RESUMO
Introdução: A realização de grupos é uma das possibilidades de atuação das equipes da Atenção Primária à Saúde. Esse tipo de intervenção possibilita o desenvolvimento de ações de cuidado que extrapolam as consultas individuais, propiciando educação em saúde, integração, troca de experiências e ampliação da rede de apoio. Ainda que não tenham necessariamente o propósito de serem terapêuticos em termos de saúde mental, apresentam-se como espaços de promoção de saúde e prevenção de agravos. O trabalho com grupos é capaz de gerar aprimoramento para todas as pessoas envolvidas usuários e profissionais na medida em que possibilita colocar em evidência os saberes da comunidade, abrindo a possibilidade de que as intervenções em saúde sejam criadas em coletivo. Objetivo: Analisar o processo de desenvolvimento da habilidade de facilitação de grupos e os impactos das habilidades adquiridas na sua dinâmica, bem como na sua efetividade como ferramenta de produção de saúde, considerando as habilidades e competências da Medicina de Família e Comunidade. Métodos: Trata-se de pesquisa qualitativa desenvolvida na UBS Santa Cecília. Os encontros aconteceram semanalmente pelo período de uma hora durante seis meses. A ferramenta utilizada para acompanhamento do desenvolvimento da habilidade de facilitação se deu pela observação estruturada, baseada em cinco competências básicas para facilitação de grupos. A dinâmica estabelecida consistiu na determinação de uma profissional facilitadora e outra observadora, que registrou as intervenções realizadas, sendo esses papéis invertidos a cada encontro. Quinzenalmente os dados eram analisados, gerando reflexões e sugestões para melhoria das intervenções. Resultados: Cada competência descrita na ferramenta utilizada teve como resultado o desenvolvimento de habilidades primordiais para o funcionamento do grupo. Um dos maiores indicadores do êxito em alcançar as habilidades desejadas ocorreu pela observação de intervenções cada vez menos necessárias, tomando as participantes os papéis de protagonistas e responsáveis pelo desenvolvimento do grupo, questionando, produzindo e obtendo saúde. Conclusões: A utilização de um instrumento de observação e reflexão das competências do agente atuante como facilitador de um grupo permitiu que a dinâmica se estabelecesse de forma fluida com rápido entendimento das participantes sobre seus papéis no contexto geral do grupo. Observou-se também que a relação estabelecida entre elas resultou na formação de rede de apoio, melhoria do autocuidado e conhecimento, informação em saúde e apoio social às envolvidas.
Introduction: Running support groups is one of the actions of Primary Health Care teams. This type of intervention enables the development of actions that go beyond individual consultations as the only space of care, providing health education, integration, exchange of experiences, and an enlargement in the support network. Although these groups do not necessarily have the purpose of being therapeutic in terms of mental health, they are presented as spaces for building health promotion and disease prevention. The alternative of groups as care practice generates improvement for all involved individuals users and professionals as it makes it possible to highlight the community's knowledge, opening the possibility that health interventions are created collectively. Objective: To analyze the process of ability development in regards to the facilitation of support groups and the impacts of the acquired skills on its dynamics, as well as on its effectiveness as a health production tool, considering the skills and competencies in Family and Community Medicine. Methods: Qualitative study developed at Santa Cecilia BHU. The meetings took place for one hour weekly over a six months period and the tool used to monitor the development of the facilitation skill was the instrument "Structured Observation", based on five basic skills for facilitating groups. The dynamics consisted of the determination of a professional facilitator and an observer, who recorded the interventions that were carried out, with these roles being reversed at each meeting. The data were analyzed bi-weekly, with reflections and suggestions for improving interventions. Results: Each competence described in the tool resulted in the development of essential skills for the functioning of the group. One of the major indicators of the achievement of the desired skills occurred by observing interventions that were less and less necessary, with participants taking on the roles of protagonists and becoming responsible for the development of the group, questioning, producing, and acquiring health. Conclusions: The use of an instrument for observing and reflecting on the skills of the agent acting as a group facilitator allows the dynamics to be fluidly established, with a quick understanding of the participants about their roles in the general context of the group. It was also observed that the relationship established between them resulted in the formation of a support network, improvement of self-care and knowledge, health information and social support for those involved.
Introducción: La realización de grupos es una de las acciones de los equipos de la Atención Primaria a la Salud. Este tipo de intervención hace posible el desarrollo de acciones que extrapolan las consultas individuales como único espacio de cuidado, ofreciendo educación en salud, integración, intercambio de experiencias y ampliación de la red de apoyo. Aunque estos grupos no tengan necesariamente el propósito de ser terapéutico en términos de salud mental, se presentan como sitios de construcción de promoción de salud y prevención de agravios. La alternativa de los grupos como una práctica asistencial crea una mejora para todas las personas involucradas usuarios y profesionales ya que habilita colocar en evidencia los saberes de la comunidad, abriendo la posibilidad de que las intervenciones en salud sean creadas en colectivo. Objetivo: Analizar el proceso de desarrollo de la habilidad de facilitación de grupos y los impactos de las habilidades adquiridas en la dinámica de este, así como en la efectividad como herramienta de producción de salud, considerando las habilidades y competencias de la Medicina de Familia y Comunidad. Métodos: Se trata de estudio cualitativo llevado a cabo en la UBS Santa Cecília. Los encuentros ocurrieron semanalmente durante una hora por seis meses y la herramienta utilizada para seguimiento del desarrollo de la habilidad de facilitación fue el instrumento Observación Estructurada, basado en cinco competencias básicas para facilitación de grupos. La dinámica establecida consistió en la determinación de una profesional facilitadora y otra observadora, que registró las intervenciones realizadas, siendo esos papeles cambiados a cada encuentro. A cada quince días los datos eran analizados, haciendo reflexiones y sugestiones para mejorar las intervenciones. Resultados: Cada competencia descrita en la herramienta utilizada tuvo como resultado el desarrollo de habilidades primordiales para el funcionamiento del grupo. Uno de los grandes indicadores del éxito en alcanzar las habilidades deseadas ocurrió por la observación de intervenciones cada vez menos necesarias, tomando las participantes los papeles de protagonistas y responsables por el desarrollo del grupo, cuestionando, produciendo y obteniendo salud. Conclusiones: La utilización de un instrumento de observación y reflexión de las competencias del agente actuante como facilitador de un grupo permiten que la dinámica se establezca de forma fluida con rápido entendimiento de las participantes sobre sus papeles en el contexto general del grupo. Se pudo observar también que la relación establecida entre ellas resultó en la formación de red de apoyo, mejora del autocuidado y conocimiento, información en salud y apoyo social a las involucradas.
