Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study.

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women's experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women's needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Neurosurgical training and global health education: systematic review of challenges and benefits of in-country programs in the care of neural tube defects.

OBJECTIVE: The recognition that neurosurgeons harbor great potential to advocate for the care of individuals with neural tube defects (NTDs) globally has sounded as a clear call to action; however, neurosurgical care and training in low- and middle-income countries (LMICs) present unique challenges that must be considered. The objective of this study was to systematically review publications that describe the challenges and benefits of participating in neurosurgery-related training programs in LMICs in the service of individuals with NTDs. METHODS: Using MEDLINE (PubMed), the authors conducted a systematic review of English- and Spanish-language articles published from 1974 to 2019 that describe the experiences of in-country neurosurgery-related training programs in LMICs. The inclusion criteria were as follows-1) population/exposure: US residents, US neurosurgeons, and local in-country medical staff participating in neurosurgical training programs aimed at improving healthcare for individuals with NTDs; 2) comparison: qualitative studies; and 3) outcome: description of the challenges and benefits of neurosurgical training programs. Articles meeting these criteria were assessed within a global health education conceptual framework. RESULTS: Nine articles met the inclusion criteria, with the majority of the in-country neurosurgical training programs being seen in subregions of Africa (8/9 [89%]) and one in South/Central America. US-based residents and neurosurgeons who participated in global health neurosurgical training had increased exposure to rare diseases not common in the US, were given the opportunity to work with a collaborative team to educate local healthcare professionals, and had increased exposure to neurosurgical procedures involved in treating NTDs. US neurosurgeons agreed that participating in international training improved their own clinical practices but also recognized that identifying international partners, travel expenses, and interference with their current practice are major barriers to participating in global health education. In contrast, the local medical personnel learned surgical techniques from visiting neurosurgeons, had increased exposure to intraoperative decision-making, and were given guidance to improve postoperative care. The most significant challenges identified were difficulties in local long-term retention of trained fellows and staff, deficient infrastructure, and lower compensation offered for pediatric neurosurgery in comparison to adult care. CONCLUSIONS: The challenges and benefits of international neurosurgical training programs need to be considered to effectively promote the development of neurosurgical care for individuals with NTDs in LMICs. In this global health paradigm, future work needs to investigate further the in-country professionals' perspective, as well as the related outcomes.

Pharmacy Students' Reflections on an Experiential Learning Visit to a Psychiatric Hospital.

Objective. To create a brief, experiential educational intervention for undergraduate pharmacy students aimed at developing appropriate attitudes, knowledge, and skills for the delivery of recovery-focused pharmacy services to people with mental illness, and to elicit student perceptions of the value and impact of the intervention. Methods. A brief intervention was developed in which a cohort of 44 fourth-year pharmacy students attended a psychiatric teaching hospital in groups of 10 to12. The intervention was integrated into the therapeutics module, and was based on Fink's taxonomy of learning. Delivery of the intervention included input from a multidisciplinary team of mental health professionals and the use of active-learning strategies to give students an insight into the holistic approach to care and the patient journey. Students participated in an exercise in reflective practice following the visit. Content analysis was performed on the reflective writings of consenting students to identify themes and insights gained. Results. Thirty-eight of the 44 students gave their consent for their reflective writings to be analyzed for the purpose of this research. Students expressed some apprehension before their visit to the hospital, but later gained an appreciation of the patient experience of care in the psychiatric setting. Students also described having a greater appreciation of the role of the pharmacist in caring for psychiatric patients as well as an insight into the role of other health care professionals and interventions supporting recovery. Conclusion. A brief experiential intervention helped students integrate their learning and appreciate the value of their expertise in supporting those experiencing mental illness.

Telemonitoring to improve nutritional status in community-dwelling elderly: design and methods for process and effect evaluation of a non-randomized controlled trial.

