Association between sedentary behavior and Brain-Derived Neurotrophic Factor (BDNF) in children and adolescents: A protocol for systematic review and meta-analysis.

BACKGROUND: There is evidence in the literature suggesting that high time spent in sedentary behavior (SB) can reduce the Brain-Derived Neurotrophic Factor (BDNF) levels, an important neurotrophin that plays a role in modulating cognition, learning and memory. Children and adolescents usually spend many hours a day on SB, either sitting for a long time and/or using screen equipment. OBJECTIVE: The aim of this study is to describe a systematic review and meta-analysis protocol on the associations between SB and BDNF levels in children and adolescents. METHODS: This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and was published in the International Prospective Register of Systematic Reviews database (PROSPERO: CRD42023392246). The databases that will be searched are EMBASE, Scopus, ScienceDirect, Web of Science, SPORTDiscus, CINAHL, and PubMed. Cross-sectional and cohort studies conducted with children and adolescents (5 to 19 yr) that analyzed the association between SB and BDNF will be included in the systematic review. The characteristics of the studies, methodological aspects, and main results will be described. Then, the risk of bias (assessed by STROBE and Newcastle-Ottawa scales) and the level of evidence (assessed by the GRADE tool) from included studies will be evaluated. Sub-group analysis will also be performed. Two experienced reviewers will perform the studies selection, data extraction, and methodological quality assessment. CONCLUSION: This systematic review and meta-analysis will analyze the association between SB and BDNF in children and adolescents. The results will provide subsidies to better understand this relationship and will strengthen evidence-based practice for both health professionals and future researches.

Gamification as a health education strategy of adolescents at school: Protocol for a systematic review and meta-analysis.

The objective of the study is to present a systematic review and meta-analysis protocol for evaluating the effects of health education gamification-based interventions, on health parameters (food consumption, sleep quality and physical activity) of adolescent students. This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022373833). The search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA, and ADOLEC. Intervention studies (clinical trials - randomized or non-randomized) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomized controlled trials, non- randomized controlled trials and quasi-experimental trials. Two independent researchers will conduct all assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed using RevMan 5.4.1 software. We will conduct the study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guideline. The review will summarize the current evidence on gamification health education changes in parameters related to the health of adolescents. Gamification has been used to verify the increase in adherence to healthy habits or the development of health-related skills, but there are still few results for the adolescent population. We expect that the systematic review could indicate strategies with gamification interventions and also determine how these strategies can improve health parameters of adolescent students, and they will be available as a reference for these interventions.

Extended reality as a health education strategy of adolescents at school: protocol for systematic review and meta-analysis.

INTRODUCTION: Extended reality (XR) is the ensemble of interactive experiences based on a computer-simulated environment that encompasses virtual reality and augmented reality and has been proven to be potentially innovative in the field of health education with adolescents. The objective of this study is to present a systematic review and meta-analysis protocol that seeks to evaluate the main effects of interventions that use XR on health parameters (food intake, sound quality and physical activity) of adolescent students. METHODS AND ANALYSIS: The literature search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA and ADOLEC. Intervention studies (clinical trials-randomised or non-randomised) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomised controlled trials (RCTs), non-RCTs and quasi-experimental trials. Two independent researchers will conduct all the assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be performed using RevMan V.5.4.1 software. The study will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guideline. ETHICS AND DISSEMINATION: Ethical approval and human consent were not required, as this is a protocol for a systematic review and only secondary data will be used. The findings will be published in a journal and presented at conferences. In case of any changes to this protocol, it will be updated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses website, and the modifications will be explained in the final report of this review. PROSPERO REGISTRATION NUMBER: CRD42022373876.

Effect of School-Based Food and Nutrition Education Interventions on the Food Consumption of Adolescents: A Systematic Review and Meta-Analysis.

The school is a favorable environment for the development of interventions to prevent obesity. The objective of this systematic review is to evaluate the effects of school-based food and nutrition education interventions on adolescent food consumption. The literature search was conducted on databases: MEDLINE/PubMed, Embase, Scopus, ERIC, Science Direct, Web of Science, Cochrane, LILACS, and ADOLEC. The following research strategies were focused on: population (adolescents), intervention (food and nutrition education), outcome (food consumption), and study design (clinical trial). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement guidelines were followed and all stages of this review were performed by two researchers and, when necessary, a third researcher resolved discrepancies. Included studies are randomized clinical trials (RCT). A total of 24 articles were included for review and 11 articles in meta-analysis. In the evaluation of the general effects, there was a significant effect (mean difference (MD) for fruit consumption (MD = 0.09, CI 0.05, 0.14) in serving/day; and for vegetables (MD = 0.59, IC 0.15, 1.03) at times/week. In the consumption of FV (fruits and vegetables), there was no significant effect (standardized mean difference (SMD) of interventions in their consumption (SMD = 0.00, 95% C1 -0.11, 0.11). The evidence available in this review and meta-analysis concludes that food and nutrition education interventions in schools presented favorable results in the food consumption of adolescents. Registered on the PROSPERO database (CRD42019116520).