Assuntos
Humanos , Feminino , Atenção Primária à Saúde , Mulheres , Educação em Saúde , Participação da Comunidade , Prática de GrupoRESUMO
Introdução: A terminalidade é uma situação cada vez mais vivenciada nos serviços de saúde em razão da progressão da expectativa de vida da população e, consequentemente, do incremento de pacientes com doenças crônicas graves. No Brasil, os serviços de cuidados paliativos ainda se encontram centralizados nos serviços de atenção terciária. Entretanto, em diversos países, a Atenção Primária à Saúde tem sido a grande prestadora e coordenadora de cuidados paliativos dos usuários, em prol da descentralização dessa assistência e da promoção do cuidado integral. Objetivo: Realizar uma revisão narrativa da literatura, a fim de identificar a relação dos médicos de família e comunidade na atuação de cuidados paliativos na Atenção Primária à Saúde. Métodos: Revisão bibliográfica por meio do acesso às bases de dados: Portal da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO) e PubMed. Foram selecionados 16 artigos, os quais foram submetidos a análise temática e posterior discussão das principais características que colaboram para a maior atuação dos médicos de família e comunidade em cuidados paliativos. Resultados: Observou-se a importância da atuação dos médicos de família e comunidade em cuidados paliativos no âmbito da Atenção Primária à Saúde, bem como a interligação entre as duas especialidades, os desafios existentes nesse caminho e os benefícios dessa prática. Conclusões: A oferta de cuidados paliativos pelos médicos de família e comunidade na atenção primária favorece o acesso e acompanhamento dos pacientes. Entretanto, a atuação dos profissionais das Equipes de Saúde da Família nessa linha de cuidado ainda é insuficiente em razão da escassa capacitação na área.
Introduction: Terminality is a situation increasingly experienced in healthcare services due to the progression of the population's life expectancy and, consequently, the increase in patients with serious chronic diseases. In Brazil, Palliative Care services are still centralized in tertiary care services. However, in many countries, Primary Health Care has been the major provider and coordinator of Palliative Care for users, in favor of decentralizing this assistance and promoting comprehensive care. Objective: To carry out a narrative literature review to identify the relationship of Family Practice Doctors in the performance of Palliative Care in Primary Health Care. Methods: Bibliographic review through access to databases: CAPES, LILACS, SciELO, and PUBMED. Sixteen articles were selected, which were submitted to thematic analysis and subsequent discussion of the main characteristics that contribute to the greater performance of Family Practice Doctors in Palliative Care. Results: The importance of Family Practice Doctors in Palliative Care within the scope of Primary Health Care was observed, as well as the interconnection between the two specialties, the challenges along this path, and the benefits of this practice. Conclusions: The offer of Palliative Care by Family Practice Physicians in Primary Care favors the access and monitoring of patients. However, the performance of the professionals in Family Health Teams in this line of care is still insufficient due to the lack of training in the area.
Introducción: La terminalidad es una situación cada vez más experimentada en los servicios de salud debido a la progresión de la esperanza de vida de la población y, en consecuencia, al aumento de pacientes con enfermedades crónicas graves. En Brasil, los servicios de Cuidados Paliativos todavía están centralizados en los servicios de atención terciaria. Sin embargo, en varios países, la Atención Primaria de Salud ha sido la principal proveedora y coordinadora de los Cuidados Paliativos para los usuarios, a favor de descentralizar esta asistencia y promover la atención integral. Objetivo: Realizar una revisión narrativa de la literatura, con el fin de identificar la relación de los Médicos de Familia y Comunitarios en la actuación de los Cuidados Paliativos en la Atención Primaria de Salud. Métodos: Revisión bibliográfica mediante acceso a bases de datos: Portal CAPES, LILACS, SciELO y PubMed. Fueron seleccionados dieciséis artículos, que fueron sometidos al análisis temático y posterior discusión de las principales características que contribuyen para una mayor actuación de los Médicos de Familia y Comunidad en Cuidados Paliativos. Resultados: Se constató la importancia del trabajo de los Médicos de Familia y Comunitarios en Cuidados Paliativos en el ámbito de la Atención Primaria de Salud, así como la interconexión entre las dos especialidades, los desafíos que existen en este camino y los beneficios de esta práctica. Conclusiones: La oferta de Cuidados Paliativos por Médicos de Familia y Comunitario en Atención Primaria favorece el acceso y seguimiento de los pacientes. Sin embargo, la actuación de los profesionales de los Equipos de Salud de la Familia en esta línea de atención aún es insuficiente debido a la falta de formación en el área.
