Evaluación de una estrategia tutorial para la formación pedagógica de monitores en la Facultad de Medicina de la Universidad Katyavala Bwila, República de Angola / Evaluation of a tutorial strategy for the pedagogical training of monitors in the Faculty of Medicine of the

Introducción: el Programa Extracurricular de Atención Tutelar a Estudiantes de Medicina creado por profesores cubanos en la Facultad de Medicina de la Universidad Katyavala Bwila incluye una estrategia tutorial que garantiza la formación de monitores aptos para ingresar como docentes al concluir la licenciatura.Objetivo: evaluar los resultados de la estrategia tutorial en el cuatrienio 2012-2015. Método: investigación de corte cualitativo. Se utilizó el análisis documental, la observación no participante y encuestas de satisfacción. Resultados: desde el inicio de la aplicación de la estrategia hasta el momento se han realizado cuatro ediciones con un total de 70 monitores, los cuales se distribuyeron en 22 asignaturas y el mayor número correspondió a: Genética Médica, Anatomía, Medicina Interna, Cirugía, Anatomía Patológica, Embriología e Histología. De acuerdo al criterio de tutores, claustro y de la Federación de Estudiantes los monitores recibieron evaluación entre bien y excelente. El 92 por ciento de los monitores refirieron un alto grado de satisfacción.Conclusiones: la experiencia obtenida en las cuatro ediciones de la implementación de la estrategia tutorial para la formación de monitores y los resultados de las encuestas de satisfacción de los monitores permiten considerar a esta como una vía factible y útil para la formación de los recursos humanos en la FMUKB. Esto le permitirá en un futuro contar con recursos humanos propios que den continuidad al trabajo que desarrollan los profesores cubanos en la República de Angola. La incorporación del acompañamiento por los monitores a los estudiantes con bajo rendimiento académico resultó beneficiosa para ambos(AU)

Introduction: the Extracurricular Program of Tutelary Care for Medical Students created by Cuban professors in the Faculty of Medicine of the University of "Katyavala Bwila" includes a tutorial strategy that guarantees the formation of suitable monitors to enter as teachers at the end of the degree.Objective: to evaluate the results of the tutorial strategy in the four-year period 2012-2015.Method: qualitative research. Documentary analysis, non-participant observation and satisfaction surveys were used.Results: from the beginning of the application of the strategy up to the moment, fourth editions have been carried out with a total of 70 monitors which were distributed in 22 subjects and the largest number of monitors corresponded to the subjects of: Medical Genetic, Anatomy, Internal Medicine, Surgery, Pathologic Anatomy, Embryologic and Histology. All the monitors received an evaluation between good and excellent according to the criterion of tutors, cloister and of the Federation of Students.Conclusions: the experience obtained in the four editions of the implementation of the tutorial strategy for the training of monitors and the results of the satisfaction surveys of the monitors allow to consider this as a feasible and useful way for the formation of human resources in the FMUKB. This will allow it in the future to have its own human resources that give continuity to the work that Cuban professors develop in the Republic of Angola. The incorporation of the accompaniment by the monitors to the students with low academic performance was beneficial for both(AU)

Serum pantetheinase/vanin levels regulate erythrocyte homeostasis and severity of malaria.

Tissue pantetheinase, encoded by the VNN1 gene, regulates response to stress, and previous studies have shown that VNN genes contribute to the susceptibility to malaria. Herein, we evaluated the role of pantetheinase on erythrocyte homeostasis and on the development of malaria in patients and in a new mouse model of pantetheinase insufficiency. Patients with cerebral malaria have significantly reduced levels of serum pantetheinase activity (PA). In mouse, we show that a reduction in serum PA predisposes to severe malaria, including cerebral malaria and severe anemia. Therefore, scoring pantetheinase in serum may serve as a severity marker in malaria infection. This disease triggers an acute stress in erythrocytes, which enhances cytoadherence and hemolysis. We speculated that serum pantetheinase might contribute to erythrocyte resistance to stress under homeostatic conditions. We show that mutant mice with a reduced serum PA are anemic and prone to phenylhydrazine-induced anemia. A cytofluorometric and spectroscopic analysis documented an increased frequency of erythrocytes with an autofluorescent aging phenotype. This is associated with an enhanced oxidative stress and shear stress-induced hemolysis. Red blood cell transfer and bone marrow chimera experiments show that the aging phenotype is not cell intrinsic but conferred by the environment, leading to a shortening of red blood cell half-life. Therefore, serum pantetheinase level regulates erythrocyte life span and modulates the risk of developing complicated malaria.

