Psicologia escolar na educação superior: demandas apresentadas por coordenadores de cursos / School psychology in higher education: demands presented by course coordinators / Psicología escolar en educación superior: demandas presentadas por coordinadores de cursos

A Psicologia Escolar e Educacional vem conquistando novos espaços para a atuação e campo de pesquisa, dentre eles, destacamos a educação superior. Assim, este estudo teve por objetivo conhecer as demandas apresentadas por coordenadores de cursos de graduação, analisá-las à luz da Psicologia Escolar na vertente crítica e apontar possibilidades de atuação do psicólogo escolar junto a estes. A pesquisa, de caráter qualitativo, foi realizada a partir da análise de conteúdo das respostas obtidas dos questionários enviados por e-mail aos coordenadores dos 77 cursos de graduação oferecidos por uma instituição pública de ensino superior de Minas Gerais. Contamos com 28 questionários respondidos. As demandas apresentadas referem-se a questões acadêmicas e emocionais dos estudantes; sobrecarga de trabalho docente; relações interpessoais e formação continuada; burocracias enfrentadas pelos coordenadores; além da falta de preparação prévia e apoio para o exercício da função e concepções sobre o trabalho do psicólogo escolar. Concluímos que o coordenador, ao ouvir e compreender demandas advindas de discentes, docentes e técnicos, responde a elas por meio de uma parceria auspiciosa com o psicólogo escolar, juntamente com outros segmentos e instâncias da instituição.(AU)

The School and Educational Psychology has been conquering new spaces for professional performance and research field, among them, we highlight Higher Education. Therefore, this study aimed to get the demands presented by coordinators of undergraduate courses and analyze them in the light of School Psychology in the critical perspective and to point out possibilities for the performance of the school psychologist with them. The qualitative research was carried out based on the content analysis of the answers obtained from the questionnaires sent by e-mail to the coordinators of the 77 undergraduate courses offered by a public Higher Education institution in Minas Gerais. We have 28 answered questionnaires. The demands presented refer to students' academic and emotional issues; the overload of teaching work; interpersonal relationships and continuing education; the bureaucracies faced by coordinators; and the lack of prior preparation and support for the practice of the function and conceptions about the work of the school psychologist. We conclude that the coordinator, when listening to and understanding demands from students, teachers, and technicians, seeks to respond to them with an auspicious partnership with the school psychologist, together with other segments and instances of the institution.(AU)

La Psicología Escolar y Educacional sigue conquistando nuevos espacios para la actuación y campo de investigación, entre ellos destaca la educación superior. Por lo tanto, este estudio tuvo como objetivo conocer las demandas presentadas por los coordinadores de cursos de graduación, analizarlas desde la perspectiva crítica de la Psicología Escolar y señalar posibilidades de actuación del psicólogo escolar. La investigación cualitativa realizó el análisis de contenido de las respuestas obtenidas de los cuestionarios enviados por correo electrónico a los coordinadores de los 77 cursos ofrecidos por una institución pública de educación superior en Minas Gerais (Brasil). Se respondieron 28 cuestionarios. Las demandas presentadas se refieren a cuestiones académicas y emocionales de los estudiantes; a la sobrecarga del trabajo docente; a las relaciones interpersonales y educación continua; a las burocracias que enfrentan los coordinadores; además de la falta de preparación previa y apoyo para el ejercicio de la función y concepciones sobre el trabajo del psicólogo escolar. Se concluye que el coordinador escucha y considera las demandas de los estudiantes, profesores y técnicos, y trata de responderlas por medio de una asociación favorable con el psicólogo escolar, junto con otros segmentos e instancias de la institución.(AU)

Effectiveness of a brief intervention for acceptance of influenza vaccine in reluctant primary care patients / Efectividad del consejo breve para la vacunación antigripal en pacientes reacios en atención primaria

Objective: To determine the effectiveness of a brief intervention in increasing influenza vaccination coverage compared with the usual advice in people who refuse it, and to record the main reasons for refusing to be vaccinated. Method: A cluster randomized clinical trial was conducted in which the study population was individuals with high risk factors who initially had refused to be vaccinated against influenza. Professionals (doctors and nurses) who voluntarily accepted to participate were assigned randomly to the intervention group (brief intervention) and the control group (usual advice). Results: 57 professionals recruited 524 people who had previously declined the influenza vaccination (271 in the control group and 253 in the intervention group). Brief intervention showed its effectiveness with an odds ratio of 2.48 (1.61-3.82; p < 0.001), in individuals aged 60 or over, both healthy or with risk factors. The most frequent reasons for rejection of vaccination were the belief that there was no risk of getting sick (53.0%) and the fear of the side effects (33.3%). (AU)

Objetivo: Determinar la efectividad del consejo breve para la vacunación antigripal frente al consejo habitual en personas que la rechazan, y conocer los principales motivos de rechazo. Método: Se realizó un ensayo clínico aleatorizado por clusters, en el que la población de estudio eran personas con factores de riesgo y que inicialmente rechazaban vacunarse. Los/las profesionales (médicos/as y enfermeros/as) que aceptaron participar se distribuyeron aleatoriamente en un grupo de intervención (consejo breve) y un grupo de control (consejo habitual). Resultados: Cincuenta y siete profesionales reclutaron 524 personas que rechazaron la vacunación (271 en el grupo control y 253 en el grupo de intervención). El consejo breve demostró su efectividad, con una odds ratio de 2,48 (1,61-3,82; p < 0.001), en las personas de 60 años o más, sanos o con factores de riesgo. Los principales motivos para no vacunarse fueron la creencia de no estar en riesgo de enfermar (53,0%) y el miedo a los efectos secundarios (33,3%). Conclusiones: El consejo breve es una herramienta efectiva para mejorar las coberturas de vacunación en personas que la rechazan inicialmente. (AU)

