The Evolution of Parental Leave Policies During Surgical Training in the US.

This article discusses the ACGME requirement that sponsoring institutions of postgraduate medical training provide trainees with at least 6 weeks of paid parental leave throughout their training period.

Hospital policy of tranexamic acid to reduce transfusion in major non-cardiac surgery (TRACTION): protocol for a phase IV randomised controlled trial.

INTRODUCTION: Tranexamic acid (TXA) is an inexpensive and widely available medication that reduces blood loss and red blood cell (RBC) transfusion in cardiac and orthopaedic surgeries. While the use of TXA in these surgeries is routine, its efficacy and safety in other surgeries, including oncologic surgeries, with comparable rates of transfusion are uncertain. Our primary objective is to evaluate whether a hospital-level policy implementation of routine TXA use in patients undergoing major non-cardiac surgery reduces RBC transfusion without increasing thrombotic risk. METHODS AND ANALYSIS: A pragmatic, registry-based, blinded, cluster-crossover randomised controlled trial at 10 Canadian sites, enrolling patients undergoing non-cardiac surgeries at high risk for RBC transfusion. Sites are randomised in 4-week intervals to a hospital policy of intraoperative TXA or matching placebo. TXA is administered as 1 g at skin incision, followed by an additional 1 g prior to skin closure. Coprimary outcomes are (1) effectiveness, evaluated as the proportion of patients transfused RBCs during hospital admission and (2) safety, evaluated as the proportion of patients diagnosed with venous thromboembolism within 90 days. Secondary outcomes include: (1) transfusion: number of RBC units transfused (both at a hospital and patient level); (2) safety: in-hospital diagnoses of myocardial infarction, stroke, deep vein thrombosis or pulmonary embolism; (3) clinical: hospital length of stay, intensive care unit admission, hospital survival, 90-day survival and the number of days alive and out of hospital to day 30; and (4) compliance: the proportion of enrolled patients who receive a minimum of one dose of the study intervention. ETHICS AND DISSEMINATION: Institutional research ethics board approval has been obtained at all sites. At the completion of the trial, a plain language summary of the results will be posted on the trial website and distributed in the lay press. Our trial results will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: NCT04803747.

Initial leadership concerns and availability of tobacco cessation services moderate changes in employee-reported concerns about tobacco-free workplace policy implementation over time.

Tobacco-free workplace policies (TFWPs) are underused evidence-based interventions that reduce the elevated use of tobacco among substance use treatment center (SUTC) employees and patients. SUTC employees' anticipated concerns about stakeholder pushback are barriers to TFWP adoption. Examination of discrepancies between anticipated and actualized employee-reported TFWP concerns arising from coworkers, patients, and community members in the context of leadership concerns and tobacco cessation care availability for employees may inform strategies to increase TFWP uptake. This study analyzed changes in employee-reported TFWP concerns from before to after a comprehensive tobacco-free workplace intervention that included TFWP implementation, using Chi-square/Fisher's exact tests. Preimplementation leadership policy concerns and tobacco cessation care availability were examined as moderators in generalized linear mixed models. Overall, 452 employees and 13 leaders provided data from 13 SUTCs collectively serving >82 000 patients annually. Results revealed significant decreases over time in employee-reported concerns about TFWP resistance from coworkers. Moderation analyses indicated that employee-anticipated concerns from coworkers and patients, respectively, were less likely to be actualized in SUTCs where leadership endorsed preimplementation TFWP concerns, whereas employee-reported patient concerns rose over time in SUTCs where leadership had no initial implementation concerns. Additionally, employee-anticipated concerns from coworkers were overestimated in SUTCs that did not offer tobacco cessation care to employees. Results supporting the nonactualization of anticipated employee concerns following TFWP implementation can be used to engage other SUTCs for TFWP adoption. Furthermore, moderation effects may suggest that center characteristics translate to greater attention to rollout, ultimately enhancing TFWP stakeholder acceptance.