Análise conceitual e aplicabilidade de telessimulação no ensino em saúde: Revisão de escopo / Análisis conceptual y aplicabilidad de la telesimulación en educación en salud: Revisión del alcance / Conceptual analysis and applicability of telesimulation in health education: A scoping review

RESUMO Objetivo analisar o conceito de telessimulação e sua aplicabilidade no contexto do ensino em saúde. Método trata-se de uma análise conceitual, realizada através de uma scoping review realizada em maio de 2021, nas seguintes bases de dados: PubMed, PMC, Educational Resources Information Center, Web of Science, Science Direct, Scopus, LILACS, Scientific Electronic Library Online e Google Scholar, mediante o uso do descritor "telessimulação" e suas respectivas traduções para inglês e espanhol. Para análise dos estudos, avaliaram-se os atributos, antecedentes e consequentes do conceito. Resultados a telessimulação é definida como uma ramificação da simulação clínica que se caracteriza pela promoção/viabilização de práticas educativas no ensino em saúde, realizadas remotamente, síncrona, através de videochamada. Tem como objetivo facilitar o contato entre instrutores e participantes em situações de necessidade de distanciamento social, acesso dificultado por razões econômicas, como a escassez de recursos humanos e materiais, e/ou geograficamente distantes, com a intenção de desenvolver e aperfeiçoar competências e habilidades pertinentes as profissões da saúde. Conclusão e implicações para a prática a telessimulação representa uma nova oportunidade na formação em saúde, ao ampliar as possibilidades de ensino e romper barreiras que vão desde as geográficas até as econômicas.

RESUMEN Objetivo analizar el concepto de "telesimulación" y su aplicabilidad en el contexto de la educación para la salud. Método se trata de un análisis conceptual realizado a través de una revisión de alcance realizada en mayo de 2021 en las siguientes bases de datos: PubMed, PMC, Educational Resources Information Center, Web of Science, Science Direct, Scopus, LILACS, Scientific Electronic Library Online y Google Scholar, mediante el uso del descriptor "telesimulación" y sus respectivas traducciones al inglés y al español. Para analizar los estudios, se evaluaron los atributos, antecedentes y consecuencias del concepto. Resultados la telesimulación se define como una rama de la simulación clínica que se caracteriza por la promoción/habilitación de prácticas educativas en educación para la salud, realizadas de forma remota, sincrónica, mediante videollamada. Tiene como objetivo facilitar el contacto entre instructores y participantes en situaciones de necesidad de distancia social, acceso dificultado por razones económicas, como la escasez de recursos humanos y materiales, y/o geográficamente distantes, con la intención de desarrollar y mejorar las habilidades y competencias relevantes. habilidades las profesiones de la salud. Conclusión e implicaciones para la práctica la telesimulación representa una nueva oportunidad en la educación para la salud, ya que amplía las posibilidades de enseñanza y rompe barreras que van desde las geográficas hasta las económicas.

ABSTRACT Objective to analyze the "telesimulation" concept and its applicability in the context of health education. Method this is a conceptual analysis performed through a scoping review carried out in May 2021 in the following databases: PubMed, PMC, Educational Resources Information Center, Web of Science, Science Direct, Scopus, LILACS, Scientific Electronic Library Online and Google Scholar, through the use of the descriptor "telesimulação" and its respective translations into English and Spanish. To analyze the studies, the concept's attributes, antecedents, and consequences were assessed. Results telesimulation is defined as a branch of clinical simulation that is characterized by the promotion/enabling of educational practices in health education, performed remotely, synchronously, through video call. It aims to facilitate contact between instructors and participants in situations of need for social distance, access made difficult for economic reasons, such as the scarcity of human and material resources, and/or geographically distant, aiming at developing and improving relevant skills and abilities for health professions. Conclusion and implications for practice telesimulation represents a new opportunity in health education as it expands teaching possibilities and breaks down barriers ranging from geographic to economic.

Laboratório de habilidades e simulação clínica em época de Covid-19: possibilidades e recomendações práticas / Skills and clinical simulation laboratory in times Covid-19: possibilities and practical recommendations

RESUMO: Este artigo teve por objetivo refletir sobre as possibilidades do laboratório de habilidades e simulação clínica enquanto espaço potencial para o treino e desenvolvimento de competências e habilidades no ensino em saúde, além de compartilhar estratégias para o planejamento docente e para o uso desses espaços em tempos de pandemia pela COVID-19. Estudo descritivo, exploratório e qualitativo realizado a partir da consulta a protocolos de recomendações sanitárias, diretrizes/planejamento de universidades públicas nacionais e internacionais para o retornodas atividades acadêmicas práticas em cursos da área da saúde e a opinião de especialistas em simulação clínica. São compartilhadas orientações específicas e comuns considerando os tipos de simulação propostas, estratégias de apoio às experiências clínicas simuladas, além de diretrizes sanitárias. Trata-se de recomendações que devem ser discutidas e adaptadas conforme as diferentes realidades, atualização de diretrizes sanitárias dos órgãos de saúde e educação, além do monitoramento do comportamento da pandemia causada pelo coronavírus em todo o mundo. (AU)

ABSTRACT: This article aimed to reflect on the possibilities of the skills laboratory and clinical simulation as a potential space for training and development of skills and abilities in health education, in addition to sharing strategies for teaching planning and the use of these spaces in times of the COVID-19 pandemic. A descriptive, exploratory, qualitative study based on the consultation of health recommendation protocols, guidelines/planning of national and international public universities for the return of practical academic activities in health area courses and the opinion of experts in clinical simulation. Specific and common guidelines are shared considering the types of simulation proposed, strategies to support simulated clinical experiences, and health guidelines. These recommendations should be discussed and adapted according to the different realities, updating health and education agencies' health guidelines, besides monitoring the pandemic's behavior caused by the coronavirus world. (AU)

Training in communication skills for self-efficacy of health professionals: a systematic review.

