ABSTRACT
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.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications, Infectious/diagnosis , HIV Infections/diagnosis , Directive Counseling/methods , Simulation Training/methods , HIV Testing/methods , Reproducibility of Results , Delphi Technique , Patient SimulationABSTRACT
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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Subject(s)
Humans , Male , Female , Middle Aged , Aged , Self Medication/statistics & numerical data , Nonprescription Drugs/therapeutic use , Community Pharmacy Services/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Cross-Sectional Studies , Quality of Health Care/statistics & numerical data , Directive Counseling/methodsABSTRACT
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
Subject(s)
Humans , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Prehospital Care/methods , Cell Phone Use , Directive Counseling/methods , Community ParticipationABSTRACT
Introducción: La madre primeriza se enfrenta a grandes cambios en su nuevo rol y es necesario conocer los aspectos que lo favorecen para diseñar intervenciones de apoyo. Objetivo: Explorar los aspectos percibidos por las madres primerizas como favorecedores en la adopción de su nuevo rol. Métodos: Estudio cualitativo con análisis de contenido según Bardin en la Clínica Materno Infantil, Bucaramanga, Colombia, 2018. Incorporación progresiva, según los criterios de conveniencia y suficiencia. Principio de saturación teórica con 10 madres primerizas. Se realizó análisis de contenido a los 94 escritos elaborados por las madres primerizas quienes daban respuesta a la pregunta ¿cuáles aspectos considera le han ayudado en su proceso como nueva madre? Se siguieron las siguientes fases: preanálisis, aprovechamiento del material y tratamiento de resultados, inferencia e interpretación. Resultados: Los aspectos que favorecen el nuevo rol de las madres primerizas se definen en tres grandes temas con sus correspondientes categorías: primer tema: aprendiendo a ser mamá (búsqueda de información, tiempo para estar con el bebé, planea tu día, consejos, intuición materna); segundo tema: apoyo percibido y recibido (apoyo de la pareja, apoyo de la familia, apoyo de amigos y persona que ayuda a cuidar el bebé) y tercer tema: asesoría por profesionales de salud (curso psicoprofiláctico, la consulta después del parto, asesoría en lactancia materna, asesoría de un profesional). Conclusiones: Las madres primerizas van aprendiendo a enfrentar las tareas de la maternidad y los aspectos principales que las favorecen en su nuevo rol son el apoyo social y la asesoría profesional(AU)
Introduction: First-time mothers face major changes in their new role and it is necessary to know the aspects that favor it to design support interventions. Objective: To explore the aspects perceived by first-time mothers as supportive in the adoption of their new role. Methods: Qualitative study with analysis of content according to Bardin in the Children-Mother Clinic, Bucaramanga, Colombia, 2018. A progressive incorporation was implemented according to advisability and adequacy criteria; and principle of theoretical saturation with 10 first-time mothers. Content analysis was carried out to the 94 papers prepared by first-time mothers who gave answer to the question: What aspects do you considered to have helped you in your process as a new mother? These stages were followed: pre-analysis, better use of material; and results, inference and interpretation treatment. Results: The aspects that favor the new role of first-time mothers are defined in three major subjects with their corresponding categories: First subject: learning to be a mom (search for information, time to be with the baby, plan your day, tips, maternal intuition); Second subject: perceived and received support (partner support, family support, friends support and person who helps to take care of the baby); Third subject: counselling by health professionals (psychoprophylactic course, consultation after childbirth, breastfeeding counselling, advisory by a professional). Conclusions: First-time mothers learn to cope with the tasks of motherhood and the main aspects that favor them in their new role with social support and professional advice(AU)
Subject(s)
Social Support , Maternal-Child Nursing , Directive Counseling/methods , Mother-Child Relations/ethnology , ColombiaABSTRACT
Abstract Objective: To describe the users' drug abuse characteristics, problematic behaviors associated with addiction, the motivation of teenagers and young adults to quit cocaine and/or crack abuse, and then compare these characteristics. Methods: A cross-section study was conducted with 2390 cocaine/crack users (teenagers from 14 to 19 years of age, and young adults from 20 to 24 years of age); 1471 were young adults and 919 were teenagers who had called a phone counseling service between January 2006 and December 2013. Semi-structured interviews were performed via phone calls. The questionnaires included sociodemographic information; assessment of the characteristics of cocaine/crack abuse; assessment of the problematic behaviors; also, the Contemplation Ladder was used to evaluate the stages of readiness to cease substance abuse. Results: Participants reported using cocaine (48.2%), crack and other smoking forms (36.7%) and combined consumption of both drugs (15%). Young adults were more prone to using crack or crack associated with cocaine (OR = 1.9; CI 95% = 1.05-1.57) and they were exposed to substance abuse for longer than two years (OR = 3.45; CI 95% = 2.84-4.18), when compared to teenagers. On the other hand, they showed higher readiness to quit. Conclusion: Data shows important differences in drug abuse characteristics, problematic behaviors and motivation to cease substance abuse between teenager and young adult cocaine and/or crack users. Behaviors displayed by young adults involve greater physical, mental and social health damages. These findings reinforce the importance of public policy to act on prevention and promoting health, to increase protection factors among teenagers and lower risks and losses during adult life.
