RESUMO
OBJECTIVE:: To examine the association between tobacco-related risk factors and smoking among third-year dental students in Latin American countries. MATERIALS AND METHODS:: Logistic regression models were used to analyze Global Health Professions Student Survey (GHPSS) data. RESULTS:: Of 5 605 respondents, 33% smoked and 45% had been exposed to secondhand smoke during the previous month, 34% smoked in school buildings during the past year, and 85% had never received formal training in smoking cessation. Smoking was significantly associated with male sex; Bolivian, Chilean, or Mexican nationality; exposure to secondhand smoke; lacking self-perception of being a "role model" for patients; and not believing that health professionals who smoke are less likely to advise patients to quit smoking. CONCLUSIONS:: All dental schools should encourage tobacco-free policies and offer cessation services. Cessation training must be incorporated into dental curricula to include dental professionals in the battle against the tobacco epidemic.
Assuntos
Atitude Frente a Saúde , Fumar/epidemiologia , Estudantes de Odontologia/psicologia , Adolescente , Adulto , Estudos Transversais , Humanos , América Latina/epidemiologia , Prevalência , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: Dental caries is one of the most prevalent chronic diseases in children. Currently, no data are available on dental caries prevalence in the Dominican Republic. The purpose of this study was to estimate the prevalence of dental caries in schoolattending 12-year-olds in San Pedro de Macorís, Dominican Republic. METHODS: A cross-sectional epidemiological study using a probabilistic sample, stratified by type of school (public/private) and gender, was conducted. Two calibrated examiners conducted the evaluations of oral soft/hard tissues. Caries experience was summarized in terms of prevalence; the number of decayed, missing, and filled teeth (DMFT) and surfaces (DMFS); and the significant caries (SiC) index, in all the participants, and by gender and school type. Logistic and Poisson regression models were used to compare caries experience by sex and school type. RESULTS: Four hundred and two 12-year-olds enrolled in 14 public and 11 private schools were evaluated. The overall dental caries prevalence was 73%. The mean DMFS was 3.87, the mean DMFT was 2.64, and the SiC index was 5.07. Girls had significantly higher mean DMFS, DMFT, and SiC indices than did boys. Public school attendees had significantly higher DMFS, DMFT, and SiC indices than did those children attending private schools. The decayed (D) component accounted for 71% of the DMFT value. CONCLUSION: The WHO's goal of all 12-year-olds having a DMFT less than or equal to 3 was met by all the participants in our study. Girls and public-school attendees carry the burden of the disease. The high D component of the index suggests that there are unmet dental-caries needs. This information will assist in the design and implementation of future primary and secondary prevention programs.
Assuntos
Cárie Dentária/epidemiologia , Saúde Bucal , Criança , Estudos Transversais , Índice CPO , República Dominicana/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , Fatores SexuaisRESUMO
Abstract Objective: To estimate and compare the levels of empathy between undergraduate dentistry students and professors at a university in the Dominican Republic. Material and Methods: Cross-sectional and descriptive study. The studied population consisted of two groups. The first: students of the Dentistry Career (N=520; n=335: 64.42% of total students) were distributed in two areas, basic-preclinical and clinical, while the second group corresponded of teachers who work in both areas (N=92; n=56; 60.87% of all teachers). The total sample was n = 391. The Jefferson Scale of Physician Empathy (S-Version) was used. Reliability was estimated using Cronbach's α and intraclass correlation coefficient, descriptive statistics, two-way analysis of variance, Tukey's test, effect size, and power of the test. Significance level: α≤0.05 and β≤0.20. Results: The empathy and dimension values were, in general, higher in the professors of the clinical area in relation to the other areas studied, with the exception of the compassionate care dimension. Conclusion: The finding that clinical teachers have a greater value of empathy is potentially an advantage for training students, especially in the clinical area (AU).
Assuntos
Humanos , Masculino , Feminino , Estudantes de Odontologia , Odontologia , Empatia , Docentes de Odontologia/psicologia , Psicometria/métodos , Estudos Transversais/métodos , Análise de Variância , Análise Fatorial , República DominicanaRESUMO
Abstract Introduction: The concept of empathy has been incorporated as one of the key elements for the achievement of the teaching-learning process goals in health science students. Objective: To estimate and compare the levels of empathy among dental students and professors in the undergraduate dental medicine program at the Universidad Central del Este (Dominican Republic). Materials and methods: Cross-sectional study. The study population (n=264) was divided into two groups: the first consisted of students in their first to fifth year of dental school (N=223; n=215), distributed in two areas (basic-preclinical and clinical courses), while the second group comprised professors working in both areas in the dental school of the university (N=53; n=49). The Jefferson Scale of Empathy (S-Version) was used. The descriptive analysis of the data included the estimation of means, standard deviations and percentages, and the reliability of the data was estimated using Cronbach's alpha. In addition, a two-way ANOVA was performed, calculating the effect size and the statistical power of the test; furthermore, when the Fisher's exact test was significant for any factor, Tukey's test was used to estimate differences between means. A significance level of α<0.05 and β<0.20 was established. Results: Overall empathy scores and compassionate care dimension scores among the professor group did not differ significantly from the scores obtained by the students (basic-preclinical and clinical area), but there were differences between students from both areas (p<0.05). There were no significant differences between the three subgroups in the Perspective Taking and Walking in the Patient's Shoes dimensions (p=0.428 and p=0.866). Conclusion: The levels of empathy and compassionate care dimension of professors are similar to those of students in general (regardless of the area).