BACKGROUND: A good nutritional status is key for maintaining health and quality of life in older adults. In the Netherlands, 11 to 35% of the community-dwelling elderly are undernourished. Undernutrition or the risk of it should be signalled as soon as possible to be able to intervene at an early stage. However, in the context of an ageing population health care resources are scarce, evoking interest in health enabling technologies such as telemonitoring. This article describes the design of an intervention study focussing at telemonitoring and improving nutritional status of community-dwelling elderly. METHODS: The PhysioDom Home Dietary Intake Monitoring intervention was evaluated using a parallel arm pre-test post-test design including 215 Dutch community-dwelling elderly aged > 65 years. The six-month intervention included nutritional telemonitoring, television messages, and dietary advice by a nurse or a dietician. The control group received usual care. Measurements were performed at baseline, after 4.5 months, and at the end of the study, and included the primary outcome nutritional status and secondary outcomes behavioural determinants, diet quality, appetite, body weight, physical activity, physical functioning, and quality of life. Furthermore, a process evaluation was conducted to provide insight into intervention delivery, feasibility, and acceptability. DISCUSSION: This study will improve insight into feasibility and effectiveness of telemonitoring of nutritional parameters in community-dwelling elderly. This will provide relevant insights for health care professionals, researchers, and policy makers. TRIAL REGISTRATION: The study was retrospectively registered at Clinical-Trials.gov (identifier NCT03240094 ) since August 3, 2017.

Legibilidad, relevancia y calidad de la información en español en la Web para pacientes con artritis reumatoide / Readability, relevance and quality of the information in Spanish on the Web for patients with rheumatoid arthritis

La educación es un determinante mayor de salud y uno de los predictores independientes de desenlace en artritis reumatoide (AR). El uso del Internet por pacientes ha crecido en forma exponencial en la última década. Objetivos. Evaluar las características, legibilidad y calidad de la información disponible en Internet en idioma español en relación con la AR. Material y métodos. Se buscó la frase AR en Google. Se evaluaron las primeras 30 páginas de resultados de acuerdo con un formato diseñado ex profeso (relevancia, autoría, tipo de publicación, enfermedad discutida e interés financiero); además se evaluaron la calidad y la legibilidad de las páginas, con las herramientas DISCERN e INFLESZ, respectivamente. La extracción de datos se realizó por médicos pasantes y la evaluación fue por consenso. Resultados. Se obtuvieron 323 resultados, pero solo el 63% de ellos fueron relevantes; el 80% de estos fueron sitios de información (71% discutían exclusivamente AR, 44% terapia convencional y 12% terapias alternativas). Un 12,5% tenía interés financiero. El 60% de los sitios fueron creados por organizaciones no lucrativas y 15% por asociaciones médicas. Las asociaciones médicas de Estados Unidos de América se posicionan mejor en español (Arthritis Foundation en la posición 4 y el American College of Rheumatology en la 10) que los sitios web de países de habla hispana. Conclusiones. Existe riesgo de desinformación para los pacientes con AR que utilizan la Web. Se identifica además áreas de oportunidad para instituciones médicas de países de habla hispana para tener un mayor involucramiento social en la educación de sus pacientes (AU)

Background. Education is a major health determinant and one of the main independent outcome predictors in rheumatoid arthritis (RA). The use of the Internet by patients has grown exponentially in the last decade. Objective. To assess the characteristics, legibility and quality of the information available in Spanish in the Internet regarding to rheumatoid arthritis. Material and methods. The search was performed in Google using the phrase rheumatoid arthritis. Information from the first 30 pages was evaluated according to a pre-established format (relevance, scope, authorship, type of publication and financial objective). The quality and legibility of the pages were assessed using two validated tools, DISCERN and INFLESZ respectively. Data extraction was performed by senior medical students and evaluation was achieved by consensus. Results. The Google search returned 323 hits but only 63% were considered relevant; 80% of them were information sites (71% discussed exclusively RA, 44% conventional treatment and 12% alternative therapies) and 12.5% had a primary financial interest. 60% of the sites were created by nonprofit organizations and 15% by medical associations. Web sites posted by medical institutions from the United States of America were better positioned in Spanish (Arthritis Foundation 4th position and American College of Rheumatology 10th position) than web sites posted by Spanish speaking countries. Conclusions. There is a risk of disinformation for patients with RA that use the Internet. We identified a window of opportunity for rheumatology medical institutions from Spanish-speaking countries to have a more prominent societal involvement in the education of their patients with RA (AU)