Trascendencia de los Comités de Ética de Investigación en Seres Humanos en el Ecuador / Research Ethics Committees of Human Beings in Ecuador

INTRODUCCIÓN. Los Comités de Ética de Investigación en Seres Humanos deben proteger la dignidad, los derechos, el bienestar y la seguridad de los sujetos investigados; evalúan aspectos éticos, metodológicos y jurídicos de los protocolos de investigación, competencia otorgada por el ente sanitario del país que ameritó observar si se cumplió. OBJETIVO. Evaluar la situación de los Comités de Ética de Investigación en Seres Humanos, basados en la percepción del cursillista, la normativa, las repercusiones y consecuencias para mantener su condición activa y su trascendencia. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal y ambispectivo con un universo de 1 327 profesionales del área de la salud y una muestra de 385 encuestados que expresaron su percepción sobre trece Comités de Ética de Investigación en Seres Humanos a nivel nacional, con revisión bibliográfica nacional e internacional, se excluyeron los suspendidos. Se aplicó encuesta validada online, período abril a octubre de 2019. Data analizada en Excel y SPSS versión 23. RESULTADOS. El 76,92% Comités de Ética de Investigación en Seres Humanos fueron de la ciudad de Quito. Los cursillistas percibieron que el 64,16%, no trascendieron en su labor; desconocieron que: la Dirección Nacional de Inteligencia de la Salud, cuestionó el nombramiento de algún miembro un 97,14%; el cuestionamiento estuvo basado en la norma vigente un 79,48%; sobre la aprobación del plan anual de capacitación en investigación, 2019, un 95,06%; el plan anual de capacitación específico un 77,40%, y no recibieron directrices ni retroalimentación en temas de capacitación en calidad de investigador, un 90,39%. Además, percibieron que los Comités fueron responsables de capacitar otros Comités de ética de Investigación en Seres Humanos, un 81,82% y a los investigadores, un 85,71%; que deben elaborar el plan anual de educación específica para los miembros del comité, un 89,35%. CONCLUSIÓN. Se identificó entre los problemas que los investigadores casi no los conocen y hay necesidad de actualizar la norma que afectó el funcionamiento. Los justificativos para mantener la condición activa no se cumplieron, se evidenció la necesidad de asesoría para los comités por parte de las autoridades competentes, sin lograr conformación consolidada con actores y repercutió en su trascendencia.

INTRODUCTION. The Research Ethics Committees on Human Beings must protect the dignity, rights, well-being and safety of the research subjects; evaluate ethical, methodological and legal aspects of the research protocols, a competence granted by the health entity of the country that merited see if it is done. OBJECTIVE. Evaluate the situation of the Ethics Committees for Research in Human Beings, based on the perception of the trainee, the regulations, the repercussions and consequences to maintain their active condition and their transcendence. MATERIALS AND METHODS. Descriptive, cross-sectional and ambispective study with a universe of 1,327 professionals in the health area and a sample of 385 respondents who expressed their perception of thirteen Research Ethics Committees on Human Beings at the national level, with national and international bibliographic review. those suspended were excluded. An online validated survey was applied, from April to October 2019. Data analyzed in Excel and SPSS version 23. RESULTS. 76.92% Human Research Ethics Committees were from the city of Quito. The trainees perceived that 64,16%, did not transcend in their work; they did not know that: the National Directorate of Health Intelligence, questioned the appointment of a member 97,14%; the questioning was based on the current norm 79,48%; on the approval of the annual research training plan, 2019, 95,06%; the specific annual training plan 77,40%, and did not receive guidelines or feedback on training issues as a researcher, 90,39%. In addition, they perceived that the Committees were responsible for training other Human Beings Research Ethics Committees, 81,82% and the researchers, 85,71%; that they must prepare the annual specific education plan for the members of the committee, 89,35%. CONCLUSION. It was identified among the problems that the researchers hardly know them and there is a need to update the norm that affected the operation. The justifications to maintain the active condition were not fulfilled, the need for advice for the committees by the competent authorities was evidenced, without achieving a consolidated conformation with actors and had repercussions on its importance. hardly know them and there is a need to update the norm that affected the operation. The justifications to maintain the active condition were not fulfilled, the need for advice for the committees by the competent authorities was evidenced, without achieving a consolidated conformation with actors and had repercussions on its importance.

Construção e validação de simulação clínica sobre testagem e aconselhamento para o hiv em gestantes / Construction and validation of a clinical simulation on hiv testing and counseling in pregnant women / Construcción y validación de un simulacro clínico sobre pruebas y asesoramiento del vih en mujeres embarazadas

RESUMO Objetivo: construir e validar um cenário de simulação clínica sobre a testagem rápida e aconselhamento para o HIV em gestantes. Método: estudo metodológico, de validação de aparência e conteúdo, desenvolvido no período de junho a outubro de 2020 por meio da técnica Delphi. Para a validação, foram incluídos os juízes que obtiveram cinco ou mais pontos segundo os critérios de Fehring adaptados. Os dados foram analisados mediante o cálculo do Índice de Validade de Conteúdo (IVC). Resultados: depois da primeira rodada Delphi, dois itens (5,7%) não atingiram o I-CVI necessário para validação em todos os critérios avaliados, que foram: comportamental, objetividade, simplicidade, clareza, relevância, precisão, variedade, modalidade, tipicidade e credibilidade. Ao final da segunda rodada Delphi, todos os itens (100%) atingiram o I-CVI necessário para validação. Conclusão: o roteiro se mostrou válido, contribuindo para subsidiar o ensino da testagem e do aconselhamento de gestante sobre o HIV.