Resumen Introducción. El concepto de empatía se ha integrado como uno de los elementos centrales para el logro final del proceso de enseñanza-aprendizaje en estudiantes de ciencias de la salud. Objetivo. Estimar y comparar los niveles de empatía entre estudiantes y profesores de pregrado de odontología de la Universidad Central del Este (República Dominicana). Materiales y métodos. Estudio transversal. La población de estudio (n=264) se dividió en dos grupos: el primero, compuesto por estudiantes de primero a quinto año de la carrera de odontología (N=223; n=215) distribuidos en dos áreas (básica-preclínica y clínica), y el segundo, por los docentes de ambas áreas en la escuela de odontología de la universidad (N=53; n=49). Se utilizó la Escala de Empatía Médica de Jefferson (Versión-S). El análisis descriptivo de los datos incluyó la estimación de medias, desviaciones estándar y porcentajes, y la confiabilidad de los datos se estimó mediante CC de Cronbach; además, se realizó un ANOVA bifactorial, calculándose el tamaño del efecto y la potencia de la prueba, y en los casos en que la prueba exacta de Fisher fue significativa para algún factor, se utilizó la prueba de Tukey para estimar las diferencias entre las medias. El nivel de significancia estadística utilizado fue α<0.05 y β<0.20. Resultados. Los valores globales de empatía y de la dimensión Cuidado con compasión en los profesores no difirieron significativamente con los obtenidos por los estudiantes (área básica-preclínica y clínica), pero sí hubo diferencias entre los estudiantes de ambas áreas (p<0.05). En las dimensiones Adopción de perspectiva y Ponerse en los zapatos del otro no existieron diferencias entre los tres subgrupos (p=0.428 y p=0.866). Conclusión. Los niveles de empatía y de la dimensión Cuidado compasivo de los profesores no difieren de los de los estudiantes en general (ambas áreas).
RESUMO
INTRODUCTION: The controversy over the presence of empathic decline within the course in students of medicine, dentistry and health sciences in general, has not fully been studied. This controversy could be partially solved if massive studies of empathy levels are made in similar cultural, social and economic contexts. MATERIAL AND METHODS: Empathy levels within the course were studied in eighteen dental schools from six countries in Latin America (2013). The mean of the empathy levels were used to study the behavior between first and fifth academic years. The values of empathy levels within the course were observed by applying the Jefferson Scale of Physician Empathy, the Spanish version. All these studies were cross-sectional. The value of means observed, were subjected to regression studies and further adjustment curves were obtained and the coefficient of determination were calculated. RESULTS: Six different models of behavior were observed, which found that five of them suffer empathic decline within the course, but with different final results: in some the decline persists until the fifth academic year and in others, this decline 'recovers' persistently until the fifth academic year. The sixth model is characterized by a constant and persistent increase of levels of empathy within the course until the last academic year. DISCUSSION: There are six different models for the behavior of means of levels of empathy within the course evaluated by a common methodology in eighteen dental schools from six countries of Latin America. These findings support the existence of variability of empathic response and a comprehensive approach is needed to find the causes that give rise to this variability. CONCLUSION: In dental students of Latin America, there is variability in the behavior of the distribution in means between the academic years of the dentistry schools examined in this study.