Integração do currículo modular do curso de medicina da UFPI/Campus Ministro Reis Velloso

O currículo médico e a forma de ensinar a medicina têm sido discutidos em todo o mundo contemporâneo. Nesse contexto, a integração curricular preconizada no Projeto Pedagógico do Curso (PPC) de Medicina do Campus Ministro Reis Velloso (CMRV) da UFPI constitui um grande desafio para a formação, cuja superação inicia com a compreensão dos conceitos básicos de integração curricular, por parte dos atores envolvidos no processo. De maneira geral, o estudo busca avaliar o nível de integração de módulos componentes curriculares do curso. De maneira específica visa caracterizar os docentes de três módulos do curso de medicina da UFPI/CMRV; Descrever como os professores se articulam para ensinar os conteúdos do módulo de forma integrada; Identificar as metodologias de ensinoaprendizagem mais utilizadas e as formas como avaliam a aprendizagem dos conteúdos de cada módulo; Elencar as contribuições dos Círculos de Cultura para a construção da integração curricular. Para tanto, realizou-se um estudo exploratório e descritivo, de abordagem quantitativa e qualitativa, com professores de três módulos do curso de Medicina da UFPI, sendo eles: Bases dos Processos de Agressão e Defesa (BPAD), Bases dos Processos Psicossociais (BPPS), e Atenção Primária em Saúde (APS). Utilizou-se um questionário para caracterizar a amostra e foram realizados quatro Círculos de Cultura (CC) orientados por perguntas problematizadoras, que foram gravadas e depois transcritas e analisadas. Os dados quantificáveis foram analisados por meio do programa estatístico SPSS, versão 18.0 e a etapa qualitativa contemplou a análise de conteúdo. A avaliação do nível de integração se baseou na escada de integração de Harden (2000) composta por 11 degraus...

The medical curriculum and the way of teaching medicine have been discussed throughout the contemporary world. In this context, the curricular integration advocated in the Pedagogical Project of the Course of Medicine of Campus Ministro Reis Velloso (CMRV) of the UFPI constitutes a great challenge for the formation, whose overcoming begins with the understanding of the basic concepts of curricular integration, on the part Of the actors involved in the process. In general, the study seeks to evaluate the level of integration of modules curricular components of the course. Specifically, it aims to characterize the professors of three modules of the UFPI / CMRV medical course; Describe how teachers articulate themselves to teach the contents of the module in an integrated way; To identify the most used teaching-learning methodologies and the ways in which they evaluate the learning of the contents of each module; List the contributions of the Culture Circles for the construction of curricular integration. For that, an exploratory and descriptive study, with a quantitative and qualitative approach, was carried out with professors from three modules of the UFPI Medicine course, namely: Bases of the Processes of Aggression and Defense (BPAD), Bases of Psychosocial Processes (BPPS) and Primary Health Care (APS). A questionnaire was used to characterize the sample and four Circles of Culture (CC) were conducted, guided by questioning questions, which were recorded and then transcribed and analyzed. The quantifiable data were analyzed using the statistical program SPSS, version 18.0 and the qualitative step contemplated content analysis. The integration level assessment was based on the Harden integration ladder (2000) consisting of 11 steps...

Encuesta de satisfacción con el cuidado de la salud en las personas con enfermedad crónica / Survey of satisfaction with health care in people with chronic disease

Objetivo Desarrollar y validar la Encuesta de satisfacción con el cuidado de la salud para personas con enfermedad crónica no trasmisible (ECNT), para ser utilizada en el contexto Latinoamericano. Método: Estudio metodológico desarrollado entre 2012 y 2014. Para ello se cumplieron tres fases: 1) Revisión de la literatura relacionada con la satisfacción con el cuidado en situaciones de ECNT. 2) Estructuración de la propuesta preliminar de la «Encuesta de satisfacción con el cuidado de personas con enfermedad crónica», conocida como GCPC-UN-ESU. 3) validez fácil y de contenido con expertos 4) Prueba de campo en la aplicación a 111 personas con ECNT. Resultados: La encuesta GCPC-UN-ESU contiene 19 ítems y 4 dimensiones: satisfacción con los cuidados, con la educación en salud, con la calidad en el servicio prestado y el nivel de fidelización con el servicio. La encuesta en conjunto valora de manera integral la percepción de satisfacción con el cuidado de la salud por parte de las personas con ECNT, puede ser autodiligenciada. Conclusiones. La encuesta CPC-UN ESU fue validada y mostró contar con las variables necesarias para determinar el nivel de satisfacción de las personas con ECNT en el contexto de América Latina. Esta herramienta constituye una respuesta a las demandas de acreditación de los servicios en esta región (AU)