Substance use treatment center (SUTC) employees and patients use tobacco at elevated rates and suffer disproportionately from tobacco-related diseases. The implementation of a tobacco-free workplace policy (TFWP) can reduce tobacco use disparities in this setting. However, employee concerns about TFWPs are often a deterrent to their adoption. This study assessed how employee-reported concerns changed over time and whether these changes differed based on center characteristics like center leadership concerns about the TFWP and availability of tobacco cessation services for employees. Overall, the most common employee-reported concerns were those arising from patients, followed by coworkers and community members throughout policy implementation. Results demonstrated that anticipated concerns from coworkers decreased over time in all SUTCs. Furthermore, TFWP concerns from coworkers and patients were overestimated by employees at centers wherein leadership had concerns about TFWP implementation, whereas patient concerns were underestimated at centers where leadership had no preimplementation concerns. Finally, employee-anticipated concerns from coworkers were overestimated in SUTCs without tobacco cessation care for employees. Findings suggest that employees may overestimate concerns/complaints from various stakeholders based on organizational factors. This information may be used to engage additional SUTCs in TFWP implementation by alleviating employee concerns about policy adoption.

Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires that all graduate medical education (GME) programs provide at least 6 paid weeks off for medical, parental, and caregiver leave to residents. However, it is unclear whether all orthopaedic residency programs have adapted to making specific parental leave policies web-accessible since the ACGME's mandate in 2022. This gap in policy knowledge leaves both prospective and current residents in the dark when it comes to choosing residency programs, and knowing what leave benefits they are entitled to when having children during training via birth, surrogacy, adoption, or legal guardianship. QUESTIONS/PURPOSES: (1) What percentage of ACGME-accredited orthopaedic surgery residency programs provide accessible parental leave policies on their program's website, their GME website, and through direct contact with their program's administration? (2) What percentage of programs offer specific parental leave policies, generic leave policies, or defer to the Family and Medical Leave Act (FMLA)? METHODS: As indicated in the American Medical Association's 2022 Freida Specialty Guide, 207 ACGME-accredited orthopaedic residency programs were listed. After further evaluation using previous literature's exclusion criteria, 37 programs were excluded based on osteopathic graduate rates. In all, 170 ACGME-accredited allopathic orthopaedic surgery residency programs were identified and included in this study. Three independent reviewers assessed each program website for the presence of an accessible parental leave policy. Each reviewer accessed the program's public webpage initially, and if no parental leave policy was available, they searched the institution's GME webpage. If no policy was found online, the program administrator was contacted directly via email and phone. Available leave policies were further classified into five categories by reviewers: parental leave, generic leave, deferred to FMLA, combination of parental and FMLA, and combination of parental and generic leave. RESULTS: Our results demonstrated that 6% (10 of 170) of orthopaedic residency programs had policy information available on their program's main orthopaedic web page. Fifty nine-percent (101 of 170) of orthopaedic residency programs had a clearly stated policy on their institution's GME website. The remaining 35% (59 of 170) had no information on their public website and required direct communication with program administration to obtain policy information. After directly contacting program administration, 12% (21 of 170) of programs responded to researchers request with a PDF explicitly outlining their policy. Twenty-two percent (38 of 170) of programs did not have an accessible policy available. Of the programs that had available policies, a total of 53% (70 of 132) of programs were categorized as offering explicit parental leave policies, 9% (12 of 132) were categorized as offering general leave policies, and 27% (36 of 132) deferred to FMLA. Seven percent (9 of 132) offered combined parental leave policies with FMLA, and 4% (5 of 132) offered combined general leave policies with FMLA. CONCLUSION: Although most ACGME-accredited allopathic orthopaedic surgery residency programs met the ACGME requirement of written parental leave policies in 2023, a small minority of programs have clear, accessible parental leave policies provided on their webpage. CLINICAL RELEVANCE: Parental leave policies should be easily accessible to prospective and current trainees and should clearly state compensation and length of leave. Ensuring orthopaedic surgery residency programs provide accessible and transparent parental leave policies is important for maintaining diversity in prospective applicants and supporting the work-life balance of current residents.

Transforming Perceptions: The Impact of a Formal Parental Leave Policy on Surgical Trainees.