BACKGROUND: Communication skills are essential for health professionals to establish a positive relationship with their patients, improving their health and quality of life. In this perspective, communication skills training can be effective strategies to improve the care provided by professionals in patient care and the quality of health services. OBJECTIVE: To identify the best available evidence on training programs in communication skills to promote changes in attitude and behavior or self-efficacy of health professionals. METHODS: Systematic searches were performed in eight databases, evaluating Randomized Controlled Trials and quasi-experimental studies with a control group, focusing on training communication skills for health professionals, who assessed self-efficacy or behaviors related to these skills. The phases of study selection and data extraction were carried out by two independent researchers, and the conflicts were resolved by a third. The risk of bias was assessed using the Cochrane method. RESULTS: Eight studies were included in the review. Most programs lasted between 4½ h and 2 days, involved information about communication skills and the content was applied to the health professionals' context. Several teaching strategies were used, such as lectures, videos and dramatizations and the evaluation was carried out using different instruments. Improvements in the performance and in the self-efficacy of communication skills were observed in the trained groups. The RCT had a low risk of bias and the quasi-experimental studies had a moderate risk. CONCLUSION: Training in communication skills can improve the performance and self-efficacy of health professionals. Programs that approach the conceptual issues and promote the space for experiential learning could be effective in communication skills training for professionals. PROSPERO: CRD42019129384.

The Control and Prevention of COVID-19 Transmission in Children: A Protocol for Systematic Review and Meta-analysis.

BACKGROUND: The pandemic following the rapid spread of the new SARS-CoV-2 virus has hit all continents and caused thousands of deaths worldwide. Evidence has been published on epidemiological and clinical characteristics of population groups considered at risk; however, information for the other population groups, especially for the child population, is needed. In this context, this protocol describes a systematic review that will aim to identify the evidence on control and prevention of COVID-19 transmission among children and adolescents, as well as to describe the epidemiological profile and clinical and immunological characteristics of COVID-19 in this population. METHODS: This protocol will be developed in accordance with PRISMA-P. The searches will be conducted in PubMed, Web of Science, ScienceDirect, EMBASE, and Scopus, seeking clinical trials. Observational studies and case reports with Children and adolescents (≤19 years) infected with SARS-CoV-2 will be included whether they report information on the control of prevention and COVID-19 transmission. Two independent researchers will perform the selection of articles, removal of duplication, and screening by Rayyan QCRI application. Cochrane's RoB 2.0, ROBINS-I, and CASP tools will be used to assess the risk of bias. Meta-analysis, subgroup analyses, and/or descriptive analyses will be carried out based on the data conditions included. RESULTS: A high-quality synthesis of the available evidences on the epidemiological profile, the clinical and immunological characteristics involved in children, and adolescents diagnosed with COVID-19, as well as the participation of this population in the transmission dynamics of SARS-CoV-2 will be provided. CONCLUSION: This systematic review has an important relevance in the current context because it has a great potential to help the development of new control and prevention strategies in the pediatric population. RECORD OF SYSTEMATIC REVIEW: CRD42020179263.

The Effects of Exercise on BDNF Levels in Adolescents: A Systematic Review with Meta-Analysis.

The aim of this study was to analyze the evidence available in the literature about the effects of exercise on brain-derived neurotrophic factor levels in adolescents. The literature searches were conducted in PubMed, Embase, Scopus, ScienceDirect, Web of Science, SportDiscus, the Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL. Randomized controlled trials and non-randomized controlled trials performed with adolescents (10-19 years) who underwent different exercise programs and who evaluated BDNF levels before and after the intervention were included. We included six studies, four RCTs and two non-RCTs in the systematic review with a total of 407 adolescents. In two randomized trials and one non-RCT, the intervention groups showed significant improvements in BDNF levels compared with the control group. The results presented in the meta-analysis indicate that despite the positive effect in favor of the intervention, there were no significant differences (standardized mean difference 0.28 ng/mL, 95% confidence interval -0.28 to 0.85; p = 0.32, I² = 0%). The results presented in our review indicate that aerobic exercise programs practiced in moderate- or high-intensity are promising strategies to increase BDNF levels in adolescents. However, further studies are required to support this finding.

Training programs in communication skills to improve self-efficacy for health personnel: Protocol for a systematic review and meta-analysis.

