Validation of clinical simulation scenarios for the teaching of soft skills in child-centered care.

Consultations with children and their families are complex and require soft skills. However, there is a gap in the medical curriculum concerning these skills, especially as encounter training is often adult-centered. We developed, validated, and applied simulation scenarios that prioritize active participation of children to train soft skills in child-centered care for undergraduate medical students. This is a methodological study to develop three scenarios and a checklist of what is expected. The content was validated by 18 experts. A pre-test was carried out for adjustments. Then, the simulations were applied and evaluated by 18 medical undergraduate students. They included the participation of 6 pediatric simulated patients aged 9-12 years trained by a drama teacher. According to the results, the scenarios and checklist proved to be valid instruments in content terms (ICV-I > 0.8). The scripts were followed by the simulated pediatric patients, but they had difficulty mimicking a hypoactive state. Some were anxious, but everyone enjoyed participating in the feedback. The simulated parents had difficulty participating and giving space to the child's speech. Participants assessed that the simulations performed as they were proposed and, after experimenting them, felt more prepared. The simulations provided an opportunity for students to practice soft skills by interacting with children in a safe environment. Using children as simulated patients is feasible but presents some challenges. Our study has expanded the ways in which children's health content can be taught. We are investigating whether this training leads to better patient outcomes in real clinical settings.

Uterine leiomyoma: understanding the impact of symptoms on womens' lives.

BACKGROUND: Most women report negative experience about the symptoms of uterine leiomyoma (UL) in their lives, such as abnormal uterine bleeding and pelvic pain. Many studies have been conducted about efficacy of UL treatment, but little research has been performed about womens health related quality of life (HRQL). METHODS: This is a semi-structured, descriptive, observational, qualitative study that was performed during eight months. Focus group (FG) interviews were performed with women attending at a tertiary hospital in Brazil, who were consecutively included in the study. Seventy women with symptomatic UL were recruited to this study. FG duration was one hour with mediators with 5-6 women at each group. Collected data from discussions was processed according to thematic analysis and stored at a qualitative software. RESULTS: Women were negatively influenced by the presence of symptomatic UL. The major themes that were noticed during analysis were: beliefs and attitudes towards UL; limitation to social and professional activities; sensation of fear/unfairness/discouragement towards the symptoms and adverse effects during treatment with GnRH analogs. CONCLUSIONS: Symptomatic UL has a negative impact on womens HRQL. Health providers should consider such impact when counseling women on their treatment options, since it may have an important influence in these patients' decision-making process. While current pharmacological treatments may improve disease specific outcomes, such as bleeding intensity and tumor volume, they fail on actually improving quality of life.

Interprofessional education as an approach for reforming health professions education in Brazil: emerging findings.

Interprofessional education (IPE) is an important issue to insert in the debate on the reform of the education of health professions in Brazil. This paper provides details on an emerging study, based in Brazil, whose aim is to explore the use of IPE as a strategy to reform health professional education to become more collaborative in nature. The study has adopted a sequential mixed-methods approach, and will conduct focus groups, individual interviews and surveys with students, teachers and administrators based in two universities. Initial findings have indicated that, at present, participants were not aware of systematic strategies to bring students from different courses together for IPE, which has created problems for the development of knowledge and skills for collaborative work. Further data will be gathered to expand this analysis. Nevertheless, there is already clear evidence that there is a need to integrate and strengthen the use of IPE in Brazil, as a key route forward to strengthening the process of reorientation training of health professionals.

Analysis of heart rate variability in polycystic ovary syndrome.

OBJECTIVE: To compare the modulation of heart rate in a group of volunteers with polycystic ovary syndrome (PCOS) to that of a group of healthy ovulatory women on the basis of R-R interval variability and analyze the relationships between heart rate variability (HRV) and other cardiovascular risk factors. METHODS: In a cross-sectional study, HRV and anthropometric, biochemical and hormonal parameters were measured in 23 women with PCOS and 23 age-matched controls. Mean outcomes measures: HRV indexes in the time (SDNN and rMSSD) and frequency domain (low frequency-LF and high frequency-HF). Differences between groups and correlation analysis were performed. RESULTS: Intergroup analysis showed significant differences (p < 0.05) between groups, with lower SDNN, rMSSD, LF and HF indexes in PCOS women when compared to the control group. There was significant negative correlation between BMI and SDNN, LF and HF, indicating a decrease in the autonomic modulation of heart rate with increasing weight. A negative correlation was also found between the high-sensitivity C-reactive protein level and the rMSSD index. CONCLUSION: Our results show that PCOS is associated with alterations in the autonomic modulation of heart rate, possibly due to the influence of weight gain.