Introdução: A controvérsia sobre o declínio da empatia relativamente ao curso em estudantes de Medicina, Odontologia e Ciências da Saúde em geral ainda não foi completamente elucidada. Esta controvérsia poderia ser parcialmente solucionada se fossem realizados estudos significativos sobre os níveis de empatia em contextos culturais, sociais e económicos similares. Material e Métodos: Foram estudados os níveis de empatia com o curso em dezoito escolas de Odontologia de seis países na América Latina (2013). As médias dos níveis de empatia foram usadas para estudar o comportamento entre académicos do primeiro e quinto anos. Os valores de níveis de empatia para com o curso foram observados aplicando a versão em espanhol da escala Jefferson de Empatia Médica. Todos estes estudos foram transversais. O valor das médias observadas sujeito a tratamento estatístico de regressão, obtendo-se as subsequentes curvas de ajustes e calculado o coeficiente de determinação. Resultados: Foram observados seis diferentes modelos de comportamento, sendo que em cinco deles se verificou declínio da empatia, com diferentes resultados finais: em alguns, o declínio persistiu até o quinto ano académico e, em outros, o declínio 'recuperou-se' persistentemente até ao quinto ano académico. O sexto modelo caracterizou-se por um constante e persistente aumento nos níveis de empatia com o curso até o último ano académico. Discussão: Existem seis modelos diferentes para o comportamento das médias dos níveis de empatia para com o curso, avaliados por uma metodologia comum em dezoito escolas de Odontologia de seis países na América Latina. Estes resultados suportam a existência de variabilidade de resposta empática, sendo necessária uma abordagem compreensiva para encontrar as suas causas. Conclusão: Em estudantes de Odontologia da América Latina verifica-se variabilidade no comportamento da distribuição de meios entre os anos acadêmicos das escolas de odontologia examinadas neste trabalho.
Assuntos
Educação em Odontologia , Empatia , Estudantes de Odontologia/psicologia , Estudos Transversais , Humanos , América Latina , Estudantes de Odontologia/estatística & dados numéricosRESUMO
Abstract Introduction: Empathy is an important trait in the training of medical students, as it has been shown that it improves the doctor-patient relationship. Objective: To evaluate the decline of empathy levels and possible sex differences in undergraduate medical students from the Universidad Central del Este, Dominican Republic. Materials and methods: Exploratory cross-sectional study. A Spanish version of the Jefferson Scale of Empathy for Medical Students (S-version) Scale was administered in September 2018 to 1 144 1st-year to 5th-year medical students (887 women and 257 men). Data reliability was verified using the Cronbach's alpha and the intraclass correlation coefficient (ICC). A generalized linear equation model (Type III) was applied to analyze data and the Wald chi-squared test was used to determine differences in overall empathy levels and the mean scores obtained in each of its three components based on the year of medical training and sex. Results: Cronbach's alpha was satisfactory (0.839), and the ICC was 0.834 (F=5.68; p=0.005). The variability of the estimated curves in relation to empathic behavior by course (year of medical training) and sex was observed using linear and non-linear regression equations: Wald x2=115.6, p=0.0001 between courses; and Wald x2 =12.85, p=0.001 between men and women. Conclusions: Sex differences were observed regarding empathy levels in the study population. Moreover, a decline in empathy levels (overall empathy and Compassionate Care component in men and Walking in the Patient's Shoes component in men and women) was also observed as students progressed in their medical training. The behavior of these data raises questions regarding the need to determine the factors causing these differences and the decline in empathy levels.
Resumen Introducción. La empatia es un rasgo importante en los estudiantes de medicina, ya que se ha demostrado que mejora la relación médico-paciente. Objetivo. Evaluar la declinación empática y las posibles diferencias según el sexo en los niveles de empatia en estudiantes de pregrado de Medicina en la Universidad Central del Este, República Dominicana. Materiales y métodos. Estudio exploratorio transversal. La versión en español de la Escala de Empatia de Jefferson adaptada para estudiantes de medicina (versión S) fue aplicada a 1 144 estudiantes de medicina de 1° a 5° año (887 mujeres y 257 hombres). La confiabilidad de los datos se verificó mediante el alfa de Cronbach y el coeficiente de correlación intraclase (CCI). Los datos se analizaron utilizando un modelo de ecuación lineal generalizada (Tipo III) y se utilizó la prueba x2 de Wald para determinar las diferencias en los niveles globales de empatia y los puntajes promedio de sus tres componentes según el año de formación y el sexo. Resultados. El alfa de Cronbach fue satisfactorio (0.839) y el CCI fue de 0.834 (F=5.68; p=0.005). Mediante ecuaciones de regresión lineal y no lineal se observó variabilidad de las curvas estimadas en relación con el comportamiento empático según el curso (año de formación médica) y el sexo: entre cursos: x2 de Wald= 115.6; p=0.000i, y entre hombres y mujeres: x2 de Wald= 12.85; p=0.001). Conclusiones. Se observaron diferencias en los niveles de empatia según el sexo; también se evidenció una declinación en los niveles de empatia (empatia global y componente Cuidado con compasión en los hombres, y en el componente Ponerse en los zapatos del otro en hombres y mujeres) a medida que los estudiantes avanzaban en su formación. El comportamiento de estos datos genera interrogantes relacionados con la necesidad de determinar los factores que causan estas diferencias y dicha declinación empática.