Assuntos
Cuidados Paliativos , Atenção Primária à Saúde , Medicina de Família e Comunidade , Estratégias de Saúde NacionaisRESUMO
Introdução: Os acidentes ocupacionais com material biológico representam um problema de saúde pública. A exposição ocupacional dos profissionais da saúde configura-se como um risco de transmissão de diversos patógenos. Na literatura, há carência de estudos que analisem o perfil dos acidentes com material biológico nos médicos da atenção primária. Objetivo: Buscou-se compreender o perfil epidemiológico dos acidentes com material biológico em médicos da atenção primária em Minas Gerais. Métodos: Estudo epidemiológico descritivo com análise do perfil dos acidentes com material biológico em médicos da atenção primária em Minas Gerais, utilizando dados secundários. Resultados: No período analisado, foram registrados 111 acidentes com material biológico, dos quais 54% ocorreram somente em 2020 e 2021. A maioria dos casos deu-se em mulheres (59%), e os tipos mais frequentes de exposição foram mucosa (38%) e percutânea (33%). Dos médicos, 23% não possuíam esquema vacinal contra a hepatite B completo. Em média, em 36% dos acidentes os testes sorológicos foram negativos e em 61% não foram realizados ou o campo foi ignorado/deixado em branco. Em apenas 7,2% dos casos a quimioprofilaxia foi indicada, mas ressaltam-se os registros ignorados ou em branco. Mais da metade dos acidentados não emitiu a Comunicação de Acidente de Trabalho (CAT). Conclusões: Os acidentes com material biológico predominam em médicas e nas formas de exposição mucosa e percutânea. Investimentos em medidas de biossegurança e educação permanente são necessários para prevenir casos e estimular sua notificação.
Introduction: Occupational accidents with biological material represent a public health problem. The occupational exposure of health professionals represents a risk of transmission of various pathogens. In the literature, there is a lack of studies that analyze the profile of accidents with biological material among primary health care physicians. Objective: We aimed to understand the epidemiological profile of accidents involving biological material among primary health care physicians in Minas Gerais, Brazil. Methods: Descriptive epidemiological study that analyzed the profile of accidents with biological material among primary health care doctors in Minas Gerais, using secondary data. Results: In the period analyzed, 111 accidents with biological material were recorded, of which 54% occurred only in 2020 and 2021. Most cases occurred in women (59%) and the most frequent types of exposure were mucosal (38%) and percutaneous (33%). About a quarter (23%) of physicians did not have a complete immunization record for hepatitis B. On average, in 36% of accidents serological tests were negative and in 61% they were not performed or the field was ignored/left blank. In only 7.2% of cases, chemoprophylaxis was indicated, but ignored or blank records stood out. More than half of the victims did not fill out a work accident report. Conclusions: Accidents with biological material predominate in female doctors and in forms of mucosal and percutaneous exposure. Investments in biosafety measures and permanent education are necessary to prevent cases and encourage their notification.
Introducción: Los accidentes de trabajo con material biológico representan un problema de salud pública. La exposición ocupacional de los profesionales de la salud representa un riesgo de transmisión de varios patógenos. En la literatura faltan estudios que analicen el perfil de accidentes con material biológico en médicos de atención primaria. Objetivo: Buscamos comprender el perfil epidemiológico de los accidentes con material biológico en médicos de atención primaria en Minas Gerais. Métodos: Estudio epidemiológico descriptivo con análisis del perfil de accidentes con material biológico en médicos de atención primaria en Minas Gerais, utilizando datos secundarios. Resultados: En el período analizado se registraron 111 accidentes con material biológico, de los cuales el 54% ocurrió solo en 2020 y 2021. La mayoría de los casos ocurrieron en mujeres (59%) y los tipos de exposición más frecuentes fueron mucosa (38%) y percutánea (33%). El 23% de los médicos no disponía de un calendario completo de vacunación frente a la hepatitis B. En promedio, en el 36% de los accidentes, las pruebas serológicas fueron negativas y en el 61% no se realizó o se ignoró/dejó el campo en blanco. Solo en el 7,2% de los casos se indicó quimioprofilaxis, pero destacan los registros ignorados o en blanco. Más de la mitad de las víctimas no emitieron el CAT. Conclusiones: Predominan los accidentes con material biológico en médicas y en formas de exposición mucosa y percutánea. Son necesarias inversiones en medidas de bioseguridad y educación permanente para prevenir casos e incentivar su notificación.
Assuntos
Humanos , Epidemiologia Descritiva , Saúde Ocupacional , Medicina de Família e ComunidadeRESUMO
Enquanto no Norte Global se discute uma crise na Atenção Primária à Saúde, a maioria dos países nunca chegou a constituir sistemas de saúde baseados propriamente numa atenção primária robusta. Nesse cenário, o Brasil apresenta uma tendência mais favorável, com conquistas importantes para a atenção primária e a medicina de família e comunidade nos últimos dez anos. Restam desafios a serem superados para que o Sistema Único de Saúde alcance níveis satisfatórios de acesso a seus serviços, com profissionais adequadamente formados e valorizados pela população.
While the Global North is discussing a crisis in primary health care, the majority of countries have never managed to establish health systems based on robust primary care. Brazil presents a more favorable trend, with important achievements for primary care and family practice over the last ten years. There are still challenges to be overcome so that the Unified Health System achieves satisfactory levels of access to its services, with professionals who are properly trained and valued by the public.
Mientras que en el Norte Global se habla de una crisis de la atención primaria, la mayoría de los países nunca han creado realmente sistemas sanitarios basados en una atención primaria robusta. Brasil, muestra una tendencia más favorable, con importantes logros para la atención primaria y la medicina familiar y comunitaria en los últimos diez años. Aún quedan retos por superar para que el Sistema Único de Salud alcance niveles satisfactorios de acceso a sus servicios, con profesionales debidamente formados y valorados por la población.
