Oficina de linguagem na atenção psicossocial: vez e voz do sujeito / Language workshop in the psychosocial care: the subject's turn and voice / Taller de lenguaje en la atención psicosocial: vez y voz del sujeto

Introdução: A oficina de linguagem, tecnologia, por excelência, de trabalho com a saúde mental, é constituída por três pilares: protagonismo, potência criadora e a própria linguagem, como espaço de empoderamento. Objetivo Verificar a percepção dos participantes sobre os efeitos da oficina de linguagem, objeto deste estudo. Método: Foi feito um estudo transversal, descritivo, por meio da introdução de uma temática específica nas rodas de conversa da oficina em questão durante o período do recorte. As sessões foram filmadas por doze semanas, e as rodas de conversa foram transcritas. Utilizou-se a análise de conteúdo do tipo temática para análise e interpretação dos dados obtidos dos discursos dos seus participantes que exibiam a diversidade postulada em termos de idade, gênero, condição social e saúde. Resultados: Três categorias temáticas foram identificadas e selecionadas por sua relevância: enlaçamento social, protagonismo subjetivo e circulação discursiva. Conclusões: Os resultados apontam narrativas de empoderamento que as vivências da oficina proporcionam, com clara expressão de reconhecimento da assunção ao lugar de falante por todos, posicionamento fundamental para a possibilidade de alcançar vez e voz nas suas relações sociais.

Introduction: The workshop of language, a technology par excellence, when working with mental health, consists of three pillars: protagonism, creative power and language itself as a space of empowerment. Objective: The aim of this study was to verify the perception of participants about the effects of the language workshop, object of this study. Methods: This research used the methodology of transverse, descriptive design. A specific theme was introduced in the Conversation Wheels of the workshop over a period of 12 weeks. Those sessions were filmed and the conversation wheels transcribed. "Thematic content analysis" was used to analyze and interpret the data obtained from the discourses of its participants. These participants exhibited the diversity postulated in terms of age, gender, social condition, health. Results: Three thematic categories were identified and selected for their relevance: social binding, subjective protagonism and discursive circulation. Conclusions: The results highlight narratives of empowerment that the experiences of the workshop propose, with clear expression of recognition of the occupation of the place of speaker by all, an essential prerequisite for the possibility of reaching time and voice in their social interrelations.

Introducción: El taller de lenguaje se considera la tecnología por excelencia para trabajar con la salud mental y se apoya en tres pilares básicos: el protagonismo; la capacidad creativa y el propio lenguaje en sí mismo como espacio de empoderamiento. Objetivo: Comprobar como perciben los participantes los efectos del taller de lenguaje Método: Se hizo un estudio transversal y descriptivo por medio de la introducción de una temática específica en las ruedas de conversación del taller durante su realización. Las conversaciones se fueron filmando durante las doce semanas de trabajo y se transcribieron. Se utilizó el análisis temático de contenidos para analizar e interpretar los datos obtenidos de los discursos de sus participantes que mostraron la diversidad propuesta respecto a edad, género, condición social y salud. Resultados: Se identificaron tres categorías temáticas y se seleccionaron por su importancia: las relaciones sociales, el protagonismo subjetivo y la circulación discursiva. Conclusiones: Los resultados muestran que las experiencias del taller proporcionan empoderamiento, al ir ocupando todos los participantes el puesto de hablante, siendo esto fundamental para poder tener voz y espacio en sus relaciones sociales.

Recommending encounters according to the sociodemographic characteristics of patient strata can reduce risks from type 2 diabetes.