RESUMO
Objetivo: identificar y describir, desde la perspectiva del derecho fundamental a la sa-lud, la garantía de la atención sanitaria en menores dominicanos afectados con labio y/o paladar hendido (LPH) y sus madres. Métodos: en tanto este es un estudio descriptivo, se realizaron encuestas semiestructuradas y se aplicó la observación no participante en los territorios de residencia de familias con menores afectados por LPH, atendidos en una fundación de República Dominicana. Resultados: la mayoría de familias afectadas por LPH pertenecen a clases sociales vulnerables con limitada capacidad de pago para adquirir seguros de salud. De las 39 familias abordadas, 26 madres no contaron con seguro de salud durante la gestación, pero los 39 pacientes con LPH sí contaban con algún tipo de aseguramiento. Se evidenció negación sistemática en la prestación de servicios sanitarios, barreras administrativas, invisibilización de la problemática del LPH en los servicios de salud y en definitiva, un sistema de salud excluyente en la prác-tica. Conclusión: pese a que la atención sanitaria a gestantes y menores de 18 años se reconoce constitucionalmente como un derecho fundamental a cargo del Estado, la forma en que opera el sistema de salud dominicano supedita la atención a la capacidad de pago de las familias, lo que genera inequidades sociales y sanitarias que vulneran el goce efectivo del derecho a la salud de las madres y los menores que nacen con LPH.
Objective: Identify and describe from the perspective of the fundamental right to health, the guarantee of health care, in Dominican children affected with cleft lip and / or palate (CLP) and their mothers. Methods: Descriptive study on the guarantee of the right to health care in Dominican families affected with CLP and their characteristics. Semi-structured surveys and non-participant observation were carried out in the territories of residence of families with children under 18 years of age with CLP treated at a Foundation in the Dominican Republic Results: Most families affected by CLP belong to vulnerable social classes with limited ability to pay to purchase health insurance. Of the 39 families investigated, 26 mothers did not have health insurance during pregnancy, but all the patients did have some type of insurance. A systematic denial of health services, administrative barriers, invisibility of the CLP problem in health services, and an exclude health system in practice were evident. Conclusion:Despite the fact that health care for pregnant women and those under 18 years of age is constitutionally recognized as a fundamental right in charge of the State, the way the Dominican health system operates, subordinates attention to families' ability to pay, generating social inequities and health services that violate the effective enjoyment of the right to health of mothers and minors born with CLP.
Assuntos
Fenda Labial , Fissura Palatina , Acessibilidade aos Serviços de Saúde , Equidade em Saúde , Atenção à Saúde , Direito à SaúdeRESUMO
Abstract: Objective: To examine the association between tobacco-related risk factors and smoking among third-year dental students in Latin American countries. Materials and methods: Logistic regression models were used to analyze Global Health Professions Student Survey (GHPSS) data. Results: Of 5 605 respondents, 33% smoked and 45% had been exposed to secondhand smoke during the previous month, 34% smoked in school buildings during the past year, and 85% had never received formal training in smoking cessation. Smoking was significantly associated with male sex; Bolivian, Chilean, or Mexican nationality; exposure to secondhand smoke; lacking self-perception of being a “role model” for patients; and not believing that health professionals who smoke are less likely to advise patients to quit smoking. Conclusions: All dental schools should encourage tobacco-free policies and offer cessation services. Cessation training must be incorporated into dental curricula to include dental professionals in the battle against the tobacco epidemic.
Resumen: Objetivo: Analizar la asociación entre ciertos factores de riesgo relacionados con el tabaquismo en estudiantes de tercer año de odontología de países latinoamericanos. Material y métodos: Se analizaron los datos de la Encuesta Mundial de Estudiantes de Profesiones de la Salud (GHPSS, por sus siglas en inglés) mediante la aplicación de modelos de regresión logística. Resultados. De los 5 605 encuestados, 33% fumó y 45% estuvo expuesto al humo de segunda mano durante el mes pasado; 34% fumó en los edificios de las escuelas dentales durante el pasado año y 85% nunca recibió entrenamiento formal en cesación de tabaquismo. Ser boliviano, chileno o mexicano; estar expuestos al humo de segunda mano; no auto-percibirse como un “modelo a seguir” para los pacientes; y no creer que un profesional de salud que fuma es menos propenso a aconsejar a sus pacientes para dejar de fumar fueron factores asociados significativamente con el tabaquismo. Conclusiones: Todas las escuelas dentales deben fomentar las políticas contra el consumo de tabaco y ofrecer servicios de cesación de tabaquismo. La formación sobre cesación debe incorporarse a los planes de estudio con el fin de incluir a los profesionales dentales en la batalla contra la epidemia de tabaquismo.