Objective: To develop and validate the survey of satisfaction with health care in people with non-communicable chronic diseases(NCDs), for use in the Latin American context. Method: This is a methodological study developed between 2012 and 2014, as part of the Latin American Network for Chronic Patient Care, under the Program for the Reduction of the burden of chronic disease in Colombia. Three stages were met: 1) Review of the literature on satisfaction with care in chronic diseases situations. 2) Structuring the preliminary proposal of the «Survey of satisfaction with health care in people with chronic disease» known as GCPC-UN-ESU and 3) facial validity and experts review 4) Test application to 111 people with NCDs. Results: The GCPC-UN-ESU, survey contains 19 items and 4 dimensions: satisfaction with care, with health education and with the quality of the service provided and the level of loyalty to the service. The survey holistically perceived satisfaction with health care by people with NCDs and it can be personally developed. Conclusions: The CPC-A ESU survey was validated and it had the necessary variables in order to determine the level of satisfaction of people with NCDs in the Latin American context. This tool is a response to the demands of accreditation services in this región (AU)

[Patients' increasing role in healthcare]. / Chi conduce le danze? Il crescente ruolo dei pazienti nella sanità.

Since the late '90s citizens have been increasingly involved in healthcare, thanks to a shift in access to healthcare information, greater patients' and citizens' awareness about their rights and needs, and a change in physicians' attitudes and behavior. At the same time, to ensure the sustainability of the national health services, patients' needs are increasingly being examined in relation to the services and interventions needed, and to foster informed demand by patients and citizens, and appropriate prescriptions by physicians. Nowadays, patients already have a section in an authoritative medical journal. Working with clinicians, they set research priorities and the outcomes to be studied. Especially in UK and USA, they are invited to participate in the design and development of trials and in deciding which trials should be funded. The situation varies widely in different countries, though involving citizens in healthcare decisions is a common mantra. Even when they consult a clinician, the patients' role has evolved. People ask for information more often and want an active part in decisions about their health. Physicians start to pay more attention to the person and the social context, feelings and emotions, and person-centered care has become a reference in the doctor-patient relationship. This article offers an overview of the changing roles of patients and citizens in healthcare.

An economy of scales: A selective review of obesity's economic causes, consequences, and solutions.

This paper reviews the economic research on obesity, covering topics such as the measurement of, and trends in, obesity, the economic causes of obesity (e.g. the monetary price and time cost of food, food assistance programs, income, education, macroeconomic conditions, and peer effects), and the economic consequences of obesity (e.g. lower wages, a lower probability of employment, and higher medical care costs). It also examines the extent to which obesity imposes negative externalities, and economic interventions that could potentially internalize such externalities, such as food taxes, subsidies for school-based physical activity programs, and financial rewards for weight loss. It discusses other economic rationales for government intervention with respect to obesity, such as imperfect information, time inconsistent preferences, and irrational behavior. It concludes by proposing a research agenda for the field. Overall, the evidence suggests that there is no single dominant economic cause of obesity; a wide variety of factors may contribute a modest amount to the risk. There is consistent evidence regarding the economic consequences of obesity, which are lower wages and higher medical care costs that impose negative externalities through health insurance. Studies of economic approaches to preventing obesity, such as menu labeling, taxes on energy-dense foods, and financial rewards for weight loss find only modest effects on weight and thus a range of policies may be necessary to have a substantial effect on the prevalence of obesity.