Resumo Objetivo: Descrever as características de consumo, comportamentos problemáticos associados ao uso e motivação para cessar o consumo entre adolescentes e jovens usuários de cocaína e/ou crack e comparar essas características. Métodos: Realizou-se um estudo transversal, com 2.390 usuários de cocaína/crack (adolescentes: 14 - 19 anos e jovens: 20 - 24 24 anos) sendo 1471 jovens e 919 adolescentes, que ligaram para um serviço de aconselhamento telefônico entre janeiro de 2006 e dezembro de 2013. Foram realizadas entrevistas semiestruturadas por telefone. Os questionários incluíram informações sociodemográficas; avaliação das características do consumo de cocaína/crack; avaliação dos comportamentos problemáticos e escala de Contemplação Ladder para avaliar os estágios de motivação. Resultados: Os participantes relataram uso de cocaína (48,2%), crack e outras formas fumadas (36,7%) e uso associado de ambas as formas (15%). Os jovens faziam maior uso de crack ou crack associado à cocaína (OR = 1,19; IC 95% = 1,05-1,57) e estavam expostos ao uso da droga havia mais de 2 anos (OR = 3,45; IC 95% = 2,84-4,18) quando comparados aos adolescentes. Por outro lado, mostraram-se mais motivados para cessar o consumo. Conclusão: Os dados mostraram haver importantes diferenças nas características de consumo, comportamentos problemáticos e motivação para cessar o consumo entre adolescentes e jovens usuários de cocaína e/ou crack. Os jovens apresentaram comportamentos que envolvem maiores prejuízos para a saúde física, mental e aspectos sociais. Esses achados reforçam a importância de ações de políticas públicas de prevenção e promoção de saúde para aumentar os fatores de proteção entre os adolescentes e reduzir riscos e prejuízos para a vida adulta.
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Crack Cocaine , Cocaine-Related Disorders/prevention & control , Directive Counseling/methods , Motivation , Socioeconomic Factors , Telephone , Cross-Sectional StudiesABSTRACT
ABSTRACT The objective was to describe and evaluate a model of drug dispensing developed and implemented in a community pharmacy in Brazil. This was a descriptive, observational, quasi-experimental study performed in the period between 21 January 2013 and 20 April 2013. The model was evaluated and described in terms of three parameters: structure, process and outcome. The description and assessment of each parameter was performed as follows: (I) Structure: profile of patients, pharmacist's professional profile, physical facility, informational material; (II) Process: drug-related problems, pharmaceutical interventions performed, results of pharmaceutical interventions; (III) Outcome: patient knowledge of medications. Dispensing service improved patient knowledge of medications (p < 0.05), which was associated with pharmacotherapy complexity (p < 0.05). The main problems identified were related to lack of patient knowledge regarding their medication (52.9%). Pharmaceutical interventions were mostly performed directly to the patients (86.3%) by verbal (95.4%) and written (68.2%) information, and most of the problems were completely solved (62.7%). The medicine dispensing model was able to identify and solve drug-related problems and promote an improvement in patient knowledge about medication.
RESUMO O objetivo foi descrever e avaliar um modelo de serviço de dispensação de medicamentos desenvolvido e implantado em uma Farmácia Comunitária no Brasil. Trata-se de restudo descritivo, observacional e quase-experimental, realizado no período de 21 de janeiro a 20 de abril de 2013. A descrição e avaliação do modelo foi realizada segundo os parâmetros: estrutura, processo e resultado.Os aspectos descritos e avaliados foram: 1. Estrutura: perfil dos pacientes, perfil profissiográfico dos farmacêuticos, estrutura física, material de informação; 2. Processo: problemas relacionados ao medicamento detectados, intervenções farmacêuticas realizadas, resultados das intervenções farmacêuticas; 3. Resultado: conhecimento do pacientes sobre os medicamentos utilizados. A dispensação proporcionou melhora do conhecimento do paciente sobre os medicamentos (p < 0,05), que demonstrou-se associada à complexidade da farmacoterapia (p < 0,05). Foram identificados majoritariamente problemas relacionados à falta de condições do paciente em utilizar o medicamento (52,94%). As intervenções farmacêuticas foram realizadas predominantemente junto ao paciente (86,27%) através do fornecimento de informações verbais (95,4%) e escritas (68,2%) e, em sua maioria, o problema que originou a intervenção foi totalmente resolvido (62,75%).O serviço foi capaz de identificar e resolver os problemas relacionados ao medicamento e contribuiu para a melhoria do conhecimento dos pacientes relativo aos medicamentos utilizados.