OBJECTIVES: Physician encounters with patients with type 2 diabetes act as motivation for self-management and lifestyle adjustments that are indispensable for diabetes treatment. We elucidate the sociodemographic sources of variation in encounter usage and the impact of encounter usage on glucose control, which can be used to recommend encounter usage for different sociodemographic strata of patients to reduce risks from Type 2 diabetes. DATA AND METHODS: We analyzed data from a multi-facility clinic in the Midwestern United States on 2124 patients with type 2 diabetes, from 95 ZIP codes. A zero-inflated Poisson model was used to estimate the effects of various ZIP-code level sociodemographic variables on the encounter usage. A multinomial logistic regression model was built to estimate the effects of physical and telephonic encounters on patients' glucose level transitions. Results from the two models were combined in marginal effect analyses. RESULTS AND CONCLUSIONS: Conditional on patients' clinical status, demographics, and insurance status, significant inequality in patient encounters exists across ZIP codes with varying sociodemographic characteristics. One additional physical encounter in a six-month period marginally increases the probability of transition from a diabetic state to a pre-diabetic state by 4.3% and from pre-diabetic to the non-diabetic state by 3.2%. Combined marginal effect analyses illustrate that a ZIP code in the lower quartile of high school graduate percentage among all ZIP codes has 1 fewer physical encounter per six months marginally compared to a ZIP code at the upper quartile, which gives 5.4% average increase in the probability of transitioning from pre-diabetic to diabetic. Our results suggest that policymakers can target particular patient groups who may have inadequate encounters to engage in diabetes care, based on their immediate environmental sociodemographic characteristics, and design programs to increase their encounters to achieve better care outcomes.

Produção de sentidos em um grupo reflexivo para homens autores de violência / Producción de significados en un grupo reflexivo para hombres autores de violencia / Production of meanings in a reflexive group for male perpetrators of violence

Resumo Objetivou-se analisar o cenário de produção de sentidos em um grupo reflexivo para homens autores de violência conjugal: posicionamentos, dificuldades e efeitos que o grupo suscita em seus diferentes atores - homens e facilitadoras. Para tanto, foi realizada observação participante durante 10 sessões, com registros em diário de campo. A posteriori realizaram-se entrevistas semiestruturadas com dois integrantes do grupo e as profissionais condutoras. De modo geral, o grupo demonstrou ser um ambiente propício de produção, circulação e atualização de repertórios discursivos sobre o fenômeno da violência de gênero. No entanto, estes deslocamentos discursivos não acontecem de forma homogênea, tampouco sem dificuldades e tensões. O campo e os dados das entrevistas revelaram dificuldades provenientes de diferentes ordens: tanto operacional/metodológicas, institucional/burocráticas, mas, sobretudo, acerca do vínculo profissionais/homens por este se sustentar por um frágil "acordo judicial".

Resumen El objetivo de este artículo fue analizar el escenario de producción de significados en un grupo reflexivo de hombres autores de violencia conyugal: posiciones, dificultades y efectos que tiene el grupo sobre sus diferentes actores - hombres y facilitadores. Para eso, se realizó observación participante durante 10 sesiones, con registro en un diario de campo. Posteriormente, se realizaron entrevistas semiestructuradas con dos miembros del grupo y los profesionales directores. En general, el grupo resultó ser un entorno propicio para la producción, circulación y actualización de repertorios discursivos sobre el fenómeno de la violencia de género. Sin embargo, estos desplazamientos discursivos no ocurren de manera homogénea, tampoco sin dificultades y tensiones. El campo y los datos de las entrevistas revelaron dificultades derivadas de diferentes órdenes: tanto operacional/metodológico, institucional/burocrático, pero, sobre todo, acerca del vínculo profesional/masculino porque se sustenta en un frágil "acuerdo judicial".

Abstract This article aimed to analyze the scenario of production of meanings in a reflexive group for men who committed conjugal violence: the positioning, difficulties and effects the group has in its different actors - men and facilitators. For this, 10 sessions of participative observation were made, being reported on a field journal, as well as semi-structured interviews with two group members and the conductive professionals. Generally, the group has shown itself to be propitious for the production, circulation and update of discursive repertoires on the gender violence phenomena. However, these discursive movements do not happen in a homogeneous form, nor without struggles and tensions. The fieldwork and the data from the interview revealed difficulties of different orders: operational/methodological, institutional/bureaucratic, but, above all, on the professional/men bond as it is sustained by a fragile "judicial agreement".