BACKGROUND: Patient-centered care should be the focus of health services, where improvements in the communication skills of health professionals promote excellent health and quality care. Thus, this study is a protocol for a systematic review and meta-analysis to evaluate the effectiveness of training programs in communication skills to promote self-efficacy in the communication of health personnel. METHODS: This systematic review protocol is conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) statement guidelines and the Cochrane Handbook of Systematic Reviews of Interventions. The review should include studies carried out with health professionals who have undergone training in communication skills aimed at promoting their self-efficacy. Clinical trials (randomized, non-randomized), community trials, and quasi-experimental studies should be included. Therefore, the comprehensive search strategy will be conducted in the following databases: PubMed/Medline, Scopus, Web of Science, EMBASE, Science Direct, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers will conduct all study selection procedures, data extraction, and methodological evaluation, and disagreements will be referred to a third reviewer. RevMan 5.3 software will be used to gather data and perform the meta-analysis if possible. RESULTS: This systematic review will provide evidence on more effective programs for communication skills training and will consider information such as duration, educational strategies, assessment measures, and outcomes that promote health worker self-efficacy. DISCUSSION: This systematic review should provide evidence for effective communication skills training for health professionals in order to guide new strategies for quality care. DISSEMINATION AND ETHICS: The findings of this scoping review will be disseminated in print, at conferences, or via peer-reviewed journals. Ethical approval is not necessary as this paper does not involve patient data. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019129384.

Tecnologias leves para a promoção das habilidades de comunicação na atenção primária à saúde / Light technologies to promote communication skills in primary health care

Habilidades de comunicação constituem como importante ferramenta para sistemas e serviços de saúde centrados no paciente. A relação profissional-paciente eficaz deve considerar as necessidades do paciente, colocando-o como sujeito ativo no processo de decisão dos seus cuidados de saúde. A melhoria do cuidado pode ser estimulada por meio de avaliação e treinamento em habilidades de comunicação que permitam mudanças de comportamento na prática clínica. O presente estudo tem como objetivo desenvolver tecnologias para a melhoria das habilidades de comunicação dos profissionais da Atenção Primária à Saúde. Estrutura-se em modelo metodológico de duas fases. A fase 1 contempla o estudo de Revisão Sistemática e o processo de Adaptação transcultural e validação do Questionário de Autoeficácia (SE-12), e a fase 2, a construção do programa de promoção das habilidades de comunicação. A execução da Revisão Sistemática foi desenvolvida para fornecer informações científicas sobre os treinamentos em habilidades de comunicação eficazes para a melhoria da autoeficácia de profissionais de saúde. Foram incluídos 5 estudos clínicos que investigam a eficácia de treinamentos de habilidades de comunicação, por meio de busca em 8 bases de dados, sendo extraídas informações sobre tempo, conteúdo e métodos de avaliação empregados. A qualidade dos estudos foi avaliada pelo Risk of Bias pelo software RevMan. A revisão apontou que os programas contemplam conteúdos relacionados aos conceitos básicos de comunicação, contextualizados a realidade em que os profissionais estão inseridos, e centrados no paciente. Utilizam estratégias de aprendizagem centrada no aluno, como vídeos e role play, apontando melhoria nas habilidades de comunicação após a intervenção. O processo de adaptação transcultural e validação do Questionário de Autoeficácia (SE-12) foi realizado por meio de metodologia padrão, por meio das etapas: equivalência conceitual e de itens, equivalência semântica (traduções, retraduções, apreciação formal, discussão e síntese e pré-teste), equivalência operacional e idiomática e equivalência de mensuração, por meio da análise da consistência interna pelo Alpha de Cronbach (α) e análise fatorial exploratória. Foi produzido um instrumento viável ao contexto brasileiro, que após alguns ajustes foi considerado válido, apresentando alta consistência interna (α = 0,946), e a análise fatorial apontando um único fator dominante no SE-12, com alta correlação entre os itens. A fase 2 se constitui da construção de um programa de treinamento de habilidades de comunicação para profissionais de saúde, composto por 2 módulos de conteúdos, que devem abordar conceitos básicos e temas específicos de comunicação, por meio de metodologias ativas de aprendizagem. O programa deve ser executado através de 3 encontros em cada módulo, com acompanhamento em 12 meses. A avaliação dos participantes deve acontecer em seis momentos, por meio do Questionário de Autoeficácia (SEbr-12) e a Escala Jefferson de Empatia. A sistematização das evidências científicas, a construção de uma medida precisa e útil para avaliar a autoeficácia de comunicação de profissionais de saúde, e a proposta de um programa de intervenção em habilidades de comunicação podem instrumentalizar os processos de melhoria que tem como foco o cuidado centrado ao paciente (AU).

Communication skills used as an important tool for patient-centered health systems and services. An effective professional-patient relationship should consider the patient's needs, placing them as an active subject in the decision-making process of their healthcare. Improved care can be stimulated through assessment and training in communication skills that enable behavioral changes in clinical practice. This study aims to develop technologies to improve communication skills of primary health care professionals. It is structured in a two-phase methodological model. Phase 1 includes the Systematic Review study and the process of cross-cultural adaptation and validation of the Self-Efficacy Questionnaire (SE-12), and phase 2, the construction of the communication skills promotion program. The implementation of the Systematic Review was designed to provide scientific information on effective communication skills training to improve the self-efficacy of health professionals. We included 5 clinical studies investigating the effectiveness of communication skills training by searching 8 databases, extracting information on time, content and assessment methods employed. The quality of the studies was assessed by Risk of Bias by RevMan software. The review pointed out that the programs include content related to the basic concepts of communication, contextualized to the reality in which professionals are inserted, and patientcentered. They use student-centered learning strategies such as videos and role play, pointing to improved communication skills after the intervention. the process of cross-cultural adaptation and validation of the Self-Efficacy Questionnaire (SE-12) was performed using standard methodology, through the following steps: conceptual and item equivalence, semantic equivalence (translations, retranslations, formal appraisal, discussion and synthesis, and pretest), operational and idiomatic equivalence, and measurement equivalence through Cronbach's Alpha (α) internal consistency analysis and exploratory factor analysis. A viable instrument was produced for the Brazilian context, which after some adjustments was considered valid, presenting high internal consistency (α = 0.946), and factor analysis indicating a single dominant factor in SE-12, with high correlation between items. Phase 2 is the construction of a communication skills training program for health professionals, consisting of 2 content modules, which should address basic concepts and specific themes of communication through active learning methodologies. The program should be implemented through 3 meetings in each module, with follow-up at 12 months. The evaluation of the participants should take place in six moments, through the Self-efficacy Questionnaire (SEbr-12) and the Jefferson Empathy Scale. The systematization of scientific evidence, the construction of an accurate and useful measure to assess the self-efficacy of communication of health professionals, and the proposal of a communication skills intervention program can instrument the improvement processes that focus on focused care. to the patient (AU).