Subject(s)
Patient Education as Topic/classification , Directive Counseling/methods , Behind-the-Counter Drugs , Pharmacies , Drug UtilizationABSTRACT
Abstract Objective: to evaluate the effect and gender differences of an innovative intervention involving in-person and telephone nursing counseling to control cardiovascular risk factors (arterial hypertension, dyslipidemia, and overweight), improve health-related quality of life and strengthen self-efficacy and social support in persons using the municipal health centers' cardiovascular health program. Method: a randomized controlled clinical trial involving participants randomized into the intervention group who received traditional consultation plus personalized and telephone nursing counseling for 7 months (n = 53) and the control group (n = 56). The study followed the Consolidated Standards of Reporting Trials Statement. Results: women in the intervention group presented a significant increase in the physical and mental health components compared to the control group, with decreases in weight, abdominal circumference, total cholesterol, low-density lipoprotein cholesterol, and the atherogenic index. The effects attributable to the intervention in the men in the intervention group were increased physical and emotional roles and decreased systolic and diastolic pressure, waist circumference, total cholesterol, low-density lipoprotein cholesterol, atherogenic index, cardiovascular risk factor, and 10-year coronary risk. Conclusion: this intervention is an effective strategy for the control of three cardiovascular risk factors and the improvement of health-related quality of life.
Resumen Objetivo: evaluar efecto y diferencias por sexo de una intervención innovadora "Consejería de Enfermería Personalizada y Telefónica", dirigida al control de factores de riesgo cardiovascular (hipertensión arterial, dislipidemia y sobrepeso) y al mejoramiento de la calidad de vida relacionada con la salud, fortaleciendo la autoeficacia y el apoyo social en personas usuarias del programa de salud cardiovascular de los Centros de Salud Municipales de Concepción. Método: ensayo clínico controlado aleatoriamente y selección aleatoria de participantes; grupo intervención con consulta tradicional más consejería de enfermería personalizada y telefónica durante 7 meses (n=53); y grupo control (n=56); siguiendo la declaración del Consolidated Standards of Reporting Trials. Resultados: mujeres del grupo intervención, presentaron aumento significativo con respecto al grupo control, en componentes de salud física y mental; disminución de: peso, circunferencia abdominal, colesterol total, colesterol lipoproteínas de baja densidad e índice de aterogenicidad. En hombres del grupo intervención se reflejó como efectos atribuibles a la intervención: 1) aumento en dimensiones del rol físico y emocional; 2) disminución: presión sistólica y diastólica, circunferencia abdominal, colesterol total, colesterol lipoproteínas de baja densidad, índice de aterogenicidad, factor de riesgo cardiovascular y riesgo coronario a 10 años. Conclusión: esta intervención es una estrategia efectiva para el control de tres factores de riesgo cardiovascular y mejoría de calidad de vida relacionada con la salud.
Resumo Objetivo: avaliar o efeito e as diferenças por sexo de uma intervenção inovadora: o aconselhamento personalizado e por telefone em enfermagem, visando o controle de fatores de risco cardiovascular (hipertensão arterial, dislipidemia e sobrepeso) e a melhora na qualidade de vida relacionada à saúde, fortalecendo a autoeficácia e o apoio social a pessoas que usam o programa de saúde cardiovascular de Centros Municipais de Saúde. Método: ensaio clínico controlado e randomizado, participantes randomizados, grupo de intervenção: consulta tradicional mais aconselhamento personalizado e por telefone em enfermagem por 7 meses (n = 53); e grupo de controle (n = 56); seguindo a declaração Consolidated Standards of Reporting Trials Statement. Resultados: mulheres do grupo intervenção apresentaram um aumento significativo, em relação ao grupo controle, nos componentes de saúde mental e física, com diminuição do peso, circunferência abdominal, colesterol total, colesterol de lipoproteínas de baixa densidade e índice aterogênico. Em homens do grupo intervenção, os efeitos atribuíveis à intervenção foram: aumentos nos papeis físicos e emocionais, com diminuições na pressão sistólica e diastólica, circunferência abdominal, colesterol total, colesterol de lipoproteínas de baixa densidade, índice aterogênico, fator de risco cardiovascular e risco coronariano em 10 anos. Conclusão: essa intervenção é uma estratégia eficaz para o controle dos três fatores de risco cardiovascular e a melhora da qualidade de vida relacionada à saúde.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Telephone , Cardiovascular Diseases/nursing , Directive Counseling/methods , Quality of Life , Social Support , Single-Blind Method , Risk Factors , Self EfficacyABSTRACT
O objetivo deste trabalho foi verificar como trabalhadores bancários avaliam seu estado de saúde e os principais fatores associados a esse indicador nessa população. Trata-se de um estudo transversal com 525 funcionários de uma rede bancária do Estado do Espírito Santo, Brasil. A magnitude das associações foi avaliada através de regressão logística hierarquizada em níveis. Verificou-se que 17% (n = 87) dos bancários autoavaliaram seu estado de saúde como regular ou ruim. Estiveram associados à pior autoavaliação de saúde o reduzido nível socioeconômico (OR = 1,80; IC95%: 1,06-3,05), o estilo de vida sedentário (OR = 2,64; IC95%: 1,42-4,89), o excesso de peso (OR = 3,18; IC95%: 1,79-5,65), o baixo apoio social (OR = 3,71; IC95%: 2,10-6,58) e a presença de doenças crônicas (OR = 5,49; IC95%: 2,46-12,27). Concluiu-se que, comparado com outras localidades, houve um expressivo número de bancários que autoavaliaram seu estado de saúde como regular ou ruim, e que a presença de doenças crônicas apresentou-se como o fator de maior impacto sobre a forma como o indivíduo avalia sua própria saúde.
