The Von Restorff effect in the Brazilian version of the Rey Auditory Verbal Learning Test in an elderly population / Efeito de Von Restorff na versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey em idosos

ABSTRACT. The Von Restorff (isolation) effect refers to a stimulus that is more likely to be remembered amongst other stimuli in memory tasks. It has been demonstrated with different age ranges and methodologies. Objective: To investigate: a) the presence of the isolation effect in elders tested with the new Brazilian Portuguese version of the Rey Auditory Verbal Learning Task (RAVLT) in which a word with potential emotional weight (mother) was introduced; b) whether isolation effects persist in memory disorders of different degrees of severity (Mild Cognitive Impairment [MCI]; Alzheimer's Dementia [AD]). Methods: The RAVLT was administered to 287 consecutive volunteers. Individuals underwent medical and neuropsychological evaluation and were further sub-grouped into normal controls (n=114), MCI (n=87) and AD (n=86) patients. One-way analysis of variance (ANOVA) and Chi-squared tests were performed. Post-hoc Tukey analysis was conducted to assess significance of group differences. Results: There were significant group effects on the learning curve. A W-shape - instead of the classical U-shape - was found for the serial position curve in all groups. Conclusion: The new Brazilian version of the RAVLT exhibited the Von Restorff effect, where this phenomenon was evident not only in older adults but also patients with MCI and AD, providing further psychometric measures for inter-group analyses.

RESUMO. Efeito de von Restorff (efeito de isolamento) refere-se ao estímulo que é mais facilmente lembrado em relação a outros em tarefas de memória. Tal efeito foi demonstrado em diferentes faixas etárias com diferentes metodologias. Objetivo: Investigar: a) presença do efeito de isolamento numa população idosa avaliada com a nova versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey (RAVLT), em que uma palavra com potencial carga emocional ('mãe') foi introduzida; b) se o efeito de isolamento persiste em distúrbios de memória de diferentes gravidades (Comprometimento Cognitivo Leve [MCI]; Demência de Alzheimer [AD]). Métodos: RAVLT foi aplicado em 287 voluntários. Indivíduos participaram de avaliações médica e neuropsicológica e foram posteriormente agrupados em controles normais (n=114), MCI (n=87) e DA (n=86). Análises de variância e testes de Chi-quadrado foram realizados. Análises post-hoc foram conduzidas para avaliar diferenças de características entre os grupos. Resultados: Observaram-se efeitos significativos de grupo na curva de aprendizagem. Todos os grupos apresentaram curva de posição serial em formato W - invés do clássico formato em U. Conclusão: A nova versão brasileira do RAVLT evidenciou um efeito de von Restorff. Tal fenômeno foi visto não apenas em idosos, mas também em pacientes com MCI e AD, fornecendo medidas psicométricas adicionais para análises de diferenças intergrupais.

Dementia screening in Brazil: a systematic review of normative data for the mini-mental state examination

The Mini-Mental State Examination (MMSE) is the most widely used instrument for the screening of older adults with suspected cognitive impairment; the MMSE has been translated and validated in numerous languages and countries. The cultural and sociodemographic characteristics of the sample can influence performance on the test; therefore, applying the MMSE in different populations usually requires adjustments of those variables. From this perspective, the present study aims to review the normative data for the MMSE in the Brazilian older population, including those adaptations to the original test. Database searches were performed in Medline, Web of Knowledge, Scielo and Pepsic for articles assessing healthy elderly Brazilian samples using the MMSE. Heterogeneity across and within the studies was analyzed. Of a total of 1,085 retrieved articles, 14 were included. Significant differences across studies were identified for the characteristics of the samples, the presence of alterations to the MMSE subtests and the presentation of the results. The risk of biases was relevant for all the studies. Considering the large methodological heterogeneity among studies, the generalization of the available normative data for the MMSE may not be appropriate for the general elderly Brazilian population.

A preceptoria na rede básica da Secretaria Municipal de Saúde do Rio de Janeiro: opinião dos profissionais de Saúde / Student supervision in primary care clinics in the Rio de Janeiro City Health Department: opinions by healthcare professionals

A formação de profissionais de saúde com as competências para prestação de cuidados básicos deve ser iniciada na graduação. Entretanto, o treinamento na rede básica de saúde (RBS) ainda encontra barreiras nas esferas docente, discente e nas unidades das Secretarias Municipais de Saúde (SMS). Considerando a relevância do papel dos preceptores na formação dos estudantes da área da saúde, avaliamos a opinião dos profissionais de saúde da RBS da SMS do Rio de Janeiro sobre a atividade de preceptoria. Um questionário foi respondido por 351 profissionais de saúde de 13 das 67 unidades da RBS. Destes, 77 por cento consideram que a preceptoria faz parte das atribuições do profissional e 61 por cento gostariam de assumir esta tarefa. Várias dificuldades foram apontadas, incluindo problemas estruturais e de recursos humanos. Os resultados responsabilizam, de alguma forma, as instituições de ensino superior (IES) e o Estado pela pouca valorização e estímulo às ações de preceptoria, na medida em que apontam a necessidade de rever as condições de trabalho e de ensino na RBS. Destacam-se a melhoria dos salários e da infraestrutura e a oportunidade de capacitação profissional, o que implica parcerias efetivas entre as IES e as SMS.

Training of health professionals with the necessary skills in primary care should begin during undergraduate medical education. However, training in the primary care network still faces obstacles among faculty, students, and the primary care clinics operated by municipal health departments. Considering the relevant role of supervisors in training students in health-related fields, we investigated the opinions of healthcare professionals in the primary care network in Rio de Janeiro concerning their student supervision activities. A total of 351 health professionals from 13 of the 67 primary care clinics answered a questionnaire. Of these, 77 percent felt that student supervision is part of their responsibilities, and 61 percent said they would like to play this role. Various difficulties were identified, including structural and human resources problems. According to the findings, medical schools and the government are responsible for the under-valuing of student supervision, emphasizing the need to review the working and teaching conditions in the primary care network. The results also highlight improvements in wages and infrastructure and the opportunity for professional advancement, requiring effective partnerships between medical schools and the Municipal Health Department.