it is the need for family planning (FP) information and services instead of lack of interest that prevents men from participating more in FP. 3 pilot projects in Pakistan, Zimbabwe, and Colombia have acted on this belief. In geographically isolated Mardan, Pakistan, the all male Urban Community Developing Council (UCDC) started a community education project to involve men in FP. 5 UCDC member form 1 community educator team of which there are 60. The teams visit families in Mardan. In 1988, 1 team reported that some men in the households wanted a women to inform their wives about FP. Eventually UCDC located enough women free to be members on 40 teams. In 4 years, contraceptive prevalence among married couples rose from 9% to 21%. Initially the methods tended to be temporary methods but are now longer lasting methods (IUDs, sterilization, injectables, and even a few vasectomies). Other community groups donate about US$541/month to the project. In 1988, the Zimbabwean National Family Planning Council (ZNFPC) began its national education/male motivation project which included sending messages via popular radio soap opera, discussions, and leaflet distribution. The program reached many rural men since they tend to have radios. In 1 year, more men were taking part in decisions about FP (25-35%). ZNFPC has learned it needs to design 2 campaigns to promote condom use: 1 for single and 1 for married men. PROFAMILIA in Colombia began its 1st male clinic in 1985 in Bogota. By 1992, it had 8 male clinics. The key to its success is attractive clinics, low cost vasectomy, individualized care, wide range of services such as condom distribution and treatment of sexually transmitted diseases, and Saturday hours. Despite the 3 projects' successes, they face many obstacles that need to be addressed.^ieng