The aim of this study was to determine how bank employees assess their health status and risk factors associated with this indicator in this population. This is a cross-sectional study involving 525 workers of a banking system in the State of Espírito Santo, Brazil. The magnitude of the associations was assessed using logistic regression hierquizada in levels. It was found that 17% (n = 87) of bank self-rated their health status as fair or poor. Were associated with worse self-assessed health of the low socioeconomic level (OR = 1.80; 95%CI: 1.06-3.05), the sedentary lifestyle (OR = 2.64; 95%CI: 1.42-4.89), the excess weight (OR = 3.18; 95%CI: 1.79-5.65), low social support (OR = 3.71; 95%CI: 2.10-6.58), and the presence of chronic diseases (OR = 5,49; 95%CI: 2.46-12.27). It is concluded that, compared with other locations, there was a significant number of banking that self-rated their health status as fair or poor, and that the presence of chronic diseases was presented as the factor with the greatest impact on how the individual evaluates their own health.
El objetivo de este estudio fue investigar cómo los empleados del banco a evaluar su estado de salud y factores de riesgo asociados a este indicador en esta población. Se trata de un estudio transversal con 525 trabajadores de un sistema bancario en el estado de Espírito Santo, Brasil. La magnitud de las asociaciones se evaluó mediante regresión logística hierquizada en niveles. Se encontró que 17% (n = 87) de los trabajadores del banco auto-calificaron su estado de salud como regular o mala. Se asociaron con la salud autopercibida peor del bajo nivel socio-económico (OR = 1,80; IC95%: 1,06-3,05), el sedentarismo (OR = 2,64; IC95%: 1,42-4,89), el exceso de peso (OR = 3,18; IC95%: 1,79-5,65), el baja apoyo social (OR = 3,71; IC95%: 2,10-6,58), y la presencia de enfermedades crónicas (OR = 5,49; IC95%: 2,46-12,27). Se concluye que, en comparación con otros lugares, hubo un número significativo de la banca que la auto-calificaron su estado de salud como regular o mala, y que la presencia de enfermedades crónicas se presenta como el factor de mayor impacto en cómo los evalúa individuales su propia salud.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Male , Directive Counseling/methods , Headache/diagnosis , Headache/therapy , Patient Care Planning , Diagnosis, DifferentialABSTRACT
This randomized controlled trial study aimed to investigate the effects of a lifestyle intervention on metabolic syndrome (MetS) among middle-aged Koreans. A total of 243 middle-aged Koreans with MetS were randomly assigned to either of 2 types of lifestyle intervention for MetS and followed for 12 months. Health examinations and interventions were implemented at 16 regional branch facilities of a Korean medical institution from 2010, following the NCEP-ATP III criteria and recommendations. Lifestyle intervention (LI) group (n = 137) participated in a 12-week multi-component intervention including individual counseling, group sessions, and self-help materials. Basic usual intervention (BI) group (n = 106) was provided with one-page health information sheet on MetS and MetS management at baseline. Prevalence of MetS and each of MetS components, except for low HDL-cholesterol, in both groups were significantly reduced and maintained after the intervention. Notably, prevalence of hypertension and abdominal obesity continued to improve during the follow-up period. Between-group differences in results were not found. Both interventions were effective when they were accompanied with repeated check-ups and notification of MetS status. It is recommended to design clear guidelines for the notification of MetS after MetS screening and to encourage checking MetS status periodically for effective MetS management (KCT 0000446).