Vivência integrada na comunidade: inserção longitudinal no Sistema de Saúde como estratégia de formação médica / Integrated experience in the community: longitudinal health care insertion as medical education strategy / Vivencia integrada en la comunidad: inserción longitudinal en el Sistema de Salud como estrategia de formación médica

Propostas inovadoras para o processo ensino-aprendizagem nos cursos de Medicina vêm sendo desenvolvidas em busca de uma formação profissional generalista, humanista e crítica. A partir da aprovação do Programa Mais Médicos (PMM), novas escolas foram criadas adotando metodologias de ensino ativas e promovendo maior integração ensinoserviço-comunidade. Este artigo é um relato de experiência sobre o desenvolvimento do módulo Vivência Integrada na Comunidade no curso de Medicina da Escola Multicampi de Ciências Médicas do Rio Grande do Norte, que oportuniza ao estudante uma inserção longitudinal no sistema de Saúde em municípios do interior do Nordeste. Essa proposta vem promovendo maior integração entre a universidade, os gestores e os trabalhadores da Saúde. A aposta é a de que este módulo poderá contribuir com a fixação do médico na região e fortalecer o sistema de Saúde no interior do Brasil.

Innovative teaching-learning process proposals for medical courses have been developed for generalist, humanistic, critical professional education. Beginning with approval of the More Doctors Program, new schools were created, adopting active teaching methodologies and promoting further community-service-teaching integration. This paper is an experience report on the development of the Integrated Experience in the Community module in the medical course at the Medical Sciences Multi-campuses College of Rio Grande do Norte, which provides students with longitudinal insertion opportunities in the healthcare system of the hinterland towns of the Northeast region. This proposed module has been promoting further integration between the university managers, and healthcare workers. The goal of this module is to contribute to securing physicians for in the region and strengthening the healthcare system in the Brazilian hinterland.

Se han desarrollado propuestas innovadoras para el proceso enseñanza-aprendizaje en los cursos de medicina a la búsqueda de una formación profesional generalista, humanista y crítica. A partir de la aprobación del Programa Más Médicos se crearon nuevas escuelas, adoptando metodologías de enseñanza activas y promoviendo una mayor integración enseñanza-serviciocomunidad. Este artículo es un relato de experiencia sobre el desarrollo del módulo "Vivencia integrada en la comunidad" en el curso de medicina de la Escuela Multicampi de Ciencias Médicas de Rio Grande do Norte que proporciona al estudiante una inserción longitudinal en el sistema de salud en municipios del interior del Nordeste de Brasil. Esta propuesta ha promovido una mayor integración entre la Universidad, los gestores y los trabajadores de la salud. La apuesta es que este módulo podrá contribuir con la fijación del médico en la región y fortalecer el sistema de salud en el interior de Brasil.

Repetição de gravidez na adolescência: estudos sobre a prática contraceptiva em adolescentes / Repeat pregnancy in adolescence: study about the practice of contraception in adolescents

A gravidez na adolescência é um período crítico que traz riscos não apenas para a mãe, mas também, para o seu bebê. Tais riscos podem ser potencializados pela repetição de gravidez, constituindo-se como problema de saúde pública. Objetivou-se considerar o conhecimento e o uso de métodos contraceptivos entre 50 adolescentes, com idade média de 17 anos e com repetição de gravidez, atendidas em enfermarias da Maternidade Escola Januário Cicco, em Natal/RN/BR. Trata-se de um estudo do tipo descritivo-exploratório, com a utilização de questionário semi-estruturado. A análise dos dados foi realizada com base na estatística descritiva através da análise das frequências das respostas das adolescentes. Resultados mostram que 44 por cento das adolescentes conhecem pelo menos 3 métodos contraceptivos, sendo a camisinha o método mais utilizado na primeira relação (78,3 por cento) e a pílula o mais utilizado no período que antecedeu a atual ou última gestação (68 por cento). Há conhecimento dos métodos e relato do uso, mas a repetição de gravidez evidencia a necessidade de estimular práticas contraceptivas mais eficazes que considerem as peculiaridades da adolescência.(AU)