Práticas grupais com jovens promovendo bons encontros e saúde ético-política / Group practices with young people promoting good meetings and ethical-political health / Prácticas grupales con jóvenes que promueven buenos encuentros y salud ético-política

Este artigo buscou analisar, com base no conceito de sofrimento éticopolítico, cunhado por Sawaia, se e de que modo a prática grupal possibilitou o aumento da potência da força de existir de jovens e a promoção da saúde ético-política. O trabalho foi realizado com jovens que se inscreveram para atendimento psicológico em uma clínica-escola de uma universidade no interior do Estado de Minas Gerais. Em dez encontros foi possível perceber as afetações dos jovens em relação aos aspectos que permeiam suas vidas e como estes aumentam, diminuem, favorecem ou refratam suas potências de existir. Os resultados da pesquisa apontam que a prática grupal aumenta a potência de ação de jovens ao promover identificações, espaço de escuta e questionamentos. Além disso, configurou-se como espaço para os afetos e para a (res)significação das experiências, bem como para a constituição de relações que se estenderam para além daquele dos encontros.

This article aimed to analyze, based on the concept of ethical-political suffering, coined by Sawaia, whether and how group practice enabled the increase of potency of young people’s existence and the promotion of ethicalpolitical health. The study was carried out with youths who enrolled for psychological assistance in a clinical school of a university in the hinterland of Minas Gerais State. After ten reunions, it was possible to perceive the youths’ feelings related to the aspects that permeate their lives and how these aspects increase, decrease, favor or hamper their power to exist. The research results show that group practice increases young people’s potential to act when developing identifications, space to be listened and to utter questions. Furthermore, it turned out to be structured as a space for affections and for the (re)signification of experiences, as well as for the constitution of relationships that extended beyond those reunions.

Este artículo tuvo como objetivo analizar, basado en el concepto de sufrimiento ético-político, acuñado por Sawaia, si y cómo la práctica grupal permitió el aumento de la potencia de existencia de los jóvenes y la promoción de la salud ético-política. El estudio fue realizado con jóvenes que se inscribieron para recibir asistencia psicológica en una clínica-escuela de una universidad en el interior de Minas Gerais. En diez encuentros fue posible percibir las afectaciones de los jóvenes en relación a los aspectos que marcan sus vidas y cómo estos aspectos aumentan, disminuyen, favorecen o refractan sus potencias para existir. Los resultados de la investigación muestran que la práctica grupal aumenta el potencial de acción de los jóvenes al promover identificaciones, espacios de escucha y cuestionamientos. Además, se configuró como un espacio para los afectos y para el (re) significado de las experiencias, así como para la constitución de relaciones que se extendían más allá de los encuentros.

The impact and utility of encounter patient decision aids: Systematic review, meta-analysis and narrative synthesis.

OBJECTIVE: To determine the effect of encounter patient decision aids (PDAs) as evaluated in randomized controlled trials (RCTs) and conduct a narrative synthesis of non-randomized studies assessing feasibility, utility and their integration into clinical workflows. METHODS: Databases were systematically searched for RCTs of encounter PDAs to enable the conduct of a meta-analysis. We used a framework analysis approach to conduct a narrative synthesis of non-randomized studies. RESULTS: We included 23 RCTs and 30 non-randomized studies. Encounter PDAs significantly increased knowledge (SMD = 0.42; 95% CI 0.30, 0.55), lowered decisional conflict (SMD= -0.33; 95% CI -0.56, -0.09), increased observational-based assessment of shared decision making (SMD = 0.94; 95% CI 0.40, 1.48) and satisfaction with the decision-making process (OR = 1.78; 95% CI 1.19, 2.66) without increasing visit durations (SMD= -0.06; 95% CI -0.29, 0.16). The narrative synthesis showed that encounter tools have high utility for patients and clinicians, yet important barriers to implementation exist (i.e. time constraints) at the clinical and organizational level. CONCLUSION: Encounter PDAs have a positive impact on patient-clinician collaboration, despite facing implementation barriers. PRACTICAL IMPLICATIONS: The potential utility of encounter PDAs requires addressing the systemic and structural barriers that prevent adoption in clinical practice.

Enhancing Outcomes of Low-Intensity Parenting Groups Through Sufficient Exemplar Training: A Randomized Control Trial.

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5-8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes.