Estrategia Tutorial para la formación pedagógica de monitores en la Facultad de Medicina de la Universidad “Katyavala Bwila”, República de Angola / Tutorial Strategy for pedagogical training of monitors at the Faculty of Medicine of the University

Introducción: la Dirección de la Facultad de Medicina de la Universidad “Katyavala Bwila” (FMUKB) en Benguela, Angola, consciente de la necesidad de formar sus propios recursos humanos, inició a partir del año 2011 un proceso de selección y preparación de monitores, para proporcionar una formación pedagógica que permita a los futuros profesionales adquirir las competencias necesarias para ejercer la docencia universitaria.Objetivo: presentar la Estrategia Tutorial para la formación de monitores y el diseño del Programa de Formación Pedagógica que se realiza en la Facultad de Medicina de la Universidad Katyavala Bwila.Método: investigación de corte cualitativo. Se utilizó el análisis documental, la observación no participante, entrevistas a informantes clave y grupo nominal.Resultados: se diseñó una estrategia tutorial que contó con tres etapas: 1- Determinación de problemas y organización, 2- Diseño del programa para la formación de monitores (preparación pedagógica inicial y preparación pedagógica continuada), 3- Evaluación de la estrategia.Conclusiones: los resultados obtenidos hasta el momento demuestran que están creadas las condiciones estructurales necesarias para desarrollar y evaluar el programa de formación. La propuesta de programa de preparación de alumnos que cumplen con los criterios de selección para ser monitores desde los primeros años de la carrera de Medicina es una vía útil de formación de recursos humanos para la docencia en la FMUKB(AU)

Introduction: the Management of the Faculty of Medicine of the University "Katyavala Bwila" (FMUKB) in Benguela, Angola, conscious of the need to form their own human resources, started from the year 2011 a selection process and preparation of monitors to provide a pedagogical training to enable future professionals acquire the competition to exert university teaching skills.Objective: to present the Tutorial Strategy for monitor training and design of the Teacher Training Program to be held in the Faculty of Medicine of the University Katyavala Bwila. Method: qualitative research. Document analysis was used, non-participant observation, interviews to key informants and nominal group.Results: a tutorial strategy with three stages was designed: 1. Problem determination and organization, 2- Design of the program to train monitors (initial and continuing pedagogical training), 3- Evaluation of the strategy.Conclusions: the results up to now show that are created the structural conditions for developing and evaluating the training program. The proposed program of preparation of students who meet the selection criteria to be monitors from the early years of the Medical career is a useful way of human resources training for teaching in FMUKB(AU)

Current status on health sciences research productivity pertaining to Angola up to 2014.

BACKGROUND: Health research driven by the healthcare demands of the population can provide an informative evidence base to support decision-making processes on health policies, programmes, and practices. This paper surveyed the production of scientific research concerning health in Angola, specifically to access the publication rate over time, the main research topics and scientific fields, and the contribution of Angolan researchers and institutions. METHODS: The study focused on data collected in a retrospective literature search in Biblioteca Virtual em Saúde (BVS) as of June 8, 2014, with the keyword "Angola" and on content information in correspondent publications deposited in PubMed. RESULTS: BVS generated 1,029 hits, 74.6 % of which were deposited in PubMed where 301 abstracts were described. From 1979 to 2003, there were 62 publications and in 2004-2013 the quantity increased four-fold (n = 232); malaria was the most frequent topic (n = 42). Angola was the country with the largest number of publications, taking into account the primary affiliation of the first author (n = 45). Universities, institutes, or research centres accounted for 65 % of the publications and in descending order Portugal, Brazil, and the United States of America occupied the three first positions. Epidemiology was by far the most frequent field of research (n = 165). CONCLUSIONS: The number of publications has increased steadily over the past 10 years, with predominance on malaria topics. Angola was the country with the largest number of major affiliations of the first author, but the contribution of Angolan institutions was relatively low, indicating a need to reinforce academic research institutions in the country.

The rise of medical training in Portuguese speaking African countries.

BACKGROUND: Medical training has shown to be strategic for strengthening health systems, especially in those countries identified to have critical shortage of human resources for health. In the past few years, several studies have been conducted to characterize and identify major challenges faced by medical schools worldwide, and particularly in Africa. Nevertheless, none has previously addressed medical training issues in Portuguese Speaking African Countries (PSAC). The aim of this study was to establish baseline knowledge of the PSAC's medical schools in terms of creation and ownership, programmes offered, applicants and registered students, barriers to increased intake of students, teaching workforce and available resources. METHODS: A quantitative, observational, multicentric, cross-sectional study of all medical schools active in 2012 in the PSAC. An adapted version of the questionnaires developed by Chen et al. (2012) was sent to all medical schools electronically. Data were analyzed using descriptive statistics. RESULTS: A total of nine medical schools answered the questionnaire (three from Angola, two from Guinea Bissau and four from Mozambique). Since 2006 an effort has been made to increase the number of medical trainees. Besides the medical degree offered by all schools, some offered other undergraduate and postgraduate training programmes. The number of applicants to medical schools largely outnumbers the available vacancies in all countries but insufficient infrastructures and lack of teaching personnel are important constraints to increase vacancies. The teaching personnel are mainly trained abroad, employed part-time by the medical school and do not have a PhD qualification. CONCLUSION: Governments in the PSAC have significantly invested in training to address medical shortages. However, medical schools are still struggling to give an adequate and effective response. Developing a local postgraduate training capacity for doctors might be an important strategy to help retain medical doctors in the home country and develop local faculty capacity.