[Prevalence of mental disorders and assessment of quality of life in the climaterium]. / Prevalência de transtornos mentais comuns e avaliação da qualidade de vida no climatério.

OBJECTIVE: To evaluate prevalence of mental distress and health-related quality of life (HRQoL) in climacteric women. METHODS: A total of 191 women (45 to 65 years of age) were included in this cross-sectional study. A questionnaire about personal information, habits/health, and demographic data was administered in association with the two validated instruments to measure HRQoL, SF-36, Medical Outcomes Study 36-item Short-Form Health Survey and to estimate prevalence of common mental distress (20-item SRQ, Self Reporting Questionnaire). RESULTS: By using the 20-item SRQ for assessing mental distress, and establishing a cut-off level of at least 8 items, 39.8% of the women were categorized as having mental distress. A higher prevalence of mental distress and lower SF-36 scores were found in women in the perimenopause, particularly those with poor education and low family income who did not work outside the home. All SF-36 domains were significantly lower in women with mental distress than those in women without mental distress. CONCLUSION: Prevalence of mental distress is high in this sample of climacteric women and is associated with negative repercussions on the quality of life. This shows that psychosocial factors are significantly involved and psychological support strategies should be instituted in the form of health policies for climacteric women.

[Psicological aspects in infertile women]. / Estudo dos aspectos psicológicos em mulheres inférteis.

PURPOSE: To assess the frequency of stress and anxiety levels in infertile women, and to correlate these aspects with risk factors, in order to obtain data for specific psychological guidance. METHODS: The case-control study included a total of 302 women, 152 being infertile (case group: 30.3 +/- 5.4 years), and 150 non-fertile (control group: 25.7 +/- 7.9 years). The quantitative approach involved the application of Lipp's Stress Symptoms Inventory and State-Trait Anxiety Inventory. Response variables considered were: stress frequency and anxiety scores (State and Trait). Statistical analysis was performed by using the Chi-squared and Mann-Whitney tests, and logistical regression to test associations between response variables and considered risk factors. Statistical significance was defined as p < 0.05. RESULTS: The stress was more frequent in the case group than the control group (61.8 and 36.0%, respectively), however, no significant differences were observed between groups in relation to stress phases and predominant symptoms. With respect to anxiety, there were no significant differences between case and control groups as to median state scores (39.5 and 41.0; respectively) and anxiety trait scores (44.0 and 42.0; respectively). Factors significantly associated with greater risk for high anxiety scores in the case group were: primary infertility, unawareness of the causal factor, diagnostic phase investigation, religion, lack of children from other marriages. CONCLUSIONS: It can be concluded that infertile women are more vulnerable to stress; however, they are capable of adapting to stressful events without serious physical or psychological compromising.

[Translation, adaptation and validation of the Brazilian version of the Utian Quality of Life for evaluation of quality of life in the climacteric]. / Tradução, adaptação e validação da versão brasileira do questionário Utian Quality of Life para avaliação da qualidade de vida no climatério.