ABSTRACT Objective: to construct and validate a clinical simulation scenario on rapid HIV testing and counseling in pregnant women. Method: methodological study, of appearance and content validation, developed between June and October 2020 through the Delphi technique. For validation, the judges who obtained five or more points according to the adapted Fehring criteria were included. The data were analyzed by calculating the Content Validity Index (CVI). Results: After the first Delphi round, two items (5.7%) did not reach the I-CVI required for validation in all the criteria evaluated, which were: behavioral, objectivity, simplicity, clarity, relevance, accuracy, variety, modality, typicality, and credibility. At the end of the second Delphi round, all items (100%) reached the I-CVI required for validation. Conclusion: the script proved to be valid, contributing to subsidize the teaching of HIV testing and counseling of pregnant women.

RESUMEN Objetivo: construir y validar un escenario de simulación clínica sobre pruebas rápidas y asesoramiento para el VIH en mujeres embarazadas. Método: estudio metodológico, de valoración de la apariencia y el contenido, desarrollado en el período de junio a octubre de 2020 mediante la técnica Delphi. Para la validación, se incluyeron los jueces que obtuvieron cinco o más puntos según los criterios adaptados de Fehring. Los datos se analizaron calculando el Índice de Validez del Contenido (IVC). Resultados: Tras la primera ronda Delphi, dos ítems (5,7%) no alcanzaron el I-CVI requerido para la validación en todos los criterios evaluados, que fueron: comportamiento, objetividad, simplicidad, claridad, relevancia, precisión, variedad, modalidad, tipicidad y credibilidad. Al final de la segunda ronda Delphi, todos los ítems (100%) alcanzaron el I-CVI requerido para la validación. Conclusión: el rodillo se mostró válido, contribuyendo a subvencionar la enseñanza de la prueba y el asesoramiento de gestores sobre el VIH.

Strengthening access to long-acting reversible contraception within postabortion care in Tanzania: A pre-post evaluation

Postabortion care services provide lifesaving treatment for abortion-related complications and addresses women's needs by offering family planning (FP) counseling and voluntary access to contraception. Between 2016 and 2020, the Government of Tanzania sought to strengthen its PAC program by enhancing FP counseling and clients' access to a wide range of contraceptive options.The project team conducted a pre-post evaluation in 17 public sector healthcare facilities in mainland Tanzania and 8 in Zanzibar. It comprised structured client exit interviews (CEIs), completed first in 2016 (n=412) and again in 2020 (n=484). These data complemented an evaluation that used routine service statistics to demonstrate the intervention's effects on client-reported outcomes. Primary outcomes of the CEIs reflected client experience and satisfaction with services, and researchers compared prepost differences using chi-square tests. There were improvements in numerous indicators, including client waiting times, recall of emergency procedure counseling, contraceptive uptake, and satisfaction with the quality of overall counseling and FP information and services; however, triangulation of CEI data with service statistics indicated that some outcomes, though still improved since baseline, attenuated. Strengthening the FP component of PAC is feasible in Tanzania and Zanzibar, but strategies to sustain quality improvements over time are needed. (Afr J Reprod Health 2022; 26[5]: 28-40)

Abordaje integral de la interrupción voluntaria del embarazo (primera entrega) / Comprehensive approach to the voluntary interruption of pregnancy (first issue)

En enero de 2021 entró en vigencia en Argentina la ley de Interrupción Voluntaria del Embarazo (IVE). Este cambio en la legislación implica una modificación sustancial de la práctica médica. En una serie de artículos, el equipo PROFAM comparte su punto de vista a través de una adaptación de su material educativo sobre la IVE. En esta primera entrega, las autoras abordan la aplicación de las cuestiones legales que determinan la práctica, la consejería general, y algunos lineamientos de cómo actuar ante la situación de un diagnóstico de embarazo inesperado. (AU)

In January 2021, the Voluntary Interruption of Pregnancy (VIP) law came into force in Argentina. This change in legislation implies a substantial modification regarding medical practice. In a series of articles, the PROFAM team shares its point of view through an adaptation of its educational material on the VIP. In this first issue, the authors address the application of the legal aspects that determine the practice, general counselling, and some guidelines on how to act when faced with a diagnosis of an unexpected pregnancy. (AU)

Consejería personalizada en salud en personas con enfermedades crónicas / Personalized health counseling for people with chronic diseases

La Consejería Personalizada en Salud es considerada una herramienta de ayuda para propiciar cambios especialmente relacionados con estilos de vida. Objetivo: Describir las bases teóricas de la consejería y su aplicación en la práctica clínica. Se identifican los objetivos, las etapas y la metodología de trabajo de la consejería. La Consejería Personalizada en Salud es una herramienta inherente al conocimiento y crecimiento personal, para tratar cambios en salud sobre todo en enfermedades de tipo crónico no transmisible. (AU)

Personalized Health Counseling is considered a helpful tool to promote changes especially related to lifestyles. Objective: Describes the theoretical bases of counseling, and its application in clinical practice. The objectives, stages, and work methodology of the counseling are identified. Personalized Health Counseling is a tool inherent to knowledge and personal growth, to treat changes in health, especially in non-communicable chronic diseases. (AU)

Aconselhamento diretivo como instrumento para melhoria nos índices de aleitamento materno exclusivo: uma revisão integrativa / La consejería directiva como herramienta para mejorar las tasas de lactancia materna exclusiva: una revisión integradora / Advice as an instrument for improvement in exclusive breastfeeding indices: and integrative review

Objetivo: identificar, na literatura científica, publicações sobre como o aconselhamento diretivo serve de instrumentopara melhoria nos índices de aleitamento materno exclusivo. Método: trata-se de um estudo qualitativo, do tipo revisão integrativa, realizado nas bases de dados Scielo, PubMed, Lilacs, Cinahl e BVS, na série temporal de 2009 a 2019, nos idiomas português e inglês, com os descritores e operadores booleanos. Resultados: foram encontrados 757 artigos que após identificação dos critérios e análise, apenas 21 artigos foram selecionados. Evidenciou-se que não receber informações sobre amamentação no pré-natal interfere na manutenção do aleitamento materno. Nesse sentido, os estudos reforçam a necessidade de práticas de apoio que favoreçam a escolha e manutenção do aleitamento materno. Conclusão: a maioria dos estudos demonstrou impacto positivo na manutenção do aleitamento materno exclusivo quando utilizado o aconselhamento profissional para auxiliar possíveis intervenções no decorrer da amamentação. (AU)