Pregnancy adolescence presents risks not only to the mother, but also to her baby, which may be increased by repeat pregnancy resulting in health policy problems. This study intended to consider the knowledge and usage of contraception amongst 50 repeat pregnancy adolescents whose average age was 17 years in Natal/RN/BR, during their prenatal follow up in nurseries of the Januário Cicco maternity hospital. This is an exploratory-descriptive study that was executed by means of a semi-structured questionnaire. Data analysis was performed by descriptive statistics through frequency response analysis. Results showed that 44 percent of these adolescents were aware of at least 3 types of contraception methods, of which condoms were the most utilized during first sexual intercourse (78,3 percent), with the oral contraceptive pill most used during the period prior to the current or last pregnancy (68 percent). Despite the knowledge about these methods and also usage reports by adolescents, repeat pregnancy demonstrates a need for more efficient encouragement of contraception practice.(AU)

Repetição de gravidez na adolescência: estudos sobre a prática contraceptiva em adolescentes / Repeat pregnancy in adolescence: study about the practice of contraception in adolescents

A gravidez na adolescência é um período crítico que traz riscos não apenas para a mãe, mas também, para o seu bebê. Tais riscos podem ser potencializados pela repetição de gravidez, constituindo-se como problema de saúde pública. Objetivou-se considerar o conhecimento e o uso de métodos contraceptivos entre 50 adolescentes, com idade média de 17 anos e com repetição de gravidez, atendidas em enfermarias da Maternidade Escola Januário Cicco, em Natal/RN/BR. Trata-se de um estudo do tipo descritivo-exploratório, com a utilização de questionário semi-estruturado. A análise dos dados foi realizada com base na estatística descritiva através da análise das frequências das respostas das adolescentes. Resultados mostram que 44 por cento das adolescentes conhecem pelo menos 3 métodos contraceptivos, sendo a camisinha o método mais utilizado na primeira relação (78,3 por cento) e a pílula o mais utilizado no período que antecedeu a atual ou última gestação (68 por cento). Há conhecimento dos métodos e relato do uso, mas a repetição de gravidez evidencia a necessidade de estimular práticas contraceptivas mais eficazes que considerem as peculiaridades da adolescência. (AU)

Pregnancy adolescence presents risks not only to the mother, but also to her baby, which may be increased by repeat pregnancy resulting in health policy problems. This study intended to consider the knowledge and usage of contraception amongst 50 repeat pregnancy adolescents whose average age was 17 years in Natal/RN/BR, during their prenatal follow up in nurseries of the Januário Cicco maternity hospital. This is an exploratory-descriptive study that was executed by means of a semi-structured questionnaire. Data analysis was performed by descriptive statistics through frequency response analysis. Results showed that 44 percent of these adolescents were aware of at least 3 types of contraception methods, of which condoms were the most utilized during first sexual intercourse (78,3 percent), with the oral contraceptive pill most used during the period prior to the current or last pregnancy (68 percent). Despite the knowledge about these methods and also usage reports by adolescents, repeat pregnancy demonstrates a need for more efficient encouragement of contraception practice. (AU)

Dor e funcionalidade na atenção básica à saúde / Pain and functionality in primary health care

A dor osteoarticular e a funcionalidade são elementos ligados à saúde dos indivíduos e, portanto, influenciam o modo de interação entre si e entre eles e o meio ambiente que os cerca. Contudo, não são muitos os estudos que levantam essas questões de saúde na população em geral, sobretudo quando aproximamos o olhar da atenção básica sobre elas. Este artigo tem o objetivo de fornecer dados iniciais sobre dor e funcionalidade nos indivíduos com queixa osteoarticular em uma população adscrita a uma unidade básica de saúde (UBS) e suscitar o debate sobre integralidade da atenção nesse serviço. O trabalho descritivo foi realizado na UBS (n1=64) e nos domicílios (n2=48), entre indivíduos a partir dos 20 anos de idade. Foi aplicado um instrumento de avaliação de funcionalidade e a Escala Visual Analógica de dor, e foram exploradas questões sociodemográficas. Com esses instrumentos, buscou-se avaliar o perfil dos indivíduos em relação ao seu grau de dor musculoesquelética, o grau de funcionalidade nas atividades da vida diária, idade e ocupação. Nos resultados, encontramos uma predominância do sexo feminino nos dois grupos, 84,37 por cento e 81,25 por cento, respectivamente. Quase metade das pessoas com dor musculoesquelética eram donas de casa, e a média de idade entre os grupos estava acima dos 55 anos.

Musculoskeletal pain and functionality are linked to the individual health and, thus, influence the mode of interaction between individuals and between them and the environment that surrounds them. However, there are not many studies that question such health issues concerning the population in general, especially when we look at these issues from the basic care point of view. The aim of this article is to present initial data on the subject of pain and functionality in individuals with musculoskeletal complaints enrolled in a primary care unit and prompt a discussion on how complete the services provided by these units are. This study was carried out in a primary care unit and various households, among subjects aging 20 years or older. A functionality assessment tool and a Visual Analogue Scale were applied, and social and demographic issues were also considered. By using these tools, it was made an attempt to evaluate the profile of individuals in association with their degree of musculoskeletal pain and the degree of functionality in the activities of their daily lives, ages and occupations. We found a predominance of women in both groups: 84.37 percent and 81.25 percent, respectively. Nearly half of all people with musculoskeletal pain were housewives, and the average age between groups was over 55.