Caracterização, reincidência e percepção de homens autores de violência contra a mulher sobre grupos reflexivos / Caracterización, reincidencia y percepción de hombres autores de violencia contra la mujer sobre grupos reflexivos / Characterization, recidivism and perception of men perpetrators of violence against women about reflective groups

RESUMO Este estudo busca caracterizar homens autores de violência contra mulheres (HAV) que participaram de Grupos Reflexivos (GR) do Núcleo Especializado de Atendimento ao Homem ao Autor de Violência Doméstica e Familiar (NEAH) em Belém-PA, com destaque para a reincidência e a percepção dos HAV sobre os GR. Trata-se de um estudo documental, com registros feitos entre 2012 e 2015. Entre os resultados, verificou-se que 33,8% desses homens (n=24) não haviam completado o Ensino Fundamental, 58,8% (n=40) eram usuários de álcool e 54,8% (n=40) conviviam com a mulher no momento da agressão. Ademais, 61,2% (n=41) deles foram processados por violência física contra a mulher, mas apenas 1,3% (n=1) reincidiram nesta forma de agressão após a participação no GR. Estes foram descritos como um mecanismo acessível na prevenção da violência, pois proporciona cuidado, aprendizado e reflexão, porém, demanda por maiores pesquisas e investimentos que se aproximem de outras políticas sociais a fim de construir uma rede sólida de reformulação das relações sociais de gênero.

RESUMEN Este estudio busca caracterizar a hombres autores de violencia contra mujeres (HAV) y su participación en Grupos Reflexivos (GR) del Núcleo Especializado de Atendimento ao Homem ao Autor de Violência Doméstica e Familiar (NEAH) en Belém-PA, con destaque para la reincidencia y la percepción de los HAV sobre los GR. Se trata de un estudio documental con registros realizados entre 2012 y 2015. Entre los resultados, se verificó que el 33,8% de esos hombres (n = 24) no habían completado la Enseñanza Fundamental, el 58,8% (n = 40) eran usuarios de alcohol y el 54,8% (n = 40) residían con la mujer en el momento de la agresión. Además, 61,2% (n = 41) de ellos fueron procesados por violencia física contra la mujer, pero sólo el 1,3% (n = 1) reincidieron en esta forma de agresión después de la participación en Grupos Reflexivos. Estos fueron descritos como un mecanismo accesible en la prevención de la violencia, pues proporciona cuidado, aprendizaje y reflexión, pero demanda mayores investigaciones e inversiones que se aproximen a otras políticas sociales a fin de construir una red sólida de reformulación de las relaciones sociales de género.

ABSTRACT This study seeks to characterize men who were perpetrators of violence against women (HAV) and their participation in Reflexive Groups (GR) of the Nucleus X in Belém-PA, Brazil, highlighting the recidivism and the perception of HAV about GR. This is a documentary study with records made between 2012 and 2015. Among the results, 33.8% of these men (n = 24) did not complete Elementary School, 58.8% (n = 40) were alcohol users, 54.8% (n = 40) lived with the woman at the time of the aggression. In addition, 61.2% (n = 41) were prosecuted for physical violence against women, but only 1.3% (n = 1) relapsed in this form of aggression after participating in the GR. These have been described as an accessible mechanism in the prevention of violence that provides care, learning and reflection, demand for more research and investments that approach other social politics in order to build a solid network of reformulation of social relations of gender.

Revisión sistemática sobre los programas de Entrenamiento Socioemocional para niños y adolescentes de 6 a 18 años publicados entre 2011 y 2015 / Systematic Review of Social-Emotional Training Programs For Children and Adolescents

Resumen En las últimas décadas ha aumentado el número de publicaciones sobre programas de entrenamiento socioemocional y se consideran como factores protectores que facilitan la adaptación de la persona al contexto y favorecen un mejor afrontamiento ante diferentes situaciones de la vida, así como ante situaciones de estrés. El objetivo del presente trabajo fue realizar una revisión sistemática de programas de entrenamiento socioemocional realizados en niños y adolescentes con el fin de seleccionar los más apropiados. El proceso de búsqueda se efectuó a partir de las bases de datos: PsycInfo, MedLine, ERIC, Red de Revistas Científicas de América Latina y El Caribe, Scielo, PUBMED, con palabras claves en inglés y español. Los resultados muestran que, de los 19 artículos que fueron seleccionados por cumplir con los criterios, se identificaron 17 programas de entrenamiento, la mayoría realizados en España y en el período 2011-2015. Los objetivos fueron, en mayor medida, destinados a entrenar la inteligencia emocional, seguido por los entrenamientos mixtos y en menor medida los destinados a entrenar las habilidades sociales. Se identificaron las técnicas empleadas en estos programas, la duración promedio de las intervenciones, la modalidad de aplicación, los administradores y los destinatarios. Por último, del total de los estudios analizados, la mayoría evidencia efectividad del entrenamiento para algunas de las variables analizadas. La evidencia presentada puede ser de utilidad para investigadores y profesionales del área de la salud y la educación que trabajen con niños y adolescentes.