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Combined Modality Therapy , Directive Counseling/methods , Mass Screening/methods , Metabolic Syndrome/diagnosis , Patient Education as Topic/methods , Risk Reduction Behavior , Self-Help Groups , Treatment OutcomeABSTRACT
Los incentivos en el acceso universal a la terapia antirretroviral para el control del VIH-sida, estimularon la diversificación de los modelos de testeo del VIH, que se expresa en la coexistencia del Voluntary Counseling and Testing (VCT) y Provider-Initiated HIV Testing and Counseling (PITC). Este artículo analiza los conceptos, los fundamentos y la aplicación de los modelos VCT y PITC con respecto a la consejería, la confidencialidad y el consentimiento informado en Brasil y en otros países, a partir de una revisión de la bibliografía en las bases Lilacs, Medline, Sociological Abstracts y Cochrane, publicada entre 2000 y 2013. Según los estudios, el PITC aumenta las tasas de testeo en relación con el VCT, pero reduce los derechos sexuales y reproductivos y la autonomía de los usuarios. Estos resultados señalan los desafíos técnicos y las tensiones éticas entre el paradigma de la excepcionalidad y la normalización del test. Se destaca la necesidad de conciliar el aumento en el acceso al examen con la capacidad local de cuidado integral a las personas que viven con VIH-sida y se recomienda ampliar los estudios interdisciplinares sobre los efectos sociales del VCT y PITC.
Incentives to provide universal access to antiretroviral therapy in order to control the HIV/AIDS epidemic also encouraged the diversification of HIV testing strategies, as demonstrated by the simultaneous existence of Voluntary Counseling and Testing (VCT) and Provider-Initiated HIV Testing and Counseling (PITC). This paper analyzes the concepts, principles and implementation of the VCT and PITC models regarding counseling, confidentiality and informed consent in Brazil and other countries, based on a literature review of works in the Lilacs, Medline, Sociological Abstracts and Cochrane databases published between 2000 and 2013. According to the literature, PITC increases rates of testing in comparison with VCT, but reduces sexual and reproductive rights and the autonomy of users. These findings suggest technical challenges and ethical tensions between the paradigm of exceptionalism and the normalization of HIV testing. The necessity to reconcile increased access to HIV tests with the local capacity to offer comprehensive care for people living with HIV/AIDS is highlighted. It is recommended that interdisciplinary studies about the social effects of VCT and PITC be amplified.
Subject(s)
Humans , Directive Counseling , HIV Infections/diagnosis , Mass Screening/methods , AIDS Serodiagnosis , Brazil , Confidentiality , Directive Counseling , Directive Counseling/methods , HIV Infections/prevention & control , Informed Consent , Mass Screening , Patient Acceptance of Health Care , PoliticsABSTRACT
En este artículo se revisa el papel del dentista en la deshabituación tabáquica con especial énfasis en el consejo sanitario y en la intervención breve. Sin embargo, no parece necesario que el dentista conozca en profundidad los distintos tipos de tratamiento y los lleve a cabo en su consulta. Si bien, en la consulta dental parecen darse todas las condiciones necesarias para realizar el tratamiento del tabaquismo. Si se decide no tratar el tabaquismo de un paciente es recomendable que tras el obligatorio consejo sanitario se le dé al paciente algún tipo de folleto con información sobre cómo dejar de fumar para que ayudar al paciente hasta éste acuda a una Unidad de Tabaquismo (AU)
This paper reviews on the role of dentists in smoking cessation, focusing in counselling and short intervention. It does not seem to be necessary for the dentist to be knowdegeable on the different treatments and to provide them at his/her practice, although the dental office seems to meet all requirements to undertake effective tobacco-cessation therapies. In case the dentist decides not to treat tobacco addiction, adequate advice should be provided and the patient offered leaflets on how to quit smoking in order to help him/her until seen at a tobacco control unit (AU)
Subject(s)
Humans , Smoking/epidemiology , Smoking Cessation/methods , Directive Counseling/methods , Comprehensive Dental Care/trends , Attitude , Patient Education as TopicABSTRACT
Presentamos el caso de una gestación de 20 semanas, con el diagnóstico ecográfico de variante del síndrome de Dandy Walker. La confirmación del diagnóstico implica el asesoramiento prenatal a los padres, muy complejo por el reducido número de casos que se diagnostican y la variabilidad en la expresión posnatal. Aunque algunos autores consideran la variante del síndrome de Dandy Walker como menos severa en cuanto a resultados, otros le confieren la misma agresividad. A la gestante que no opte por la interrupción legal del embarazo podemos ofrecerle análisis del cariotipo, descartar otras anomalías en ecos seriadas y un seguimiento posnatal (AU)