Assuntos
Humanos , Atenção Primária à Saúde , Sistemas de Saúde , Saúde Global , Medicina de Família e ComunidadeRESUMO
Introdução: Este artigo explora o tema da empatia na relação médico-paciente. Objetivo: Contribuir para o aperfeiçoamento das habilidades de comunicação clínica ao revisar o entendimento e a aplicação da empatia na prática clínica. Métodos: Trata-se de uma revisão não sistemática dos principais livros utilizados na comunicação clínica sobre o tema da empatia. O recorte metodológico compreendeu as seguintes etapas: (1) amostra intencional da literatura; (2) coleta e leitura de dados i.e., extração de fragmentos dos textos; (3) análise do conteúdo, com o foco na definição, importância e instrumentalização para a aplicação prática; (4) seleção e síntese, para facilitar a compreensão e a contextualização sobre o tema; e (5) comparação e ponderação do conteúdo selecionado. Resultados: A abrangência com que a empatia foi trabalhada na literatura selecionada resultou em três níveis de densidade empática: baixa, moderada e alta. Assim, a baixa densidade empática limitou-se mais à definição e importância do tema; a densidade moderada incorporou algum exemplo de como aplicar a empatia, porém de forma fragmentada; e a alta densidade empática abordou o tema de modo mais completo, facilitando a instrumentalização na prática clínica. Há concordância na literatura analisada de que a prática da empatia reflete-se na melhoria do cuidado médico, entretanto seu exercício permanece no campo racional. Ao exemplificar a aplicação prática da empatia, os autores sugerem que o médico adote uma postura isenta de julgamentos, ao mesmo tempo que propõem um exercício imaginativo, de adivinhação dos sentimentos/emoções do paciente. Apesar de os autores de alta densidade empática compreenderem a importância das emoções e nomeá-las no processo, percebe-se a necessidade de um desdobramento e aprofundamento a partir desse ponto. Conclusões: Por se tratar de um assunto complexo, com vários matizes, a empatia é abordada de diferentes formas na literatura selecionada. Isso evidencia sua riqueza e originalidade, ao mesmo tempo que apresenta lacunas para sua aplicação na prática clínica.
Introduction: This article explores the theme of empathy in the doctor-patient relationship. Objective: To contribute to the improvement of clinical communication skills by reviewing the understanding and application of empathy in clinical practice. Methods: A non-systematic review of the main books used in clinical communication on the topic of empathy. The methodological approach consisted in the following steps: (1) An intentional sample of the literature; (2) Data collection and reading, i.e., extracting fragments from texts; (3) Content analysis, focusing on definition, importance and instrumentalization for practical application; (4) Selection and synthesis to facilitate understanding and contextualization on the topic; and (5) Comparison and ponderance of the selected content. Results: The scope within which empathy was worked on in the selected literature resulted in three levels of empathic density: low, moderate, and high. Thus, low empathic density was limited to definition and importance; moderate density incorporated some examples of how to apply empathy in a fragmented way; high empathic density addressed the topic more fully, facilitating instrumentation in clinical practice. There is agreement in the literature analyzed that the practice of empathy reflects on the improvement of medical care. However, its exercise remains in the rational field. By exemplifying the practical application of empathy, the authors suggest that the physician adopt a non-judgmental posture, while proposing an imaginative exercise of guessing the patient's feelings/emotions. Although high-density empathy authors understand the importance of emotions and name them in the process, there is a need for an unfolding and deepening from this point on. Conclusions: Empathy is a complex subject with several nuances and is approached in different ways in the selected literature. This evidences its richness and originality, at the same time that it presents gaps for the application of empathy in clinical practice.
Introducción: Este artículo explora el tema de la empatía en la relación médico-paciente. Objetivo: contribuir a la mejora de las habilidades de comunicación clínica mediante la revisión de la comprensión y aplicación de la empatía en la práctica clínica. Método: se trata de una revisión no sistemática de los principales libros utilizados en comunicación clínica sobre el tema de la empatía. El enfoque metodológico comprendió los siguientes pasos: (1) Una muestra intencional de la literatura; (2) Recopilación y lectura de datos, es decir, extracción de fragmentos de textos; (3) Análisis de contenido, centrándose en definición, importancia e instrumentalización para la aplicación práctica; (4) Selección y síntesis para facilitar la comprensión y contextualización sobre el tema; y (5) Comparación y ponderación del contenido seleccionado. Resultados: el alcance con el que se trabajó la empatía en la literatura seleccionada tuvo como resultado tres niveles de densidad empática: baja, moderada y alta. Así, la baja densidad empática se limitaba más a la definición y la importancia; densidad moderada, incorporó algún ejemplo de cómo aplicar la empatía, pero de manera fragmentada; alta densidad empática se acercó del tema de manera más completa, facilitando la instrumentación en la práctica clínica. Existe acuerdo en la literatura analizada en que la práctica de la empatía se refleja en la mejora de la atención médica. Sin embargo, su ejercicio queda en el campo racional. Al ejemplificar la aplicación práctica de la empatía, los autores sugieren que el médico adopte una postura no crítica, al tiempo que propone un ejercicio imaginativo de adivinar los sentimientos/emociones del paciente. Si bien los autores de alta densidad empática entienden la importancia de las emociones y las nombran en el proceso, existe la necesidad de un desdoblamiento y profundización a partir de este punto. Conclusiones: Por tratarse de un tema complejo y con varios matices, la empatía es abordada de diferentes maneras en la literatura seleccionada. Esto evidencia su riqueza y originalidad, al mismo tiempo que presenta vacíos para la aplicación de la empatía en la práctica clínica.
Assuntos
Relações Médico-Paciente , Educação Médica , Empatia , Medicina de Família e ComunidadeRESUMO
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Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.
Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.