Objective: to identify, in the scientific literature, publications on how directive counseling serves as an instrumentto improve the rates of exclusive breastfeeding. Method: this is a qualitative study, integrative review type, carried out in the Scielo, PubMed, Lilacs, Cinahl and BVS databases, in the time series from 2009 to 2019, in Portuguese and English, with Boolean descriptors and operators. Results: 757 articles were found, after identification of the criteria and analysis, only 21 articles were selected. lt was evident that not receiving information about breastfeeding in the prenatal period interferes with the maintenance of breastfeeding. ln this sense, the studies reinforce the need for supportive practices that favor the choice and maintenance of breastfeeding. Conclusion: most studies have shown a positive impact on maintaining exclusive breastfeeding when professional counseling is used to assist possible interventions during breastfeeding.(AU)

Objetivo: identificar, en la literatura científica, publicaciones sobre cómo lo consejería directiva sirve como instrumentopara mejorar las tasas de lactancia materna exclusiva. Método: se trata de un estudio cualitativo, tipo revisión integradora, realizado en las bases de datos Scielo, PubMed, Lilacs, Cinahl y BVS, en la serie temporal de 2009 a 2019, en portugués e inglés, con descriptores y operadores booleanos. Resultados: se encontraron 757 artículos, luego de identificar los criterios y análisis, solo se seleccionaron 21 artículos. Fue evidente que no recibir información sobre la lactancia materna en el período prenatal interfiere con el mantenimiento de la lactancia materna. En este sentido, los estudios refuerzan la necesidad de prácticas de apoyo que favorezcan la elección y el mantenimiento de la lactancia materna. Conclusión: la mayoría de los estudios han demostrado un impacto positivo en el mantenimiento de la lactancia materna exclusiva cuando se utiliza la asesoría profesional para ayudar a posibles intervenciones durante la lactancia(AU)

Self-medication consultations in community pharmacy: an exploratory study on teams' performance, client-reported outcomes and satisfaction

BACKGROUND: Community pharmacy teams (CPTs) have an established role in assisting self-medication, contributing to the safe and effective use of non-prescription medicines. OBJECTIVE: The study aimed to describe CPTs' performance in self-medication consultation, client-reported outcomes, and satisfaction. A secondary purpose was to develop an explanatory model for better understanding clients' satisfaction with this service. METHODS: Descriptive, cross-sectional exploratory study. Data were collected in a purposive sample of pharmacy clients recruited in six community pharmacies in Portugal. CPTs adopted a structured approach to self-medication consultations, encompassing 11 quality criteria (five for case evaluation and six for counselling). An evaluation score, a counselling score and an overall quality score were estimated. Client-reported outcomes and satisfaction were ascertained via a follow-up telephone interview. Besides descriptive statistics, the association with several independent variables on the clients' overall satisfaction was explored, using linear regression. RESULTS: Product-based dispensing was more frequent for lower educated clients. Reported compliance with the criteria by CPTs was overall high (93.95% of maximum compliance), mostly missing the 'other medication' questioning. Most clients (93%) reported improvement after the consultation. Clients' satisfaction score was 4.70 out of 5. The variables that seem to better explain clients' overall satisfaction are pharmacy loyalty, the evaluation score, and the female gender. CONCLUSIONS: Clients' reported outcomes were favourable, as well as satisfaction with the service. Clients' satisfaction appears to be determined by consultation quality (evaluation score), suggesting the advancement of the pharmacists' clinical role. A larger study is warranted to confirm these findings

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Percepções sobre o plantão psicológico em uma Delegacia de Defesa da Mulher / Percepciones sobre el turno psicológico en una Estación de Defensa de la Mujer / Perceptions du soutien psychologique dans un Commissariat de défense de la Femme / Perceptions about the emergency psychological service at a Women's Police Station

Resumo O plantão psicológico realizado em Delegacia de Defesa da Mulher (DDM) é uma ferramenta no combate à violência contra a mulher. Entretanto as plantonistas estão inseridas em um ambiente de muita carga emocional. Objetivou-se analisar as percepções das plantonistas e agentes de uma DDM sobre a violência de gênero e seus impactos psíquicos no cotidiano pessoal e de trabalho dessas mulheres. Entrevistaram-se 23 mulheres com idade entre 19 e 56 anos (M=28, 26; DP=10, 15), e o material coletado foi analisado pelo software Iramuteq. Foram avaliados 1.304 segmentos de texto, gerando uma retenção de 98,27% do total, os quais conceberam seis classes, dentre as quais a de maior expressividade foi a classe 1 "impacto da violência", com 21,55% dos segmentos de texto. Desgastes físicos e emocionais são desencadeados pelos atendimentos, porém as plantonistas e agentes da DDM não recebem apoio emocional para realizar suas funções, tendo assim que desenvolver estratégias de enfrentamento pessoal.

Resumen El turno psicológico realizado en Estación de Defensa de la Mujer (EDM) es una herramienta para combatir la violencia contra la mujer. Sin embargo, los oficiales de guardia se encuentran insertados en el ambiente de mucha carga emocional. Este estudio tuvo como objetivo analizar las percepciones de los oficiales de guardia y de agentes de EDM sobre la violencia de género y sus impactos psíquicos en la rutina personal y laboral de estas mujeres. Se entrevistó a 23 mujeres, de entre 19 y 56 años (M=28,26; DE=10,15), y para el análisis de datos se utilizó el software Iramuteq. Se analizaron 1.304 segmentos de texto, que generó retención del 98,27% del total, en seis clases, la más expresiva fue la clase 1 "impacto de la violencia", con el 21,55% de segmentos de texto. El desgaste físico y emocional se desencadena por la asistencia, pero el personal de guardia y los agentes de EDM no reciben apoyo emocional para desempeño de sus funciones, por lo que se debe desarrollar estrategias de afrontamiento personal.