PURPOSE: To translate, to adapt and to validate the Utian Quality of Life (UQOL) for the Brazilian population. METHODS: Women in the climacteric phase, residents in the city of Natal, Rio Grande do Norte, located in the Brazilian Northeast, were randomly selected. UQOL and SF-36 questionnaires were used, and the translation from English to Portuguese was made by three teachers, while the adaptation stage of the translated version was made by applying the questionnaire to 35 women, which could mark the answer choice "I did not understand the question"; reproducibility measurements (test-retest) and construct validity were used to validate, following international methodological standards. RESULTS: The Brazilian version was fully recognized by the target population, which was comprised of 151 women, as no question showed a percentage of "non-understanding" equal to or greater than 20%. The results for intra and interobserver reproducibility demonstrated significant agreement on all the questionnaire items. This version showed consistency above the required criteria (>70), demonstrating its accuracy, while the construct validity was obtained by statistically significant correlations between the domains occupation, health and emotional of UQOL and the SF-36 domains. The Cronbach's alpha coefficient for the whole instrument was 0.82, representing good accuracy. Item-total correlation analysis showed the scale homogeneity. CONCLUSION: From the steps taken, the UQOL questionnaire was translated and adapted for its use in Brazil, with high reproducibility and validity. Thus, it can be included and used in Brazilian studies that aim at evaluating the quality of life of women during the peri- and postmenopausal.

Raloxifene therapy does not affect uterine blood flow in postmenopausal women: a transvaginal Doppler study.

OBJECTIVE: To monitor the effects of raloxifene therapy on the uterus of postmenopausal women by transvaginal ultrasonography and color flow Doppler. METHODS: Twenty-five healthy postmenopausal women were enrolled in this prospective longitudinal study performed at Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto. The patients were treated with raloxifene hydrochloride (60 mg per day) for 6 months. All were submitted to transvaginal ultrasound examination with color flow Doppler (ATL-HDI 3000 equipment) before the beginning and after 1, 3 and 6 months of treatment. Resistance index (RI) and pulsatility index (PI) of the uterine arteries were determined by the Doppler method, being considered as indicators of uterine perfusion. The following variables were analyzed: endometrial thickness, uterine volume, RI, and PI. Data were analyzed statistically by repeated-measures analysis of variance. RESULTS: Before treatment, endometrial thickness was 3.38 +/- 0.73 mm, and similar values were observed after 1, 3 and 6 months of treatment (3.04 +/- 0.82; 3.3 +/- 0.83; and 3.37 +/- 0.79, respectively) (P > 0.05). No significant differences in uterine volume were observed between the pre- and post-treatment periods. Uterine artery perfusion as indicated by RI and PI measured by Doppler also showed no significant variation, with a high impedance flow being maintained throughout treatment. CONCLUSIONS: In the group studied here, raloxifene treatment at the dose of 60 mg per day for 6 months did not induce significant changes in endometrial thickness, uterine volume or uterine artery perfusion, confirming that short-term raloxifene treatment does not affect the uterus of postmenopausal women.

[Impact of sexual and reproductive health theme insertion in the undergraduate medical]. / Impacto da inserção da temática saúde sexual e reprodutiva na graduação de Medicina.

PURPOSE: To evaluate the impact of sexual and reproductive health theme insertion in the undergraduate medical curriculum at a Brazilian public university. METHODS: We developed an instrument for cognitive assessment in sexual and reproductive health based on the subjects addressed in the optional curriculum component Reproductive Health, resulting in an objective multiple choice test containing 27 items. The selected topics were: human, sexual and reproductive rights (HSRR), sexuality, institutional violence, gender, sexual violence, conception, contraception, abortion/legal interruption of pregnancy, maternal mortality and sexually transmitted infections (STIs) - HIV/AIDS. The subjects were grouped into three dimensions of knowledge: HSRR, legal/institutional and biomedical. Two multivariate models were adjusted in the analysis of covariance. RESULTS: The study included 183 students, 127 of the group who took the elective curriculum course reproductive health (RH Group) and 56 who did not (Non-RH Group). Ninety-six students (52.5%) were males and 87 (47.5%) were females. Mean age was 24.7±1.9 years for the RH Group and 24.4±2.6 for the Non-RH Group. The average performance of the SR Group was higher than that of Non-RH subjects regarding the following subjects: HSRR, sexuality, institutional violence, sexual violence, abortion/legal interruption, and STDs - HIV/AIDS. There was no gender difference in performance, except for the theme maternal mortality, in which males scored worse than females (6.9±0.2 and 7.8±0.2, respectively; p<0.05). CONCLUSIONS: The participation of students in the elective curriculum component Reproductive Health was associated with better performance in some dimensions of cognitive assessment, suggesting a positive impact of this initiative on general medical education.