Papel de las enfermeras en reproducción asistida: dimensión emocional / The role of nurses in Assisted Reproduction: the emotional dimensión

OBJETIVO: analizar y actualizar el papel que llevan a cabo las enfermeras en el ámbito de la reproducción humana asistida desde la perspectiva psicosocial. MÉTODO: revisión narrativa mediante búsqueda bibliográfica en las bases de datos PubMed, Cuiden, Red SciELO, Cochrane Plus y Cinahl, con lenguaje libre y controlado (términos MeSH), utilizándolos operadores booleanos y, en algunos casos, el truncado. La búsqueda se limitó a artículos publicados entre 2004 y 2014. Se seleccionaron 10 artículos en total, en función de los criterios de inclusión y exclusión establecidos. RESULTADOS: se identificaron cinco categorías de análisis: el apoyo emocional, la labor educativa y la formación, la continuidad de los cuidados, la relación enfermera-paciente y el trabajo en equipo. Las enfermeras llevan a cabo un rol múltiple, proporcionando cuidados holísticos a las mujeres y parejas que reciben técnicas de reproducción asistida (TRA), siendo un proceso notablemente costoso en el ámbito emocional. CONCLUSIONES: las enfermeras se presentan como unas profesionales imprescindibles en las Unidades de Reproducción Asistida(URA) para proporcionar una asistencia sanitaria de calidad. Es necesario aplicar los últimos avances a la práctica clínica, fomentarla utilización de la metodología enfermera y promover la labor investigadora en esta temática

OBJECTIVE: to review and update the role performed by nurses in the setting of Human Assisted Reproduction from a psychosocial perspective. METHOD: a narrative review through bibliographic search in the following databases: PubMed, Cuiden, Red SciELO, Cochrane Plus and Cinahl, with free and controlled language (MeSH terms),using boolean operators, and truncation in some cases. The search was limited to articles published between 2004 and2014. Ten articles were selected in total, based on the established inclusion and exclusion criteria. RESULTS: five categories were identified for review: emotional support, educational activities and training, continuity of care, nurse-patient relationship, and team work. Nurses conduct a multiple role, providing holistic care to those women and couples who receive Assisted Reproduction Techniques (ARTs), which represents a significantly difficult process in the emotional setting. CONCLUSIONS: nurses appear as indispensable professionals in the Assisted Reproduction Units (ARUs), in order to provide high quality healthcare. It is necessary to implement the latest advances in clinical practice, to encourage the use of nursing methodology, and to promote research work within this subject

Dermatology on pinterest.

BACKGROUND: Pinterest is a social media internet service utilized by individuals, organizations, and businesses to collect and share ideas related to projects or interests. OBJECTIVE: The literature related to dermatology-related content on Pinterest is scarce. This study aims to investigate the presence of dermatology related content available on Pinterest. METHODS: Investigators searched five terms related to dermatology in the "pins" and "boards" search categories of pinterest. The first 20 results were evaluated for content and assigned to a content group of "advocacy," "informative," or "home remedies." Boards were also categorized as being posted by an MD or professional society versus others. The top ten dermatology journals were also searched for under the boards category. RESULTS: Informative pins were the most common (49%) followed by advocacy (37%) and home remedies (14%). Informative boards were the most common (53%) followed by home remedies (31%) and advocacy (16%).We identified that only 24% of boards were created by either M.D.s or advocacy organizations. The top ten dermatology journals identified by prior studies had little presence, with only one board posted by JAMA Dermatology. CONCLUSIONS: Our study contributes to a growing body of data that dermatology organizations are relatively absent from new social media sites, and Pinterest represents a potential outlet for targeted intervention in high-risk groups for skin disease.

Sixty years of fear appeal research: current state of the evidence.

Fear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence argues against the use of threatening health information. The authors reviewed the current state of empirical evidence on the effectiveness of fear appeals. Following a brief overview of the use of fear arousal in health education practice and the structure of effective fear appeals according to two main theoretical frameworks-protection motivation theory and the extended parallel process model-the findings of six meta-analytic studies in the effectiveness of fear appeals are summarized. It is concluded that coping information aimed at increasing perceptions of response effectiveness and especially self-efficacy is more important in promoting protective action than presenting threatening health information aimed at increasing risk perceptions and fear arousal. Alternative behavior change methods than fear appeals should be considered.

[Anticancer propaganda: myth or reality?].