Abstract: In recent decades the number of publications on social-emotional training programs has increased, achieving consideration as protective factors that facilitate the adaptation of the individual to their context and allow better coping with different life situations, as well as of stressful situations. The objective of the present study was to perform a systematic review of social-emotional training programs in children and adolescents in order to select the most appropriate ones. The search process was carried out in the following databases: PsycInfo, MedLine, ERIC, Red de Revistas Científicas de América Latina y el Caribe, Scielo, PUBMED, with key words in English and Spanish and certain inclusion criteria. The results showed that of the 19 articles that were selected because they met the criteria, 17 training programs were identified, most of them carried out in Spain during the 2011-2015 period. The objectives of these training programs were to a greater extent, adapted to emotional intelligence, followed to a lesser extent by mixed training. The techniques used in these programs were identified, together with the duration of the interventions, the mode of application, the administrators and the recipients. Finally, of the total studies analyzed, most evidenced the effectiveness of training for some of the variables analyzed. The evidence presented may be useful for researchers and professionals in the area of health and education who work with children and adolescents.

Hepatitis B virus contact disclosure and testing in Lusaka, Zambia: a mixed-methods study.

OBJECTIVES: The aim of this study was to estimate the frequency of disclosure to and testing of contacts of patients with hepatitis B virus (HBV) in Zambia. DESIGN: We used a convergent parallel mixed-method research design including a quantitative survey and focus group discussions with patients with HBV. SETTING: A university hospital in Lusaka, Zambia. PARTICIPANTS: 79 hepatitis B surface antigen (HBsAg)-positive, HIV-negative, adults (18+ years) receiving HBV care completed a quantitative survey and 32 also participated in a focus group discussion. OUTCOMES AND ANALYSIS: Contacts of patients with HBV were enumerated and patient-reported disclosure, contact testing and contact HBV test results were used to develop a testing cascade. Using multivariable logistic regression, we identified factors associated with disclosure of HBV status. In focus groups, we explored how index patient knowledge and awareness of their condition shaped perspectives on contact disclosure and testing. Focus groups coding and analysis followed a thematic analysis approach. RESULTS: Among 79 patients with HBV (median age 35 years; 26.6% women), the majority reported disclosure to ≥1 contact. According to the index patients' knowledge, of 776 contacts enumerated, 326 (42.1%) were disclosed to, 77 (9.9%) were tested, 67 (8.6%) received results and 8 (11.9%) were HBsAg-positive. Increased stigma score was associated with reduced disclosure. In focus groups, HBV awareness, knowledge and stigma emerged as barriers to disclosure and referral of contacts for testing. Association of HBV with HIV-related stigma was also reported as a strong barrier to contact disclosure and testing and to taking antivirals for HBV monoinfection. CONCLUSIONS: HBV contact disclosure and testing were feasible and yielded new diagnoses in Zambia. A better understanding of barriers to seeking HBV testing and treatment is needed to scale-up this important intervention in Africa. TRIALS REGISTRATION NUMBER: NCT03158818.

Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America / Comunidades terapéuticas en Latinoamérica: un estudio descriptivo en varios países de Latinoamérica

ABSTRACT Objective: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. Design: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. Methods: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. Results: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. Conclusions: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