OBJECTIVE: Surgical trainees who welcome a new child during residency often face challenges related to appropriate parental leave. To address this, we instituted a comprehensive family medical leave policy within our training program and assessed resident perceptions before and after the policy's introduction. We hypothesized that this new formal policy would enhance feelings of support amongst all (not just childbearing) trainees. DESIGN: A web-based survey to gauge resident perceptions on parental leave was distributed to all residents at a single academic general surgery residency at 2 intervals: prior to policy implementation and 1 year after policy implementation. SETTING: The study was conducted at a single institution, academic general surgery residency program. PARTICIPANTS: All general surgery residents at the institution were included (n = 95). RESULTS: About 40 out of 95 (42%) residents participated in the initial survey and 25 of 95 (26%) completed the subsequent survey. There was a significant improvement in resident reported satisfaction with the policy from pre to post: 15% pre to 68% post, p < 0.001, report the policy frequently supported trainees' needs, 20% pre to 88% post, p < 0.001, perceived the policy as fair. Most residents (90.0% pre and 80.0% post) perceived pregnancy as a risk during surgical training. There were no differences in perception of the new policy between residents who were parents and residents who were not parents. CONCLUSIONS: The introduction of a comprehensive family medical leave policy improved all surgical trainees' (including nonparents) perception of policy effectiveness and policy fairness. This is counter to the published perception that parental leave creates a burden on fellow trainees. However, pregnancy remains a stressor for the individual new parent. Surgical programs can develop supportive formal family medical leave policies; it is important to address the inherent systemic and cultural barriers surrounding childrearing during surgical training.

What are the effects of smoke-free and tobacco-free university campus policies, and how can they be assessed? A systematic review.

OBJECTIVE: This article looks at the evaluation of smoke-free (SF) and tobacco-free (TF) university campus policies that ban smoking (and often vaping) both indoors and outdoors. To assess the effectiveness of these policies, we performed a systematic literature review to answer the following questions: what is the effect of SF/TF policies on campus users' behaviors/norms/perceptions around smoking? Are the SF/TF policies an effective measure for reducing smoking among young adults? What methods and indicators can we use to assess the impact of SF/TF campus policies? What is the theoretical model underpinning the influence of SF/TF policies on the behavior of campus users? METHODS: Three databases (PubMed, Scopus, and Web of Science) were searched over the period from January 2005 to December 2022. The article selection process included 54 articles published in scientific journals that analyzed the post-implementation impact of SF/TF campus policies. The quality of these articles was analyzed using six ad hoc indicators based on the Critical Appraisal Skills Program checklist and Joanna Briggs Institute scoping tools. RESULTS: Most of the research on SF/TF campus policies has been conducted in the United States using quantitative methodologies. Most of these studies show that SF/TF policies reduce positive beliefs about smoking and its acceptability, influence smoking behavior (reducing smoking initiation and increasing the number of quits and quit attempts), and reduce exposure to passive smoking and pollution from cigarette butts. User acceptability of SF/TF policies is generally high. Limitations of SF/TF campus policies include difficulty for smokers to comply with them, persistence of passive smoking around campuses, and limited uptake of on-campus cessation support services provided to smokers. DISCUSSION: The various mediating and moderating variables identified in the literature have made it possible to propose a model of the potential influence of SF/TF policy on campus users, based on the theory of planned behavior. Based on this review, we provide health professionals and higher education institutions wishing to implement a SF/TF campus policy with a set of indicators that can serve to assess the impact of a SF/TF campus policy (attitudes, acceptability, beliefs, norms, exposure to passive smoking and pollution, changes in smoking behavior). CONCLUSION: Based on scientific evidence, the implementation of SF/TF campus policies in France is an important measure to help combat smoking in young adults.

Implementation of state health insurance benefit mandates for cancer-related fertility preservation: following policy through a complex system.