The authors raise a very important problem of anticancer propaganda aimed at the early detection of cancer to be solved nowadays by means of screening and constructive interaction between oncologists and the public. To increase the level of knowledge of the population in this area it is necessary to expand the range of its adequate awareness of tumor diseases. Only joint efforts can limit the destructive effect of cancer on people's minds, so that every person would be responsible for his own health, clearly understanding the advantages of early visit to a doctor. This once again highlights the need of educational work with the public, motivational nature of which allows strengthening the value of screening in the whole complex of measures to fight cancer.

The fourth level of health literacy.

The World Health Organization defines health literacy as cognitive and social skills determining individuals' motivation and ability to receive, understand, and use information in a health-promoting manner. This study discusses health literacy in the light of general upper secondary education students' test answers (N = 611) on the Finnish Matriculation Examination. The data were analyzed based on three levels of health literacy: the basic, communicative, and critical level. Analysis suggests the three existing levels do not fully describe the depth of health literacy. A fourth level was derived, called "holistic health literacy," with the following dimensions: (1) tolerance, (2) understanding culture as wide and multidimensional phenomena, (3) environmental consciousness, and (4) analysis of the state of the world from various points of view. The means of developing the subject of health education are discussed.

Aplicación de un programa educativo sobre la enfermedad diarreica aguda: Policlínicas René Vallejo y Bayamo-Oeste, 2011 / Application of and educative program about acute diarrheic diseases. René Vallejo and West Bayamo Polyclinics

Se aplicó un programa educativo sustentado en los factores de riesgo de la enfermedad diarreica aguda con el objetivo de evaluar su eficacia para elevar el conocimiento de los familiares de niños y niñas menores de un año atendidos con esta enfermedad en las áreas de salud de las policlínicas René Vallejo y Bayamo Oeste del municipio Bayamo, en el período comprendido de enero a diciembre del 2011. Las variables fueron: la lactancia materna exclusiva hasta el sexto mes, lavado de las manos, el uso de sales de rehidratación oral al inicio de un episodio diarreico, el consumo de agua hervida, el lavado de manos para manipular alimentos y después de defecar, la higiene personal y de utensilios antes de alimentar al niño, la administración de remedios caseros, la presencia de vectores en el hogar. El universo estuvo constituido por 346 familiares de niños y niñas menores de un año el que se hizo coincidir con la muestra. Una vez aplicado en programa educativo, mediante la prueba de ANOVA de Friedman se constató el incremento del conocimiento sobre los factores de riesgo en los familiares de los niños y niñas menores de un año beneficiarios de la investigación, al pasar el conocimiento de un rango promedio medio (1,14) a un rango promedio alto (1,86); (n=346; X2=252,0; p=0,0; α=0,05); demostrándose la eficacia del programa educativo para incrementar el conocimiento de los familiares de los niños y niñas menores de un año(AU)

An educative program based on risk factors of acute diarrhea disease was used to evaluate its efficacy to increase the awareness of family members of children under one year old who had been treated for this condition in different health areas of the policlinics René Vallejo and Bayamo Oeste in Bayamo Municipality, from January to December, 2011. The variables studied were lactation up to the six month of life, hand washing, the use of oral rehydration salts at the onset a diarrhea episode, the use of boiled water, hand washing to manipulate foods and after defecation, personal hygiene and hygiene of utensils before feeding the baby, administration of home remedies, and presence of carriers at home. The universe consisted of 346 family members of children under one year old and it coincided with the sample. After the educative program was introduced, ANOVA and Friedman tests were used to evaluate whether the level of awareness about risk factors had increased in family members of children under one year old who benefitted with this investigation. The level of awareness shifted from a mid (1,14) to a high (1,86) average; N=346; X2=252,0; p=0,0; α=0,05. It demonstrated the efficacy of the educative program to increase the awareness of family members of children under one year old(EU)

Long-term effectiveness of maternal dietary counseling in a low-income population: a randomized field trial.