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Introducción. En la adolescencia, se comienzan a tomar decisiones autónomas sobre la salud. En la vacunación intervienen dimensiones contextuales, grupales y relativas a cada vacuna. Se busca conocer el proceso de información, confianza y decisión de vacunarse contra COVID-19 en adolescentes usuarios de un centro de salud en Buenos Aires. Objetivos. Identificar ámbitos y canales a través de los cuales los adolescentes accedieron a información sobre la vacuna contra COVID-19 en un centro de salud de Buenos Aires. Describir sus opiniones respecto a los distintos discursos sobre vacunación. Describir su participación en la vacunación contra COVID-19. Identificar barreras y facilitadores respecto del acceso a la vacunación contra COVID-19 en esta población. Población y métodos. Investigación cualitativa. Se hicieron entrevistas semiestructuradas a adolescentes usuarios del efector. La muestra fue heterogénea; su tamaño se definió por saturación teórica. Se realizó un análisis temático de los datos. Resultados. Se realizaron 14 entrevistas. Los entrevistados recibieron información sobre la vacuna contra COVID-19 de sus familias, la televisión y las redes sociales. Todos recibieron tanto publicidad oficial como discursos reticentes a la vacunación. Analizaron la información recibida y formaron opinión autónoma. Su decisión sobre vacunarse no siempre fue respetada. La desconfianza, la baja percepción del riesgo, el temor a las inyecciones, las barreras administrativas y geográficas fueron motivos de no vacunación. Conclusiones. Se requieren estrategias de comunicación destinadas a adolescentes que promuevan su participación en el acceso a la vacunación.
Introduction. During adolescence, individuals start to make autonomous decisions about their health. Vaccination involves contextual, group, and vaccine-specific dimensions. We sought to know the information, trust, and decision to receive the COVID-19 vaccine among adolescents who attended a healthcare center in Buenos Aires. Objectives. To identify settings and channels through which adolescents accessed information about the COVID-19 vaccine at a healthcare center in Buenos Aires. To describe their opinions about the different statements on vaccination. To describe their participation in COVID-19 vaccination. To identify barriers and facilitators to COVID-19 vaccination in this population. Population and methods. Qualitative study. Semi-structured interviews with adolescents who attended this healthcare facility. The sample was heterogeneous; the sample size was estimated by theoretical saturation. A thematic analysis of data was done. Results. A total of 14 interviews were conducted. Interviewees obtained information about the COVID-19 vaccine from their families, TV, and social media. All received information from both official campaigns and anti-vaccine communications. They analyzed the information they received and formed their own opinion. Their decision about the vaccine was not always respected. Hesitancy, a low perception of risk, fear of needles, administrative and geographic barriers were reasons for not receiving the vaccine. Conclusions. Communication strategies targeted at adolescents are required that encourage their involvement in access to vaccination.
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Humanos , Masculino , Feminino , Adolescente , Confiança , Pesquisa Qualitativa , Vacinas contra COVID-19/administração & dosagem , Argentina , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Entrevistas como Assunto , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Tomada de Decisões , COVID-19/prevenção & controle , Hesitação Vacinal/psicologia , Hesitação Vacinal/estatística & dados numéricos , Instalações de Saúde , Acessibilidade aos Serviços de SaúdeRESUMO
OBJECTIVE: The purpose of this study was to conduct a literature review on transition programs from pediatric to adult care and the role of neurosurgery as individuals with spina bifida (SB) transition, and to provide a framework for neurosurgical providers to assist in the transition to adult-centered care. METHODS: A comprehensive literature review was conducted according to the PRISMA statement, with a search in Medline and Embase to identify US clinical programs reporting on their experiences establishing a transition program for adolescents and young adults with SB. Data were collected for authors, year, transition clinic location, model of care for transition clinic, ages served, and specialty clinical team. RESULTS: The literature search yielded 698 articles, 5 of which met the inclusion criteria. These 5 studies included 4 transition programs for which models of care and approach to transition, clinical services involved, establishment of goals, and age of initiation and transition were identified. All programs described setting transition goals, ranging from community services, to self-management, to health care navigation, to patient-driven goals, with 1 program reporting a quality-of-life measurement component to their model. CONCLUSIONS: Robust SB transition programs can be established by applying the expanded chronic care model, reviewing lessons learned by other programs, advocating at the institutional level, and seeking support via professional organizations. While the comprehensive role of neurosurgical providers in these programs is still being defined, a shared vision of enhancing the health and quality of life for individuals with SB and their families is needed by all subspecialists involved.
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Disrafismo Espinal , Transição para Assistência do Adulto , Humanos , Disrafismo Espinal/cirurgia , Adolescente , Neurocirurgia , Adulto Jovem , Adulto , Procedimentos Neurocirúrgicos/métodosRESUMO
PURPOSE: Little is known about the knowledge of paediatric dentists on bruxism in children. The aim of this cross-sectional study was to assess the knowledge of paediatric dentists on the concept, associated factors of bruxism and management of sleep bruxism (SB) in children'. METHODS: An electronic questionnaire was sent to paediatric dentists in the state of Goiás, Brazil. Information was collected on (1) characteristics of the participants; (2) the concept of bruxism; (3) diagnosis; (4) associated factors; (5) strategies for the management of SB; and (6) updated knowledge on bruxism in children. The data were analysed descriptively. RESULTS: Fifty-seven paediatric dentists participated (10.7% of the total number of professionals). A high level of agreement was found with statements on the concepts of SB (94.7%) and awake bruxism (96.5%). The main strategy for the diagnosis was the combination of a parental report and a clinical examination (79.0%). Most participants indicated that bruxism is associated with anxiety/stress (96.5%), screen use (93%), airway obstruction (91.2%), and sleep apnoea (91.2%). In suspected cases of bruxism, the dentists would send the child for assessment by other health care providers (87.7%). The management options frequently indicated were the use of an occlusal splint, aromatherapy, and homeopathy. More than 70% of them considered themselves to be updated on the issue and sought information through scientific articles and discussions with colleagues. CONCLUSION: Paediatric dentists have knowledge on the concept of bruxism and associated factors. However, further information is needed on the management of this condition in children.