BACKGROUND: A myriad of federal, state, and organizational policies are designed to improve access to evidence-based healthcare, but the impact of these policies likely varies due to contextual determinants of, reinterpretations of, and poor compliance with policy requirements throughout implementation. Strategies enhancing implementation and compliance with policy intent can improve population health. Critically assessing the multi-level environments where health policies and their related health services are implemented is essential to designing effective policy-level implementation strategies. California passed a 2019 health insurance benefit mandate requiring coverage of fertility preservation services for individuals at risk of infertility due to medical treatments, in order to improve access to services that are otherwise cost prohibitive. Our objective was to document and understand the multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to fertility preservation services. METHODS: We conducted a mixed-methods study and used the policy-optimized exploration, preparation, implementation, and sustainment (EPIS) framework to analyze the implementation of California's fertility preservation benefit mandate (SB 600) at and between the state insurance regulator, insurer, and clinic levels. RESULTS: Seventeen publicly available fertility preservation benefit mandate-relevant documents were reviewed. Interviews were conducted with four insurers; 25 financial, administrative, and provider participants from 16 oncology and fertility clinics; three fertility pharmaceutical representatives; and two patient advocates. The mandate and insurance regulator guidance represented two "Big P" (system level) policies that gave rise to a host of "little p" (organizational) policies by and between the regulator, insurers, clinics, and patients. Many little p policies were bridging factors to support implementation across levels and fertility preservation service access. Characterizing the mandate's functions (i.e., policy goals) and forms (i.e., ways that policies were enacted) led to identification of (1) intended and unintended implementation, service, and patient outcomes, (2) implementation processes by level and EPIS phase, (3) actor-delineated key processes and heterogeneity among them, and (4) inner and outer context determinants that drove adaptations. CONCLUSIONS: Following the midstream and downstream implementation of a state health insurance benefit mandate, data generated will enable development of policy-level implementation strategies, evaluation of determinants and important outcomes of effective implementation, and design of future mandates to improve fit and fidelity.

Parental leave policies in general surgery residencies.

BACKGROUND: Prospective residents use program websites to glean information regarding parental leave policies. This study investigates the online availability and content of parental leave policies for general surgery residency programs. METHODS: Parental leave policy information was collected from general surgery residency program and Graduate Medical Education (GME) websites. Descriptive statistics and multivariable logistic regression were used for analysis. RESULTS: Of the 344 general surgery residency programs, parental leave policies were found on 6% of program and 52% of GME websites. Family Medical Leave Act policies were reported the most, followed by maternity, then paternity, and then adoption/other clauses. Academic programs, program location in the Southeastern US and larger program size were all significant predictors of online policy availability. CONCLUSIONS: General surgery parental leave policies vary and are not readily available online. These findings identify a significant opportunity for surgery residency programs to improve the disclosure of parental leave policy information.

Trajetória e participação política da enfermagem em Santa Catarina no período 1972-2018 / Trajectory and political participation of nursing in Santa Catarina in the period 1972-2018 / Trayectoria y participación política de la enfermería em Santa Catarina em el período 1972-2018

Objetivo: conhecer a participação política dos profissionais da enfermagem enquanto reflexo de suas entidades representativas. Métodos: pesquisa qualitativa de abordagem histórico-social. Dentro do recorte histórico de 1972 a 2018, entre março e setembro de 2019, entrevistaram-se 5 ex-presidentes das Associação Brasileira de Enfermagem - Seção Santa Catarina e do Conselho Regional de Enfermagem de Santa Catarina. A compreensão dos dados se deu por meio da análise de conteúdo de Bardin e interpretação através do marco conceitual de Denise Elvira Pires de Pires. Resultados: percebe-se uma significativa mudança de quadro da participação política da enfermagem através das décadas. Desde a criação da ABEn-SC a enfermagem transita de um corpo forte e unido para uma trajetória e participação em subsequente desarticulação. Conclusão: A desmobilização de uma categoria é multifatorial. Reflexo da desarticulação das entidades representativas da profissão, raízes histórico-culturais de sua fundação e do imaginário individual e social de uma profissão. (AU)

Objective: To Know the political participation of nursing professionals as a reflection of their representative entities. Methods: qualitative research of a historical-social nature in the history of 1975 to 2018, between March and September 2019. Interviewed 5 former presidents of the Brazilian Nursing Association - Santa Catarina Section and the Regional Nursing Council of Santa Catarina. The understanding of the data took place through the analysis of Bardin's content and interpretation through the conceptual framework of Denise Elvira Pires de Pires, profession, discipline and work. Results: there is a significant change in the framework of political participation in nursing over the decades. With a fragile articulation between the entities representing the category. Conclusion: The demobilization of the professional category is multifactorial. Reflection of the disarticulation of the entities representing the profession, the historical and cultural roots of its foundation and the individual and social imagery of the profession. (AU)