We present the case of a 20-week pregnancy with an ultrasound scan diagnosis of Dandy Walker variant. Confirmation of this diagnosis involves prenatal counselling of the parents, which is highly complex due to the small number of cases diagnosed and postnatal variability. Although some authors consider Dandy Walker variant to be less severe in terms of outcome, others believe it to be equally aggressive. In women not opting for legal abortion, amniocentesis can be offered, other anomalies excluded, and postnatal follow-up provided (AU)
Subject(s)
Humans , Female , Pregnancy , Ultrasonography, Prenatal/methods , Dandy-Walker Syndrome , Directive Counseling/methods , Abortion, TherapeuticABSTRACT
Justificación: La decisión sobre la alternativa terapéutica más conveniente, que corresponde al paciente asesorado por el equipo sanitario, se hace especialmente difícil en casos de mal pronóstico. Pacientes: Paciente joven con tumor cerebral, reintervenido en diversas ocasiones, al que se detecta una recidiva. Resultados: En contra de la opinión del equipo multidisciplinar, el paciente decide someterse a una reintervención, falleciendo a los cuatro meses presentado una calidad de vida aceptable. Conclusiones: Se plantea la necesidad, a través de un counselling adecuado, de permitir que el paciente escoja el resultado clínico preferido tras la transmisión clara de las distintas consecuencias de cada decisión y de la probabilidad de que cada una de ellas ocurra, evitando el uso de términos confusos, como la descripción técnica de procedimientos y las sugerencias globales sobre las decisiones. Se enfatiza el respeto a la autonomía del paciente, bajo condiciones de no maleficencia (AU)
The patient´s decisión regarding the most advisable therapeutic alterantive is difficult, speccially in patients with por prognosis. Patients: Young patient who was operated on several times by brain tumour and he was admitted again by tumour recurrence. Results: The patient preferred to be reoperated against the multidisciplinary team decision. His quality of life was acceptable gut the patient died four months later. Conclusion: We think that the patient could be able to choose the preferred therapeutic option after adequate counseling. Confusing term such as technical description should be avoided. We emphasize the respect to the patient´s autonomy under non-maleficent conditions (AU)
Subject(s)
Humans , Decision Support Systems, Clinical , Brain Neoplasms/psychology , Directive Counseling/methods , Personal Autonomy , Patient Freedom of Choice LawsABSTRACT
Fundamento: El consejo antitabaco aumenta la probabilidad de que nuestros fumadores dejen el tabaco. Cuanto más intenso, mayor es la eficacia. Objetivo: Estimar la eficacia de nuestro protocolo de intervención(PDM) basado en el Conjunto Mínimo de Datos del Fumador(CMDF), respecto al Consejo simple (CS), como ayuda para el abandono del tabaco de nuestros pacientes. Material y método: Muestra aleatoria y representativa de la zona básica del Centro de Salud Felipe II de Móstoles (Madrid) de 227 pacientes, 71 de ellos fumadores (19/71 incluidos en la Cartera de Servicios de Atención Primaria, como grupo de riesgo cardiovascular (GRCV)). Análisis de las historias médicas abiertas, para determinar en función del tipo de intervención sobre el tabaquismo de los pacientes (ninguna, CS o PDM) durante los 28 meses del estudio, el porcentaje de abandonos y de recaídas, los meses desde la intervención hasta la cesación del tabaco y los meses de abstinencia. Estimación de proporciones y medias, odds ratio (OR) en fumadores según el tipo de intervención, estratificadas por sexo, y pertenencia o no a GRCV. Resultados: El 56,17% de los fumadores recibieron consejo antitabaco: el 24,66% como PDM, el 31,51% como CS y en el 43,84% no consta ninguno de ellos. El 21,91% de los pacientes dejaron de fumar, recayeron el 9,67%. Se incorporaron al tabaquismo un 5,50% de nuevos fumadores. La probabilidad de abandonar el tabaquismo es mayor en los hombres OR (hombre/mujer) = 3,5; y en fumadores con riesgo cardiovascular añadido OR (GRCV/sanos) = 2,63. La OR PDM/CS es 3,69. Conclusiones: Nuestro PDM es eficaz como instrumento en la intervención sobre pacientes fumadores, al ser más intensa consigue mejores resultados que el consejo simple (AU)
Background: Counselling from Primary Health Care specialists may achieve better results in assisting patients to stop smoking. Objectives: Determine the effectiveness of direct, thorough counselling with help of our Minimum Data Protocol (MDP) as opposed to the more widespread generic advice. Data collection means and analysis: Random sample of 227 patients(+ 16 years old) from the Felipe II Primary Health Care Centerat Móstoles, Madrid, 71 smokers (19 presence in other cardiovascular risk groups). The choice of data to be collected was taken based on theRecommendations on the Diagnostic and Therapeutic Approach toSmokers (RDTAS) and were added: age, sex, kind of counselling (brief counselling, thorough and MDP, or no advice at all), presence in other cardiovascular risk groups, together with rate of smoking cessation, new smokers, smoking relapse, months of abstinence, time lapse between last interview and smoking cessation. Upon these data we estimated ratios, averages and odds ratios (OR) with a 95% Confidence Interval. Main results: 1) 56,17% of smokers were given advice for smoking cessation. 31,51% were given brief advice, 24,66% using MDP and43,84% were not advised at all. 2) The rate of smoking cessation was of21,91%; the rate of new smokers was of 5,50%; and the relapse ratio9, 67%. 3) Man/woman ratio of smoking cessation odds: 3,50; cardiovascular risk group OR: 2,63; MDP/ brief counselling OR of 3,69. Conclusions: Our statistical analysis proves that the usage of thisMDP works as a better means of assisting smokers in their attempt to stop smoking, than the mere advice which is already common use. We have seen that the more strong and individualized the counselling is, the better its results are (AU)