Résumé Le Soutien Psychologique tenu au Commissariat de défense de la femme (CDF) est un outil de lutte contre violence envers les femmes ; cependant, les femmes en service sont insérés dans un environnement à forte charge émotionnelle. L'objectif était d'analyser les perceptions des officiers et agents de service d'un CDF sur la violence de genre et ses impacts psychiques sur leurs quotidien personnelle et professionnelle. Nous avons interviewées 23 femmes âgées de 19 à 56 ans (M=28,26; ET=10,15), et les donnés ont été analysé par le logiciel Iramuteq. Au total, 1304 segments de texte ont été analysés, générant une rétention de 98,27% du total, qui engendrait six classes, parmi lesquelles la plus expressive était la classe 1 "impact de la violence", avec 21,55% des segments de texte. L'usure physique et émotionnelle est déclenchée per le service, mais les officiers et les agents de service du CDF ne reçoivent pas de soutien émotionnel pour remplir leurs fonctions, et doivent donc développer des stratégies d'adaptation personnelle.

Abstract The emergency psychological service held at Women's Police Stations (DDMs) is a tool in the combat against women violence. However, on-duty emergency workers are included in an emotionally intense environment. We aimed at analyzing the perceptions of DDM on-duty emergency workers and agents about gender violence, as well as its psychic impacts on their personal and work routines. We interviewed 23 women aged between 19 and 56 (M=28, 26; DP=10, 15), and analyzed the obtained data using IRAMUTEQ. We evaluated 1,304 text segments, retaining 98.27% of the total, which originated six classes. The most expressive among those was Class 1 "service impact", with 21.55% of the text segments. Even though the emergency psychological service triggers physical and emotional wear and tear, DDM on-duty emergency workers and agents do not receive emotional support to perform their functions, thus developing personal coping strategies.

Criação e implantação do Centro de Testagem e Aconselhamento para o Vírus da Imunodeficiência Humana em Nova Iguaçu: contribuições de Enfermagem / Creation and implementation of the Testing and Counseling Center for the Human Immunodeficiency Virus in Nova Iguaçu: contributions from Nursing

Trata-se de um estudo histórico-social, de abordagem qualitativa, na perspectiva da História do Tempo Presente, cujo cenário foi o Centro de Testagem e Aconselhamento do município de Nova Iguaçu. As fontes históricas diretas escritas constituíram-se de Manuais, projeto de criação do CTA de Nova Iguaçu, relação nominal da equipe de profissionais, fôlder de eventos científicos, entre outros; as fontes diretas orais constaram de 11 entrevistas; as fontes indiretas foram artigos científicos e livros sobre o tema. Esta pesquisa tem como objeto de estudo: a atuação do enfermeiro no processo de criação e implantação do Centro de Testagem e Aconselhamento (CTA) para HIV/Aids, do município Nova Iguaçu. O marco inicial é o ano de 1995, quando tiveram início as atividades do CTA/NI. Nesse mesmo ano, foi publicada a Portaria n.o 931, de 1995, que designava um enfermeiro como Gerente Técnico da Unidade de Gerenciamento Municipal do Programa de DST/Aids, no município do estudo. O marco final é o ano de 1996, mediante a consolidação do CTA, com atendimento expressivo de usuários nesse curto período ‒ ou seja, 851 atendimentos de julho de 1995 a dezembro de 1996. Os objetivos da Tese foram: Descrever o processo de criação do Centro de Testagem e Aconselhamento no município de Nova Iguaçu; Analisar as estratégias ou lutas simbólicas empreendidas pelo enfermeiro no processo de criação do Centro de Testagem e Aconselhamento, no município de Nova Iguaçu; Discutir os efeitos simbólicos para os enfermeiros que atuaram nas ações de prevenção, controle e tratamento do HIV/Aids no Centro de Testagem e Aconselhamento, no município de Nova Iguaçu. Os resultados: no Brasil, em meados do século XX, o aparecimento da Aids considerada ‒ nova doença no campo da saúde ‒, causou um grande impacto na sociedade em função da alta mortalidade e do estigma ao doente. No sentido de minimizar os efeitos da epidemia, algumas iniciativas foram implementadas pelas autoridades de saúde, à época, como a criação do Centro de Testagem e Aconselhamento, em âmbito nacional. pesquisa evidenciou que, para a criação do Centro de Testagem e Aconselhamento para HIV/Aids de Nova Iguaçu, houve um grande investimento por parte do enfermeiro, designado Gerente Técnico da Unidade de Gerenciamento de DST/Aids. Iniciado em 1995, tal Centro alinhou-se com a Política de Saúde nacional, com a elaboração do Projeto de Criação do COAS/CTA, a escolha do local adequado para funcionamento do Centro, a composição da equipe de saúde, a capacitação dos profissionais visando um novo fazer, além da realização de cursos e eventos científicos, com a divulgação de conhecimentos sobre a temática. Foi possível concluir que o enfermeiro, apoiado por uma aliança pactuada com o Secretário de Saúde do Município de Nova Iguaçu, em atender às exigências para o controle da epidemia, na região, contribuiu para que o CTA atendesse aos critérios e objetivos determinados pelo Programa Nacional de Controle de DST/Aids. Dessa forma, o enfermeiro se destacou, empreendendo eficazes estratégias, e alcançou resultados significativos nas ações de prevenção, diagnóstico e tratamento do HIV/Aids. À medida que participava desse investimento, transformava-se em porta-voz legítimo de um discurso autorizado no campo da infectologia em Nova Iguaçu. Assim, a incorporação de um novo serviço reconfigurou o habitus profissional nas ações para o controle da epidemia, evidenciando sua importância enquanto integrantes da equipe de saúde e com ganhos simbólicos para a enfermagem.