Objetivo: conocer la participación política de los profesionales de enfermería como reflejo de sus entidades representativas. Métodos: investigación cualitativa de carácter histórico-social en la historia de 1975 a 2018, entre marzo y septiembre de 2019. Se entrevistó a 5 ex presidentes de la Asociación Brasileña de Enfermería - Sección Santa Catarina y el Consejo Regional de Enfermería de Santa Catarina. La comprensión de los datos se llevó a cabo a través del análisis del contenido y la interpretación de Bardin a través del marco conceptual de Denise Elvira Pires de Pires, profesión, disciplina y trabajo. Resultados: hay un cambio significativo en el marco de participación política en enfermería a lo largo de las décadas. Con una articulación frágil entre las entidades que representan la categoría. Conclusión: La desmovilización de la categoría profesional es multifactorial. Reflejo de la desarticulación de los entes representativos de la profesión, las raíces históricas y culturales de su fundación y el imaginario individual y social de la profesión. (AU)

Imaging Care for Transgender and Gender Diverse Patients: Best Practices and Recommendations.

Transgender and gender diverse (TGD) people experience health disparities, and many avoid necessary medical care because of fears of discrimination or mistreatment. Disparate care is further compounded by limited understanding of gender-affirming hormone therapy (GAHT) and gender-affirming surgery among the medical community. Specific to radiology, TGD patients report more negative imaging experiences than negative general health encounters, highlighting the need for guidance and best practices for inclusive imaging care. A patient's imaging journey provides numerous opportunities for improvement. Inclusive practice in a radiology department starts with ordering and scheduling the examination, facilitated by staff education on appropriate use of a patient's chosen name, gender identity, and pronouns. Contemporary electronic health record systems have the capacity for recording detailed sexual orientation and gender identity data, but staff must be trained to solicit and use this information. A welcoming environment can help TGD patients to feel safe during the imaging experience and may include institutional nondiscrimination policies, gender-neutral signage, and all-gender single-user dressing rooms and bathrooms. Image acquisition should be performed using trauma-informed and patient-centered care. Finally, radiologists should be aware of reporting considerations for TGD patients, such as avoiding the use of gender in reports when it is not medically relevant and using precise, respectful language for findings related to GAHT and gender-affirming surgical procedures. As a field, radiology has a range of opportunities for improving care delivery for TGD patients, and the authors summarize recommended best practices. See the invited commentary by Stowell in this issue. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.

Disparities in the use of screening breast magnetic resonance imaging persist in Louisiana after the Affordable Care Act: A question of access, policy, institutional support, or something else?

BACKGROUND: Louisiana continues to have one of the highest breast cancer mortality rates in the nation, and Black women are disproportionally affected. Louisiana has made advances in improving access to breast cancer screening through the expansion of Medicaid. There remains, however, broad underuse of advanced imaging technology such as screening breast magnetic resonance imaging (MRI), particularly for Black women. METHODS: Breast MRI has been proven to be very sensitive for the early detection of breast cancer in women at high risk. MRI is more sensitive than mammography for aggressive, invasive breast cancer types, which disproportionally affect Black women. Here the authors identify potential barriers to breast MRI screening in Black women, propose strategies to address disparities in access, and advocate for specific recommendations for change. RESULTS: Cost was identified as one of the greatest barriers to screening breast MRI. The authors propose implementation of cost-saving, abbreviated protocols to address cost along with lobbying for further expansion of the Affordable Care Act (ACA) to include coverage for screening breast MRI. In addition, addressing gaps in communication and knowledge and facilitating providers' ability to readily identify women who might benefit from MRI could be particularly impactful for high-risk Black women in Louisiana communities. CONCLUSIONS: Since the adoption of the ACA in Louisiana, Black women have continued to have disproportionally high breast cancer mortality rates. This persistent disparity provides evidence that additional change is needed. This change should include exploring innovative ways to make advanced imaging technology such as breast MRI more accessible and expanding research to specifically address community and culturally specific barriers.