Subject(s)
Humans , Tobacco Use Disorder/therapy , Directive Counseling/methods , Tobacco Use Cessation/methods , Primary Health Care/methodsABSTRACT
Fundamento y objetivo: Hay suficiente evidencia acerca de que la actividad física disminuye el riesgo de experimentar determinadas enfermedades crónicas. Sin embargo, hay pocos estudios de calidad que valoren la efectividad del consejo sanitario en cuanto a incrementar el índice de actividad física de la población. Tampoco hay datos acerca de si este consejo sanitario puede ser eficaz para reducir otros hábitos no saludables, como el tabáquico. Pacientes y método: Tras cuantificar la actividad física en una muestra de población adulta, se seleccionó al grupo con actividad física ligera (< 143 kcal/día), y se aleatorizó a estos pacientes en dos grupos: a) intervención, al que se dio consejo sanitario para fomentar su actividad física en tiempo libre, y b) control, en el que no se realizó esta intervención. En ambos grupos, se realizó una encuesta de actividad física y hábitos saludables a los 12 meses de la intervención. Resultados: A los 12 meses, en el grupo intervención se produjo un incremento medio de calorías/semana de 1.766 (intervalo de confianza [IC] del 95%, 1.400-2.132) frente a 488 (IC del 95%, 295-620) en el grupo control (p < 0,001). Un 69% de los pacientes del grupo intervención realizaba una actividad física intensa, comparado con un 15% en el grupo control (p < 0,001). En el grupo intervención se produjo también una mejoría significativa de la autopercepción de salud y hubo una reducción significativa del consumo de cigarrillos. Conclusiones: El consejo sanitario es eficaz para aumentar el índice de actividad física en el tiempo libre. Como beneficio adicional, se obtiene una mejor percepción de salud y un mayor porcentje de abandono del hábito tabáquico
Background and objective: There is enough evidence about how physical activity decreases the risk of some chronic diseases; although there are few studies that value the efectiveness of clinical counseling on increase physical activity levels on the population. There is no information about the efectiveness of clinical counseling on decreasing other non-healthy habits, like smoking. Patients and method: After measure the amount of physical activity on adult population, we selected the group with light level (< 143 Kcal/day), dividing them in two random groups: intervention, that received sanitary advice on increase physical activity on free time, and control, without this intervention. On both, we inquire about physical activity and healthy habits 12 months after the intervention. Results: Affer twelve months, in the intervention group we observed a mean increase of 1,766 cal/week (95% confidence interval [CI], 1,400-2,132) vs 488 (95% CI, 295-520) in control group (p < .001). 69% of patients from intervention group made intense physical activity vs 15% from controls (p < .001). Control group also improved health-self perception and had a significant reduction on cigarettes comsumption. Conclusions: Sanitary counseling is efficient on improving physical activity on leisure. An added benefit is to gain better self-perception health and smoking cessation
Subject(s)
Male , Female , Humans , Physical Exertion/physiology , Exercise/physiology , Directive Counseling/methods , Habits , Case-Control Studies , Tobacco Use Disorder/prevention & control , Tobacco Use Cessation/statistics & numerical data , Attitude to HealthABSTRACT
No disponible
Subject(s)
Physical Exertion/physiology , Exercise/physiology , Directive Counseling/methods , Attitude to HealthABSTRACT
Objetivo. Determinar la efectividad de un programa de consejo antitabaco intensivo, sistemático, realizado por profesionales de enfermería. Diseño. Ensayo clínico controlado y aleatorizado. Emplazamiento. Consultas de medicina y enfermería de atención primaria. Participantes. Fumadores que demandaron asistencia en las consultas de medicina de nuestro centro durante el período de captación, hasta alcanzar el tamaño muestral requerido (125 pacientes). Los criterios de inclusión fueron: edad entre 18 y 70 años, personas que fumaron diariamente durante el último mes cualquier cantidad de cigarrillos y puntuación del test de Richmond > 7. Intervenciones. Los pacientes captados se asignaron de forma aleatoria, según la consulta de la que procedían, al grupo que recibía consejo breve por parte del médico (grupo control) o al grupo que recibía consejo breve más seguimiento por enfermería (grupo intervención). En este grupo se programaron visitas de seguimiento hasta 3 meses después de dejar de fumar. Mediciones principales. Abstinencia a los 12 y 24 meses. Resultados. La efectividad de la intervención, considerada como la tasa de abstinencia a los 12 meses, fue del 13,8% (intervalo de confianza [IC] del 95%, 6,5-24,7) en el grupo control y del 6,7% (IC del 95%, 1,8-16,2) en el grupo intervención, sin diferencias significativas entre ellos. Conclusiones. La efectividad de un programa de consejo antitabaco intensivo realizado por enfermería no es más efectivo que el consejo breve aislado del médico en fumadores atendidos en atención primaria. El consejo breve tiene una mejor relación coste-efectividad que el intensivo