RESUMEN Objetivo: En Latinoamérica no se conoce a ciencia cierta la cantidad o la calidad de las comunidades terapéuticas disponibles en los distintos países de la región. El objetivo de este estudio es identificar y describir la cantidad y la calidad de las comunidades terapéuticas existentes en 5 países de la región. Diseño: Se realizó un estudio multicéntrico descriptivo cuantitativo de las comunidades terapéuticas en Argentina, Brasil, Colombia, México y Perú. Métodos: Mediante las entidades reguladoras de las comunidades terapéuticas de cada país, se realizó una encuesta a las que aceptaran participar en el estudio. Resultados: De las 285 comunidades terapéuticas identificadas en los 5 países, 176 (62%) aceptaron participar en el estudio. La calidad de las comunidades terapéuticas se evaluó por las puntuaciones establecidas con los criterios de De León; se encontró que el 70% de las instituciones tienen puntuaciones de 11/12 o 12/12 según estos criterios. También se encontró que cumplen la mayoría de los criterios de De León más del 90% de las instituciones; sin embargo, las dimensiones «separación de la comunidad¼ y «grupos de encuentro entre residentes¼ fueron los menos cumplidos (el 63 y el 85% de las comunidades respectivamente). Las principales razones de abandono de las comunidades terapéuticas fueron no aceptar las normas de la institución, falta de recursos económicos y no sentirse a gusto con ella. El 98% de las comunidades terapéuticas prestaban servicios para problemas de abuso de otras sustancias, el 94% para abuso de alcohol y el 40% para otros tipos de abusos. Conclusiones: La mayoría de las comunidades terapéuticas identificadas en nuestra muestra cumplen los criterios de calidad establecidos por De León, y en su gran mayoría prestan servicios para abuso de sustancias, pero deben instaurarse políticas para mejorar las condiciones no cumplidas e indagar los motivos de las disconformidades y el abandono de estas instituciones.

[Effect observation of cleaning up the external auditory canal by otoendoscope combined with Clotrimazole Ointment in the treatment of pregnancy with otitis externa mycotica].

Objective:To investigate the clinical effect of cleaning up the external auditory canal under otoendoscope combined with Clotrimazole Ointment in the treatment of pregnancy with otitis externa mycotica.Method:From May 2015 to May 2017,16 cases of pregnant patients(19 ears)with otitis externa mycotica were divided into two groups:pure cleaning up group and cleaning up combined with medication group.In the pure cleaning up group,external auditory canal were only cleaned up under otoendoscope conventionally in 9 patients(11 ears),while in the cleaning up combined with medication group,Clotrimazole Ointment was topically applied after cleaning up the external auditory canal under otoendoscope in 7 patients(8 ears).After treatment of 2 weeks,the clinical curative effect,adverse reaction and average time interval to take effect were compared at the end of treatment.Result:The total effective rate(100%)in cleaning up combined with medication group's was significantly better than that in pure cleaning up group's(81.81%)(P<0.05);The average time interval to take effect in cleaning up combined with medication groupwas significantly shorter than that in pure cleaning up group's[(2.71±0.70)d vs(5.40±1.96)d,P<0.05].After the two-week treatment,there was a four-week follow-up.Only one patient in pure cleaning up group relapsed.After two-week treatment by Clotrimazole Ointment,this patient was cured.Conclusion:Cleaning up the external auditory canal under otoendoscope combined with Clotrimazole Ointment is effective and safe for the treatment of otitis externa mycotica in pregnant women.The addition of topical application of Clotrimazole Ointment further improve the therapeutic efficacy,as compared to the conventional method of cleaning up the external auditory canal under otoendoscope.We suggest clinical application of this method.

Effectiveness of CenteringPregnancy on Breastfeeding Initiation Among African Americans: A Systematic Review and Meta-analysis.

While breastfeeding initiation rates for African American mothers are low, an innovative model of group prenatal care, CenteringPregnancy, holds promise to increase breastfeeding rates. The aim of this systematic review and meta-analysis was to examine the effects of CenteringPregnancy versus individual prenatal care on breastfeeding initiation among African American mothers. Using a systematic approach and PRISMA guidelines, 4 electronic databases were used to search the literature. English-language studies, comparing CenteringPregnancy and individual prenatal care, including African American participants, and specifying breastfeeding initiation as an outcome were screened for inclusion. Study strength and quality were assessed and 7 studies were systematically reviewed and meta-analyzed. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 53% (95% confidence interval = 29%-81%) (n = 8047). A subgroup analysis of breastfeeding initiation among only African American participants was performed on 4 studies where data were available. Participation in CenteringPregnancy increased the probability of breastfeeding initiation by 71% (95% confidence interval = 27%-131%) (n = 1458) for African American participants. CenteringPregnancy is an effective intervention to increase breastfeeding initiation for participants, especially for African Americans. To close the racial gap in breastfeeding initiation, high-quality research providing specific outcomes for African American participants in CenteringPregnancy are needed.