Impact of a training course on the quality of malaria diagnosis by microscopy in Angola.

BACKGROUND: In Angola, malaria is an endemic disease having a major impact on the economy. The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as reference method. METHODS: This study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo, Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a written test, the quality of slide preparation and the performance of microscopy. RESULTS: It was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and 98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in any laboratory analysed. DISCUSSION: The findings of this study support the need of continuous refresher training for microscopists and other laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis, such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and qualified personnel.

Desafios da educação médica e da investigação em saúde no contexto de angola / Challenges in medical education and healthcare research in Angola

Os apelos para reformas na educação médica são constantes e têm sido objeto de recomendações produzidas nos últimos cem anos, destacando-se as resultantes da avaliação crítica feita por Abraham Flexner, em 1910, nos Estados Unidos da América. No presente trabalho, abordam-se as tendências e os desafios atuais da educação médica e da investigação em saúde, com ênfase para os países em desenvolvimento, ressaltando-se a realidade africana. Com base na bibliografia consultada, apontam-se e discutem-se alguns desafios que se colocam ao binômio educação médica/investigação em saúde em Angola, muito em especial no contexto da II Região Acadêmica, que integra as províncias de Benguela e Kwanza Sul, destacando-se: (i) a necessidade de incorporar novas abordagens curriculares para o reforço da aprendizagem ao longo da vida; (ii) a aquisição e o desenvolvimento de competências de investigação científica orientadas para a caracterização e intervenção sobre a situação de saúde local; (iii) a inovação dos métodos de ensino e a incorporação de novas tecnologias na educação e prática médica; (iv) a contribuição para o reforço e melhoria da distribuição de médicos na região.

Calls for reforms to medical education are constant and have led to various recommendations over the last 100 years, especially those resulting from critical assessments made by Abraham Flexner in 1910 in the United States. In this paper, we discuss the trends and current challenges affecting medical education and healthcare research, with emphasis on developing countries, highlighting the African reality. Finally, based on the bibliography, we identify and discuss several challenges related to the binomial of medical education/healthcare research in Angola, particularly in the context of the Academic Region II, which includes the provinces of Benguela and Kwanza Sul. The challenges emphasize: (i) the need to incorporate new curricular approaches for strengthening lifelong learning, (ii) the acquisition and development of skills in scientific research aimed at characterizing and intervening in local health; (iii) the innovation in teaching methods and the incorporation of new technologies in education and medical practice and (iv) the contribution to strengthening and improving the distribution of physicians in the region.

NOS2 variants reveal a dual genetic control of nitric oxide levels, susceptibility to Plasmodium infection, and cerebral malaria.

Nitric oxide (NO) is a proposed component of malaria pathogenesis, and the inducible nitric oxide synthase gene (NOS2) has been associated to malaria susceptibility. We analyzed the role of NOS2 polymorphisms on NO bioavailability and on susceptibility to infection, Plasmodium carrier status and clinical malaria. Two distinct West African sample collections were studied: a population-based collection of 1,168 apparently healthy individuals from the Príncipe Island and a hospital-based cohort of 269 Angolan children. We found that two NOS2 promoter single-nucleotide polymorphism (SNP) alleles associated to low NO plasma levels in noninfected individuals were also associated to reduced risk of pre-erythrocytic infection as measured anti-CSP antibody levels (6.25E-04 < P < 7.57E-04). In contrast, three SNP alleles within the NOS2 cistronic region conferring increased NO plasma levels in asymptomatic carriers were strongly associated to risk of parasite carriage (8.00E-05 < P < 7.90E-04). Notwithstanding, three SNP alleles in this region protected from cerebral malaria (7.90E-4 < P < 4.33E-02). Cohesively, the results revealed a dual regimen in the genetic control of NO bioavailability afforded by NOS2 depending on the infection status. NOS2 promoter variants operate in noninfected individuals to decrease both NO bioavailability and susceptibility to pre-erythrocytic infection. Conversely, NOS2 cistronic variants (namely, rs6505469) operate in infected individuals to increase NO bioavailability and confer increased susceptibility to unapparent infection but protect from cerebral malaria. These findings corroborate the hypothesis that NO anti-inflammatory properties impact on different steps of malaria pathogenesis, explicitly by favoring infection susceptibility and deterring severe malaria syndromes.