Objective. To determine the effectiveness of a systematic intensive tobacco counselling programme conducted by nursing professionals. Design. Randomised clinical trial with control. Setting. Primary care nursing and medical consultations. Participants. Smokers requesting help in our centre's medical clinics during the recruitment period, up to the sample size required (125). Inclusion criteria were: aged between 18 and 70, people who smoked during the preceding month any number of cigarettes a day, and a score over 7 on the Richmond test. Interventions. The patients recruited were randomised, according to the clinic from which they came, to the group that received brief counselling from the doctor (control group) or to the group that received brief counselling plus nursing follow-up (intervention group). Follow-up visits were programmed in this latter group for up to 3 months after giving up smoking. Main measurements. Abstinence at 12 and 24 months. Results. The effectiveness of the intervention considered as the rate of abstinence at 12 months was 13.8% (95% CI, 6.5-24.7) in the control group and 6.7% (95% CI, 1.8-16.2) in the intervention group, with no significant differences between the two. Conclusions. In smokers seen in primary care, the effectiveness of a programme of intensive tobacco counselling by nursing staff is no more effective than the doctor's brief, one-off counselling. Brief counselling has a better cost-effectiveness relationship than intensive counselling
Subject(s)
Humans , Directive Counseling/methods , Tobacco Use Disorder/prevention & control , Tobacco Use Cessation/methods , Nursing Care/methods , Primary Health Care/methods , Clinical Trial , Health Promotion/methodsABSTRACT
This article describes a group technique designed to assist (affective and contention needs from) relatives of children who have suffered HUS. It consists on group meetings, called Life-Experience Workshops, where central topics considered important by the participants are discussed. These group meetings with HUS patient's relatives have no reported precedents and permit analyzing the traumatic value of life-experiences during and after the disease acute phase and its impact on the family involved. As a conclusion, it is considered that this first step opens possibilities to continue working and searching in this field, unexplored so far. A contribution to an integral approach for the child and his or her family is pursued, which complements medical treatment with a psychological and social perspective.
Subject(s)
Humans , Child, Preschool , Directive Counseling/methods , Family/psychology , Hemolytic-Uremic Syndrome/psychology , Hemolytic-Uremic Syndrome/therapy , Critical Care/psychology , Life Change Events , Acute Disease , Adaptation, Psychological , Family Health , Critical Care/methodsABSTRACT
This article describes a group technique designed to assist (affective and contention needs from) relatives of children who have suffered HUS. It consists on group meetings, called Life-Experience Workshops, where central topics considered important by the participants are discussed. These group meetings with HUS patients relatives have no reported precedents and permit analyzing the traumatic value of life-experiences during and after the disease acute phase and its impact on the family involved. As a conclusion, it is considered that this first step opens possibilities to continue working and searching in this field, unexplored so far. A contribution to an integral approach for the child and his or her family is pursued, which complements medical treatment with a psychological and social perspective.(AU)
Subject(s)
Humans , Child, Preschool , Directive Counseling/methods , Family/psychology , Hemolytic-Uremic Syndrome/psychology , Hemolytic-Uremic Syndrome/therapy , Critical Care/psychology , Life Change Events , Acute Disease , Adaptation, Psychological , Family Health , Critical Care/methodsABSTRACT
En este trabajo se describen las líneas generales de actuación del médico de Atención Primaria ante uno de los trastornos de mayor prevalencia en su práctica diaria como es la depresión. Se expone el marco general de esta intervención, descrita minuciosamente en el manual original de Klerman y colaboradores y que ha sido posteriormente adapta da al contexto de AP. Se describen los cuatro focos entorno a los que se articula la intervención: duelo, transiciones de rol, disputas interpersonales y déficits interpersonales, aportando ejemplos de cada uno de ellos procedentes de la práctica clínica (AU)