"Rare place where I feel normal": Perceptions of a social support conference among parents of and people with Moebius syndrome.

BACKGROUND: Moebius syndrome is a rare congenital disorder resulting in impaired facial and eye movement. People with rare diseases like Moebius syndrome experience stigma and a lack of specialized information. Support conferences may provide important forms of social support for people with rare disorders. AIMS: To examine reasons for attending, benefits, and limitations of support conferences. METHODS AND PROCEDURES: 50 adults with Moebius syndrome and 57 parents of people with Moebius syndrome completed open-ended items in an online study. OUTCOMES AND RESULTS: Mixed- methods content analysis revealed that companionship and informational support were most frequently mentioned as reasons for and benefits of attending. Finances were the most frequently mentioned reason for not attending. Parents were more likely than people with Moebius to describe instrumental support as a conference benefit. When describing conference limitations, parents were significantly more concerned by lack of information relevance, while people with Moebius noted more often that conference attributes were not relevant to their age. CONCLUSIONS AND IMPLICATIONS: Being surrounded by others who share one's condition offers a unique opportunity for destigmatizing companionship support, which normalizes, reduces isolation, and promotes solidarity. Ways to increase facilitators and decrease barriers to accessing support for rare disorders should be investigated.

Intimidade e Vinculo nas práticas de cuidado na ESF: enlace entre o binômio mãe-filho mediante a estratégia de abordagem grupal desenvolvida na Residência Multiprofissional em Saúde / Intimacy and Relationship in the care practices at the FHS: connection between mother and child through the strategy of group approach developed in the Multiprofessional Health Residency / Intimidad y Vínculo en las prácticas de cuidado en la ESF: Enlace del binomio madre-hijo mediante una estrategia de ampliación desarrollada en la Residencia Multiprofesional en Salud

Objetiva-se conhecer o universo vocabular de necessidades, a partir da leitura do mundo de um grupo de gestantes, com base nos Círculos de Cultura de Paulo Freire, no cotidiano dos profissionais de uma residência multiprofissional em saúde. Trata-se de uma pesquisa exploratória com abordagem qualitativa, realizada no interior do Ceará. Os resultados mostram a residência multiprofissional como instituidora de espaços coletivos, uma vez que possibilita encontros entre sujeitos que desenvolvem suas ações fundamentadas em uma formação pedagógica e pautadas na utilização de tecnologias educativas como os Círculos de Cultura. Conclui-se que os integrantes da residência têm a possibilidade de pensar outros modos de produzir saúde, incentivando a busca pelas transformações das práticas profissionais para produzir novas ações em saúde.

Our goal is to discover the vocabulary universe of the necessities of a group of pregnant women, through their lecture of the world, based on Paulo Freire's Culture Circles, in the daily life of the professionals of a multiprofessional health residency. It is an exploratory research with a qualitative approach, carried out in the interior of Ceará, Brazil. The results show that the multiprofessional residency facilitates the creation of collective spaces, since it allows encounters among subjects who develop their actions based on a pedagogical formation and on the use of educational technologies such as the Circles of Culture. It is concluded that the members of the residency have the possibility to think about other ways of producing health, encouraging the search for the transformations of professional practices to produce new actions in health.

Nuestro objetivo es conocer el universo del vocabulario de necesidades a partir de la lectura de mundo de un grupo de gestantes, con base en los Círculos de Cultura de Paulo Freire, en el cotidiano de los profesionales de una residencia multiprofesional en salud. Se trata de una investigación exploratoria con abordaje cualitativo, realizada en el interior de Ceará, Brasil. Los resultados muestran la residencia multiprofesional como instituidora de espacios colectivos, una vez que posibilita encuentros entre sujetos que desarrollan sus acciones fundamentadas en una formación pedagógica y pautadas en la utilización de tecnologías educativas como los Círculos de Cultura. Se concluye que los integrantes de la residencia tienen la posibilidad de pensar otros modos de producir salud, incentivando la búsqueda por las transformaciones de las prácticas profesionales para producir nuevas acciones en salud.