Velhice e projetos de vida: um estudo com idosos residentes no município de Natal/RN, Brasil / Old age and life projects: a study with elderly residents in the city of Natal/RN

A visão da velhice como fase de declínios vem se modificando e a literatura já elucida ganhos e influências da subjetividade na vivência da velhice e nas expectativas dos idosos. Neste estudo, buscouse contemplar os projetos de vida de idosos usuários da Rede de Atenção Básica de Saúde do Distrito Leste de Natal/RN. Participaram da pesquisa 65 idosos, com idade média de 71 anos, a qual ocorreu através de um estudo transversal com um questionário estruturado. Observou-se que 81% da amostra são do sexo feminino e 40% são viúvos. Os idosos residem com duas (41%) ou três (37%) gerações, as quais geralmente correspondem a filhos, já que 88% os têm, e netos, presentes na vida de 81% dos idosos. Com relação aos projetos de vida, 65% afirmaram ter algum projeto, dos quais 20% remetem a comprar ou reformar a casa, 6% viver bem e com saúde e 5% trabalhar. Dentre os projetos, 20% apontaram ainda projetos diversos para si próprios, enquanto 9% responderam ter algum projeto voltado para seus filhos e/ou netos. Percebe-se que alguns idosos não conseguem deixar de envolver o seu cotidiano e ambiente social na escolha de seus projetos de vida, os quais envolvem interesses, motivações, desejos e aspirações pessoais. Apesar das adversidades e condições de existência que impõem desafios, a velhice se configura como uma fase de desenvolvimento, de acréscimo, de maturidade e com perspectivas positivas para o futuro. Além disso, a velhice não impossibilita a elaboração de projetos de vida, já que esses são inerentes à vida e à constituição de cada indivíduo.(AU)

The vision of the oldness as a phase of declines has been modified and the literature already clarifies gains and context influences of subjectivity in the old age and in the expectations of the elderly. In this study, it was sought to contemplate the life projects of the elderly, who are users of the network basic health care of Natal Eastern District/RN. Sixty five elderly, with an average age of 71 years old, participated in the research, which happened through a crosssectional study with a structured questionnaire. It was found that 81% of the sample were women, and 40% of it, were widows. The elderly reside with two (41%) or three (37%) generations, which usually correspond to sons,88% of the elderly have them , and grandsons, present in the life of 81% of the elderly. Regarding life projects, 65% of the interviewed stated to have some. From those projects, 20% resemble on buying or reforming houses, 6%, on living well and with health, and 5%, on working. Among the projects, 20% of the elderly pointed out various projects for themselves, while 9%, responded to have some project directed to their sons and/or grandsons. It`s possible to observe that some elderly are not able not to involve their day-by-day and social environment when choosing their life projects, which involve interests, motivations, personal desires and aspirations. Despite the adversities and challenges imposed by existence conditions, the old age is configurate as a developing and maturing phase, with positive perspectives for the future..Besides that, the oldness doesn`t prevent the development of life projects, since these are inherent to life and to the constitution of each one.(AU)

Riscos psicossociais e repetição de gravidez na adolescência / Psychosocial risks and repeated pregnancy during adolescence

A gravidez na adolescência pode ser entendida como um período de crises que traz riscos e conseqüências negativas para a adolescente, podendo ser potencializados pela repetição. Mostra-se relevante conhecer a realidade biopsicossocial dessas adolescentes e analisar os fatores envolvidos nessa repetição. Aplicou-se, então, um questionário semi-estruturado, numa Maternidade Escola em Natal/RN, a 50 puérperas com idade entre 12 e 18 anos de idade (média 17 anos), das quais 82 por cento não freqüentam a escola, 62 por cento vivem em união estável e 68 por cento têm renda familiar até três salários mínimos. Iniciaram a vida sexual aos 13 anos e o intervalo entre a gravidez anterior e a atual foi de 1 a 12 meses para 52 por cento das entrevistadas. Assim, o início precoce da vida sexual, a convivência com o companheiro e o abandono escolar podem tornar as adolescentes vulneráveis à gravidez e sua repetição e acentuar os riscos psicossociais.(AU)

Adolescent pregnancy can be understood as a period of crisis that brings risks and negatives consequences for a teenager that can be potentiated by repetition. It is important to know the biopsychosocial reality of these teenagers and analyze the factors involved in this repetition. A semistructured questionnaire was administered to 50 mothers aged between 12 and 18 years of age (mean 17 years old) in a Maternity School from Natal/RN. Results showed that 82 percent of them were not attending school, 62 percent were in a stable marriage and the family income of 68 percent did not exceed three minimum wages. The sexual initiation occurred at 13 years old and the distance between the first and current pregnancy were 1 to 12 months for 52 percent of interviewed. Therefore, early initiation in a sexual life, living with a partner and abandoning school can make teenagers vulnerable to repeated pregnancy and strengthen psychosocial risks.(AU)

Velhice e projetos de vida: um estudo com idosos residentes no município de Natal/RN, Brasil / Old age and life projects: a study with elderly residents in the city of Natal/RN