[Quality of life and psychosocial aspects of polycystic ovary syndrome: a quali-quantitative approach]. / Qualidade de vida e aspectos psicossociais da síndrome dos ovários policísticos: um estudo quali-quantitativo.

PURPOSE: To evaluate the quality of life of women with polycystic ovary syndrome (POS) and to learn about the experience of these women regarding the symptoms of their disease. METHODS: The study complementarily employed two methodological approaches - quantitative and qualitative ones. The quality of life of 213 women was evaluated (quantitative approach) using the SF-36 questionnaire. Of these, 109 had POS (Case Group: 26.8 ± 5.4 years of age) and 104 were healthy ( CONTROL GROUP: 23.9 ± 6.7 years of age). Data were analyzed statistically by the Student t-test, the chi-square test and the Pearson correlation test, with the level of significance set at 5%. Fifteen women with POS participated in the quantitative study and were interviewed using a semi-structured questionnaire. The qualitative data were analyzed by the technique of categorical thematic analysis. RESULTS: The women with POS showed impaired quality of life compared to Control (functional capacity: 76.5 ± 20.5 and 84.6 ± 15.9, respectively; physical aspects 56.4 ± 43.3 and 72.6 ± 33.3; general health status: 55.2 ± 21.0 and 62.5 ± 17.2; vitality: 49.6 ± 21.3 and 55.3 ± 21.3; social aspects: 55.3 ± 32.4 and 66.2 ± 26.7; emotional aspects: 34.2 ± 39.7 and 52.9 ± 38.2; mental health: 50.6 ± 22.8 and 59.2 ± 20.2). Regarding the qualitative data, thematic categorical analysis revealed that feelings of "abnormality", sadness, fear and anxiety were associated with the main symptoms of POS, i.e., hirsutism, menstrual irregularity, infertility and obesity. These symptoms affected the social, professional and marital life of these women. CONCLUSION: POS compromises the quality of life of affected women, causing them to feel that they are different from other women. Thus, women with POS do not simply require medical treatment regarding the reproductive, aesthetic and metabolic effects of the disease, but also need multiprofessional care.

Physical violence against women from the perspective of health professionals.

OBJECTIVE: To comprehend the perception of health professionals regarding physical violence against women by an intimate partner. METHODOLOGICAL PROCEDURES: This is a qualitative study performed in 2006 on 30 health professionals from three National Health System units in the city of Natal, Northeastern Brazil. Semi-structured interviews were conducted on three thematic topics: ideas associated to physical violence suffered by women; action of the health professional; and the role of health services. The series of interviews included questions on the perception of professionals about gender relations, physical violence, action as a health professional, and the role of health services. Categories were formed from these topics using the thematic content analysis. RESULTS: Health professionals pointed several factors that influence domestic violence situations, among which are machismo, poor economic conditions, alcoholism, and previous experiences of violence in the family environment. The study group reported they did not feel qualified to discuss the subject with the population and stressed the need that health services promote educational activities with this aim. CONCLUSIONS: The results suggest the need for systematized and effective actions aimed at humanizing health care for the battered woman.

[Lifestyle modifications in the polycystic ovary syndrome: role of physical exercise and importance of multidisciplinary approach]. / Modificações do estilo de vida na síndrome dos ovários policísticos: papel do exercício físico e importância da abordagem multidisciplinar.

The polycystic ovaries syndrome (POS) is a heterogeneous endocrinal disorder prevalent in 5 to 10% of women in reproductive age. In POS, there is an association with risk factors linked to the development of cardiovascular disease such as insulin resistance, dislipidemia, diabetes mellitus, arterial hypertension, endothelial dysfunction, central obesity, metabolic syndrome and chronic pro-inflammatory markers. Physical exercise practice together with nutritional guidance have been recommended as first rate strategies in the treatment of oligomenorrhea, hirsutism, infertility and obesity in POS women. This way, the objective of the present review was to analyze the specific role played by exercise and/or physical activity in changes of the body shape, in biochemical and hormonal plasmatic levels, and in the POS women's reproductive function.