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Odontopediatria , Bruxismo do Sono , Humanos , Estudos Transversais , Brasil , Feminino , Masculino , Criança , Inquéritos e Questionários , Odontólogos , Adulto , Bruxismo/complicações , Padrões de Prática Odontológica/estatística & dados numéricos , Competência ClínicaRESUMO
INTRODUCTION AND HYPOTHESIS: Enhancing women's knowledge, attitude, and practice (KAP) concerning urinary incontinence (UI) through diverse educational strategies has been a focal point for professionals in recent years. This study was aimed at assessing the impact of the educational application Continence App® on the KAP of postpartum women experiencing UI. We hypothesized that access to the app would lead to improved KAP among these women. METHODS: Postpartum women who had undergone vaginal birth, aged 18 years or above, literate, admitted in a maternity ward, delivered a full-term or large-for-gestational-age infant, and possessed a smartphone or compatible device for app usage were included. Changes in KAP were evaluated using a survey specifically designed for this purpose. The Mann-Whitney U test was employed to compare KAP scores between control and intervention groups, as well as between baseline and post-intervention assessments. RESULTS: Among the 542 women screened for eligibility, 349 were enrolled in the study, with 138 completing post-intervention assessments. The mean (standard deviation [SD]) age of participants was 25.9 (5.8) years. Post-intervention scores for knowledge and practice demonstrated a decline among non-app users, whereas a significant increase was observed among those in the intervention group. Attitudinal changes remained insignificant. CONCLUSIONS: The findings highlight the effectiveness of an app-based educational intervention in enhancing the knowledge and practice related to UI among postpartum women.
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Conhecimentos, Atitudes e Prática em Saúde , Aplicativos Móveis , Período Pós-Parto , Incontinência Urinária , Humanos , Feminino , Adulto , Incontinência Urinária/terapia , Incontinência Urinária/psicologia , Adulto Jovem , Educação de Pacientes como Assunto/métodos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The implementation of clinical practice guidelines (CPGs) is a cyclical process in which the evaluation stage can facilitate continuous improvement. Implementation science has utilized theoretical approaches, such as models and frameworks, to understand and address this process. This article aims to provide a comprehensive overview of the models and frameworks used to assess the implementation of CPGs. METHODS: A systematic review was conducted following the Cochrane methodology, with adaptations to the "selection process" due to the unique nature of this review. The findings were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Electronic databases were searched from their inception until May 15, 2023. A predetermined strategy and manual searches were conducted to identify relevant documents from health institutions worldwide. Eligible studies presented models and frameworks for assessing the implementation of CPGs. Information on the characteristics of the documents, the context in which the models were used (specific objectives, level of use, type of health service, target group), and the characteristics of each model or framework (name, domain evaluated, and model limitations) were extracted. The domains of the models were analyzed according to the key constructs: strategies, context, outcomes, fidelity, adaptation, sustainability, process, and intervention. A subgroup analysis was performed grouping models and frameworks according to their levels of use (clinical, organizational, and policy) and type of health service (community, ambulatorial, hospital, institutional). The JBI's critical appraisal tools were utilized by two independent researchers to assess the trustworthiness, relevance, and results of the included studies. RESULTS: Database searches yielded 14,395 studies, of which 80 full texts were reviewed. Eight studies were included in the data analysis and four methodological guidelines were additionally included from the manual search. The risk of bias in the studies was considered non-critical for the results of this systematic review. A total of ten models/frameworks for assessing the implementation of CPGs were found. The level of use was mainly policy, the most common type of health service was institutional, and the major target group was professionals directly involved in clinical practice. The evaluated domains differed between the models and there were also differences in their conceptualization. All the models addressed the domain "Context", especially at the micro level (8/12), followed by the multilevel (7/12). The domains "Outcome" (9/12), "Intervention" (8/12), "Strategies" (7/12), and "Process" (5/12) were frequently addressed, while "Sustainability" was found only in one study, and "Fidelity/Adaptation" was not observed. CONCLUSIONS: The use of models and frameworks for assessing the implementation of CPGs is still incipient. This systematic review may help stakeholders choose or adapt the most appropriate model or framework to assess CPGs implementation based on their specific health context. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) registration number: CRD42022335884. Registered on June 7, 2022.
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Ciência da Implementação , Guias de Prática Clínica como Assunto , Humanos , Guias de Prática Clínica como Assunto/normas , Fidelidade a DiretrizesRESUMO
La mayoría de las preguntas de investigación (PI), conducirán a un proyecto que apunta a generar nuevo conocimiento, sin embargo el escenario, la población a estudio y la metodología pueden ser muy diferentes, lo que determinará que los resultados obtenidos y por ende, el nivel de evidencia (NE) y el grado de recomendación (GR) puedan variar notablemente. El objetivo de este artículo fue proporcionar recomendaciones para formular una PI asociada al NE y respectivos GR que se pueden desprender a partir de los resultados generados. Este artículo entregará algunos conocimientos sobre la PI y su relación con los NE y GR de la evidencia generada a partir de resultados obtenidos por un proceso de investigación en diferentes escenarios de investigación.
SUMMARY: Most research questions (RQ) will lead to a project that aims to generate new knowledge. However, the setting, study population and methodology may be very different, which will determine the results obtained and therefore, the level of evidence (LOE) and the grade of recommendation (GOR) may vary significantly. The aim of this study was to provide recommendations to formulate a RQ associated with the LOE and respective GOR that can be derived from the generated results. This article will provide some knowledge about the RQ and its relationship with the LEO and GOR of the generated evidence from results obtained by a research process in different research scenarios.