A visão da velhice como fase de declínios vem se modificando e a literatura já elucida ganhos e influências da subjetividade na vivência da velhice e nas expectativas dos idosos. Neste estudo, buscouse contemplar os projetos de vida de idosos usuários da Rede de Atenção Básica de Saúde do Distrito Leste de Natal/RN. Participaram da pesquisa 65 idosos, com idade média de 71 anos, a qual ocorreu através de um estudo transversal com um questionário estruturado. Observou-se que 81 por cento da amostra são do sexo feminino e 40 por cento são viúvos. Os idosos residem com duas (41 por cento) ou três (37 por cento) gerações, as quais geralmente correspondem a filhos, já que 88 por cento os têm, e netos, presentes na vida de 81 por cento dos idosos. Com relação aos projetos de vida, 65 por cento afirmaram ter algum projeto, dos quais 20 por cento remetem a comprar ou reformar a casa, 6 por cento viver bem e com saúde e 5 por cento trabalhar. Dentre os projetos, 20 por cento apontaram ainda projetos diversos para si próprios, enquanto 9 por cento responderam ter algum projeto voltado para seus filhos e/ou netos. Percebe-se que alguns idosos não conseguem deixar de envolver o seu cotidiano e ambiente social na escolha de seus projetos de vida, os quais envolvem interesses, motivações, desejos e aspirações pessoais. Apesar das adversidades e condições de existência que impõem desafios, a velhice se configura como uma fase de desenvolvimento, de acréscimo, de maturidade e com perspectivas positivas para o futuro. Além disso, a velhice não impossibilita a elaboração de projetos de vida, já que esses são inerentes à vida e à constituição de cada indivíduo.

The vision of the oldness as a phase of declines has been modified and the literature already clarifies gains and context influences of subjectivity in the old age and in the expectations of the elderly. In this study, it was sought to contemplate the life projects of the elderly, who are users of the network basic health care of Natal Eastern District/RN. Sixty five elderly, with an average age of 71 years old, participated in the research, which happened through a crosssectional study with a structured questionnaire. It was found that 81 percent of the sample were women, and 40 percent of it, were widows. The elderly reside with two (41 percent) or three (37 percent) generations, which usually correspond to sons,88 percent of the elderly have them , and grandsons, present in the life of 81 percent of the elderly. Regarding life projects, 65 percentof the interviewed stated to have some. From those projects, 20 percent resemble on buying or reforming houses, 6 percent, on living well and with health, and 5 percent, on working. Among the projects, 20 percent of the elderly pointed out various projects for themselves, while 9 percent, responded to have some project directed to their sons and/or grandsons. It`s possible to observe that some elderly are not able not to involve their day-by-day and social environment when choosing their life projects, which involve interests, motivations, personal desires and aspirations. Despite the adversities and challenges imposed by existence conditions, the old age is configurate as a developing and maturing phase, with positive perspectives for the future..Besides that, the oldness doesn`t prevent the development of life projects, since these are inherent to life and to the constitution of each one.

Riscos psicossociais e repetição de gravidez na adolescência / Psychosocial risks and repeated pregnancy during adolescence

A gravidez na adolescência pode ser entendida como um período de crises que traz riscos e conseqüências negativas para a adolescente, podendo ser potencializados pela repetição. Mostra-se relevante conhecer a realidade biopsicossocial dessas adolescentes e analisar os fatores envolvidos nessa repetição. Aplicou-se, então, um questionário semi-estruturado, numa Maternidade Escola em Natal/RN, a 50 puérperas com idade entre 12 e 18 anos de idade (média 17 anos), das quais 82 por cento não freqüentam a escola, 62 por cento vivem em união estável e 68 por cento têm renda familiar até três salários mínimos. Iniciaram a vida sexual aos 13 anos e o intervalo entre a gravidez anterior e a atual foi de 1 a 12 meses para 52 por cento das entrevistadas. Assim, o início precoce da vida sexual, a convivência com o companheiro e o abandono escolar podem tornar as adolescentes vulneráveis à gravidez e sua repetição e acentuar os riscos psicossociais.

Adolescent pregnancy can be understood as a period of crisis that brings risks and negatives consequences for a teenager that can be potentiated by repetition. It is important to know the biopsychosocial reality of these teenagers and analyze the factors involved in this repetition. A semistructured questionnaire was administered to 50 mothers aged between 12 and 18 years of age (mean 17 years old) in a Maternity School from Natal/RN. Results showed that 82 percent of them were not attending school, 62 percent were in a stable marriage and the family income of 68 percent did not exceed three minimum wages. The sexual initiation occurred at 13 years old and the distance between the first and current pregnancy were 1 to 12 months for 52 percent of interviewed. Therefore, early initiation in a sexual life, living with a partner and abandoning school can make teenagers vulnerable to repeated pregnancy and strengthen psychosocial risks.

[Evaluation of trait and state anxiety in first year students]. / Universidade, contexto ansiogênico? Avaliação de traço e estado de ansiedade em estudantes do ciclo básico.

The purpose of this study is to evaluate trait anxiety and state anxiety in first year students from the Federal University of Rio Grande do Norte, verifying differences between three great areas of knowledge - Biomedical, Humanistic and Technological. The entrance to a University can be perceived as a threatening situation that seems to suffer influence from the different characteristics of each of these areas. 158 students, 71 females and 87 males aged 20.04 +/- 3,37 years, answered an Identification Form and the State and Trait of Anxiety Inventory (STAI). The means of trait anxiety and state anxiety observed in these students were as expected for this population although the Biomedical area is perceived as the most anxiogenic for having a dense curriculum with intense academic demands, what seems to increase the scores of the students of this area, especially of the men.