OBJECTIVE: To assess the impact of dietary counseling given to mothers during the first year of infants' lives on food consumption, nutritional status, and lipid profile of the children up to 7 to 8 years old. METHODS: The randomized trial was conducted with 500 mothers who gave birth to full-term infants with birth weight ≥ 2500 g between October 2001 and June 2002 in São Leopoldo, Brazil. Mothers were randomly assigned to intervention (n = 200) and control groups (n = 300) and those in the intervention group received counseling on breastfeeding and complementary feeding by 12 fieldworkers on 10 home visits during the first year of children's lives. Blinded fieldworkers assessed dietary and anthropometric data at 12 to 16 months, 3 to 4 years, and 7 to 8 years and lipid profiles at 3 to 4 years and 7 to 8 years old. The lipid profile was the primary outcome. RESULTS: Of the 500 recruited children, 397 underwent the 12- to 16-month, 354 the 3- to 4-year, and 315 the 7- to 8-year assessment. The energy-dense foods intake was significantly lower in the intervention group at 12 to 16 months and 3 to 4 years old. At 3 to 4 years, serum lipid levels did not differ between groups. At 7 to 8 years, high-density lipoprotein levels were 0.11 mmol/L higher (0.00 to 0.20), and triglycerides concentration was 0.13 mmol/L lower (-0.25 to -0.01) in intervention children but only among the girls. Overweight/obesity rates did not differ between groups. CONCLUSIONS: Dietary counseling for mothers during infancy decreased the energy-dense foods consumption and improved lipid profile.

La risa: diferencias según el género / Laughter: gender differences

La risa se acompaña de numerosos beneficios fisiológicos y psicológicos. Aunque las mujeres ríen más que los varones, la frecuencia diaria de risas no parece diferir. La risa es un indicador de vitalidad de la familia y de la salud de la pareja. Resulta muy atractiva en el aspecto interpersonal, especialmente para las mujeres. Los varones utilizan mucho más el humor y la risa cuando se trata de discutir sobre temas sensibles de salud. En las mujeres, la risa está más relacionada con la esfera social y se utiliza para afrontar situaciones de estrés. La facilitación de la risa en la consulta puede ser muy útil a la hora de ofrecer determinados mensajes. Tener en cuenta las posibles diferencias en el uso del humor y de la risa por varones y mujeres puede ayudar a mejorar la relación con el paciente y optimizar su aplicación clínica en el ámbito de la educación y la atención sociosanitarias(AU)

Laughter is associated to many physiological and psychological benefits. Although women laugh more than men do, the daily frequency of laughter does not seem to differ. Laughter in all its forms and manifestations is an indicator of family vitality and healthy couples. Laughter is very attractive at the interpersonal level, especially for women. Men use humor much more and laughter when it comes to discussing sensitive health issues. In women, laughter would be more associated with greater social support in relationships and as a tool to cope with stress. Inviting laughter in the doctor's office may be very useful when directing certain messages on therapeutic management. Taking into account possible gender differences in the use of humor and laughter may help to improve the relationship with the patient and optimize the clinical application of laughter in health care and education setting(AU)

Experiences about HIV-AIDS preventive-control activities. Discourses fromnon-governmental organizations professionals and users

Objectives: The main aim of this study was to identify the experiences of professionals in nongovernmental organizations (NGO) in Catalonia (Spain) working in HIV/AIDS prevention and control activities and potential areas of improvement of these activities and their evaluation. A further aim was to characterize the experiences, knowledge and practices of users of these organizations with regard to HIV infection and its prevention. Methods: A phenomenological qualitative study was conducted with the participation of both professionals and users of Catalan nongovernmental organizations (NGO) working in HIV/AIDS. Theoretical sampling (professional) and opportunistic sampling (users) were performed. To collect information,the following techniques were used: four focus groups and one triangular group (professionals), 22 semi-structured interviews, and two observations (users). A thematic interpretive content analysis was conducted by three analysts. Results: The professionals of nongovernmental organizations working in HIV/AIDS adopted a holisticapproach in their activities, maintained confidentiality, had cultural and professional competence and followed the principles of equality and empathy. The users of these organizations had knowledge of HIV/AIDS and understood the risk of infection. However, a gap was found between knowledge, attitudes and behavior. Conclusions: NGO offer distinct activities adapted to users’ needs. Professionals emphasize the need for support and improvement of planning and implementation of current assessment. The preventive activities of these HIV/AIDS organizations are based on a participatory health education model adjusted to people’s needs and focused on empowerment (AU)