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Projetos de Pesquisa , Medicina Baseada em Evidências , Pesquisa Biomédica/métodos , Prática Clínica Baseada em EvidênciasRESUMO
Introducción: Las redes académicas adquieren elevada significación para la gestión colaborativa de la interdisciplinariedad en la educación de posgrado, de ahí que se suscite el análisis, para su optimización, en el proceso pedagógico de posgrado. El objetivo del presente estudio consistió en revelar criterios teórico-metodológicos para el empleo de las redes académicas en función de la interdisciplinariedad en la educación de posgrado. Métodos: Investigación cualitativa, comprendida entre noviembre de 2022 a septiembre de 2023. Incluyó el empleo de métodos teóricos como el análisis y síntesis, el histórico y lógico, la sistematización y la modelación. Entre los métodos empíricos se aplicó la revisión de documentos y la consulta a especialistas. También se empleó el análisis porcentual para procesar datos. Resultados: Se revelan criterios teórico-metodológicos que fundamentan el empleo de redes académicas en el posgrado, al considerar elementos asociados a la interdisciplinariedad, el trabajo colaborativo, las relaciones interprofesionales e intersectoriales y las alianzas interinstitucionales, a partir de las exigencias de ese nivel educacional. Este resultado es ampliamente generalizable al diseño y gestión de programas de posgrado en sus dos vertientes: superación profesional y formación académica. Discusión: Investigaciones precedentes evidencian un consenso sobre las potencialidades de las redes académicas para el desarrollo del aprendizaje colaborativo, la gestión de proyectos y la práctica interdisciplinaria. Los resultados de este estudio optimizan su empleo en el proceso pedagógico de posgrado. Los criterios teórico-metodológicos revelados en el presente trabajo, tienen un enfoque holístico con elevada pertinencia, según criterios valorativos de los especialistas que participaron en el estudio.
Introduction: Academic networks acquire high significance for the collaborative management of interdisciplinarity in postgraduate education, hence the analysis arises, for its optimization, in the postgraduate pedagogical process. The objective of this study was to reveal theoretical-methodological criteria for the use of academic networks based on interdisciplinarity in postgraduate education. Methods: Qualitative research, between november 2022 and september 2023. It included the use of theoretical methods such as analysis and synthesis, historical and logical, systematization and modeling. Among the empirical methods, document review and consultation with specialists were applied. Percentage analysis was also used to process data. Results: Theoretical-methodological criteria are revealed that support the use of academic networks in postgraduate studies, when considering elements associated with interdisciplinarity, collaborative work, interprofessional and intersectoral relationships and inter-institutional alliances, based on the demands of that educational level. This result is widely generalizable to the design and management of postgraduate programs in its two aspects: professional development and academic training. Discussion: Previous research shows a consensus on the potential of academic networks for the development of collaborative learning, project management and interdisciplinary practice. The results of this study optimize its use in the postgraduate pedagogical process. The theoretical-methodological criteria revealed in this work have a holistic approach with high relevance, according to the evaluation criteria of the specialists who participated in the study.
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BACKGROUND: Hemophilia is a rare congenital bleeding disorder that results from complete or partial deficiency of blood coagulation factor (F)VIII (hemophilia A) or FIX (hemophilia B) due to pathogenic variants in their coding genes. Hemophilia requires complex management. To date, there is no evidence-based clinical practice guideline on hemophilia treatment based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. OBJECTIVES: This evidence-based clinical practice guideline from the International Society on Thrombosis and Haemostasis aims to provide an overview of evidence and support patients, caregivers, hematologists, pediatricians, other clinicians, researchers, and stakeholders in treatment decisions about congenital hemophilia A and B. METHODS: The International Society on Thrombosis and Haemostasis formed a multidisciplinary guideline panel of physicians and patients with global representation, balanced to minimize potential bias from conflicts of interest. The panel prioritized a set of clinical questions and outcomes according to their importance for clinicians and patients. A methodological team supported the guideline development process, including searching for evidence and performing systematic reviews. The GRADE approach was used, including GRADE Evidence to Decision frameworks. The recommendations were subject to public comment. RESULTS: The panel selected 13 questions, of which 11 addressed the treatment of hemophilia A and 2 the treatment of hemophilia B. Specifically, the panel addressed questions on prophylactic and episodic treatment with FVIII concentrates, bypassing agents, and nonfactor therapy (emicizumab) for hemophilia A (with and without inhibitors) as well as immune tolerance induction for hemophilia A. For hemophilia B, the panel addressed questions on prophylactic and episodic treatment of bleeding events with FIX concentrates. Agreement was reached for all 13 recommendations, of which 7 (54%) were based on evidence from randomized clinical trials, 3 (23%) on observational studies, and 3 (23%) on indirect comparisons. CONCLUSION: Strong recommendations were issued for prophylactic over episodic treatment for severe and moderately severe hemophilia A and B. Only conditional recommendations were issued for the remaining questions. Future research should focus on direct treatment comparisons and the treatment of hemophilia B with and without inhibitors. Future updates of this guideline will provide an updated evidence synthesis on the current questions and focus on new FVIII and FIX concentrates, novel nonfactor therapies, and gene therapy for severe and nonsevere hemophilia A and B.
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Medicina Baseada em Evidências , Hemofilia A , Hemofilia B , Humanos , Coagulantes/uso terapêutico , Consenso , Medicina Baseada em Evidências/normas , Fator VIII/uso terapêutico , Fator VIII/genética , Hemofilia A/sangue , Hemofilia A/genética , Hemofilia A/terapia , Hemofilia A/diagnóstico , Hemofilia B/sangue , Hemofilia B/terapia , Hemofilia B/diagnóstico , Hemofilia B/genética , Hemorragia/sangue , Hemostasia , Sociedades Médicas , Resultado do Tratamento , Hematologia/métodos , Hematologia/normasRESUMO
DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: The American Society of Health-System Pharmacists (ASHP) developed the Practice Advancement Initiative 2030 (PAI 2030) to support the continuous improvement of hospital pharmacy services in the United States. Puerto Rico (PR) hospitals' level of compliance with PAI 2030 recommendations is not currently known. The primary objective of this study was to describe the hospital pharmacy scenario in PR in the 5 areas addressed in PAI 2030 recommendations. SUMMARY: Through a collaboration between the state affiliate, a school of pharmacy, and ASHP, completion of the PAI 2030 Self-Assessment Tool was promoted among hospital pharmacy directors between August 2022 and March 2023. A total of 18 out of 66 hospitals completed the survey. The results were compared with national data provided by ASHP from 163 US hospitals. Areas where PR hospitals rated high were in PAI 2030 domain A (Pharmacy Technician Role, Education, and Training) and domain E (Pharmacist Leadership in Medication Use and Safety). PR hospitals rate their performance lower in domain A (Patient-Centered Care) and domain B (Pharmacist Role, Education, and Training). Specific focus areas for improvement by PR hospitals include pharmacist participation in medication reconciliation, 24/7 access to advanced clinical pharmacy services, expansion of the pharmacist's scope of practice, and training through the Board of Pharmacy Specialties and residency programs. CONCLUSION: This study illustrates how the PAI 2030 Self-Assessment Tool can be used to benchmark pharmacy services at the state level. We suggest that changes are needed to close the gap between hospital pharmacies working towards optimizing the role of pharmacists in healthcare systems and those still struggling with dedicating staff to well-recognized pharmacist roles and responsibilities.