This is a historical-social study, with a qualitative approach, from the perspective of the History of the Present Time, whose setting was the Testing and Counseling Center (TCC) in the city of Nova Iguaçu. The direct written historical sources consisted of Manuals, the creation project of the TCC of Nova Iguaçu, nominal list of the team of professionals, folder of scientific events, among others; direct oral sources consisted of 11 interviews; indirect sources were scientific articles and books on the subject. This research has as its object of study: the role of nurses in the process of creation and implementation of the Testing and Counseling Center (TCC) for HIV/AIDS, in the municipality of Nova Iguaçu. The initial milestone is the year 1995, when the activities of the TCC/NI began. In that same year, Ordinance No. 931, of 1995, was published, which designated a nurse as Technical Manager of the Municipal Management Unit of the STD/AIDS Program in the municipality of the study. The final milestone is the year 1996, through the consolidation of the TCC, with expressive service to users in this short period ‒ that is, 851 assistances from July 1995 to December 1996. The objectives of the Thesis were: Describe the process of creating the Testing and Counseling Center in the municipality of Nova Iguaçu; To analyze the strategies or symbolic struggles undertaken by nurses in the process of creating the Testing and Counseling Center, in the city of Nova Iguaçu; Discuss the symbolic effects for nurses who worked in the actions of prevention, control and treatment of HIV/AIDS at the Testing and Counseling Center, in the city of Nova Iguaçu. The results: in Brazil, in the mid-twentieth century, the emergence of AIDS, considered a new disease in the health field, caused a great impact on society due to the high mortality and stigma to the patient. In order to minimize the effects of the epidemic, some initiatives were implemented by the health authorities at the time, such as the creation of the Testing and Counseling Center, nationwide. The research showed that, for the creation of the HIV/AIDS Testing and Counseling Center in Nova Iguaçu, there was a large investment by the nurse, designated as Technical Manager othe STD/AIDS Management Unit. Beginning in 1995, this Center aligned itself with the national Health Policy, with the elaboration of the OSSC/TCC Creation Project, the choice of the appropriate place for the Center to function, the composition of the health team, the training of professionals aiming a new task, in addition to holding courses and scientific events, with the dissemination of knowledge on the subject. It was possible to conclude that the nurse, supported by an alliance agreed with the Secretary of Health of the Municipality of Nova Iguaçu, in meeting the requirements for the control of the epidemic in the region, contributed to the TCC meeting the criteria and objectives determined by the National Program of STD/AIDS Control. Thus, the nurse stood out, undertaking effective strategies, and achieved significant results in HIV/AIDS prevention, diagnosis and treatment actions. As he participated in this investment, he became the legitimate spokesperson for an authorized discourse in the field of infectious diseases in Nova Iguaçu. Thus, the incorporation of a new service reconfigured the professional habitus in actions to control the epidemic, highlighting their importance as members of the health team and with symbolic gains for nursing.

Health advice on alcohol consumption in pregnant women in Seville (Spain) / Consejo sanitario sobre el consumo de alcohol en embarazadas de Sevilla (España)

OBJECTIVE: To analyse to what extent pregnant women remembered having received health advice regarding alcohol consumption during pregnancy, what the message they perceived was and whether there is social inequality in this regard. METHOD: A cross-sectional descriptive study was performed with a sample of 426 pregnant women (in their 20th week of pregnancy) receiving care in the outpatient clinics of a university hospital in a southern Spanish city (Seville). The data were collected through face-to-face structured interviews carried out by trained health professionals. RESULTS: 43% of the interviewed women stated that they had not received any health advice in this regard. Only 43.5% of the sample remembered having received the correct message (not to consume any alcohol at all during pregnancy) from their midwife, 25% from their obstetrician and 20.3% from their general practitioner. The women with a low educational level were those who least declared having received health advice on the issue. CONCLUSION: The recommended health advice to avoid alcohol consumption during pregnancy does not effectively reach a large proportion of pregnant women. Developing institutional programmes which help healthcare professionals to carry out effective preventive activities of foetal alcohol spectrum disorder is needed

OBJETIVO: Analizar en qué medida las gestantes recuerdan haber recibido asesoramiento sanitario sobre el consumo de alcohol durante el embarazo, cuál es el mensaje percibido y si existe desigualdad social al respecto. MÉTODO: Se realizó un estudio transversal descriptivo con 426 mujeres en su semana 20 de embarazo en las consultas externas de un hospital universitario de Sevilla (España). Los datos se recopilaron mediante entrevistas estructuradas cara a cara realizadas por profesionales sanitarias entrenadas. RESULTADOS: El 43% de las entrevistadas afirmaron no haber recibido consejo sanitario alguno al respecto. Solo el 43,5% dijeron que habían recibido el mensaje correcto (no beber absolutamente nada de alcohol durante el embarazo) por parte de la matrona, el 25% por el obstetra y el 20,3% por el médico de atención primaria. Las embarazadas con menor nivel educativo fueron las que menos refirieron haber recibido asesoramiento sanitario sobre el tema. CONCLUSIÓN: El consejo sanitario adecuado (evitar todo consumo de alcohol durante el embarazo) no llega de manera efectiva a una amplia proporción de las gestantes. Es necesario desarrollar programas institucionales que posibiliten que los profesionales sanitarios puedan llevar a cabo con eficacia actividades preventivas de los trastornos del espectro alcohólico fetal

Una cosa es predicar, y otra dar trigo (cosas de la nutrición) / Actions speak louder than words (nutrition issues)