Uma história em construção: Manguinhos-Maré no tempo presente / A history under construction: Manguinhos-Maré in the present time

Resumo As duas primeiras décadas do século XXI foram representativas para a história contemporânea da Fundação Oswaldo Cruz e demonstraram seu protagonismo no cenário nacional da saúde. O artigo apresenta transformações espaciais ocorridas no território ocupado pela instituição a partir de 2000. Relacionam-se as transformações no uso dos territórios com sua política institucional no contexto nacional e são ressaltadas as demandas sociais que impactaram a instituição - transformações urbanas de grande porte e pandemias. O trabalho averigua, sob os pressupostos da história do tempo presente, as mudanças ocorridas no campus Manguinhos-Maré e no discurso de sujeitos institucionais gestores e projetistas. Para isso, conjuga análise dos relatórios institucionais, da base digital cartográfica e de imagens aéreas.

Abstract The two first decades of the twenty-first century were representative of the contemporary history of the Oswaldo Cruz Foundation (Fundação Oswaldo Cruz) and demonstrated its active role in the national health scenario. This article discusses the spatial transformations that took place in the territory occupied by the foundation from the year 2000 onward. The transformations in the use of this territory and it's institutional policy within the national context are described, along with the social demands that have impacted the institution, namely large-scale urban transformations and pandemics. This research uses the premises of the history of the present to investigate the changes that took place on the Manguinhos-Maré campus and in the discourse of the institutions involved in managing and planning these changes through analysis of institutional reports, digital mapping, and aerial images.

Adaptação acadêmica em universitários / Academic adaptation in university students / Adaptación académica en estudiantes universitários

O objetivo do estudo foi investigar o impacto das variáveis habilidades sociais, resolução de problemas sociais, automonitoria, autoeficácia e coping na adaptação acadêmica em estudantes de instituições de ensino superior públicas e privadas. Participaram 637 estudantes de ambos os sexos, sendo 36,5% (115) homens de instituições públicas e 22,3% (72) de instituições privadas, com idade variando entre 18 e 38 anos (M=24,7; DP=6,3), de diferentes graduações. Foram utilizados o Inventário de Resolução de Problemas Sociais, o Inventário de Habilidades Sociais, a Escala de Automonitoria, a Escala de Autoeficácia Acadêmica de Estudantes do Ensino Superior, o Inventário de Estratégias de Coping e o Questionário de Vivências Acadêmicas-reduzido. A autoeficácia na gestão acadêmica (40,9%) e a autoafirmação na expressão de afeto positivo (13,7%) apresentaram maior impacto para os estudantes de instituições públicas e privadas, podendo contribuir com possíveis intervenções no processo de adaptação ao ensino superior. Pesquisas prospectivas podem investigar questões relacionadas a dados sociodemográficos.(AU)

The aim of the study was to investigate the impact of the variables Social Skills, Resolution of Social Problems, Self-monitoring, Self-efficacy and Coping on Academic Adaptation in students from public and private higher education institutions. 637 students of both sexes participated, being 36.5% (115) men from public institutions and 22.3% (72) from private institutions, aged between 18 to 38 years (M = 24.7; SD = 6.3), of different grades. The Social Problem Solving Inventory, the Social Skills Inventory, the Self-Monitring Scale, the Higher Education Students' Academic Self-Efficacy Scale, the Coping Strategies Inventory and the Academic Experiences-Reduced Questionnaire were used. Self-efficacy in Academic Management (40.9%) and Self-affirmation in the Expression of Positive Affection (13.7%) had a greater impact on students from public and private institutions, which may contribute to possible interventions in the process of adapting to Higher Education. Prospective research can investigate issues related to sociodemographic data.(AU)