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There are few studies exploring intake diagnostic characteristics as predictors of change in integrative naturalistic settings. The aim of this study is to explore baseline variables at the intake process and establish the predictive value of the individual trajectories of the patients. We recruited 259 patients undergoing an integrative psychotherapy network of psychotherapists from Buenos Aires, Argentina. Every therapist completed the intake form of each patient involved in the routine outcome monitoring. Thereafter step-wise regressions based on forward selection strategies were used, in order to identify meaningful baseline predictors of patients' clinical evolution, derived from the intake process. The selected predictors were social support network, subjective distress, the initial measure of clinical distress, unemployment, sociocultural status and reactance. When including those six variables in a multilevel model, the results indicate that social support network, subjective distress, and the initial measure of clinical distress were significant predictors of the trajectories of OQ-30, whereas unemployment, sociocultural status and reactance were not significant. The results regarding social support network are in line with the literature, while results of socioeconomic status (unemployment and sociocultural level) move in an opposite direction in comparison to the available evidence. Moreover, the mental health findings (initial OQ-30 and subjective distress) confirm the contradictory body of literature produced in this domain. Finally, reactance seems to be a significant predictor in previous study in contradiction of our results. Overall, this endeavor constitutes important but preliminary evidence to enhance the production of bottom-up science within practice research networks in the global south.
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Psicoterapia , Apoio Social , Desemprego , Humanos , Argentina , Masculino , Feminino , Psicoterapia/estatística & dados numéricos , Adulto , Pessoa de Meia-Idade , Desemprego/estatística & dados numéricos , Transtornos Mentais/terapia , Transtornos Mentais/epidemiologia , Angústia Psicológica , Fatores Socioeconômicos , Adulto Jovem , Estresse Psicológico/epidemiologiaRESUMO
OBJECTIVES: To identify 1) factors of the evidence-practice gap (EPG) in Japan and Brazil as perceived by dentists and compare these factors between two countries, and 2) mechanisms to close this EPG. METHODS: The study employed a cross-sectional design by administering a web-based questionnaire to 136 Japanese and 110 Brazilian dentists. The survey queried dentists' reports of which factors possibly cause an EPG, using a newly developed 20-item questionnaire. RESULTS: An international comparison of 20 items related to factors of the EPG between Japan and Brazil revealed that "Dentists' own experiences are sometimes given priority over evidence" and "Dentists' own thoughts are sometimes given priority over evidence" were common factors to both countries, with over 80 % agreement. In logistic regression, "Insufficient opportunity to learn about evidence in dental education at universities", "Evidence-based treatments are sometimes not covered by the dental insurance system", and "Insufficient evidence which helps dentists choose an appropriate treatment for a patient after careful consideration of his/her own background" were significantly associated with the EPG in Japan (p < 0.05). In Brazil, "Insufficient case reports in which evidence-based dentistry (EBD) is applied to clinical practice" and "Image-based information and devices used for diagnosis vary depending on individual dentists" were significantly associated with the EPG (p < 0.05). CONCLUSIONS: This study suggests that EPG could be improved in Japan: by promoting EBD education at universities, improving the dental insurance system, and accumulating evidence according to patient background; and in Brazil: by promoting EBD case reports and standardizing diagnostic information and devices. CLINICAL SIGNIFICANCE: Two factors of EPG common to Japan and Brazil, namely the prioritization of dentists' own "experiences" and "thoughts" over evidence, are urgent issues for improving EPG. In addition, it will be necessary to address the country-specific factors of EPG that were identified in this study.
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Odontólogos , Odontologia Baseada em Evidências , Padrões de Prática Odontológica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atitude do Pessoal de Saúde , Brasil , Estudos Transversais , Odontólogos/psicologia , Educação em Odontologia , Seguro Odontológico , Japão , Padrões de Prática Odontológica/estatística & dados numéricos , Lacunas da Prática Profissional , Inquéritos e QuestionáriosRESUMO
The benefits of less repetitive practice schedules on motor learning are usually described in terms of greater demand for memory processes. The present study aimed to investigate the interactions between working memory and practice schedule and their effects on motor learning. Forty female participants had their WMC evaluated by the N-back test and were randomly allocated to either the variable random (VP) or the constant practice (CP) groups. In the acquisition phase, participants practiced 120 trials of a sequential key-pressing task with two goals: learning the relative and the absolute timing. Delayed retention and transfer tests occurred 24 h after the acquisition phase. Participants performed 12 trials of the motor task. Results showed that in the CP, learners with a high level of WMC presented better motor performance in the transfer test than learners with a low level of WMC. In the RP, no difference between WMC levels was found. Learners with a high level of WMC in the CP presented the same motor performance as learners in the RP regardless of the WMC level in the transfer test. In conclusion, learners with a high WMC could compensate for the poor working memory stimulation of a more repetitive practice schedule. The high WMC did not seem to exert an additional benefit when learners were well stimulated by a less repetitive practice schedule.