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Analysis of dispatcher-assisted cardiopulmonary resuscitation instructions to laypersons in an out-of-hospital cardiac arrest / Análisis de las instrucciones de la reanimación cardiopulmonar guiada por teléfono en paradas cardiacas extrahospitalarias atendidas por ciudadanos

Randomized simulation trial to analyze dispatcher-assisted cardiopulmonary resuscitation instructions provided from the emergency call center in an out-of-hospital heart arrest assisted by lay persons. An analysis of the telephone instructions was performed using a 14-item checklist by two external researchers. Simulations lasted nine minutes. Twenty-one volunteers were enrolled. All of them started resuscitation maneuvers. Telephone instructions were verbalized in very heterogeneous ways. Half of the indicators exceeded 90% compliance. Frequently the recommendation of push hard and fast on the patient's chest was omitted and the dispatcher tended to mark a slower compression rate. The average time from the call to the start of the resuscitation was 3 min 33 s (SD: 1 min 7 s). The telephone instructions were verbalized in a very heterogeneous way. It is necessary to standardize and provide training in how to guide a dispatcher-assisted resuscitation

Estudio de simulación para analizar el contenido de las instrucciones telefónicas de reanimación cardiopulmonar emitidas por un centro coordinador de urgencias durante la parada cardiaca extrahospitalaria asistida por ciudadanos sin entrenamiento. Cada simulación duró nueve minutos. El análisis de las instrucciones telefónicas fue realizado por dos observadores mediante una lista de comprobación de catorce indicadores. Participaron veintiún voluntarios. Todos fueron capaces de iniciar maniobras de reanimación. La mitad de los indicadores superaron el 90% de cumplimiento. Frecuentemente se omitió la necesidad de comprimir fuerte y rápido el tórax, con tendencia a marcar un ritmo de compresiones lento. El tiempo medio desde la llamada hasta el inicio de la reanimación fue de 3 min 33 s (DE: 1 min 7 s). Las instrucciones telefónicas se verbalizaron de formas muy heterogéneas. Es preciso normalizar y entrenar la forma de guiar telefónicamente una reanimación

Actividad de un servicio de medicina legal hospitalaria del siglo XXI / Activity of a 21st century hospital medico-legal department

INTRODUCCIÓN: La implantación de un Servicio de medicina legal hospitalaria, como asesor y consultor en aspectos médico-legales, éticos y deontológicos de la práctica asistencial, se ha consolidado en el Hospital Clínico de San Carlos de Madrid. Una cartera de servicios sencilla basada en la prevención de riesgos legales, ha permitido que los profesionales, la administración sanitaria y los propios pacientes confíen en él. RESULTADOS: En el período 2007-2017 se gestionaron 1.213 expedientes, aumentando de forma progresiva y destacando los años 2009 y 2017 con un 13,8 y 12,3% de la actividad total, respectivamente. Las unidades que más consultaron fueron el equipo directivo 158 (13%), el Instituto de la Mujer 144 (11,9%) y el Servicio de Atención al Paciente 116 (9,6%). DISCUSIÓN Y CONCLUSIONES: El servicio participa en múltiples comisiones y grupos de trabajo elaborando guías, documentos y protocolos, abordando conflictos, dudas normativas, deficiencias formativas, recomendando cursos de acción, e intermediando con pacientes y familiares para disminuir la incertidumbre del profesional

INTRODUCTION: A hospital legal medicine department, to advice and consult on the legal, ethical and deontological aspects of healthcare practice, has been implemented in our centre, Hospital Clínico San Carlos (Madrid Spain). A simple service portfolio based on the prevention of legal risks, has allowed professionals, health service and patients to place their trust in it. RESULTS: The number of cases over the period 2007-2017 reflects major activity, and 2009 and 2017 are highlighted with 13.8% and 12.3% of the total activity respectively. The units that consulted the most were the management team 158 (13%), the Institute for Women's Affairs 144 (11.9%) and the Patient Care Service 116 (9.6%). DISCUSSION AND CONCLUSIONS: The department participates in multiple committees and working groups preparing guidelines, documents and protocols, addressing conflicts, regulatory doubts, training deficiencies, recommending courses of action, and mediating with patients and family members to reduce professional uncertainty

Professional aspirations as indicators of responsible leadership style and corporate social responsibility. Are we training the responsible managers that business and society need? A cross-national study / Las aspiraciones profesionales como indicadores del estilo de liderazgo responsable y de la responsabilidad social corporativa. ¿Estamos formando a los directivos responsables que necesitan las empresas y la sociedad? Un estudio entre países

The relationship between responsible leadership (RL), identified from achievement expectations, and the importance attached to corporate social responsibility (CSR) was analyzed. In a survey of 1,833 business management undergraduates in six Ibero-American countries, factor analysis identified three approaches to stakeholder relations, behaviors, and professional aspirations: a relational style associated with the intention to collaborate with others; a pragmatic style geared to attaining personal and organizational objectives; and an individualist style informed by a drive for personal achievement. Regression analyses confirmed the relationship between relational and pragmatic styles and CSR geared to stakeholder well-being, protection of social and natural environments, and ethical management. Both were associated with regard to the responsibilities that ensure business survival (such as meeting customer needs), while the individualist style was aligned with hostility toward those dimensions of CSR. These findings suggest that the relational and pragmatic styles lead to more effective CSR management

Se analiza la relación entre estilos de liderazgo responsable (LR), éste último identificado a partir de las expectativas profesionales de logro, y la importancia atribuida a la responsabilidad social corporativa (RSC). Contamos con 1,833 participantes de seis países iberoamericanos que cursaban estudios universitarios relacionados con gestión empresarial. Un análisis factorial identificó un estilo de LR relacional orientado a colaborar con otras personas, un estilo pragmático asociado a logros personales y organizacionales y un estilo individualista orientado a intereses personales. Los análisis de regresión mostraron una relación positiva entre los estilos relacional prágmatico y la valoración de la RSC que busca el bienestar de la comunidad, de stakeholders internos y externos, la protección del medioambiente y el comportamiento ético, a la vez que asegura la sostenibilidad de organización, aspectos todos ellos valorados negativamente desde el estiloindividualista. Los datos sugieren que en el contexto socio-económico actual los estilos relacional y pragmático serían más efectivos para implementar la RSC