El objetivo del estudio fue investigar el impacto de las variables Habilidades sociales, Resolución de problemas sociales, Autocontrol, Autoeficacia y Afrontamiento en la adaptación académica en estudiantes de instituciones de educación superior públicas y privadas. Participaron 637 estudiantes de ambos sexos, siendo 36,5% (115) hombres de instituciones públicas y 22,3% (72) de instituciones privadas, con edades entre 18 y 38 años (M = 24,7; SD = 6,3), de diferentes grados. Se utilizaron el Inventario de Resolución de Problemas Sociales, el Inventario de Habilidades Sociales, la Escala de Autocontrol, la Escala de Autoeficacia Académica de los Estudiantes de Educación Superior, el Inventario de Estrategias de Afrontamiento y el Cuestionario de Experiencias Académicas Reducidas. La Autoeficacia en la Gestión Académica (40,9%) y la Autoafirmación en la Expresión de Afecto Positivo (13,7%) tuvieron un mayor impacto en los estudiantes de instituciones públicas y privadas, lo que puede contribuir a posibles intervenciones en el proceso de adaptación a la Educación Superior. La investigación prospectiva puede investigar cuestiones relacionadas con los datos sociodemográficos.(AU)

The impact of approaching grief on the neonatal team: professional experience report.

This case report describes the holistic performance of the multidisciplinary team in a context of approaching the moment of death of a newborn, in a cross-cultural approach, and its impact on the working group. We report the clinical case of a neonate diagnosed as severe congenital heart disease, who evolved with early surgical intervention and died on the second day of life. Considering the neonatal intensive care unit an area requiring performance of a specialized team that addresses, with a high level of complexity, in a broad way, the patient, and his family, the death of a child breaks the logic of the life cycle. The multiprofessional and family management of the newborn in question illustrates the opportunities that are still being improved in the care of mourning in the neonatal period. Demonstrating that the care process does not end at the time of death, and the period of mourning is still a challenge for the neonatal team. Even so, parents can be welcomed, with care provided in a private and secure manner, with their needs, and preserved individuality. We observe the need for professional qualification and support for mourning and the need for specific institutional policies, since the health organizations must be attentive and take care of those who care, be cared for with a different look at their emotions.

"You still have that fear": Policy constraints on informed decision making about legalized cannabis use during pregnancy and lactation.

BACKGROUND: Cannabis is the most commonly used drug during pregnancy, excluding alcohol and tobacco, in the United States. Cannabis consumption during pregnancy is increasing along with greater legal and social acceptance. METHODS: We conducted a qualitative content analysis of 23 in-depth interviews with pregnant and lactating people in Massachusetts, a state that legalized cannabis for adult use in 2016. Our aim was to explore how policy constrains or facilitates people's ability to make informed decisions about cannabis use during pregnancy and lactation. Our analysis was conducted using an ecosocial approach, recognizing that the implementation and interpretation of cannabis policy can be understood at multiple levels, which interact with each other and shape the health and experiences of individuals. Additionally, this analysis was informed by a harm reduction approach in which we acknowledge the complexity surrounding cannabis use during pregnancy and lactation, while attempting to identify ways to reduce potentially harmful consequences. RESULTS: Findings revealed that, despite the legal status of cannabis, there continues to be a lack of clarity for pregnant and lactating people regarding the legal implications of cannabis use. Inconsistent state and institutional policies about drug testing of mothers and newborns leave a cloud of fear hanging over the experiences of people who use cannabis and inhibit their ability to obtain expert advice from healthcare providers. CONCLUSION: Decision makers in public and institutional policy should work to clarify and update policies regarding substance use during pregnancy following legalization of a new substance, and ensure that pregnant and lactating people are afforded the same legal protections as the general population.

Políticas culturais de Lazer e Esporte nas universidades de Minas Gerais: os casos da CEL/UFLA, CEU/UFMG, DIESU/UFU e DLZ/UFV / Leisure and Sport cultural policies at the federal universities of Minas Gerais: the case of CEL/UFLA, CEU/UFMG, DIESU/UFU and DLZ/UFV / Políticas culturales de Ocio y Deporte en las universidades federales de Minas Gerais: los casos de CEL/UFLA, CEU/UFMG, DIESU/UFU y DLZ/UF