Objetivos: Identificar las experiencias y actividades de las organizaciones no gubernamentales (ONG) que trabajan en la prevención y control del VIH/sida, las posibles áreas de mejora de las actividades y de su evaluación, e identificar las experiencias, conocimientos y prácticas de sus usuarios sobre el VIH y suprevención. Métodos: Estudio cualitativo fenomeno lógico en el que participan los profesionales y usuarios de las ONG que trabajan en VIH. Se realizó un muestreo teórico (profesionales) y un muestreo opinático (usuarios). Se utilizaron cuatro grupos focales y uno triangular (profesionales), 22 entrevistas semi-estructuradas y dos observaciones (usuarios). Se realizó un análisis de contenido temático realizado por tres analistas. Resultados: Los profesionales de las ONG ofrecen un enfoque holístico, confidencialidad, competencia cultural y profesional, y aplican los principios de igualdad y empatía. Los usuarios tienen conocimientos sobre el VIH/sida y comprenden el riesgo de infección. Existe una separación entre conocimiento, actitud y conducta. Conclusiones: Las ONG ofrecen diversas actividades adaptadas a las necesidades de los usuarios. Los profesionales destacan la necesidad de apoyo y mejora de la planificación y ejecución del proceso de evaluación actual. Las actividades preventivas de las ONG que trabajan en VIH/sida se basan en un modelo de educación sanitaria participativa ajustado a las necesidades de la población, basada en el empoderamiento (AU)

Educación sanitaria en el tratamiento anticoagulante oral / Sanitary education when dealing with oral anticoagulation treatment

Se calcula que, en la actualidad, hay aproximadamente unas 800.000 personas descoaguladas en España. El Tratamiento Anticoagulante Oral (TAO) se utiliza en aquellos que han sufrido un accidente tromboembólico y para prevenir la aparición de estos episodios y sus nefastas consecuencias. La persona anticoagulada acude con frecuencia al Centro de Atención Primaria (CAP), bien sea para su control de la medicación anticoagulante o por otro proceso crónico que requiera seguimiento del equipo de Atención Primaria. Es preciso que el profesional de enfermería esté al corriente de las últimas actualizaciones sobre los fármacos anticoagulantes, sobre todo en lo que a prevención se refiere. Este artículo sintetiza las evidencias disponibles en nuestro medio sobre la educación sanitaria que debe ofrecerse a la persona en tratamiento con TAO(AU)

At present times, it is calculated there are some 800.000 people in Spain who need anticoagulant treatment. Oral anticoagulant treatment is used on those who have suffered a thromboembolic accident and to prevent the appearance of these episodes and their unfortunate consequences. A patient who needs anticoagulant treatment often comes to his/her Primary Health Care Center, either for control of his/her anticoagulant medication or for some other chronic process which requires follow-up by the Primary Health Care Center team. It is essential that nursing professionals keep up to date about the latest anticoagulant drugs, especially regarding health education and prevention. This article synthesizes those items available in our environment about health education which should be provided to people undergoing anticoagulant treatment(AU)

Educação em saúde na atenção médica ao paciente com hipertensão arterial no Programa Saúde da Família / Health education in connection with medical attention to hypertensive patients in the family health program

Entre os muitos contextos de desenvolvimento da ação educativa em saúde, o presente trabalho privilegiou a consulta médica. Com o objetivo de identificar e caracterizar essas ações na atenção médica, analisaram-se as transcrições de cinqüenta consultas com pacientes hipertensos, realizadas por dez médicos de Saúde da Família em três municípios baianos. Os resultados demonstram que a condução da consulta enfatiza a medicalização e o controle da hipertensão. A narrativa do paciente é inibida ou interrompida pela narrativa do médico, com a atenção médica circunscrevendo-se aos sintomas individuais, sem apreensão das dimensões psicossociais e culturais do processo saúde-doença-cuidado. A ação educativa, na maior parte dessas consultas, apresenta-se secundária e superficial, com recomendações prescritivas. Uma abordagem diferenciada foi identificada entre um dos médicos, apontando para a possibilidade de uma atenção médica dialógica e integradora de aspectos biomédicos e socioculturais ao cuidado. (AU)