Community pharmacists' recommendations for natural products for stress in Melbourne, Australia: a simulated patient study

BACKGROUND: Community pharmacists are often the first health professional approached to provide treatment for health issues, including the important mental health challenge, stress. Over-the-counter products for stress almost always are complementary and alternative medicines (CAM) and in Australia no protocol exists for their recommendation and sale in community pharmacies. OBJECTIVE: To assess the quality and relevance of community pharmacists' information gathering (questioning), counselling and product selection when interacting with customers requesting a CAM product for stress and consequently determine whether Australian pharmacy practice indicates the need for guidelines similar to those provided for 'pharmacy only' (S2) and 'pharmacist only' (S3) medicines. METHODS: A covert simulated patient was used to investigate the response of pharmacists to a request for a natural product for stress. The SPs documented the details of the pharmacist-simulated patient interaction immediately on leaving the pharmacy and then re-entered the pharmacy to debrief the pharmacist. The quality of the interaction was scored as a Total CARE (check, assess, respond, explain) Score, based on anticipated questions and counselling advice. The appropriateness of the product was scored as a Product Efficacy Score, based on evidence-based literature. RESULTS: Data from 100 pharmacies was provided. Information gathering illustrated by the questioning components Check and Assess (C and A) of the total CARE score by pharmacists was poor. The number of questions asked ranged from zero (13 pharmacists) to 7 (four pharmacists), the average being 3.1 (SD 1.9). Provision of advice was generally better (a description of the suggested product was offered by 87 pharmacists) but was lacking in other areas (duration of use and side effects were explained by only 41 and 16 pharmacists respectively). The most common product suggested was B-group vitamins (57 pharmacists) followed by a proprietary flower essence product (19 pharmacists). A two-step cluster analysis revealed two sub-groups of pharmacists: one cluster (74 pharmacists) with a high Total CARE score provided an appropriate product. The other cluster (20 pharmacists) had a low total CARE score and provided an inappropriate product. CONCLUSIONS: The pharmacy visits revealed major shortcomings in questioning, counselling and product recommendation. There is a need to develop guidelines for pharmacists to make evidence-based decisions in recommending complementary and alternative medicine

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Differences between pharmacists' perception of counseling and practice in the era of prescription drug misuse

OBJECTIVE: This study was conducted to assess pharmacists' practices when counseling patients on their prescription medications, and their preferences for training. METHODS: Five focus group discussions of community pharmacists (n=45, with seven to eleven participants in each group) were conducted in a major metropolitan city in the southern United States. Participants were recruited via email using a list of community pharmacists provided by the Texas State Board of Pharmacy. All focus group discussions were structured using a moderator guide consisting of both discrete and open-ended questions. Qualitative analysis software was used to analyze the data with a thematic analysis approach. RESULTS: The participants in this study had a high self-efficacy regarding their ability to counsel on both new and opioid prescriptions. Many pharmacists experienced the same barriers to counseling and agreed on the components o counseling. However, the themes that emerged showed that the participants exhibited only a partial understanding of the components of counseling. The themes that emerged in the thematic analysis were perceived confidence and discordant counseling practices, inadequate infrastructure, lack of comprehensive counseling, inconsistent use of the Prescription Drug Monitoring Program (PDMP), and pharmacists' desired training/assistance. CONCLUSIONS: Community pharmacists are in a unique position to help combat the opioid crisis; however, there has been very little research on the pharmacist-patient interaction in this context. With policy changes, such as the PDMP mandate, going into effect across the country, it is important to capitalize on the potential community pharmacists have in ameliorating the opioid crisis in the United States

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A naturalistic observation study of medication counseling practices at retail chain pharmacies

OBJECTIVE: This study evaluated medication counseling procedures and trends at retail pharmacies in the Houston metropolitan area through a naturalistic observational study. METHODS: A blinded cross-sectional observational study was conducted at retail pharmacies in the Houston metropolitan area. Data were collected by trained observers utilizing an observational log, to record various parameters that could have an impact on the duration of patient-pharmacist interaction in a naturalistic pharmacy practice setting. Additionally, indicators of counseling such as utilization of the counseling window and performance of show-and-tell were recorded. Statistical analyses included descriptive statistics, t-tests, Pearson correlations, ANOVAs, and multiple linear regressions. RESULTS: One hundred and sixty-five interactions between patients and pharmacy staff were recorded at 45 retail pharmacies from 7 retail pharmacy chains. The counseling window was utilized in only 3 (1.81%) out of 165 observations and the show-and-tell process was observed in just 1(0.61%) interaction during this study. Mean (SD) interaction time between patient and pharmacists [159.50 (84.50)] was not statistically different (p > 0.05) from the mean interaction time between patients and pharmacy technicians [139.30 (74.19)], irrespective of type of the retail chain observed. However, it was influenced by the number of patients waiting in queue. Patient wait time significantly differed by the time of the day the interaction was observed, weekends and weekdays had significantly different wait times and patient interaction times Multiple linear regression analyses indicated that, patient interaction time, pharmacy chain type, initial contact (pharmacist/technician), and time of the day, were significantly associated with patient wait time whereas patient wait time, pharmacy chain type, number of patients in queue, and number of pharmacy technician were significantly associated with interaction time. CONCLUSIONS: Our study found that the key indicators of counseling including the use of the counseling window and the show-and-tell process were absent, suggesting lack of adequate pharmacists counseling. Further studies are needed to evaluate the validity of this conclusion and the role of pharmacy services and its value towards medication use and safety

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