O objetivo do estudo foi compreender em que medida a existência da Coordenadoria de Esporte e Lazer (CEL) da UFLA, do Centro Esportivo Universitário (CEU) da UFMG e da Divisão de Esporte e Lazer Universitário (DIESU) da UFU pode contribuir para o desenvolvimento sistemático de políticas de lazer e esporte nas universidades mineiras. Foi utilizada uma pesquisa documental de caráter exploratório descritivo dos Regimentos, Resoluções e Regulamentos Internos, desenvolvida à luz da proposta teóricometodológica do Ciclo Político. Destaca-se que estes órgãos apresentaram definições de orientações normativas de alcance, de conteúdo, dos programas, assim como estruturas organizacionais próprias, configurando a existência de uma política institucional destinada ao lazer e ao esporte (AU).

The aim of the study was to understand in what way the existence of the Coordination of Sport and Leisure (CEL) at UFLA, the University Sports Center (CEU) at UFMG and the Division of University Sport and Leisure (DIESU) at UFU can contribute to development systematic of leisure and sport policies in Minas Gerais universities. A documentary research of descriptive exploratory character of the Internal Regiments, Resolutions and Regulations was used and developed in the light of the theoretical methodological proposal of the Police Cycle. It is noteworthy that these bodies presented definitions of normative guidelines, scope, content, programs, as well as their own organizational structures configuring the existence of an institutional policy aimed at leisure and sport

El objetivo del estudio fue comprender si la existencia de la Coordinación de Deporte y Ocio (CEL/UFLA), el Centro Deportivo Universitario (CEU/UFMG) y la División de Deporte y Ocio Universitario (DIESU/UFU) pueden contribuir al desarrollo sistemático de políticas de ocio y deporte en las universidades de Minas Gerais. Se utilizó una investigación documental de carácter descriptivo exploratorio del Regimientos, Resoluciones y Reglamentos Internos, desarrollado a la luz de la propuesta teórica metodológica del Ciclo Político. Es de destacar que estos órganos presentaron definiciones de lineamientos normativos, alcances, contenidos, programas, así como sus propias estructuras organizativas configurando la existencia de una política institucional orientada al ocio y al deporte

Perspectives of General Surgery Program Directors on Paternity Leave During Surgical Training.

Importance: Although men are increasingly involved in childrearing, little is known about paternity leave in surgical residency. Conflict between professional and family duties contribute to burnout and decreased career satisfaction for surgeons of both sexes. With men more likely than women to have children during their clinical years of surgical training, understanding the issues surrounding paternity leave is imperative to ensuring the longevity of our workforce. Objective: To explore surgical program directors' perspectives on the challenges of providing paternity leave. Design, Setting, and Participants: This qualitative descriptive study of transcripts collected from semistructured interviews of US surgical program directors was performed from October 2018 to June 2019. Program directors were selected using purposive-stratified criterion-based sampling. Interviews were audio-recorded and transcribed verbatim, with emergent themes identified using content analysis. Exposure: Paternity leave. Main Outcomes and Measures: Program directors' perspectives on paternity leave were categorized into common themes. Results: A total of 40 US general surgery program directors were interviewed (28 male [70%]; mean [SD] age, 49.7 [6.8] years; 36 [90%] were university-based programs). Twenty (50%) reported providing paternity leave of 1-week duration. Five major themes were identified: (1) paternity leave policies are poorly defined by many programs and require self-initiation by residents; (2) residents often do not take the full amount of time offered for leave; (3) stigma against male residents taking parental leave is common and may be even greater than that facing women taking maternity leave; (4) paternity leave has little to no impact on colleagues' workload owing to the brevity of time taken; and (5) men desire longer leave than what they are currently offered and wish to receive equal time off compared with childbearing parents. Conclusions and Relevance: Surgical program directors report male residents take brief paternity leave despite a desire for more time off, which may be influenced by fear of stigma and surgical culture that avoids handing off work, even for short periods of time. A cultural shift toward supporting family planning as a normal part of young adult life, rather than a medical condition to be accommodated, is necessary to promote life balance and behaviors that will sustain a long career in surgery. Implementation of defined leave policies at individual programs for the nonchildbearing parent is critical to make parental leave socially acceptable among surgical residents.